Deck 1 Exam 2 Flashcards
Cocaine effects on pregnancy
Spontaneous abortions, abruptio placentae, pre term bith and still birth
newborns exposed to cocaine exihbit
neuro behavior distrubances, marked irritability, exaggerated startle reflex, SIDS
Marijuana affects on baby
appear to have withdrawal symptoms, trembling, excessive crying
Heroin affects on baby
restlessness, high pitched cry, irritibilaty, behavior can last for 3 months or more
Methadone is used for
therapy for pregnant women on opiods(Heroin)
it does cross placenta but effects to fetus are not as harsh Given for women to not experience withdrawals during pregnancy and help to recover mom from addiction Often causes abnormal fetal presentation
Cold Turkey is considered
not advisable during pregnancy because it is a risk to the fetur
Babies with fetal alcohol syndrome characteristics are
small eye openings, smooth philtrum, thin upper lip, single crease in palm
Fetal Alcohol Syndrome affect
the ability to receive sufficient O2 and development of brain
What would you ask a pregnant mom who drinks alcohol
when do you drink? when was the last time? How much?
Ecstasy use in pregnancy
irritability, jitteryness, crying
Cardinal signs of diabetes in pregnant women
polyuria, polydipsia, polypghagia and weight loss
vaginal or urinary infections (often yeast)
weakness
poluria
polydipsia
polyphagia
frequent urine
excessive thirst
excessive hunger
There are 2 basic classifications in diabetes in pregnancy
gestational diabetes (pregnancy related) pre existing diabetes
normal maternal plasma glucose between
60-120 mg/dl
Diabetes Pregnancy
Maternal glucose crosses the placenta but mom’s insulin does not
what produces insulin
Islets of Langerhan
Pathiophysiology of diabetes
*Insufficient amount of insulin Glucose cannot enter cell=energy depleted
*cellular starvation and uses fats and proteins for energy
*ketogenesis= metabolizationi of fat
*glyconegenesis= breakdown of amino acids(protein)
*break down of amino acids=protein & ketones in urine
*high blood glucose concentration pulls H20 from cell to bloodstream and causes cellular dehydration
(thirsty, voiding more) eventually this will spill into urine
Risk Factors for diabetes
Obesity BMI>25 Older than 25 previous birth with GDM diabetes in close relative high risk ethnic group abnormal glucose tolerance level h/o
When do they perform screenings
24-28 weeks GTT(glucose challenge test)
Procedure for the 1st screening
ingest 50 g glucose(orange soda) draw blood 1 hr later >140 mg/dl 3hr GTT
3 hr GTT procedure
ingest 150 g CHO 3 days before
NPO night before test fasting blood test
give 100 g glucose 1 hr testing >180 mg/dl
2 >155 mg/dl
3 >140 mg/dl
what is another test done for checking for diabetes
Hb A1C can indicate 4-8 wks prior levels
8.6 % poor control
Effects of Diabetes/ Increased risk for
Spontaneous abortion polyhydramnios preterm labor big baby PIH infection ketoacidosis c section
Risks for baby
Macrosomia (big baby)
delayed lung maturity( insulin inhibits surfactant in lungs)
polycythemia (excess of RBC)
Pre existing diabetes increased risk for
decreased blood flow, damage to nerves, damage to blood vessels therefore the placenta may not be getting blood flow and baby is “starving” IUGR
(small baby)
Managing GDM
diet, exercise glucose monitoring, fetal surveillance
Diet for GDM
3 neals plus 3 snacks
bedtime snack most important due to a drop in blood glucose in the early am
when is glucose monitoring done
done at least 4 X a day before breakfast (60-100 mg/dl) 3 postprandial (after meals)
What can they administer to client
Glyburide- lowers blood glucose by enhancing insulin secretion but it does not cross placenta
S/S of Hypoglycemia
tremors sweating pallor, cold and clammy disorientation, irriitability H/A hunger blurred vision
What can you do to treat hypoglycemia
give pb crackers, milk, apple then retest
you want to eat something with protein
can give oj sometimes and it helps
S/S of hyerglycemia
fatigue flushed hot skin dry mouth excessive thirst frequent urination rapid deep respirations odor of breath acetone (classic) drowsiness H/A depressed reflexes
If insulin is required during labor
Regular Insulin
Postpartum
breastfeeding encouraged
converts glucose to lactose
Pregnancy Anemia defined as
hgb < 11g/dl in 1st trimester
< 10.5 g/dl 2nd
< 11 g/dl 3rd
what can you give to help with absorbing iron
orange juice
3 Anemias
Iron Deficiency
Sickle Cell
Folic Acid
What is given if serum blood draw finds viral loads not acceptable in an HIV pregnant mom
ZDV zidovudine to mom
given to baby after delivery
What are the classifications of cardiac disease?
