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maternity > exam 1 > Flashcards

exam 1 Flashcards

1
Q

how should fundus feel post partum

A

firm.
it should also be midline near the umbilical

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2
Q

how is pregnancy weeks dated

A

by last period

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3
Q

ovum

A

conception to day 14

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4
Q

embryo

A

day 15 to week 8

this is a critical time for organ development

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5
Q

fetus

A

week 9 to end of pregnancy

this is the stage when the baby actually starts to look like a baby

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6
Q

chorion

A

outer most layer of fetus membrane

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7
Q

amnion

A

inside layer closest to baby. Doesn’t have any blood vessels. Gets its nutrients from amnionic fluid. It is more translucent than chorion

thin and translucent, but high in tensile strength

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8
Q

yolk sac

A

supplies embryo with oxygen and nutrients until placenta is ready to take over

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9
Q

functions of amniotic fluid

A
  • Temp regulation
    • Cushioning
    • Protection for cord
    • Keeps embryo from tangling with membranes
    • Source of oral fluid- baby swallows it
    • Holds waste
    • Electrolytes
    • Allows for baby to move around
      Infection prevention
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10
Q

what can too much or not enough amniotic fluid mean

A

possible renal issue

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11
Q

explain baby veins and arteries

A

The arteries are carrying deoxygenated blood and vein carries oxygenated blood

This is because blood has to go to placenta from arteries to get oxygen then it returns in vein

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12
Q

how many arteries and veins are in the umbilical cord

A

2 arteries, 1 vein

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13
Q

wharton’s jelly

A

connective tissue around arteries and veins that keeps them from being compressed

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14
Q

nuchal cord

A

Umbilical cord wrapped around baby’s neck

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15
Q

where should umbilical cord be at on placenta

A

in the center

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16
Q

schultz

A

fetal side of placenta

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17
Q

duncan

A

maternal side of placenta

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18
Q

does mother’s blood mix with babies

A

no

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19
Q

human chorionic gonadotropin (hCG)

A

what pregnancy tests check for. Keeps the corpus ledum functional to maintain pregnancy

If these are high then suddenly drop- miscarriage

placental hormone

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20
Q

human chorionic somatomammotropin (hCS)

A

fetal growth hormone, breast development for lactation. Causes insulin resistance

placenta functions

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21
Q

Estrogen and progesterone

A

hormones that maintain pregnancy

they increase over pregnancy

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22
Q

maintains endometrium during pregnancy

A

progesterone

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23
Q

stimulates uterine growth and blood flow during pregnancy

A

estrogen

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24
Q

relaxin

A

hormone that relaxes ligaments to help prepare for baby to go through birth canal. Makes women waddle

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25
Q

placenta metabolic functions

A

respiration- functions as lungs
nutrition and storage of nutrients
excretion

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26
Q

hormone that spikes in early pregnancy then settles down around 20 weeks

A

hCG

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27
Q

what stage is teratogens most concerning

A

embryo

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28
Q

normal fetal heart rate

A

110-160 bpm

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29
Q

Monitors contractions and baby’s HR

A

external fetal monitor

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30
Q

variable deceleration

A

a decrease in heart rate from baseline caused by umbilical cord being compressed

needs to be 15 beats below baseline to be considered for this

looks like a V shape on monitor

we want to reposition mom when this happens

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31
Q

early deceleration

A

gradual decrease in fetal heart rate that occurs with contractions. Caused by head compression. This is usually a good thing because it means the baby is descending and we should begin to prepare for birth

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32
Q

late deceleration

A

a gradual onset of deceleration that happens after the peak of contraction. It is not reassuring, and means there is a placenta insufficiency. We need to reposition, stop pitocin, call provider and possibly prepare for C section

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33
Q

acceleration

A

increase in baseline of baby HR by 15 beats above for at least 15 secs. This is good so we know baby has good oxygen

