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diabetes and postpartum > diabetes and postpartum > Flashcards

diabetes and postpartum Flashcards

1
Q

Hypertonic uterine dysfunction (4)

A
  • Uterus never relaxes btw contractions
  • erratic
  • poorly coordinated
  • contractions: frequent, intense, and painful
  • early in labor affecting nulliparous
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2
Q

Hypotonic uterine dysfunction (4)

A
  • during active labor (>4cm)
  • poor in quality
  • lack intensity: cervix doesn’t dilate or efface
  • risk: hemorrhage
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3
Q

Labor induction vs augmentation (3)

A
  • induction: stimulating contractions via medical means
  • augmentation: enhancing ineffective contractions after labor has begun
  • indications: prolonged gestation, prolonged premature rupture of the membranes, gestational hypertension, (cardiac dz), renal dz, chorioamniotnitis, dystocia, intrauterine fetal demise, and diabetes
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4
Q

labor induction (7)

A
  • cervical ripening
  • herbal agents
  • hot baths, myths
  • sexual intercourse with breast stimulation
  • mechanical methods and surgical methods (foley bulb, amni hook)
  • pharmacologic agents
  • oxytocin
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5
Q

labor induction and augmentation: care management (5)

A

nursing assessment:
-relative indications; gestational age determination
-fetal status: maternal status: bishop’s score (mom ready for labor, consistency of cervix-soft, firm, midline, higher score more ready for induction)
nursing management:
-explanations
-oxytocin administration
-pain relief and support

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6
Q

umbilical cord prolapse/compression (3)

A
  • when cord lies below presenting part of fetus
  • risk factors: long cord (longer than 100 cm), malpresentation (breech), unengaged presenting part, AROM
  • management: prompt recognition, relieve pressure on the cord by change in position (hands and knees/trendelendburg), or putting pressure on presenting part and push away from opening
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7
Q

Amnioinfusion (6)

A

: cervix needs to be somewhat dilated

  • dilute meconium passed into the amniotic fluid
  • prevent umbilical cord compression
  • indications:
  • severe variable decelerations due to cord compression
  • oligohydramnios due to placental insufficiency
  • thick meconium fluid
  • nursing management: teaching, maternal and fetal assessment, preparation for possible cesarean birth
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8
Q

about uterine rupture (9)

A
  • very serious obstetric injury
  • first sx is sudden fetal distress
  • risk factors: (TOL) trial of labor for vbac, inductions: use of pitocin, congenital uterine anomaly, prior uterine surgery, multiparty, trauma
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9
Q

what is uterine rupture (6)

A
  • s/ and sx: vary with extent of rupture, nonreassuring fetal tracing, loss of fetal station, signs of hypovolemic shock
  • management: prevention is the best treatment, surgical intervention
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10
Q

shoulder dystocia (6)

A
  • head is born, but anterior shoulder cannot pass under pubic arch
  • high risk for neonatal birth injuries: brachial plexus injury, fractured clavicle
  • maternal risks: lacerations, excessive blood loss, extension of episiotomy, endometritis
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11
Q

tx for shoulder dystocia (6)

A

-nurse can apply suprapubic pressure to decrease diameter of shoulders (could fracture clavicle)
-mcroberts maneuver: flex and abduct the legs
-change positions
-episiotomy: from vagina to anus or lateral medial
: dec risk of blood loss, risk of infection (endometritis)

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12
Q

precipitous labor (7)

A
  • active labor < 3 hrs from onset of regular contractions to delivery may be spontaneous or cocaine induced
  • not good, very contracted state of uterus
  • complications:
  • placental abruption
  • uterine rupture
  • lacerations of maternal structures
  • postpartum hemorrhage (most common)
  • fetal hypoxia
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13
Q

pre-term labor (4)

A
  • occurrence of regular contractions accompanied by cervical effacement and dilation before the 37th wk of gestation
  • major contribute to perinatal morbidity and mortality in the world
  • exact cause is unknown
  • prevention is the goal
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14
Q

post-term labor (3)

A
  • pregnancy continues past the end of the 42 wk of gestation
  • may be from low estrogen
  • most places don’t want to wait til this long to induce, but as long as baby is ok should wait
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15
Q

post-term risks (10)

A
  • -maternal risks:
  • r/t excessively large infant
  • inc risk of dysfunctional labor, birth canal trauma
  • interventions more likely to be necessary
  • fatigue and psychological runs
  • fetal risks:
  • prolonged labor
  • shoulder dystocia
  • birth trauma
  • asphyxia
  • macrosomia: 4000-4500g
  • aging placenta may compromise FHR
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16
Q

care management: post-term (5)