Class I asymptomatic
Class II symptoms with ordinary activity slightly compromised
Class III symptom w/ sitting in chair (ex)
Class IV symptomatice at rest (cardiac insuff and anginal pain)
Is cardiac disease the most common cause of maternal death overall
Yes but is only in about 1% of pregnancies
What is your best best to relieve pain in cardiac disease pregnancy when in labor
epidural
drug therapy used in cardiac mom
heparin (blood) lasix(diuretic) betal blockers(inderal)antiarrhythmics (quindine) antibiotics (penicillin) digoxin(strenghtens contraction but does cross placenta) tocolytics but try not to use because the pulmonary edema that it can cause beta blocker (proprandol) vasodilators (hydralazine) if diastolic is over 110
Should you restrict or force fluids in a cardiac client
Restrict
What do you assess/interventions in cardiac
s/s, b/p, ap, lungs, wt gain, edema HOman’s sign, chest pain
dietary teaching- high protein, iron and folic acid
low sodium
what do you assess for post partum
wt. gain, chest pain , edema, SOB, crackles wheezes JVD
what are 2 greatest risks
maternal-cardiac decompensation and impaired fetal gas exchange
What trimester is there an increased risk for asthma
3rd trimester and after a c section in recovery period
Do not give what drug to an asthmatic with postpartum hemorrhage
HEMABATE
What clients are more than likely to seize and to abrupt 3x more
Epileptic patient
This condition in not unusual in the last trimester and post partum
Bells Palsy it is unilateral and will resolve on its own
What are the causes of some high risk pregnancies
social, demographic, medical and obstetric factors
85% of pregnancies are normal
What are nursing goals of hi risk
maintain maternal/fetal well being
provide emotional support
provide comprehensive patient teaching
If someone calls and reports bleeding what are the first questions you are going to ask
how much and how far along are you
what will you assess for
(B/P& P) (best indicator for blood loss is (P)
observe for shock, count and weigh pads, assess FHR
What will you do if bleeding is a problem
IVF w/18 gauge 02 ( CBC) Hct hgb notify type and crossmatch Rhogam if mom is RH-
Spontaneous Abortion symptoms
what should pt do
vaginal bleeding, cramp, backache, cervix closed
bed rest, no intercourse, draw/lab to check and see if HCG is high
Inevitable(Intermittent) Abortion
moderate copious blood, cramp, cervical os dilates, ROM
cannot stop, D&C usually necessary
What is an increase for hemorrage and infection after an abortion
fragments of the placenta not removed
Incomplete (SPab)
pass clot and it could be baby
chief danger is bleeding
usually D&C may need a transfusion
Complete Abortion
all products expelled
guilt is a big complication
Missed abortion
fetus dies in utero, ultrasound
symptoms of pregnancy will leave (HCG will fall)
may wait two weeks to see if deliver on own
Recurrent Abortion
3 or more consecutive abortions
d/t incompentent cervix
What is a cerclage
stitch cervix together until delivery Shirodkars
“purse string suturing”
Nursing dx for abortion
fear, pain, grief, fluid volume deficit
Where are most ectopic pregnancies
95% in fallopian tubes(ampule)
What is one of the leading causes of material death from hemorrhage
Ectopic pregnancy
what are the s/s of ectopic pregnancy
amenorrhea, abd pain(intense) breast tender, sometimes even a + pregnancy test, spotting
pain is the most predominate sign
what is cullen’s sign
blue coloration of umbilicus which is bleeding into abdomen
What is the mgmt of ectopic pregnancy
observe for s/s shock
pregnancy test, ultrasound, tubalplasty, salpingectomy
blood transfuisoins and IV fluids
What do they give to client to speed along the abortion of the ectopic pregnancy
Methotrexate IM (folic acid antagonist)
2 nd injection day 4
3rd injection day 7
What is Gestational Trophoblastic Disease
GTD molar pregnancy
