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Mother-Baby > Disorders of Pregnancy > Flashcards

Disorders of Pregnancy Flashcards

1
Q

Defining factors of hyperemesis gravidarum

A

Severe nausea and vomiting of pregnancy
Begins before 9 weeks gestation
Associated with weight loss >5% of pre-pregnancy weight
Results in dehydration, nutritional deficiencies, electrolyte imbalances and/or ketosis

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2
Q

Causes/etiology of hyperemesis gravidarum

A

Increased HCG levels
Decreased vitamin B6
Genetics
Psychosocial factors

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3
Q

Risk factors of hyperemesis gravidarum

A

Increased incidence with multiple gestation and molar pregnancies

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4
Q

Duration of hyperemesis gravidarum

A

Peak incidence 8-12 weeks
Typically resolves by 20 weeks
May persist duration of pregnancy

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5
Q

S&S of hyperemesis gravidarum

A

Protracted vomiting
Intolerance of liquids/solids
Weight loss >5%
Increased HR, decreased BP
Poor skin turgor, dry mucous membrances
Ketonuria, increased urine SG (>1.030)
Decreased Na, K, Cl
Increased HCT, RBCs

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6
Q

Nursing management of hyperemesis gravidarum

A

VS, weight, I&O
NPO for gut rest
IV fluids: TPN or enteral feeds if protracted
Antiemetic administration
Pt. education

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7
Q

What is iron deficiency anemia in pregnancy

A

Hgb <11 mg/dL in 1st and 3rd trimesters
Hgb <10.5 mg/dL in 2nd trimester

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8
Q

Nursing management/Pt. education for iron-deficiency anemia in pregnancy

A

Iron supplementation 325 mg 1-3x/daily
-take on empty stomach with OJ/vit c
-do not take with coffee or tea
-increase fluids and fiber to decrease constipation

Iron rich foods
-meats, green leafy veggies, legumes and nuts, enriched breads and cereals

Rest PRN

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9
Q

What are TORCH infections?

A

Toxoplasmosis
Other (syphilis, hepatitis, varicella, parvo, HIV, Zika, listeria)
Rubella
Cytomeglovirus
Herpes simplex virus

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10
Q

Considerations with TORCH infections

A

Prevention is key
Handwashing
Avoid soft cheeses, hot dogs, deli meats, unpasteurized milk, raw meats, undercooked eggs
Avoid cat litter
Wear gloves while gardening
Safe sex
C-section if active genital HSV lesions

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11
Q

What is spontaneous abortion

A

A pregnancy that ends due to natural causes before 20 weeks gestation

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12
Q

S&S of spontaneous abortion

A

Vaginal bleeding
Passage of products of conception
Back pain
Sudden relief of morning sickness
Rupture of membranes (2nd trimester)

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13
Q

Classifications of spontaneous abortion

A

Threatened
Inevitable
Incomplete
Complete
Missed

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14
Q

Nursing management of spontaneous abortion

A

Vital signs
Labs: CBC, HCG
Assess bleeding volume (pad counts/QBL)
Assess passage of products of conception
Assess and manage pain
Prepare and educate for procedures if needed
Administer RhoGAM if Rh negative
Acknowledge grief, active listening

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15
Q

Patient education of spontaneous abortion

A

Anticipatory guidance
-educate at first prenatal visit about signs and symptoms of miscarriage

After-care
-report heavy bleeding, fever, foul-smelling vaginal discharge
-pelvic rest x2 weeks (no tubs, sex, tampons)
-iron supplement education if needed
-provide referral to community grief support groups

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16
Q

S&S ectopic pregnancy

A

Unilateral lower abdominal pain
May have vaginal spotting
Typically occurring 6-8 wks gestation
If ruptured ectopic pregnancy
-s/s of hypovolemic shock
-shoulder pain
-cullen sign- ecchymosis around umbilicus

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17
Q

Treatment of ectopic pregnancy

A

Surgical: salpingectomy or salpingotomy
Medical: IM methotrexate
-inhibits cell division (stops embryo/fetal growth) by disrupting folic acid, cells are then reabsorbed

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18
Q

Nursing management of ectopic pregnancy

A

Vital signs
Labs
-HCG (typically lower than expected)
-CBC, blood type/Rh
Assess bleeding
Assess and manage pain
Prepare for procedures/treatment
Administer RhoGAM if Rh negative
Acknowledge grief, active listening

