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NCLEX > Complications of Maternity > Flashcards

Complications of Maternity Flashcards

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1
Q

What are the major complications related to maternity

A
  1. Miscarriage
  2. hydatidiform mole
  3. Ectopic pregnancy
  4. placenta previa
  5. Abruptio Placenta
  6. Incompetent Cervix
  7. Hyperemesis Gravidarum
  8. Preeclampsia
  9. Eclampsia
  10. Premature Labor
  11. Prolapsed Cord
  12. Shoulder dystocia
  13. Group B Streptococcus (GBS)
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2
Q

When someone has spotting and cramping what are these s/s indicative of

A

Miscarriage

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3
Q

What are the treatments for miscarriage

A
  • Bedrest and pelvic rest
  • if miscarriage imminent–>IV, Blood, D&C
  • Worry when levels of hcG start to drop
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4
Q

What is hydatidiform mole (molar pregnancy)

A

-It is when you have a benign neoplasm which could turn malignant.
-Grape like clusters of vessicles
-No fetus involvement
If uterus enlarges too fast, this is how the pregnancy start

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5
Q

When there is no fht and some bleeding with vesicles what can this be a s/s of

A

hydatiform mole (molar pregnancy)

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6
Q

What confirms a molar pregnancy

A

U/S

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7
Q

How do we treat a molar pregnancy

A
  • With a D and C cutting and emptying uterus
  • Do not get pregnant during f/u time
  • check hcg levels weekly until normal, recheck q2-4weeks, then 1-2 months for 6months to a year
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8
Q

What is it called if a molar pregnancy becomes malignant

A

Choriocarcinoma, cxr to see if it has mestastasized

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9
Q

What occurs in an ectopic pregnancy

A

It is when the gestation occurs outside uterus, in the fallopian tube

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10
Q

What confirms an ectopic pregnancy

A

U/S

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11
Q

When someone is going through pain, spotting, bleeding into peritoneum what is this a s/s of

A

Ectopic pregnancy

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12
Q

What is the Tx for ectopic pregnancy

A

1) Methotrexate- to stop growth of embryo and save tube
2) otherwise a laproscopic incision will be made into tube and embryo will be removed
3) Laprotomy if tube has ruptured or if ectopic pregnancy is advanced.

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13
Q

What do we worry if a tube has ruptured in an ectopic pregnancy

A

Hemorrhage

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14
Q

What is placenta previa

A

It is when the placenta has implanted wrong

it is when the placenta prematurely begins to separate during dilation and the fetus doesn’t get enough oxygen

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15
Q

What is the most common cause of bleeding in the later months

A

Placenta previa

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16
Q

What test should be done to confirm placental location

A

U/S

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17
Q

Normally where should the placenta be attached

A

Up high in the uterus

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18
Q

When you have painless bleeding in the 2nd half of pregnancy (spotting or profuse bleeding) what is this a s/s of

A

Placenta previa

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19
Q

What are the treatment options for someone with placenta previa

A

1) hospitalization to prevent blood loss and fetal hypoxia
2) bed rest
3) Rule out other sources of bleeding like abruption
4) Pad count
5) monitor blood count and body close
6) monitor for contractions call MD (wont be vaginal delivery)
7) C-section
8) Do not perform vaginal exam

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20
Q

What are some fetal complications related to placenta previa

A

1) Preterm delivery
2) Intrauterine growth retardation
3) Fetal Distress
4) Anemia

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21
Q

What are some maternal complications

A

1) Hemorrhage

2) Potential DIC risk

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22
Q 
is placenta position on 
-side of the uterus (low lying placenta)
-halfway covering cervix(partial previa)
-completely covering cervix (complete previa)
okay?
A

is not a good sign

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23
Q

In abruptio placenta is the placenta implanted normally

A

yes

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24
Q

What an occur in a abruptio placenta

A

The placenta could be partial or completely abrupted

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25
Q

what happens when the placenta abrupts

A

the placenta separates prematurely and bleeding occurs, it could be external or concealed