What is molar pregnancy
abnormal development of placenta( grapelike clusters)
proliferated tropho tissue
Grapelike clusters form where
maternal side of placenta
Complete Mole characteristics
no genetic material, embryo dies
choriocarcinoma
partial mole characteristics
normal ovum fertilized by 2 sperm
s/s of of GTD
vag bleeding (brownish(prune juice) polyuria hyperemesis gravidarum because of elevated HCG anemia PIH prior to 24 weeks absent FHY
Management of GTD
suction of evacution, cerclage, D&C, follow up, baseline chest xray(checking for cancer in lungs)
must avoid pregnancy for 1 year because the cancer feeds off of hcg in trophoblastic tissue
S/S of incompetent cervix
passive and painless dialation of cervical os without labor.
history or cervical trauma - multigravida, abortion
cervical funneling
what can be done for an incompetent cervix
cervical cerclage
What is hyperemesis gravidarum
excessive vomiting
complications from hyperemesis graviduram
dehydration and electrolyte imbalance metabolic alkalosis hypovolemia, hypotension, tachyacardia HCT and Bun high K Na Cl low small baby
What are you going to assess for in hyperemesisi
Fluid volume deficit hydrate monitor I & o assess skin turgor daily weight assess for edema administer antiemetics v/s every 4 hrs
What kinds of fluids would you give for hyperemesis
IV of TPN potassium, vit B gradually introduce oral fluids and soft foods can give phenergran, zofran Always provide mouth care
What are the classifications of PIH
gestational hypertension ^ BP after mid preg w/o protein
transient hypertension ^bp resolved by 12 weeks pp
preeclampsia after 20 weeks ^BP + protein +2
eclampsia preeclampsia + seizures
chronic hypertension before pregnanc
y
preeclampsia superimposed on chronic hypertension
Greatest risk factors in having PIH
< 20 years or > 40 yrs
low socioeconomic status
h/o pre eclampsia
ob complications:mole pregnancy, multiple gestation, diabetes
What are the normal levels for uric acid and creatine and BUN
Uric 3.5
Creatnine 0.8
BUN 12
What are risks of PIH for mom
abruptio placenta, maternal mortality, seizures, acute renal failure, DIC
What are the risks for baby
IUGR growth restricted
IUFD fetal demise
oligohydramnios(reduced fluids)
hypoxia and acidosis(fetal distress) (late decels)
Patho for PIH
H/A, visual disturbances, spots, RUQ abdominal pain, ^ liver enzymes, decreased urine
S/S of preeclampsia
hypertension 30/15 over
severe 160/110
proteinuria 0.3 greater
severe +2
What is something you can do to check for worsening signs of PIH (CLONUS)
pullt toes back and if it taps
hyperreflexia with or without clonus
knee kick is usually hyper
what can you administer to try and control seizures in PIH
magnesium sulfate IV but must be on secondary line
4-6 gms loading dose over 20 min
1-3 gms/hr mtce
what is the antidote for magnesium sulfate
calcium gluconate
you will see these if toxcicity occurs
decreased variables
What is HELLP Syndrome
b/p may or may not elevate but proteinuria will be present w/epigastric pain
life threating variation of pre-eclampsia
(hemolysis, elevated liver enzymes, low platelets)
what are the s/s of HELLP
pain in ruq, the lower chest or epigastric, liver tenderness, n/v and severe edema
what is hemolysis
breakdown of RBCS
what caused bilirubin levels to go up
hemolysis
if a mom is Rh- what must you give
Rhogam 2nd child is the one that is at risk for problem
What are some causes of sensitization
previous delivery of Rh+
ab, ectopic and mom did not receive Rhogam
cvs, amniocentesis, PUBS, maternal trauma
blood transfusions of Rh+ blood
What tests are done to detect rh sensitization
Indirect Coombs- done on mom’s blood to see antibodies present
Are present all you can do is monitor baby for anemia
If NOT present give Rhogam at 28 weeks and then 72 after delivery
Direct Coombs done on baby blood
What kind of titer is drawn for rh