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19
Q

Patient education of ectopic pregnancy

A

Weekly bHCG until non-pregnant range
Defer pregnancy for 3 months
Routine post-op teaching if surgical
If methotrexate treatment:
-No folic acid supplements or PNV/MVI
-Avoid sun exposure
-Teach S/S of ectopic rupture: severe/sharp unilateral abdominal pain, shoulder pain, dizziness/syncope

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20
Q

What is gestational trophoblastic disease (Molar pregnancy)

A

Pregnancy related tumor that forms from an abnormal growth of trophoblastic cells after conception without development of a viable pregnancy
20% will progress to choriocarcinoma

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21
Q

S&S of gestational trophoblastic disease (Molar pregnancy)

A

Uterine size greater than expected
Dark brown bleeding: looks like prune juice, usually 2nd trimester
Excessive vomiting (rule out hyperemesis)
Persistent elevation of bHCG after 10-12 weeks gestation
Preeclampsia diagnosed <24 weeks gestation

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22
Q

Nursing management gestational trophoblastic disease (molar pregnancy)

A

Prepare for surgical intervention
Acknowledge fear and grief

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23
Q

Patient education of gestational trophoblastic disease (molar pregnancy)

A

Stress importance of follow up
bHCG weekly until negative x3, then monthly x1 year
Avoid pregnancy for 1 year
Contraceptive counseling

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24
Q

What is cervical insufficiency

A

Premature dilation of the cervix that occurs without uterine contraction, after the first trimester

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25
Q

S&S of cervical insuffuciency

A

Painless and passive cervical effacement and dilation
Cervix <25mm and/or cervical funneling on ultrasound
Pelvic pressure
Backache
Increased mucoid or pink tinged vaginal discharge

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26
Q

Nursing management of cervical insufficiency

A

Prepare for procesure- Cerclage
Assess for s/s PTL

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27
Q

Patient education with cervical insufficiency

A

Activity restriction
Cerclage removed at 36 weeks
Report S/S of PTL
-cramping/contractions
-ROM
-backache
-significant increase in vaginal discharge

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28
Q

What are some causes of bleeding in late pregnancy?

A

Placenta previa
Placental abruption
Vasa previa

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29
Q

Nursing managment of late pregnancy bleeding

A

Recognize risk factors
Early identification of s/s
Maximize maternal/fetal perfusion
-side lying
-increase IV fluids
-O2 via NRB mask
Assess blood loss- OBL

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30
Q

What are S/S of placenta previa

A

PAINLESS bright red bleeding in 2nd/3rd trimester

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31
Q

Risk factors of placenta previa

A

Previous placenta previa
Prior c-section or uterine surgery
Multiple gestation
Closely spaced pregnancies
Age >35
Smoking

32
Q

S/S of placental abruption

A

PAINFUL dark red vaginal bleeding
Sudden onset of localized abdominal pain
Uterine tenderness
Uterine contractions/hypertonicity
Board-like abdominal rigidity
Fetal distress

33
Q

Risk factors of placental abruption

A

maternal hypertension/preeclampsia
Trauma
Smoking
Cocaine use
Muliple gestation
Abnormal fluid levels
Prolonged PROM

34
Q

Signs and symptoms of DIC

A

Bleeding from 3+ unrelated sites:
-spontaneous epistaxis
-oozing from incisions or IV sites
-petechiae/ecchymosis/hematomas
Hypotension and tachycardia
Signs of thrombosis
-renal impairment
-peripheral cyanosis
-confusion>coma
-cardiorespiratory failure

35
Q

Treatment of DIC

A

Treat underlying cause
Oxygen admin
Fluid replacement
Blood products

36
Q

What is preterm labor

A
  1. Gestational age 20 )/7 to 36 6/7 weeks
  2. Regular UCs accompanied by a change in dilation and/or effacement

OR

Initial presentation with regular UCs and dilation >2cm

37
Q

What is preterm birth

A

Any birth that occurs between 20 0/7 and 36 6/7 weeks gestation

38
Q

Preterm birth classifications

A

Extremely preterm: <28 weeks
Very preterm: 28-31 weeks
Moderately preterm: 32-33 weeks gestation
Late preterm: 34-36 weeks

39
Q

Risk factors for preterm labor

A

50% of women will have no risk factors or indicators
Lots of risk factors:
-black women
-underweight
-obesity
-smoking
-and all that

