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NURS 2156 OB 2 > Complications Of Preggers > Flashcards

Complications Of Preggers Flashcards

1
Q

Qualitative vs Quantitative Test

Which are routine

Give examples

A

Qualitative: Routine
Hcg ( + or - ) Detected within 3 days of implantation

Quantitative: Non Routine
Numeric value
<5 Not preggers
>5 Preggers

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2
Q

Quantitative Hcg Test: Non Routine
Numeric value
<5 Not preggers
>5 Preggers

Give normal Values of Hcg value increase

And Peak….

Monitored with preggers complications…..

A

Doubles every 48 hrs

Peaks 75th day

Threatened abortion
Ectopic preggers
Molar Preggers
Hyperemesis gravidarum

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3
Q

Ectopic vs Molar Preggers

______ occurs outside the uterus, often in a fallopian tube, and can cause dangerous bleeding. A ________ happens within the uterus due to abnormal tissue growth, leading to high hCG levels and possible bleeding. Ectopic pregnancies may need surgery

A

ectopic pregnancy

Molar Preggers

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4
Q

High Hcg levels from having twins which symptom will get increasing worse with the rise of Hcg

A

Nausea

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5
Q

Hemorrhagic conditions

Bleeding / Spotting initial months

Name 3 conditions

A

Abortion
Ectopic
Gestational trophoblastic disease
(Aka Molar/ hydatiform mole)

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6
Q

Spontaneous abortion (miscarriage)
SAB

Induced
MIP, VIP,VTP

Abortion = loss of pregnancy Before Viability

Medical / State MI definition

A

Medical: <20 weeks or <500 g

State MI: <400 g

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7
Q

Abortion: Loss of pregnancy Before

Medical: <20 weeks or <500 g

State MI: <400 g

What is it called it baby dies after these guidelines

A

Interuterine demise

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8
Q

SAB (spontaneous abortion)

19 - 31% of all pregnancies

50- 70% happen in which trimester….

Most common causes…. (3)

Care Priorities (4)

Which age group is most likely….

A

50- 70% happen in which trimester
1st trimester

Most common causes
Chromosomal 50 - 60%
Congenital anomalies
Often incompatibility with life

Care Priorities:
Hemorrhage risk
Infection risk
Pain treatment
Psychological support

Which age group is most likely

> 45 yrs old - >50%

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9
Q

Vaginal bleeding, cramping, backache & pelvix pressure occurs in a Threatened Abortion

Is the fetus still viable…..

Interventions

A

Yes still viable

Interventions
Notify provider
Vag US
Serum beta-Hcg amd progesterone levels/ Normal for GA
Limit sex when bleeding
Monitor for SS of infection
Psychological support

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10
Q

Up to inevitable Abortion cannot be stopped (Membranes rupture, cervix dilates, contractions/bleeding)

Interventions (5)

A

IV acceds and T&S (hemorrhage risk)

Natural evacuation of POC

Vacuum Curettage: Clears out uterus with Vacuum (Early GA)

Dilation and Curettage (D & C) Scraping of uterine wall to rid POC <14 WEEKS

IOL: Oxytocin & prostaglandin administration >14 Weeks

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11
Q

POC ….

A

Products of conception

Baby, membranes, placenta

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12
Q

Incomplete abortion

Fetus delivers but some POC are left.
Bleeding/ cramping

Risks…..

Interventions (5)

A

Hemorrhage & infection

Interventions

T&S
IV & Fluids
D &C
IV oxytocin
Hemorrhage meds

Misoprostol: Stops hemorrhage

Methylergonovine (Methergine)
Prevent or control postpartum hemorrhage. Raises BP Contradicted in Preeclampsia/ HTN

Carboprost (Hemabate)
Prostaglandin analogue used to control severe postpartum bleeding when other treatments are ineffective.

It induces strong uterine contractions, helping to reduce hemorrhage by constricting blood vessels in the uterine lining.

Side effects like fever, diarrhea, nausea, and vomiting.

Contraindicated in patients with asthma due to the risk of bronchospasm.

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13
Q

Interventions for a Complete Abortion
All POC are expelled (4)

A

Verify all POC are expelled

No additional interventions needed unless Bleeding & Infection occur

Monitor for Bleeding, pain, fever

Psychological support

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14
Q

Missed abortion

Fetus is dead but retained during which part of preggers….

Uterus decrease in size (Amniotic fluid absorbed) urinary frequency stops, red/brown bleeding may occur, Maceration of fetus in uterus.

Interventions

A

1st half

Interventions

US to confirm lack of FHR
hCG test

Delivery options:

Watch & Wait: Body will naturally miscarry pregnancy.
RISK: Hemorrhage, infection, prolonged emotional pain

Intervene: Dilation & Evacuation, Dilation & Curettage or IOL depends on GA

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15
Q

Usually between 13-24 weeks of pregnancy.

Dilating the cervix to allow suction and specialized tools are used to evacuate the contents.

D&E is commonly used in cases of missed or incomplete miscarriage, second-trimester abortion, or when the pregnancy poses health risks to the mother.

A

Dilation & Evacuation

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16
Q

Recurrent Spontaneous abortion

2 or more SAB

Mostly happen from…

Other causes: Abnormalities of reproductive tract
Bicornuate uterus
Uterine septum
Adhesions
Incomplete cervix
Fibroids

Diseases….

Interventions….