delta optical density if . 1 :16 PUBS can be done
If mom is Rh- and the indirect and direct are - and baby is Rh+ then
give Rhogam 300 mg
Erythroblasits fetalis
Hydrops fetalis is marked fetal edema
congestive failure
marked jaundice
What are some of the Rh Alloimmuinization fetal risks
anemia
hemolytic syndrome
erythroblastosis fetalis
when would you give Rhogam
pregnant women with no antibody titer on hand
mother whose baby’s father is rh+ or unknown
28 gestation age
after abortion
72 hours postpartum
amniocentisis and placent previa
invasive procedures that cause bleeding
ABo incompatibility
Mother has type O blood and infant has A, B, AB
first infant is oftern involved it cannot be prevented
Abo incompatibility causes
jaundice(hyperbilirubinemia)
what can you use to treat jaundice
phototherapy
bili blankets
Effects of surgery
1st trimester increase abortions
do not like to do gall bladder surgery in 1st
2nd less risk
what would you do for mom in a surgery
put a wedge under hip to stop vena cava syndrome
you must monitor FHR
What is common cause of fetal and mom death
abruption after a trauma must monitor at least 4 hours after trauma
TRAUMA stands for
T triage (assess maternal ABC)
R resuscitation (CPR given up higher on sternum)
A assessment for maternal injuries, FHR
U Ultrasound
M management/monitor
A activate transport
What does Kleihauer Betke test rule out
fetal hemorrhage
What are risks for abruptions
Trauma, PIH, Substance abuse (cocaine), hydramnios
What is T in TORCH
what would you give for it?
T- toxoplasmosis cats goats milk, undercooked meat
can cause blindness, deaf , mentally challenged
+IGM more recent infection (active)
-IGM and showing +IGG infection in past(G means gone)
Give spiramycin
What is the O in Torch
Other-
* cystitis(UTI) cause preterm labor and ROM
*pyelonephritis(kidney infection) antibiotics IV amoxicillins, cephlasoporins
* vaginal candidiasis (yeast infection)
miconazole
What is the R in TORCH
Rubella german measles
1:8 greater immune
if you are not immune you cannot have the shote until after delivery(live virus vaccine)
+IGM recent active infection
treat moms symptoms
What is the C in TORCH
cytomegalovirus (CMV) 5th disease(slapped cheek)
most frequent cause of viral infections
if mom has never had and acquired then during pregnancy can produce mental retardation, mocrcephaly, hydrocephaly, cerebral palsy or mental retardation
What is the H in TORCH
Herpes
35-36 weeks give acyclovir
c section
Group B Strep info
baby is at risk not mom
test 35-37 weeks
penicillin G be in system at least 4 hrs prior to delivery
What fetal lie do we want to see
longitudinal
what flexion do we want to see
vertex
what fetal attitude do we want
normal flexion, cephalic with ROA or LOA
what is considered a good strong contraction
60 mm of Mercury(HG)
Primary force
Secondary force
strong contractions
using addt’l abd muscles
what is frequency in contractions
beginning of 1 ot beginning of another (measured in minutes)
what is duration
how long last beginnig of contraction to end (Measured in seconds)
intensity
refers to the strength(rise in intrauterine pressure) measure by palpating but only true way is intrauterine cath (internal monitors)
what occurs during resting tone between contractions
circulation 0-15 mm HG
Causes for contractions
Pitocin
prostaglandins
progesterone when it goes down it makes contraction
True indicator of labor
cervical dilation
NST
reactive if there are 2 accels in 20 minutes
False Labor
irregular contractions that do not increase induration and intensity
contractions lessened by walking
CST
is positive if you see late decelerations
What softens cervix and weakens Ripens
cervidil thin tissue inserted around cervix
cytotec pill
True Labor
contractions at reg. intervals increase in duration and intensity
discomfort pain in back and radiates to front of abdomen
walking intensifies
Latent Phase