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26
Q

What is concealed bleeding

A

it’s bleeding into the uterus

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27
Q

what confirms the diagnosis of abruptio placenta

A

ultra sound and the severity is based on the scale 1-3 3 is the worse

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28
Q

What can a MVC, domestic violence, previous cesarean, rapid decompression of uterus, cocaine use, PIH and smoking be a cause of

A

Abruptio placenta

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29
Q

When someone has a rigid board like abdomen with or without vaginal bleeding.
Abdominal pain and increased uterine tone, and have a difficult time palpating fetus what do you think is happening

A

Abruptio placenta

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30
Q

What is the treatment for a abruptio placenta

A

C-section delivery and do not try to do any vaginal examinations

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31
Q

What are the 2 priorities with abruptio placenta

A

manage fetal status and maternal shock

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32
Q

What occurs with an incompetent cervix

A

It is when the cervix dilates prematurely

and can result in repeated, painless, second trimester miscarriages

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33
Q

When does an incompetent cervix occur

A

4th month of pregnancy

34
Q

Why does a miscarriage occur in the 2nd trimester

A

weight of baby causes pressure on the cervix to prematurely dilate

35
Q

What is the treatment for incompetent cervix

A

-purse-string suture (cerclage) at 14-18 weeks to reinforce cervix
-may have a c-section to preserve suture
and 80-90 percent chance of carrying baby to term with the cerclage

36
Q

What is a cerclage

A

It is used for incompetent cervix, suture to help reinforce cervix

37
Q

What is hyperemesis gravidarum

A

It is when you have more than the typical morning sickness, excessive vomitting, dehydration, starvation and death could occur

38
Q

What are the causes of hyperemesis gravidarum

A

high levels of estrogen and hcG

39
Q

When someone’s BP, UO, K, weight drops, and h/h go up and the patient has ketones in their urine what could this be related to

A

hyperemesis gravidarum

40
Q

What are the treatments for hyperemesis gravidarum

A
  • NPO for 24 hours
  • quiet environment
  • oral hygeine
  • IVF 3000ml for 24 hours
  • Antiemetics
  • Vitamins
  • Don’t mention food, keep emesis basin out of sight
  • 6-8 small meals followed by clear fluid
  • foods should be either icy cold/hot
  • well ventilated room
41
Q

If a person has increased bp, proteinuria edema after 20 weeks what is this considered to be

A

Preeclampsia

42
Q

What is mild preeclampsia

A

130/90 or 30/15 of their baseline

43
Q

s/s of proteinuria include

A

-sudden weight gain
-swollen hands and face
-headache, blurred vision, seeing spots,
-hyper-reflexia (increased DTR)
-clonus- seizures
VASOSPASMS

44
Q

What do we know about a clinical s/s of PIH

A

if a patient increases weight by 2 or more pounds per week

45
Q

How do we treat mild pre-eclampsia

A
  • bed rest

- increase protein

46
Q

What would your BP be with severe PIH

A

160/110

47
Q

What are the tx for severe preeclampsia

A

sedations to delay seizures
magnesium sulfate
Apresoline is given with magnesium sulfate if diastolic is greater than 100
Delivery is the only cure

48
Q

What are the functions of magnesium sulfate

A

It acts as a vasodilator

it is a simple salt solution, attracts fluid back into vascular space from tissue

49
Q

What should you be monitoring with magnesium sulfate

A

Magnesium toxicity, check BP, Resps, DTR’s, LOC every 1-2 hours
Urine output hourly and serum mg periodically

50
Q

What is used for preterm labor

A

magnesium

51
Q

What is a client at risk for with magnesium sulfate

A

Pulmonary Edema

52
Q

What should a client’s care be for someone with preeclampsia

A

Quiet single room, dim lights and no tv

53
Q

Why is betamethasone used for preeclampsia

A

stimulates sufactant production in the alvelor space and causes less tension when the infant breathes