A

Chromosomal abnormalities 60%

Bicornuate uterus: Heart shapped fetus

Uterine septum: Septum forms in uterus

Adhesions
Incomplete cervix
Fibroids

Diseases….
Antiphospholipid Syndrome
Diabetes
PCOS: Polycystic Ovarian Syndrome
Lupus
Endocrine
STD

Interventions

Rho-gam
Examine reproductive system
Genetic screening

Managing disease process:
DM : Normal BS
Endocrine: Correct hormones
Incomplete cervix: Cerclage

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17
Q

Ectopic pregnancies

97% = fallopian tube

Risk factors;

S&S

Ruptured tube is this level of medical emergency

A

Risk

Previous Ectopic
Endometriosis
Pelvic infection
PID
Surgery
Failed tubal ligation: Procedure to permanently prevent pregnancy by blocking or cutting the fallopian tubes.
IUD
ART
Multiple VTP

S&S
Missed period
+hCG test
Unilateral ab pain
Vaginal spotting

Ruptured tube = Deadly

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18
Q

Give SS of a Ruptured Tube associated with Ectopic pregnancies

A

Deadly

Sudden/Severe pain in Ab, radiating scapula pain, hemorrhage & Hypovolemic shock

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19
Q

________ is a chronic condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, and other pelvic organs.

This misplaced tissue responds to hormonal changes during the menstrual cycle, leading to inflammation, pain, and sometimes scar tissue or adhesions.

Symptoms can include severe menstrual cramps, pain during intercourse, heavy periods, and, in some cases, infertility.

The exact cause of endometriosis is not fully understood, but treatment options may include pain management, hormonal therapies, and, in some cases, surgery to remove the excess tissue.

A

Endometriosis

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20
Q

Endometriosis is a chronic condition where…..

Leading to inflammation, pain, and sometimes scar tissue or adhesions.

Symptoms can include…..

The exact cause of endometriosis is not fully understood, but treatment options may include pain management, hormonal therapies, and, in some cases, surgery to remove the excess tissue.

A

tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, and other pelvic organs.

severe menstrual cramps, pain during intercourse, heavy periods, and, in some cases, infertility.

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21
Q

ART

A

Artificial reproductive technology

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22
Q

Ectopic pregnancies

Why the increased amount…

A

AMA

And already have endometriosis

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23
Q

How to diagnose a Ectopic pregnancy

Interventions….

Medication…

A

Transvaginal US & Low beta HCG

Methotrexate (Chemo drug that stops cell growth)

Linear salpingostomy

Salpingectomy

Rhogam

f/u hCG

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24
Q

Methotrexate does what during a salpingostomy…

Type of drug…

SE

Teaching:

Avoid….
Use these precautions as a nurse

A

Stops cell growth - during salpingostomy

Chemotherapy agnet/ Folic acid Antagonist

SE: N/V & pain r/t egg expulsión

Avoid: folic acid or alcohol Decreases effectiveness

Use chemo precautions for medication & urine handling

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25
Q

Gestational Trophoblastic disease
Aka…..

Describe…..

Big risk…

A

Hydatidform Mole or Molar Preggers

Trophoblasts from fertilized ovum proliferate abnormally creating Placental-like tissue that fill the uterus

Big risk: May become cancerous - metastize To lungs, vag, liver, brain

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26
Q

Molar Preggers aka Gestational Trophoblastic disease

Interventions

A

Terminate pregnancy

D & C

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27
Q

Risk factors for Hydatidiform Mole…

SS….

Dx….

Tx / Follow up….

A

Asian
Young / Old maternal age
Hx of Molar Preggers

SS: Elevated HCG, Large uterus for GA, Hyperemisis r/t increase hCG, & PIH

Dx: High hCG, US shows vesicles, absence of fetal sac & no FHR, Preggers Induced Hypertension / Hyperemisis

Tx: Vacuum extraction & Curettage

Follow up: Serial hCG 1 for 1 year
Chest X-ray, CT Scan, MRI to R/O metastatic disease

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28
Q

LATE HEMORRHAGIC CONDITIONS

(4)

A

Placenta previa
Abruptio Placentae
Accreta/ Increata/ Percreta
Vasa Previa

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29
Q

Placenta previa
Abruptio Placentae
Accreta/ Increata/ Percreta
Vasa Previa

Have in common

A

LATE HEMORRHAGIC CONDITIONS

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30
Q

When the placenta grows over cervix blocking new borns birth route.

Complete, partial, marginal (Which are always C sections)

Can placenta move / migrate during pregnancy

A

Placenta previa

Complete & partial are always C Sections

Yes they can move

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31
Q

Placenta previa during labor (Describe the blood)

Placenta abruption (Describe what it is and blood during labor)

A

Placenta previa (Placenta blocks cervix) during labor = Bright red blood Not painful

Placenta Abruption (Placenta separates from uterine lining) Painful, board like stomach, may or may not be blood (Dark blood)

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32
Q

The placenta should grow on the uterine wall with a easily separated plane between the placenta and uterine lining.

Describe condition where the placenta grows too deep.

A

Accreta Grows too deep into uterine wall

Increta: Grows even deeper into uterine wall

Percreta: Grows through uterine wall and into surrounding organs

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33
Q

Vasa previa is a rare complication in which….

A

fetal blood vessels run near or across the opening of the cervix, unsupported by the umbilical cord or placenta.

These exposed vessels are at risk of tearing if labor begins or the membranes rupture, which can lead to rapid and life-threatening blood loss for the baby.

Vasa previa is typically diagnosed through ultrasound during pregnancy.

C/S 34 -37 Weeks

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34
Q

Total, partial, marginal Placenta Previa

Placenta too close to or covers the cervical OS. Baby can’t exit uterus

Risk factors…

S&S…..

A

Risk factors: PREVIOUS C/S or other uterine surgery, pervious Placenta Previa, AMA, Multiparas

S&S; Sudden Painless uterine bleeding, Scant or Perfuse.
Bleeding may not occur until labor starts.

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35
Q

Bloody show
Blood-tinged mucus from the cervix, often signaling that labor may begin soon. This occurs when the cervix begins to dilate & efface and the mucus plug—a thick barrier at the cervix—to dislodge.