reg. mild conrtractions dilation 0-3 cm frequency 10-30 min 5-7 min duration 30-40 sec 25-40 mm HG
4-7 cm
2-3 min
40-60 sec
50-70 mm HG
8-10 cm
1.5-2 min
60-90 sec
70-90 mm HG
Second Stage
pushing stage complete dilation
1.5-2 min
60-90 sec
70-100 mm Hg
3rd stage
placenta delivery
infant born, uterus contracts, placenta begins to separate
4th stage
1-4 hours
firm fundus decreases blood loss
tremors are normal
Will not do epidural if platelets are less than
100,000 normal value 150,000
WBC can go up to 15,000-20000
HCT <32 (not good)
What are the causes of pain in each stage
1st dilation of cervix
2nd increase from hypoxia, baby thru canal
3rd placenta expelled
What is the main reason of FHR
to see how baby is responding to each contraction
if you find heartbeat in upper quads
means BReech
Normal FHR
110-160 bpm over 10 minutes between contractions
Variability
fluctuation of FHR in 1 min
how the CNS is working
want moderate 6-25 bpm
absent no change no wiggles and jiggles
minimal 25 bpm caused by hypoxia
what affects variability
baby sleeping
medicines
early gestation
acidosis ph down when 02 down
What increases variability
need stimulation
what can cause tachycarida
mom has infection for every degree of temp high baby increase 10 bpm
fetal hypoxia (baby compensates from 02 deficit by HR increase) fetal infections
causes of bradycardia
asphyxia
abruption, cord prolapse,
continuous head compression
Accelerations
15bpm X 15 sec in 20 minutes 2 of them
Early decelerations
caused by fetal head compression
return to baseline by end of contractions(mirror the contraction)
Late decelerations
caused by UPI(uterine placenta insufficiency) b egin after contraction lines smoother
requires nursing interventions
Variable decelerations
caused by cord compression
look different shap, duration, looks like U, W,V
require nursing interventions
what are interventions for variable decels
assess if prolapsed cord then hold pressure on presenting part until someone can help reposition mom stop pitocin admnisiter8-10 02 by mouth increase IV fluids continuous electronic monitoring notify physician prepare for immediate delivery if necessary
breathing techniques what llevel is used regardless of what level
cleansing breath begins and ends each pattern
1st pattern of breathing
slow, deep breathing (slow paced) chest up and out inhales through nose exhales thru lips
2nd pattern of breathing
shallow or modified paced breathing
inhales and exhales thru mouth
3rd pattern of breathing
pant blow paterned paced
forcefulexhalation thru lips
Labor that happens so quickly within 3 hours
preciptous
what is the goal of the epidural
to provide maximum pain relief w/minimum risk to mother and fetus
Stadol
can sause n/v 1-2 mg IV
Nubain
10 mg
Demerol
25mg IV or 50 mg IV do not use unless preterm mom
Sedatives
Seconal
What is the antagonist for newborn
Narcan keeps on hand if baby doesnt want to respond “neonatal resusciation” 0.1 mg/kg given every 2-3 minutes IV or IM
can be given to mom for respiratory depression but be cautious if mom is on opiods
what is in the test dose of the epidural
epinephrine if it placed correctly the heart rate should go up
side effects of epidural
breakthrough pain, sedation, n/v pruritus, hyptoension
Pre term labor
20-36 weeks
baby not viable
before 24 weeks
to stop premature labor what can dr give
tocolytics
magnesium sulfate,
brethine- mom feels like chest pains sq
wht is given to help lung maturity
BETAMETHASONE(CELESTONE)
given to mom corticosteriods
dexamethizone
what are the 3 types of abruptio placentae
marginal blood escapes vaginally down cervix
central blood being trapped in middle
complete total separation massive bleed
DIC
puts out fibrinogena nd then just stop BLEED OUT
Abruption signs
blood loss- dark venous
severe or steady pain firm rigid abdomen(classic )
uterine may enlarge
FHT possibly absent
First assessment after finding hard rigid abd.