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34
Q

variability

A

fluctuation in baby baseline HR. We want to see this

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35
Q

absent variablity

A

no variability/change in HR. Not reassuring, call provider

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36
Q

minimal variability

A

some variability, but less than 5 bpm. If this occurs more than 30 mins a intervention is needed

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37
Q

moderate variability

A

What we like to see, bpm is 6-25 beats above baseline. lets us know fetus has good oxygen reserve

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38
Q

what causes minimal variability - 3 S’s

A

sleeping- baby
sedative
sick

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39
Q

nadir

A

lowest point of baby’s deceleration on monitor

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40
Q

peak

A

upper point of moms contraction on monitor

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41
Q

priority intervention after water breakage

A

monitor fetal HR to make sure umbilical cord isn’t decompressed

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42
Q

timed from beginning of one contraction to the beginning of another

A

frequency

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43
Q

measured by counting the seconds between onset and ending of a contraction

A

duration

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44
Q

measured by palpation when you have a external monitor, or by a internal monitor

A

strength

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44
Q

fetal tachycardia

A

above 160 bpm for 10 mins

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44
Q

fetal bradycardia

A

below 110 for 10 mins

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45
Q

how should fundus feel

A

Should feel like bouncy ball
Expected to be around umbilicus- it should go lower each day
We want it to be midline

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46
Q

how long will post partum mom bleed

A

Mom can bleed up to 6 weeks. But more commonly 3-4 weeks

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47
Q

Magnesium sulfate

A

mineral/electrolyte replacement. prevents seizures from severe eclampsia and preeclampsia

neuroprotective
tocolytic- stop contraction

diarrhea common

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48
Q

terbutaline

A

tocolytic- stops contractions

bronchodilator
may cause nervous tremor

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49
Q

nifedipine (procardia)

A

tocolytic- stops contractions
CCB relaxes smooth muscle

SE- arrhythmia, peripheral edema

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50
Q

indocin

A

tocolytic- stops contractions

antirheumatic, NSAID

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51
Q

Oxytocin

A

tocogenic- increases contractions
prevents/treats postpartum hemorrhage

hormone- induces labor. also has antidiuretic effects

SE- coma, seizure, painful contraction, intracranial hemorrhage

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52
Q

misoprostol (cytotec)

A

tocogenic- increases contractions
prevents/treats postpartum hemorrhage

antiulcer, prostaglandin

causes labor induction

SE- miscarriage, abdominal pain, diarrhea

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53
Q

cervidil

A

tocogenic- increases contractions

oxytocic, prostaglandin

given to ripen the cervix
dilates cervix, stimulates myometrium

SE- amniotic fluid embolism

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54
Q

betamethasone (celestone)

A

anti inflammatory, corticosteroid

unlabeled- gave to high risk mothers to prevent resp distress syndrome in new borns

SE- thromboembolism, HTN, nausea

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55
Q

common analgesics gave for postpartum patients

A

ibuprofen (motrin)
acetaminophen (tylenol)
ketorolac (toradol)
oxycodone
hydrocodone/acetaminophen (norco)
morphine

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56
Q

antiemetics for post partum patients

A

prevents nausea

ondansetron (zofran)
promethazine (phenergan)

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57
Q

common antihypertensives for postpartum patients

A

nifedipine (procardia)- CCB. SE- peripheral edema, flushing

labetalol- beta blocker. SE- bradycardia, orthohypo, fatigue

hydralazine (apresoline)- vasodilator. SE-drug induced lupus, tachycardia

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58
Q

postpartum meds for GI issues

A

docusate (collate)- laxative stool softener

simethicone- antiflatulent

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59
Q

methylergometrine (methergine)

A

prevents/treats postpartum bleeding

oxytocic- ergot alkaloids

SE- HTN, stroke, N/V

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60
Q

Carboprost tromethamine (hemabate)