The mucus may appear pink, red, or brown.

bloody show is a common sign that labor could start within hours or days

Describe the difference in appearance with Bloody Show and blood from Placenta Previa….

A

Placenta previa is more watery and bright red & PAINLESS

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36
Q

With placenta previa the main diagnosis is from a SVE

T or F

A

F

No vag exams. May separate the placenta

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37
Q

Placenta previa

Repeat US often due to Placental migration

Which posistions could have a vag delivery route…

A

Low-lying

Total / Complete Always C/S

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38
Q

Placenta previa may monitor from home

What are things cant a woman with placenta previa do?

A

No strenuous activity/ No sex

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39
Q

Why would bleeding during placenta previa be a Urgent C/S

A

Bleeding = Lowered perfusion to baby

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40
Q

Increases risk for PPH: Higher risk of placenta accrete among placenta previa patients

T or F

A

T

Placenta accrete: Placenta grows too deep on uterus and may attach to other organs

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41
Q

Separation of Placenta before fetus is born….

A

Abruptio Placenta

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42
Q

Abruptio Placenta

Maternal risk:
Infant risk:

Risk factors:

A

Maternal risk: Hemorrhage, shock, DIC

Infant risk: Asphyxia & Premature

Risk factors: COCAINE & TRAUMA
cigs, HTN, PROM, Multigravida, short cord & Hx of abruption

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43
Q

Abruptio Placenta: Separation of Placenta before fetus is born

Tx
Marginal: Medications

Total Abruption

A

Marginal Spotting may resolve (Bedrest, tocolytics, EFM, Steroids, home monitoring when stabel)

Total abruption: Emergency STAT C/S (No Blood flow to baby) - Treat for hypovolemia & shock

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44
Q

Bleeding vaginal or concealed (trapped in hemotoma)

Uterine tenderness or Ab

HARD BOARD-LIKE ABDOMEN

From Abruptio Placenta

Describe

Fundal height
HR
Restlessness
BP
Urine output
FHR

Name serious fetal consequences…..

ABRUPTION PATTERN: DESCRIBE UTERINE ACTIVITY & TONE

A

Fundal height UP
HR UP
Restlessness UP
BP DOWN
Urine output DOWN
FHR DOWN

Name serious fetal consequences: Hypovolemic Shock, Fetal Distress, Fetal death

ABRUPTION PATTERN: DESCRIBE UTERINE ACTIVITY & TONE
BOTH INCREASE

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45
Q

Placenta Acreta/ Increta/ Percreta

Risk factors….

Dx….

Risks….

Tx….

Small accrete pieces sometimes remain causing these risks…

A

Risk factors; Previous C/S or uterine surgery, Placenta Previa, AMA, Multiparas

Dx: US sometimes only during hemorrhage evaluation

Risks: MASSIVE POSTPARTUM HEMORRHAGE. Injury to surrounding organs (percreta), infection, infertility - due to scar tissue, sterility due to hysterectomy

Tx: Scheduled C/S, Additional PPH resources, Blood products, hysterectomy,

Infection & Subinvolution

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46
Q

Why placental anomalies when previous C/S

A

Scar tissue
Placenta doesn’t like to grow on scar tissue

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47
Q

Placental Acreta usually ends up with a hysterectomy.

Why?

A

It’s very hard to remove all the attached pieces of the Placenta from the Uterus

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48
Q

Umbilical Cord implants in membranes & and I front of cervical OS

WHICH DISEASE

A

Vasa Previa

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49
Q

Vasa Previa

DX US

S&S Sudden painless bleeding

Risk….

Goal…

Tx….

A

Risk: SROM cause membranes to rip through the cord & massive Fetal Hemorrhage

Goal: Prevention SROM

Tx: Continuous hospitalization 30+ weeks, steroids, planned delivery at 35 weeks, immediate delivery with labor, tocolytics, bedrest and No Intercourse

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50
Q

Risk of FETAL HEMORRHAGE
Goal; PREVENT SROM

This condition

A

Vasa Previa

Cord implants in membranes & infront of the cervical OS

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51
Q

What is the treatment for Vasa Previa

A

Continous hospitalization 30+ weeks

Steroids, planned delivery 35 weeks, immediate delivery with labor, tocolytics, bedrest, No intercourse

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52
Q

Late Hemorrhage Risk. all
hemorrhages happen to the mothers blood supply expect…

A

Vasa Previa

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53
Q

Disseminated Intravascular Coagulation (DIC) aka Consumptive Coagulopathy

Life threatening Macrobleeding & Microclotting

OB risk factors

A

Missed abortion/ Retained dead fetus
Abruption
Severe PIH
HELLP
Anaphylactoid syndrome (Amniotic fluid embolism)
Sepsis

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54
Q

Disseminated Intravascular Coagulation (DIC) aka Consumptive Coagulopathy

Life threatening Macrobleeding & Microclotting

Lab changes:

Fibrigen
pT
PTT
Fibrin split product
Platelets

A

Lowered: Fibrogen & Platelets

Increased: PT & aPTT / Fibrin degraded products or Fibrin Split Products (FSP)

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55
Q

DIC

CONSUMPTION OF PLASMA FACTORS resulting in a deficit and therefore BLOOD IS UNABLE TO CLOT.

While anticoagulation is occurring, inappropriate coagulation occurs in tiny blood vessels blocking blood flow to the organs causing _____

A

Ischemia

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56
Q

DIC

S&S

Interventions

A

S&S: EXCESS BLEEDING (IV sites, incisions, gums, nose & placental attachment site)

Interventions
CORRECT THE UNDERLYING CAUSE

blood replacement, whole blood, Packed RBC. Cryoprecipitate

Monitor for bleeding/bruising

Epidural maybe Contradicted

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57
Q

Define Readings

Hypertension: Systolic / Diastolic

Severe Hypertension: Systolic/ Diastolic

Hypertensive Emergency: Systolic/ Diastolic

A

Hypertension:
Systolic: >140 OR
Diastolic: >90

Severe Hypertension:
Systolic: >160 OR
Diastolic: >110

Hypertensive Emergency:
(Persistent, severe Hypertension)
2 severe BP values (>160/110) taken
15 - 60 min apart
Severe values do not need to be consecutive

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58
Q

If severe BP elevations persist for 15 min or more, begin treatment STAT

Severe HTN First line meds….