40
Q

Diagnostic predictors of preterm birth

A

Cervical length
-changes in cervical length MAY identify women at risk
Fetal fibronectin test (fFN)
-vaginal swab
-better predictor of who will NOT go into labor

41
Q

S/S of preterm birth

A

regular or frequent contractions or uterine tightening
pelvic or lower abdominal pressure
constant dull, low backache
mild abdominal cramps with/without diarrhea
obvious rupture of membranes
increase or change in vaginal discharge

42
Q

Patient education for preterm birth

A

Teach S/S of preterm labor early in pregnancy
If s/s of preterm labor:
-stop activity and lie down on side
-drink 2-3 glasses of water or juice
-if after one hour s/s countinue call provider or go to L&D
-if after one hour s/s stop, notify provider at next visit

Activity restriction
-bedrest
-pelvic rest
-work restrictions

43
Q

Medications used in preterm labor

A

promotion of fetal lung maturity
-glucocorticosteroids: betamethasone

Tocolytics
-magnesium sulfate
-Nifedipine (Adalat)
-Indomethacin
-Terbutaline

Inevitable birth:
-neuroprotection with magnesium sulfate

44
Q

Indications for betamthasone

A

Action: increases fetal lung maturity by stimulating fetal surfactant production

Reduces incidence of respiratory distress syndrome (RDS)

Administration/monitoring:
-given between 24-34 weeks gestation if risk of delivery within 7 days
-2 doses given IM 24 hours apart
-expect elevated WBC and platelets
-blood glucose, if DM may require increased insulin

45
Q

Action of tocolytic: magnesium sulfate

A

CNS depressant, relaxes smooth muscle

46
Q

Adminstration/monitoring tocolytic: magnesium sulfate

A

-HIGH RISK DRUG
–>label bag and lines
–>two person dose calculation check
–>disconnect from line if not infusing

-monitor serum magnesium: therapeutic range of 4-7 mEq/L

-educate pt about expected and common ADRs
–>hot flushes and sweating
–>burning at IV site
–>blurred vision
–>N/V
–>lethargy

47
Q

What is preterm prelabor rupture of membrane (PPROM)

A

Membrane rupture before 37 weeks gestation

48
Q

What causes PPROM

A

Inflammation
Uterine contractions
Infection
Intrauterine pressure

49
Q

Complications of PPROM

A

Infection
Cord prolapse
Cord compression due to oligohydramnios
Placental abruption

50
Q

Nursing managment of PPROM

A

If lungs mature: anticipate induction
-lung maturity = 34-36 weeks or <34 weeks with L/S ratio of >2

If lungs immature
-administer antenatal glucocorticoids as ordered
-administer antibiotics
-obtain GBS swab
-limit vaginal exams
-monitor for s/s of labor
-monitor for s/s of infection
-fetal surveillance
-anticipate delivery if s/s of infection or fetal distress

51
Q

Non-stress test indications

A

Monitor pregnancy at risk as indicator of uteroplacental sufficiency and intact fetal CNS

52
Q

Nursing interventions for non-stress test (NST)

A

Position patient in reclining chair or left-lateral
Instruct to push marker button when feels fetal movement
If no fetal movement, use vibroacoustic stimulator x3 sec

53
Q

Reactive vs nonreactive non-stress test

A

Reactive: good
-2 or more accelerations in 20 minutes
Nonreactive: bad
-less than 2 accelerations in 20 minutes

54
Q

Indication for contraction stress test

A

Earlier and more reliable test of health fetoplacental unit than NST as puts fetus under stress
Require stimulation of uterine contractions: oxytocin or nipple stimulation
Contraindications:
-Premature labor
-Multiple gestations
-Cervical insufficiency
-Placenta or vasa previa
-Prior classical cesarean section incision

55
Q

Nursing interventions for contraction stress test/ oxytocin challenge test (OCT)

A

Obtain baseline FHR
Initiate IV oxytocin
Discontinue oxytocin if:
-UC longer than 90 sec
-UC > q2 min
-Administer tocolytic prn

56
Q

Interpretation of contraction stress test

A

Negative: good
-No late or significant variable deceleration
-At least three UC in a 10-min period
Positive: bad
-Late decelerations occur with 50% or more of contractions

57
Q

Five biophysical variables of biophysical profile (BPP)

A

Rated 2 or 0 each
NST
Fetal Breathing
Fetal body movements
Fetal tone
Amniotic fluid index