54
Q

When should steroid therapy be given

A

between 24 and 34 weeks gestation

55
Q

What is expectant management

A

Balance risk between mom and baby

56
Q

What occurs from preeclampsia to eclampsia

A

Seizure occurs

57
Q

What should you be monitoring with eclampsia

A

Watch for fetal heart tones
Watch for labor
Watch for heart failure, stroke, heart attack, renal failure, DIC, HELLP syndrome, neurological damage, multisystem organ failure

58
Q

When you have proteinuria and it’s after 20 weeks what are you thinking

A

PIH

59
Q

When you have no proteinuria and it’s after 20 weeks what are you thinking

A

Gestational Hypertension

60
Q

When the client was hypertensive before pregnancy what is this called

A

Chronic Hypertension

61
Q

When the client was hypertensive prior to pregnancy but hypertension is getting worse with developing proteinuria after 20 weeks what is this called

A

Chronic hypertension with superimposed PIH

62
Q

When labor occurs 20-37 weeks what is this called

A

Premature labor

63
Q

What are the treatments for stopping labor

A

1) Tocolytics: Terbutaline (Brethine): Side effects increased pulse and hyperactivity
2) Magnesiumm sulfate: relaxes uterus
3) Bethamethazone (Celestone): given to moms to stimulate maturation of baby’s lung in case preterm occurs
It can also be stopped by hydrating mum and treating vaginal and urinary tract infections

64
Q

What happens when you get a prolapsed cord

A

The umbilical cord falls down the cervix, most likely because the presenting part is not engaged and the membranes ruptured

65
Q

What is important to check when membranes rupture either spontaneously or artificially

A

FETAL HEART TONE

66
Q

What is the next step to do if you have a compressed cord and you see variable deccelration in FHT

A

C-section

67
Q

What indicates death

A

When cord is not pulsating

68
Q

What treatment options are for Prolapse cord

A
  • Lift head off cord until physician arrives mannually
  • Trendelenburg or knee chest position
  • Oxygenation
  • Monitor fetal heart tones
69
Q

Do we push back the cord

A

No

70
Q

What is a shoulder dystocia

A

it is when the fetal head is delivered and shoulder gets impacted with pelvis

71
Q

Risks to shoulder dystocia

A
  • Hypoxia- leads to cerebral palsy and asphyxia
  • Brachial Plexus injury-leading to Erb’s palsy
  • Broken clavicle
  • Bell’s pallsy
72
Q

What is Bells’ Palsy and what is it caused from

A

It is when you have paralysis of the face with drooping to one side of the face
Forcep use

73
Q

What are some potential maternal risks related to shoulder dystocia

A
  • Traumatic delivery leading to permanent damage
  • Bruised bladder
  • Extention of episiotomy
  • Rectal Tear
  • Torn cervix and or uterus
74
Q

-What do LGA or macrosomic infants greater than 4000 grams
-Gestational diabetes
-Previous history of shoulder dystocia
-Post date delivery ,large fetus
All have in common

A

Risk for having a shoulder dystocia

75
Q

What are some nursing care regarding shoulder dystocia

A

McRoberts Maneuvers

Mazzanti techniques suprapubic pressure (never apply fundal presure)

76
Q

GBS what can you do to reduce risk

A

Routinely assess for GBS, risk factors during pregnancy (cultured around 35-37 weeks) and on admission L & D
Prophylactic antibiotic therapy; penicillin

77
Q

How is GBS transmitted

A

Through birthing canal

78
Q

When is there a risk to the fetus with GBS

A

When the rupture of the membrane occurs

79
Q

Is GBS a sexually transmitted disease

A

No

80
Q

Who is at risk for GBS

A
  • Preterm births less than 37 weeks
  • positive prenatal cultures in pregnancy
  • premature rupture of membrane
  • positive history for early-onset neonatal GBS
  • intrapartum maternal fever higher than 100.4
  • previous infant with GBS

NCLEX (21 decks)

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