Prevention of seizures in PreE….

A

IV labetalol
IV hydralazine
PO Nifedipine

Magnesium Sulfate (Prevents seizures in PreE)

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59
Q

PO Nifedipine works as quickly as IV Labetalol/ hydralazine

T or F

A

T

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60
Q

Antihypertensive/ beta blockers

Produces drop in BP without decreasing maternal HR or Cardiac output

Dosage initial 20 mg over 2 minutes. May increase IVP dosage to 80mg

200 mg PO labetalol Starting Dose

SE: Hypotension, dizziness, NV,Dysrhthmias

Nursing interventions……. (Assess How Often)

A

Labetalol

Intervention

After IVP Bolus, assess BP q5min for 30 min, then 30 min for 2 hrs, then hourly for 6

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61
Q

Which do you give first in a HTN crisis

Labetalol or hydralazine

A

Labetalol

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62
Q

_______

Antihypertensive, Vasodilator

Relaxes arterial smooth muscle

Doseage: IVP ……..
MAX Dose ……..

Excretion Liver

Precautions: CHD, Maternal pulse <60, Avoid with active asthma, heart disease, CHF. May cause Neonatal bradycardia

Adverse effects: Headache, dizzy, hypotension (Placenta impact), epigastric pain (Confused with worsening PreE)

A

Hydralazine (Apresoline)

IVP: 5 - 10 mg over 2 min. Every 20 min. PRN

MAX: Don’t exceed 25 mg / 24 hrs

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63
Q

Antidote for Magnesium Sulfate

A

Calcium Gluconate

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64
Q

_____

Anticonvulsants

Decreases the CNS to act as Anticonvulsants. Also, decreases frequency & strength of UC

Prevention / control of seizures in PreE. Neuro protection for preterm labor

Doseage…..

Therapeutic level…..

Contraindications: Myocardial damage, heart block, myasthenia gravis, impaired renal function.

A

Doseage: IV loading dose: 4 - 6 g over 20 - 30 min

Therapeutic level: 4 - 8 mg/dl
(>8 may result in respiratory depression/ cardiac arrest)

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65
Q

________

Anticonvulsant

Decrease CNS to act as Anticonvulsant

Prevent/ control seizure activity in preE & neuro protection for preterm

Dose/ Route….

Therapeutic level….

Contractions Myocardial damage, Heart Block, myasthenia gravis, impaired renal function.

A

Dose/ Route IV loading dose 4 - 6 g over 20 - 30 mins.

IVBP continous infusing 2 g / hr.

Therapeutic level 4 - 8 (>8 may result in respiration depression/ cardiac arrest)

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66
Q

During bolus dose of Magnesium Sulfate. Which is most important nursing interventions

A

Stay at bedside with patient for full 30 minutes

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67
Q

When does GHTN start

A

> 20 weeks

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68
Q

CHTN W/ Superimposed PreE

When HTN onset…

Systemic issues…

A

Before 20 weeks preggers

Systemic SS Yes

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69
Q

Chronic HTN

BP?
HTN Onset?
Systemic?

A

> 140 or >90
<20 weeks

Systemic NO

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70
Q

GHTN

BP?
HTN Onset?
Systemic?

A

> 140 or >90
HTN >20 weeks

Systemic NO

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71
Q

PreE & E

BP?
ONSET HTN?
Systemic?

A

BP Usually >140 or >90 but if no HTN but still systemic issues they Can be diagnosed with PreE

Onset Usually after 20 weeks Typically late preggers or postpartum

Systemic YES

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72
Q

Chronic hypertension

HTN <20 WKS GA

TREATMENT…..

If systemic SS of PreE develop WHAT WILL BE DIAGNOSES

A

Control BP with antihypertensive meds
Ensure baby getting perfusion
Monitor for onset symptoms of PreE
Considered IOL @ 37 weeks

If systemic SS of PreE develop: Chronic hypertension with Superimposed PreE

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73
Q

GHTN

Peripheral vascular resistance = Circulation to body’s organs decreased

HTN BP >140/90 (2 Readings 6 hrs apart)
More accurate Dx…..

Tx: increases monitoring, antihypertensive, low dose aspirin.

Cure: Deliver baby. Consider IOL @ 37 weeks

A

Systolic Increase 30 or Dystolic increase 15

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74
Q

Eclampsia…..

A

Preeclampsia with Seizures

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75
Q

PreE has multiple systems involved
NS, CV, RESP, RENAL, LIVER ,EYES

Describe what bad things happen with the placenta….

A

Lowered Perfusion, nutrients/ oxygen, IUGR hypoxia, fetal death

Usually >20 wks

Most near term or postterm

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76
Q

Primiparity
Chronic HTN / Chronic renal disease
History of thrombophilia
Multifetal pregnancy
In vitro fertilization
Type 1 or 2 DM
Obese
Lupus
AMA

Risk factors for…

A

Preeclampsia

Also

Previous preEclampsia / Family history of

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77
Q

Greater than or equal to 140 / 90
2 occasions atleast 4 hrs apart
After 20 wks
Normal BP before

&

Proteinuria (greater than 300mg per 24 hr urine collection. Or this amount extrapolated from a timed collection

Or…..