A

prevents/treats postpartum hemorrhage

oxytocic. prostaglandin

SE- diarrhea, uterine rupture, N/V

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61
Q

antibiotics commonly used for newborns

A

ampicillin, gentamycin

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62
Q

drugs commonly given to newborns for neonatal abstinence syndrome

A

morphine

lorazepam (ativan)- anti anxiety

clonidine- antihyp. management of opioid withdrawal

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63
Q

common drugs given to newborns

A

surfactant
erythromycin eye ointmemt
vitamin K
hep B vaccine

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64
Q

hormones from placenta

A

human chorionic gonadotrophin’, human placental lactogen, placental growth hormone, relaxin and kisspeptin.

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65
Q

gravida

A

pregnancy

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66
Q

gravidity

A

number of pregnancies. includes miscarriages and abortion

twins count as 1

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67
Q

nulligravida

A

woman who has never been pregnant

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68
Q

primigravida

A

woman pregnant for the first time

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69
Q

multigravida

A

woman who has had 2 or more pregnancies

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70
Q

viability

A

capacity to live outside the uterus.

occurs 22-24 weeks after last menstrual period or when fetus weighs 500g

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71
Q

parity

A

number of pregnancies in which fetus/fetuses have reached viability

not counted until baby is born

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72
Q

nullipara

A

woman who has not completed a pregnancy with fetus/fetuses who have reached stage of fetal variability

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73
Q

primipara

A

woman who has completed one pregnancy with fetus/fetuses who have reached stage of fetal viability

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74
Q

multipara

A

woman who has completed two or more pregnancies to stage of fetal viability

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75
Q

preterm

A

pregnancy that has reached 20 weeks of gestation but birthed before 37 weeks

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76
Q

early term

A

37-38 weeks

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77
Q

full term

A

39-40 weeks

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78
Q

late term

A

41 weeks

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79
Q

posttterm

A

42 weeks and beyond

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80
Q

GTPAL

A

G= gravidity
T= term - 37 weeks and above
P= preterm - before 37 weeks
A= abortion or spontaneous abortion “miscarriage”
L= living children

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81
Q

what can cause a higher than normal level of hCG in pregnancy

A

multiple fetuses, down syndrome baby

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82
Q

give an example of decreased hCG in pregnancy

A

miscarriage, sickness

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83
Q

3P signs of pregnancy

A

presumptive- subjective from mom

probable- objective from health care

positive- ultrasound confirmation

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84
Q

Normal pregnancy changes of the uterus

A

changes in size, shape, positions
changes in contactility
uteroplacental blood flow
Hegar sign

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85
Q

Hegar sign

A

uterus softens

normal in pregnancy

86
Q

normal changes of cervix in pregnancy

A

goodell sign
friability
change in shape

87
Q

friability

A

Tissue is very easily damaged- mom may have bleeding with vaginal exam due to increased vascularity

normal change in pregnancy

88
Q

goodell sign

A

cervix softens

normal change in pregnancy

89
Q

normal changes of vagina and vulva in pregnancy

A

chadwick’s sign
leukorrhea- Increase vaginal discharge- good b/c it helps prevent infection. White or gray. Smells musty. Make sure its not an infection discharge
changes in vaginal microbiome
edema

90
Q

chadwick’s sign

A

Bluing of mucosa of vagina/mucosa 6 weeks in due to vascularity

normal change in pregnancy

91
Q

ballottement

A

The fetus could float a little bit if provider taps on cervix

normal pregnancy finding

92
Q

quickening

A

First fetal movements- small. Happens in 14-20 weeks. First time moms usually 20.