A
  • incr morbidity and mortality after 42 wk
  • most docs induce at 41-42 wk
  • others allow prey past 41 wk with
  • assessment test of fetal well-being normal
  • NST and BPP 2x/wk
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17
Q

multiple gestation (2)

A
  • refers to twins, triplets, or more infants within a single pregnancy
  • incidence inc d/t infertility tx
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18
Q

operative vaginal births (6)

A

-forceps-assisted birth
: maternal indications are shortened second stage in event of dystocia
-fetal indications
: distress or certain abnormal presentations
: arrest of rotation
: delivery of head in a breech presentation

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19
Q

forceps-assisted vaginal delivery (4)

A
  • can cause bruising for the baby
  • can cause facial nerve damage
  • may need to do episiotomy to insert forceps
  • mom may be fatigued and need assistance
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20
Q

vacuum assisted vaginal birth (5)

A
  • attachment of vacuum cup to fetal head, using negative pressure to assist birth of head
  • prereqs:
  • vertex presentation
  • ruptured membranes
  • absence of CPD (cephalopelvicdisproportion, head is too big for pelvic inlet)
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21
Q

assessment after vacuum (2)

A
  • assess baby head for caput succedicum (edema in the head that crosses the suture lines)
  • assess for cephalohematoma (doesn’t cross suture so either L or R)
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22
Q

cesarean birth indications (6)

A

contributing factors

  • fetal macrosomia
  • ama
  • obesity
  • GDM
  • multifetal pregnancy
  • malpractice concerns
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23
Q

c-section birth (3)

A

additional factors

  • elective c-section
  • surgical tech: low transverse vertical incision
  • complications and risks
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24
Q

VBAC (4)

A
  • indications for primary c-section birth may be nonrecurring
  • indiv decision based on risk factors from previous and current prey
  • 9% women attempt TOL after c/s
  • risk of injury greatest for fetus
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25
Q

DM: classifications (4)

A

-typical classification
: type I (more common in euro american and middle eastern ethnic), unknown trigger
: type II (highest pref in american indian youths), half with condition are undo
: impaired fasting glucose and impaired glucose tolerance (pre-diabetes)
-classification during pregnancy: gestational

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26
Q

GDM (8)

A
  • glucose intolerance with onset or first recognition during pregnancy
  • dx w/o pre-existing dx of diabetes
  • begins in 2nd trimester and continues thru 3rd
  • testing usually around 28 wk
  • true GDM caused by placental secretion of enzymes that break down insulin, incr maternal adipose tissue, and inc insulin clearance by placenta
  • 70% dx will get type 2 in 10 yrs
  • lifestyle changes can delay or prevent type 2
  • delivery is cure
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27
Q

GDM and pancreatic consumption

A

-pregnant women with GDM are able to inc secretion of insulin during pregnancy, but ability to inc insulin secretion is 50% lower than pregnant women without hyperglycemia during pregnancy

28
Q

DM: patho and pregnancy (7)

A

-fetal demands
-role of placental hormones
-changes in insulin resistance
-effects on mother: inc wt gain, more likely c/s from preterm birth
-effects on fetus: LGA/macrosomia, test for hypoglycemia
: difficulty breathing
: jaundice

29
Q

DM: assessment (11)

A

-health hx: physical exam, risk factors
-screening at first prenatal visit, additional screening 24-28 wk for women considered at risk
-maternal surveillance: urine for protein, ketones (d/t hydration), nitrates, and leukocyte esterase
:evaluation of renal function/trimester
: eye exam in 1st trimester
: HbA1c every 4-6wk
-fetal surveillance: ultrasound
: alpha-fetoprotein levels
: bpp
:nst
:amniocentesis

30
Q

DM therapeutic management

A
  • preconception counseling
  • long term blood glucose (over 3 mo is more accurate) level control (HbA1C <7%)/hemoglobin
  • glycemic control
  • nutritional management
  • hypoglycemic agents
  • close maternal and fetal surveillance
  • management during labor and birth
31
Q

GDM: pharmacological rx (7)

A

-insulin: doesn’t cross placenta so safe (set dose or sliding scale)
-oral hypoglycemic: may cross placenta and cause complications but some are safe during preg
-iv, don’t give PO, test on an hourly basis
:glyburide
:metformin
:acarbose
:miglitol

32
Q

Amniotic fluid embolism (5)