In the absence of proteinuria new onset HTN with any of the following

Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
Cerebral / visual

A

Protein/ creatinine ratio >or equal to 0.3

Dipstixk reading of +1

78
Q

PreE diagnostic criteria

A

Greater than or equal to 140 / 90
2 occasions atleast 4 hrs apart
After 20 wks
Normal BP before

&

Proteinuria (greater than 300mg per 24 hr urine collection. Or this amount extrapolated from a timed collection
Or
Protein /creatinine ratio >or equal to 0.3
Dipstick reading +1

Or…..

In the absence of proteinuria new onset HTN with any of the following

Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
Cerebral / visual

79
Q

Severe features of preE

Renal insufficiency….
Thrombocytopenia….
Impaired liver function…
Pulmonary edema
Cerebral or Visual

A

Renal insufficiency: Serum Creatinine concentration greater than 1.1mg/dl or doubling of serum Creatinine in absence of other renal disease

Thrombocytopenia: platelet <100,000 / microliter

Impaired liver function Elevated blood concentration of liver transamimase to twice normal

80
Q

Pain in which area for preE

A

URQ

81
Q

Other Symptom of preE

Proteinuria > ____ in a 24 hr

Caused by damage to glomeruli

Urine output….
Uric acid….
Swelling of face and hands
NV 2nd half of pregnancy
Sudden weight gain
Clones & hyperactive relfexes

A

0.3 g
Urine decrease
Uric acid increase

82
Q

PreE / E precautions

When to do these precautions

A

Private room
Pad side nails / bed low
02 and suction equipment bedside
Airway, reflex hammer, ambulation bag, magnesium Sulfate/ calcium gluconate

Dim lights
Group nursing interventions
Restrict visitors

When?

When preggers arrives with HTN. No order needed

83
Q

Too much mag will cause this with the reflexes

Give scale

A

Too slow

0 Reflex Absent
+1 hypoactive
+2 Normal
+3 brisk
+4 hyperactive

84
Q

Clones assessment ….

Findings….

A

Supine

Support stretched leg and dorsiflex foot sharply and hold stretch.

Normal: No movement

Clones present

Mild 2 movements
Mod 3 - 5
Severe >6

85
Q

When to worry about edema

A

When it’s on face & hands

Weight gain 5 lbs more in 1 week

Occurs after 20 wk GA

86
Q

Mag Sulfate assessments

Have ready….

A

Hourly

VS
Neurological
RR <12 Mag too high
DTF
Urine output <30mL /hr concern
LOC

Ready:
Suction equipment
Magnesium Sulfate
Calcium Gluconate

87
Q

Signs of Mag Toxicity

RR…
SPo²…
BP…
Serum Mag Level..
DTR…
Skin…
LOC…

A

RR <12
SPo² <95
BP <100 /60
Serum Mag Level >8
DTR: Absence
Skin: Sweaty / Flushed
LOC: Confused / lethargy

88
Q

How to adminster Calcium Gluconate for Mag overdose

A

1g IVP over 3 min

89
Q

When having Mag Toxicity SE is the first answers mostly turn the mag off?

A

No. Keep mag on and provide interventions for their SE

Mag keeps from having seizures

90
Q

Eclampsia (PreE w/ seizures)

Hypoxia may occur in…

Risk for aspiration

Other risks; CVA, Cerebral edema, anoxia, coma, Maternal death (0.4 - 14%)

Eclampsia should be preventable

A

Hypoxia in mother & fetus

91
Q

Posistion for seizures patient

A

Lateral

92
Q

Mag given 2 gms over 5 minutes

Total of how much…

A

6 gms

93
Q

HELLP SYNDROME

Occurs with PreE

Define…

A

Hemolysis

Elevated Liver enzymes

Low Platelets

94
Q

DIC VS HELLP

Platelets 150,000 - 400,000
Fibrinogen 300 - 500
PT 11-13
PTT 25 - 45
FSP <10

A

Platelets DIC Down / HELLP <100,000
Fibrinogen DIC DOWN / HELLP Normal
PT 11-13 DIC Prolonged/ HELLP Normal
PTT 25 - 45 DIC Prolonged/ HELLP Nor
FSP <10 DIC > 40 U / HELLP Normal

95
Q

HELLP management

Avoid palpation of liver. Which quadrant

Transport carefully

Meds…

Fluid replacement?

Delivery?

A

RUQ

Meds: Magnesium Sulfate & Antihypertensive

Fluid replacement to replace intravascular volume

Yes if able

96
Q

Why does hyperglycemia occur with DM

Why does polydipsia happen with DM

Dehydration?

A

Lack of insulin to transport glucose from bloodstream to inside cells.

Body tries to dilute BS

Fluid goes from inside cells to blood stream to dilute BS

97
Q

GD

Is insulin required?

Does Glucose regulation return to nom after birth?

At risk for TYPE II After birth

A

Insulin maybe required

Glucose regulation returns normal after birth

Yes risk type II after

98
Q

Risk factors for GD

Fasting serum glucose….
Random serum glucose….

A

Fasting >90
Random >190

99
Q

GD risk factors

Obese
Previous birth large infant (How large)
Chronic HTN
Maternal age ….
Family history DM
Previous GD

A

> 4000g
Maternal age >25

100
Q

Increased SA
PID
UTI
Polyhydramnios - Excessive Amniotic fluid in sac
Ketoacidosis
Macrosomia - Large fetal weight

Describes which condition

A

Gestational diabetes

GD

101
Q

Congenital anomalies- Neurotube defects/ cardiac
Macrosomia
IUGR
Preterm & PROM
Respiratory distress syndrome
Hypoglycemia
Perinatal death

Fetal affects for which illness

A

GDM

102
Q

Why Macrosomia in GDM

A

Maternal hyperglycemia = fetal hyperglycemia

Excessive BS stimulates excessive insulin (a growth hormone):in fetus

103
Q

Why low BS in newborns

A

High maternal blood glucose = High fetus blood glucose.