check baby
mom vs
Sequel of prematurity
hypoxia, anemia, brain damage, fetal demise
what would you do in case of abruptio
2 lg bore ivs blood products iv fluids monitor DIC I&0 abd. girth prepare for c section neonatal resucitation equipment ready
what is placenta previa
quiet sneaky
bright red blood
no pain
low lying placenta is over cerival OS
do not put anything in vagina
what are clues to multiple gestation
visualization of 2 sacs at 5 to 6 weeks
fundal height greater than expected
ausculation of heart rates that differ at least 10 bpm
40-45 pd gain 24 pd by 24 week
what does hydramnios effect and s/s
fetal malformation taht affect swallowing and neuro disorders
more than 2000 ml amniotic fluid
if you remove fluid to ffast before birth abruptio can happen
oligohydramnios
less than 500 ml amniotici fluid
diagnosed when largest veritcal pocket is 5 cm or less
fetus is easily palpated and not ballotable
what procedure is used in oligohydramnios
amnioinfusion (infusion of 100ml to 200ml/hr)
this can also be used in thick meconium problems
what are some risks of preciptuous labor
trauma
laceration of cervix, vagina, perineum
post hemorrhage
fetal cerebral trauma from rapid descent
lose movement of shoulder(brachial plexus injury)
non reassuring fetal status
S/s of infection in mom
eleveated Temp chills, foul smelling amniotic fluid, fetal tachycardia
what can you give for precip labor and hyperstimulation of the uterus
postioning
pitocin
oxygen
prolonged pregnancy
anything over 42 weeks
what are the risks of Breech
increased risk for prolapsed cord
risk of cervical cord injuries
asphysia
birth trauma especially of the head
what can cause macrosomia
maternal obesity diabetes prior history of macrosomia male ffetus multiparity prolonged gestation hipsanic erythroblastois fetalis
what are the risks of macrosomia
cpd
prolonged labor
laceration of vaginal birth
hemorrhage
fetal meconimu aspiration asphysia shoulder dystocia fractured clavicle hypoglycemia, polycythemia hyperbilirubinemia
implications of amniotic fluid embolism
respiratory distress suddenly, circulatory collapse, acute hemorrhage, dyspnea, cyanoisis, frothy sputum is a classic sign turn gray
what is cephalopelvic disproportion (CPD)
fetus larger than pelvic diameters
retained placenta may be a symptom of
accreta, chorionic villi attach to myometrium
increta myometrium invaded
percreta myometrium penetrated
after 30 minutes dr will manually remove
amniotomy
artificial rupture of membrane AROM
Pitocin
done in mu typically start at 2 and bump every 15-30 minutes
funic presentation
umbilical cord is interposed between cervix and the presenting part
episiotomy 2 types
midline
mediolateral
vacuum assisted birth
suction cup if two tries and cannot get then go to surgery
what is hydrops fetalis
esophagus doesnt form in 1 piece
prolonged pressure to fetal head can cause in hypertonic labor
caput succedaneum, cephalhematoma, excessive molding
what can you do to speed up someone in hypotonic labor
nipple stimulation oxytocin infusion amnioty encourage voiding minimize vaginal exams
what is POP
persisitent occiput posterior (baby is face up) inadequate pushing have back labor can have lacerations big baby
what are some interventions you can do for POP
pelvic rocking
lunge from one side to another
Brow presentation
face right at you
increase mortallity
non reassurring FHR
what are some things you do for macrosomia
supra pubic pressure fist together right above pubic bone
mcroberts maneuver
knees to chest
what is the procedure to get ready for csection
start iv D5Lr bolus of fluid antibiotic, epidural abd. prep foley cath bicitra, reglan, pepsid
what kind of incision do you want for c section
transverse
insicion on the ithmus of the uterus