A

-obstetric emergency only confirmed by autopsy
-sudden onset of hypotension, hypoxia, and coagulopathy due to breakage in barrier between circulation and amniotic fluid
-nursing assessment: difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary adema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest
-nursing management: supportive measures to maintain oxygenation and hemodynamic fn and to correct coagulopathy
: critical care monitoring

33
Q

Assessment of mom pp (5)

A
  • recovery period is 2 hrs post delivery
  • q 15 mins for 1st hr
  • q 30 mins for 2nd hr
  • q 4 h for first 24 hrs
  • q 8 h (qshift) after 24 hrs
34
Q

vital signs pp (5)

A
  • T: >38 c (100.4 F)
  • P: range from 50-70
  • R: range from 16-20
  • BP
  • Pain
35
Q

identify risk factors for infection (4)

pg 445

A

endometritis

  • assisted delivery
  • retained placental fragments
  • prom
  • lacerations, episiotomy, incision
36
Q

identify risk factors for hemorrhage (2)

pg 445

A
  • uterine atony

- retained placental fragments

37
Q

endometritis (6)

A

predisposing factors from intrapartum

  • ROM>24 hrs
  • C/S
  • forceps or vacuum (invasive procedures)
  • internal monitors
  • episiotomy
  • hematomas
38
Q

s/ and sx of endometritis (5)

A
  • tender uterus
  • sub-involution
  • inc T
  • foul smelling discharge
  • chill, malaise (late sign)
39
Q

nursing care for endometritis (6)

A
  • peri-care (peri-wash, hand washing, hygiene, change pads frequently)
  • iv antibiotics
  • comfort measures (icing, sits, pain meds)
  • lochia, vs, involution (check bleeding)
  • rest
  • semi-fowlers (enhance drainage)
40
Q

uterine involution (6)

A
  • 1 cm/fingerbreadth per day
  • location of fundus in r/t the umbilicus
  • if its not going down then there may be blood or other fragments left inside
  • first r/o a full bladder
  • second fundal massage is uterus is boggy/soft
  • use pain meds for c-section fundal massage
41
Q

cervix (2)

A
  • remains open for 4-6 days

- appears as slit forever after pregnancy instead of hole

42
Q

breast changes (7)

A
  • check if they are a candidate for lactation consultant
  • check engorgement
  • check nipples, flat, long, inverted, everted
  • check for symmetry, contour
  • check nipple redness, cracking, crust
  • check colostrum, very small amounts
  • milk comes in 72-96 hrs
43
Q

suppress lactation (2)

A
  • if not breast feeding should wear a bra binder or sports bra as much as possible to suppress milk production
  • no hot showers bc that inc milk production
44
Q

engorgement (6)

A

-venous congestion, too much milk production and not being released causes swelling,
-check softness, firmness, fullness
-can use a breast pump
-manual hand
expression
-breast feed more often
-med if very very swollen

45
Q

good breastfeeding position (4)

A
  • cross-cradle (vag delivery)
  • football
  • side-lying
  • help moms to breastfeed as much as possible
46
Q

Latch scoring (6)

A
  • 10 or above for good latch
  • 7 need a latch referral
  • latch (too sleepy, reluctant, no latch to grasps breast with tongue down, lips flanged, using rhythmical sucking)
  • audible swallowing (none to spontaneous and intermittent to frequent)
  • type of nipple (inverted to everted)
  • comfort breast/nipple ( engorged, cracked, bleeding blisters to soft and non-tender)
  • hold positioning (assisted or not)
47
Q

mastitis (8)

A
  • breast infection
  • -red, hard, hot
  • caused by staph a, mrsa entering the nipple
  • sx: fever, flu-like sx
  • reason for re-admission to hospital
  • baby is already immune so can keep breast-feeding, but painful so many don’t
  • cleanse nipple with soap and water
  • inspect axillary nodes for infection
48
Q

nursing care for mastitis (5)

A
  • maintain nipple skin integrity
  • assess infant position at breast
  • comfort measures
  • continue breastfeeding or pumping of milk
  • antibiotics
49
Q

baby-friendly

A

-gold standard, best practice. its about creating an optimal environment for infant feeding and mother-baby bonding
-ebp in infant and mother baby care. edu and docu
-

50
Q

baby friendly 10 steps (10)