When birthed the glucose stops coming from the mom but baby still produces Insulin

Hypoglycemia

104
Q

Normal BS for first 4 hrs of life

Normal bs for a baby

A

4 hours = Low as 25

Baby >40

SHE SAID 40 IN CLASS

105
Q

Why Hyperbilirubinemia?

A

Fetus with recurrent hypoxia compensate by producing more RBC (to carry oxygen)

Bilirubin is a product of broken down RBCs

106
Q

Why respiratory distress in babies whose mother’s have GDM

A

Delayed production of surfactant

LECITHIN / SPHINGOMYELIN (L/S) RATIO AND PRESENCE OF PHOSPHATIDYLGLYCEROL (PG) WILL BE DONE BEFORE C/S TO EVALUATE LUNG MATURITY

107
Q

LECITHIN / SPHINGOMYELIN (L/S) RATIO AND PRESENCE OF PHOSPHATIDYLGLYCEROL (PG) WILL BE DONE BEFORE C/S TO EVALUATE

A

LUNG MATURITY

108
Q

L/S LECITHIN/ SPHINGOMYELIN Ratio

Used to evaluate lung maturity

LECITHIN in amniotic fluid is less than the amount of SPHINGOMYELIN until ____

At _____ weeks the 2 lipids will be equal value

At _____ weeks LECITHIN levels will raise sharply.

NORMAL VALUE _____

requires 3 cm of amniotic fluid

What is the ratio of fetuses of insulin dependent moms _____

A

LECITHIN in amniotic fluid is less than the amount of SPHINGOMYELIN until 26 weeks

At 30 - 32 weeks the 2 lipids will be equal value

At 35 weeks LECITHIN levels will raise sharply.

NORMAL VALUE 2:1 LECITHIN to SPHINGOMYELIN or greater

requires 3 cm of amniotic fluid

What is the ratio of fetuses of insulin dependent moms 3.5 - 1

109
Q

Nursing Management

BS monitoring

GOAL FASTING/ POSTPRANDIAL

A

Fasting: <95 (No food 4 hours)

Postprandial: < 120 (2 hrs after meal)

110
Q

Insulin needs are increased during 2nd and 3rd trimester.

3 times & types of insulin daily ….

Is an insulin drip ever used during labor….

A
  1. Regular (short acting) & NPH @ Brkfst
  2. Regular before dinner
  3. NPH at HS

Yes

111
Q

Insulin Orange Needle
Route?
Angle?
Aspiration needed?

A

SubQ
90° Fat / 45° Skinny
No aspiration needes

112
Q

Glucose Challenge Test

24 - 28 wk

How long to fast?

Pass =

If fail…

A

No fasting required

Pass <140 mg/dl

If fail 3 HR. GTT

113
Q

Fast after midnight day of test
Fasting blood level drawn AM
Ingest 100g of oral glucose

Blood drawn at 1,2,3 hrs

Dx is positive if ….

A

Positive if Fasting is abnormal or 2 or more draws are elevated

Fasting is >95

1hr >180
2hr>155
3hr>140

114
Q

Hypoglycemia looks like….

Treatment…

A

Drunk

15 grams of carbs

115
Q

Hyperglycemia looks like…

Most common cause….

Adminster….

A

Hot & Dry

Infection

Insulin

116
Q

Rh positive carries ___ on RBC
Rh neg doesn’t

When Rh positive blood enters Rh negative, What happens?

A

Antigen

Rh negative builds antibodies to attack antigen.

117
Q

Erythroblastosis fetalis is the destruction of babies RBCs by their Rh- mothers antibodies crossing into the placenta.

What diseases can happen from this

A

hydrops fetalis (severe edema)
Heart failure
Jaundice
Anemia

118
Q

What does an Indirect Coombs test do?

A

Test Rh- mother to see if she has been previously sensitized. 1st prenatal visit

If indirect Coombs Neg. Repeat at 28 weeks.

28 weeks Rho-gam is given to unsensitized, Prophylactic

119
Q

1st prenatal visit (Blood type / Rh)

Rh negative women
Draw indirect Coombs test - determines if previously sensitized.

If indirect Coombs (Pos / Neg)
Repeat at 28 weeks

What happens at 28 weeks

A

Neg

Rhogam is given to unsensitized, ( Prophylactic to prevent sensitization)

120
Q

Prenatal management

Indirect Coombs positive (what does this mean)

Management….

A

Positive = Sensitized Rh - mom has Rh + antibodies to attack infants blood.

Repeat Coombs test throughout preggers to ensure no raising tigers.

Amniocentesis: Determine babies Rh status

US: Edema, ascites, enlargement of heart

121
Q

Postpartum

How to perform direct Coombs

A

Umbilical cord

122
Q

Doseage of Rho-gam

Route

When

A

300 mcg

IM Deltoid

28 weeks preggers & within 72 hr birth

123
Q

ABO Incompatibility

Describe Severity….

Type of Antibodies….

Describe Effects on Fetus….

A

Less severe than Rh

IgM - Don’t cross thr placenta

Born with Jaundice NOT ANEMIA

124
Q

Type A blood has A antigens and anti-B antibodies.

Type B blood has B antigens and anti-A antibodies.

Type AB blood has both A and B antigens but no antibodies, making it a universal plasma reciever

Type O blood has no antigens but both anti-A and anti-B antibodies, making it a universal blood donor.

People with AB blood type are known as “universal recipients” for plasma transfusions because they have both A and B antigens on their red blood cells and do not have anti-A or anti-B antibodies in their plasma. This means they can safely receive red blood cells from any blood type:

O (no A or B antigens)
A (A antigens)
B (B antigens)
AB (both A and B antigens)

However, when it comes to donating blood, AB blood can only be given to other AB recipients due to the presence of both antigens.