58
Q

Maternal risk of diabetes in pregnancy

A

HTN
Preeclampsia
Cesarean birth
Preterm birth
Maternal mortality
Polyhydramnios
Infection
DKA and hypoglycemia

59
Q

Fetal risks of diabetes in pregnancy

A

Miscarriage
Congenital malformations
Extreme prematurity
Respiratory distress syndrome
IUFD
Placental insufficiency
Growth restrictions

Gestational:
-macrosomia: birth trauma (shoulder dystocia)
-neonatal hypoglycemia/hyperinsulinemia

60
Q

Gestational diabetes: screening and diagnosis

A

Initial 1 hr screening at 24-28 weeks:
-non fasting, any time of day
-no regard to last meal time

3 hour Oral glucose tolerance test:
-in AM fasting (>8 hrs)
-avoid caffeine and smoking x12 hrs

61
Q

Blood glucose goals

A

Fasting/premeal: <95
Postpradial (1 hr): <140
Postprandial (2 hr): <120

62
Q

Gestational DM: fetal surveillance

A

Low risk pt with diet controlled GDM <40 weeks do not generally need routine fetal surveillance
Kick counts
If oral meds, insulin, or high-risk:
-twice weekly NSTs starting at 32 weeks
-US prn to monitor fluid and growth

63
Q

Hypoglycemia vs DKA

A

Hypoglycemia:
-rapid onset
-normal BP
-normal or shallow respirations
-pale and sweating
-tremors, mental confusion, sometimes convulsions
-blood sugar lower than 70

DKA:
-slow onset- over several days
-ketoacidosis
-BP is subnormal or in shock
-Air hunger respirations
-Hot and dry skin
-general depression
-blood sugar elevated above 200
-Ketones elevated

64
Q

Nursing considerations for postpartum insulin considerations

A

Check blood sugars q 2-4 hr in first 48 hr
Give dose of subcutaneous insulin before stopping IV insulin
Most with GDM can discontinue insulin after birth

65
Q

Gestational hypertension

A

Begins after 20 weeks gestation in a previously normotensive women
BP >140 systolic or >90 diastolic
NO proteinuria

66
Q

Preeclampsia

A

Hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman
New-onset hypertension >20 weeks with any of the following:
-throbocytopenia
-renal insufficiency
-impaired liver fx
-pulmonary edema
-cerebral or visual symptoms

67
Q

What is eclampsia

A

Development of seizures or coma in a preeclampic pt

68
Q

Preeclampsia with severe features

A

Preeclampsia diagnosis with BP >160/110
Pulmonary edeam: CP, SPB
Thrombocytopenia: plt <100,000
Hepatic dysfunction: persistent RUQ/epigastric pain, liver enzymes >2x ULN
Progressive renal insufficiency: oliguria, serum creatinine >1.1
CNS dysfunction: hyperreflexia, visual changes, severe HA
HELLP syndrome

69
Q

S/S of HELLP

A

Fatigue
N/V, RUQ pain
Bleeding (epistaxis)
Weight gain
Blurry vision

70
Q

Lab findings with HELLP

A

Decreased H&H
Increased bilirubin
Abnormal peripheral smear
Increased AST/ALT
Decreased platelets

71
Q

Preeclampsia nursing assessment

A

Accurate measurement of BP
Breath sounds, respiratory effort
Edema- pitting
DTRs
Clonus
Proteinuria: >300 mg in 24-hr urine specimen

72
Q

Preeclampsia nursing assessment

A

Evaluate for s/s of severe preeclampsia
-HA
-Epigastric pain
-RUQ abd pain
-Visual disturbances

73
Q

Preeclampsia management without severe features

A

Outpatient if asymptomatic
Instruct pr on daily BP checks and fetal kick counts
Increased surveillance: weekly BP, labs
Activity restriction
Induction of labor at 37 weeks
Patient education of warning s/s to report

74
Q

Preeclampsia management with severe features

A

Inpatient management
Magnesium Sulfate
-to prevent seizures
-reduce dz progression
-NOT to lower BP
Antihypertensive meds if BP >160/110
Deliver if occurs at >34 wks
Expectant management if <34 wks and stable
Corticosteroids for fetal lung maturity if <34 wks

75
Q

Nursing care for preeclampsia with severe features

A

Environment
-quiet, dim lights
-side rails up and padded
Seizure precautions
-Ox and suction equipment
Emergency medications available:
-Calcium gluconate (antidote for MgSO4)
-Hydralizine
-Labetolol
-Nifedipine

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