A

1) have a written breastfeeding policy that is routinely communicated to all healthcare staff
2) train all healthcare staff in skills necessary to implement this policy
3) inform all prey women about the benefits and management of breastfeeding
4) practice rooming in, allow mothers and infants to remain together 24 hrs/day
5) help mothers initiate breastfeeding within 1 hr of birth
6) give newborn infants no for or drink other than breastmilk, unless medically indicated
7) show mothers how to breastfeed and how to maintain lactation (supply and demand), even if they are separated from their infant
8) encourage breastfeeding on demand
9) give no pacifiers or artificial nipples to breastfeeding infants
10) foster the establishment of breastfeeding support groups and refer mothers to them on discharge

51
Q

perineum

A
  • assess peri and butt for hemorrhoids, laceration, episiotomy
  • check sutures, discharge, bleeding, clots, bulging (hematoma from pushing with baby in same position for a long time, which can lead to blood loss)
52
Q

lochia assessment (9)

A 
Color:
-rubra~ 2-3 days
-serosa~ 3-10 days
-alba~ 
Amount: initially expect 6-8 pad changes per day
-scant: 1-2 in
-light: 4 in
-medium/moderate: 4-6 in
-heavy, entire pad saturated
-within 1 hr
53
Q

hemorroids (4)

A
  • expected
  • due to dec in progesterone
  • excessive pushing may aggravate
  • sx: itching, pain, thrombosis
54
Q

hemorroids nursing care (4)

A
  • encourage hydration and ambulation
  • diet high in fiber
  • stool softeners PRN, colace, tucks, milk of magnesia
  • comfort measures: 24 hrs-ice pack, sitz bath (after 24 hr) hygiene, circulation
55
Q

GI (10)

A
  • dec progesterone causes contipation
  • analgesia can dec bowel movement
  • may take 5 days for BM
  • assess bowel sounds
  • assess for flatulence, gas pain can get simethicone
  • inc ambulation
  • don’t introduce foods bc can regurgitate
    1) assess bowel sounds to see if can have food
    2) if no nausea, vomiting
    3) start w/ clear or NPO to normal diet
56
Q

nutrition (3)

A
  • breast feeding vs bottle feeding
  • cal inc by 500 if breast-feeding
  • encourage prenatal vit until followup apt at 4 wk for both bottle and breast
57
Q

blood info (6)

A

-PP hematocrit/hemoglobin
-8 wk for all red blood cells to go back to normal
: foods high in iron
: food high in protein
: iron supplement (black stool)
: teach about constipation effects of iron

58
Q

nutrition cultural (3)

A
  • may avoid cold foods
  • include foods of celebration
  • general health
59
Q

cardio system (7)

A
  • blood vol returns to pre-pregnant state
  • elevated WBC from labor stress
  • risk for thrombophlebitis
  • assess CBC and EBL
  • hygeine
  • VS, orthostatic bp
  • homan’s sign
60
Q

urinary tract (6)

A

-diuresis
-must void after birth
-difficulty voiding d/t
: sensation of full bladder
: pain
: edema/trauma

61
Q

nursing care for urinary tract changes (5)

A
  • assist pt to void following delivery
  • assess for fundal displacement
  • assess for pain relief
  • document voiding (attached to iv fluids, I/O)
  • before you get out of bed call nurse to use bathroom
62
Q

pain/discomfort (8)

A

-tremors
-afterbirth pains
: multiparous
: breast-feeding (inc oxytocin causes cramping)
: nipple tenderness: assess positioning, teach nipple care, lanolin
: engorgement: encourage frequent breastfeeding, warm compresses, supportive bra, cold cabbage leaves
: encourage frequent voiding
: assess pain and offer pain med

63
Q

1st phase of maternal postpartum adjustment (6)

A
  • dependent: taking-in
  • first 24 hrs (1-2 day)
  • focus: self and meeting basic needs
  • reliance on others to meet needs for comfort, rest, closeness, and nourishment
  • excited and talkative
  • desire to review birth experience
64
Q

2nd phase dependent-independent (8)

A
  • taking hold
  • starts second or third day, lasts 10 days to several weeks
  • focus: care of baby and competent mothering
  • desire to take charge
  • still has need for nurturing and acceptance by others
  • eagerness to learn and practice-optimal period for teaching by nurses
  • handling of physical discomforts and emotional changes
  • possible experience with blues
65
Q

3rd phase interdependent (5)

A
  • letting go
  • focus: forward movement of family as unit with interacting members
  • reassertion of relationship with partner
  • resumption of sexual intimacy
  • resolution of individual roles
66
Q

competency with care/discharge teaching (4)

A
  • check for understanding
  • return demonstration
  • repeat what is said
  • includes diapers, warning signs, feeding

diabetes and postpartum (1 decks)

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