A

Probably not in test

125
Q

UTI 3 major categories

Asymptomatic
Causative bacteriuria …….
No symptoms
Treatment……

Cystitis
Causative agent….
Symptoms: dysuria, frequency, urgency, suprapubic tenderness, may progress to pyelonephritis.
Treatment……

Acute Pyelonephritis
Causative agent……
Symptoms…….
Treatment…….

A

Asymptomatic
Causative bacteriuria: E. Coli, Klebsiella, Proteus
No symptoms
Treatment: Sulfonamides, ampicillin, nitrofurantoin

Cystitis
Causative agent Same as above
Symptoms: dysuria, frequency, urgency, suprapubic tenderness, may progress to pyelonephritis.
Treatment Same as above

Acute Pyelonephritis
Causative agent: same as above
Symptoms: Same as above Plus: fever, chills, flank pain, CVA, tenderness NV
Treatment: IV antibiotics & hospitalization

126
Q

Asymptomatic bacteriuria can move to the ____ and be called Cystitis.

Infection during preggers can cause early Term delivery

A

Bladder

127
Q

Eating raw eat or contact with cat feces can cause this problem from a protozoan….

Asymptomatic ___%

New born effects….

Treatment….

A

Toxoplasmosis

Asymptomatic 90%

Miscarriage (if in early preggers)
Neurological, hydrocephalus, microcephaly.

Pyrimethamine - antiprotozoal

folinic acid -protect healthy cells from folate depletion and to minimize side effects.

sulfadiazine- antibiotic

128
Q

Pyrimethamine, Folinic Acid , sulfadiazine

Treat…..

A

Toxoplasmosis

129
Q

Transmission

Body fluids

Type of virus: Herpes
Widespread- eventually infects most humans

Maternal effects: Most Asymptomatic
2% live births affected:
Severe effects: deaf, retarded, seizures, blind, dental

A

Cytomegalovirus

130
Q

Cytomegalovirus; Herpes virus - common

Management:

Mother….

Neonate….

A

Mom: treat symptoms, mild analgesia, rest

Neonate: no therapy/ CONTACT ISOLATION required

131
Q

_______

Transmission: Droplet, direct contact with nasopharyngeal secretions, transplacental.

Care precautions DROPLET & STANDARD

Viral Transmission

Maternal Effects: Fever, malaise, rash (begins on face and spreads. Last 3 days)

A

Rubella

132
Q

Woman had MMR vaccine when young. Will she ever need another one?

A

Maybe, read the titers

133
Q

Rubella risk level….

Greatest risk Trimester….

Health concerns to baby

A

Serious

1st trimester

Deaf, cataracts, IUGR, Cardiac, retarded

134
Q

Rubella titer that indicates immunity….

Women with Rubella, no special therapy.

Neonates…..

How long after Rubella vaccine does a woman have to wait to become pregnant….

A

1:8 or >

Neonates = isolation

Wait 4 weeks

135
Q

Varicella- Zoster Virus

Precaution….

A

Air born , contact, standard

136
Q

Maternal Effect

Pruritic rash
Preterm labor
Encephalitis
Varicella pneumonia
Death rate 50: 100,000

Precautions: Airborne, Contact, Standard

Name disease

A

Varicella-ZOSTER Virus

137
Q

When is Varicella contactable according to the rash associated with it…

A

3 days prior

138
Q

Does Varicella have isolation precautions…

A

Yes, and it’s Airborne too

139
Q

Varicella vaccine safe for preggers

A

No, avoid getting preggers for 1 month After vaccine

140
Q

If mom gets Varicella 5 - 7 days before labor give…

A

Zoster immune globulin (VZIG)

141
Q

Herpes 1 & 2

Care Precautions…..

Only way to distinguish between types is serum blood test

Type Of herpes infection most dangerous during preggers…

Virus is shed until lesions are ……

A

Herpes Virus 1 & 2

1st time virus outbreak

Completely healed

142
Q

Herpes + mother is always a C/S delivery…

A

False

Only if there are lesions/ outbreak is C/S needed

143
Q

Herpes

Primary infection during 1st 20 weeks may results in….

Complications are ____ from recurrent infections

A

Spontaneous abortion, IUGR, Preterm labor

Rare

144
Q

Neonatal effects

Herpes

Death rate…

What increases death rate…

A

50%

Mothers primary infection of herpes

145
Q

No cure for herpes

Use Acyclovir, this type of medication…

After delivery should infant be isolated from mom?

Is breastfeeding OK if there are lesions?

A

Antivirals

No

No

146
Q

Hyperemisis gravidarum (HEG)

Persistent vomiting

Begins when…

Risk factors…

A

<20 wks

Unmarried
White
1st preggers
Multifetal / Molar preggers

147
Q

PPROM

A

Preterm Premature Rupture of Membranes

<37 wks

148
Q

To R/O or Confirm ROM use these 2 test. Which is more accurate

A

Nitrazine

Ferning (more accurate)

149
Q

PROM Treatment

If term, labor induction if not spontaneous, if fails ….

If preterm….

If infected…

A

CS

Hospitalization. Body may form a seal to keep fluid in.

Labor induction, antibiotics, CS

150
Q

Vag birth or CS in women with heart disease

A

Vag

151
Q

SS fatigue, headache, Pica

Fetal effects: profound anemia & reduction of oxygen supply.

Take ferrous 320 mg.
Take with citrus

A

Iron deficiency

152
Q

Folic acid is essential for ….

Maternal effects…
Infants…..

What should take folic acid?

A

Cell duplication & fetal / Placental growth.

Mom: Increased risk of SROM
BABY: neural tube defects

All woman of child bearing age - 400 mcg

153
Q

This level will be measured in the following complications

Threatened abortion

Missed abortion

Ectopic pregnancy

Molar pregnancy

Hyperemisis gravidarum

A

hCG secreted from trophoblast in early pregnancy

154
Q

Gestational Trophoblastic disease is aka…

A

Molar pregnancy/ Hydatidiform mole

155
Q

Most common trimester to lose a pregnancy

A

1st 50 - 70%

156
Q

Interventions for…

TS
IV Fluids
DC
IV Oxytocin
Hemorrhage medication (3)
Misoprostol (Cytotec), Methylergonovine (Methergine)
Carboprost (Hemabate)

A

Incomplete abortion

157
Q

IV
TS
Natural Evacuation of POC
Vacuum Curettage
DC
IOL

Interventions for…

A

Inevitable Abortion

158
Q

Misoprostol (Cytotec)
Methylergonovine (Methergine)
Carboprost (Hemabate)

Are this type of medication….

A

Hemorrhage meds PRN

159
Q

Missed abortion (Dead fetus is retained in uterus during the 1st half of pregnancy)

SS Include…

A

Infection
Hemorrhage
DIC

160
Q

Is Rho-gam given with recurrent SAB to prevent future sensitization?

A

Yes

161
Q

Ectopic pregnancies are Dx how…

A

Transvaginal US and low beta hCG

162
Q

Methotrexate

Class….

SE….

PT Education

Cautions…

A

Chemotherapy agent / Folic Acid Antagonist

NV & increased pain rt egg expulsión

Edu: Don’t Take folic acid or Alcohol

Caution: Chemotherapy precautions for medication & urine

163
Q

Hydatidform Mole Continue

SS increased hCG, Large uterus for GA, Hyperemisis, PIH

Dx increased hCG, US Shows vesicles, absence of fetal sacno FHR

Tx…

A

Removal Vacuum extraction and curettage.

Follow up serial hCG for 1 year
Chest X-ray, CT , MRI RO metastic disease

164
Q

Why multiple US for placenta previa

A

Because the uterus may move to a favorable posistion to give vag birth

165
Q

Which problem has a Hard Board-like abdomen

A

Abruptio Placenta

166
Q

Which problem has the risk of Massive Postpartum Hemorrhage…

A

Accreta, Increata, Percreta

167
Q

This may cause subinvolution of the uterus or infection…

A

Accreta, Increta, Percreta

168
Q

Umbilical cord Implants in Membranes & infront of the cervical OS

A

Vasa Previa

169
Q

Does the bleeding hurt from Vasa Previa

A

Sudden Painless Bleeding

170
Q

Explain how DIC is caused…

A

Consumption of plasma factors, resulting in a deficiency, and blood is unable to clot

171
Q

ASK TEACHER

Fasting serum glucose >

Random serum glucose >

A

Fasting serum glucose > 140

Random serum glucose > 200

172
Q

Fetal affects

Congenital anomalies / Neurotube defects & Cardiac defects
Macrosomia
IUGR
Preterm birth and PROM
Respiratory distress syndrome
Hypoglycemia
Perinatal death

A

DM or GDM

173
Q

Cool & Clammy give him candy

Hot & Dry sugar high

A

OK

174
Q

Nifedipine is given via this route

A

Oral

175
Q

Avoid use of this medication with Asthma, heart disease, congestive heart failure

A

Nifedipine

176
Q

Contradictions to this medication include Myocardial damage, heart block, myasthenia gravis, impaired renal function

A

Magnesium Sulfate

Dose: IV loading 4 - 6 g over 20 - 30 minutes.

IVBP: Continuous 2g/hr via pump

177
Q

Treatment for Chronic HTN (4)

A

Control BP with antihypertensive

Ensure baby is getting perfusion

Monitor for new onset symptoms of preE

Consider IOL at 37 wks

178
Q

Symptom of preE

PROTEINURIA > ____ IN 24 HRS

A

0.3

179
Q

PreE & Eclampsia Assessments

A

VS

Neurological (Reflexes, HA, Visual disturbances, Clonus)

Respiratory Assessment q4h PE evaluation

Fetal surveillance EFM US BPP Growth US

Edema, Weight gain

I&O

RUQ Pain

Safety

180
Q

When checking DTR in brachial tendon do this…

A

Support their limp arm

Place thumb over tendon and strike with small end of hammer

181
Q

Edema assessment

Describe categories…

A

1+ slightly indentation 2mm
2+ 4mm
3+ Deep pit 6mm
4+ 8mm

Brawny edema: No pitting: Skin surface shiny, warm, moist

182
Q

Can fluid be restricted for Mag overdose…

A

Yes to 60 - 100 mL per hour

Due to PE

183
Q

Rh sensitization can occur from…

A

All types abortion

Amniocentesis

CVS

184
Q

Rapid production of erythroblasts (immature RBC) Cannot carry oxygen.

Edema results

Called…

Can progress to…

A

Hydrops fetalis

Congestive heart failure

185
Q

Toxoplasmosis

Care Precaution…

A

Standard

186
Q

Cytomegalovirus

Transmission…

Care Precautions …

Isolation for newborn…

A

Transmission; Body Fluid

Care Precautions; Standard

Contact Isolation

187
Q

Herpes 1 & 2

Care Precautions…

A

Contact precautions until lesions are dry and crusted.

Then, Standard

188
Q

Herpes 1 & 2

Primary infection during 1st 20 weeks is most serious.

Describe harm to fetus…

A

Spontaneous abortion

IUGR

Preterm Labor

189
Q

Malpresentation

Poor nutrition, incompetent cervix

Hydramnios

Multiples

Cervical infections

Possible causes of…

A

PROM

190
Q

Lack of _____

Increased risk of spontaneous abortion, Abruptio Placenta

A

Folic acid

191
Q

Antiphospholipid Syndrome
Diabetes
PCOS: Polycystic Ovarian Syndrome
Lupus
Endocrine

Diseases associated with…

A

Recurrent Spontaneous abortion

NURS 2156 OB 2 (8 decks)

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