93
Q

normal breast changes in pregnancy

A

more sensitive and sore
fullness/heaviness
areolae becomes more pigmented
montgomery tubercles
colostrum
striae gravidarum- stretch marks. Never goes away only fades

94
Q

montgomery tubercles

A

Sebaceous oil glands on areola that secrete oil and anti-infective on areola

95
Q

inhibits contraction of smooth muscle- relaxes

A

progesterone

96
Q

normal GI effects of pregnancy

A

morning sickness related to increased hHG
decreased motility- N/V/C
hemorrhoids
bleeding gums related to vasocongestion
indigestion related to increased progesterone
PICA- weird cravings
increased incidence of gall stones

97
Q

how is blood volume affected in a healthy pregnancy

A

it increases by 1200-1500 mL or 40-50%

97
Q

how is BP affected in healthy pregnancy

A

it will either go down 5-10 mmHg or stay the same. This is due to vasodilation

98
Q

how much will maternal pulse go up in healthy pregnancy

A

15-20 bpm

99
Q

what happens to moms RBC, WBC and plasma in healthy pregnancy

A

RBC will go up 20-30%
plasma will go up 40-60%
WBC could go up to about 15, but could go even higher in delivery (unpregnant normal is 5-10)

100
Q

what happens as a result of the more plasma then RBC in pregnant woman

A

anemia because of the dilution of the higher amount of plasma

101
Q

H&H levels in pregnant woman

A

Normal female hemoglobin- 12-16. expect 10.5-11 in pregnancy

Normal hematocrit 37-47. expect 32-33 in pregnancy

102
Q

what happens to cardiac output in pregnancy

A

it will increase by 30-50% by first 32 weeks, then decrease 20% by week 40

103
Q

why are pregnant women more at risk for clots

A

clotting factors are increased and fibrinolytic activity is decreased.

5-6x more at risk for clot

This is good if mom hemorrhages because theyre more likely to clot

104
Q

how should mom lay

A

ON SIDE NOT ON BACK

Lying on side helps reduce compressing the vena cava, and facilitates renal perfusion

105
Q

what changes occurs related to respiratory system in mom during pregnancy

A

o2 requirements increase
RR increases slightly
BMR increases b/c of o2 demands
SOB increases due to lower co2 threshold
nasal stuffiness increases
nose bleeds due to increased vascularity

106
Q

normal renal changes of mom during healthy pregnancy

A

anatomic changes
hormonal activity
pressure from enlarged uterus
increase in BV
Increased GFR
increased renal plasma flow

moms will feel like they need to pee more

107
Q

normal integumentary changes during pregnancy

A

chloasma- blanching on face
linea nigra- Pigmentation line from pubic bone to umbilicus. Will fade away after
striae gravidum
palmar erythema
angiomas
pruritus gravidarum- itching over abdomen
gum hypertrophy
accelerated nail growth
hirsutism
increased perspiration

108
Q

normal musculoskeletal changes for mom in pregnancy

A

center of gravity shifts forward
lordosis
pregnant waddle

109
Q

normal neurologic changes for mom in healthy pregnancy

A

sensory changes in legs related to compression of pelvic nerves or vascular stasis

carpal tunnel syndrome from edema

acroesthesia (numbness and tingling of hands), tension headache and lightheadedness and syncope related to vasomotor instability, postural hypotension, hypoglycemia

110
Q

serum prolactin

A

Prepares breasts for lactation

111
Q

oxytocin

A

Stimulates uterine contractions; stimulates milk ejection from breasts after birth

112
Q

different ways to say when baby will be born

A

EDC- estimated date of confinement
EDD- estimated date delivery
EDB- estimated date of birth

113
Q

naegeles rule

A

predicts when the baby will be born by last menstrual period

114
Q

sibling adaptation to pregnancy

A

Age 1-2 not very aware
3-4 lots of questions
School age- ask how its coming out/getting in
Adolescents- embarrassed
Older teenagers- excited but don’t care

115
Q

grandparent adaptation to pregnancy

A

Can be excited
Might be over the top for mom trying to control her
Might be unhappy because they feel old

116
Q

parent adaptation to pregnancy

A

mom adapts emotionally and early

dad typically reacts later in pregnancy

117
Q

initial visit: first pregnancy visit: what is discussed

A

OBGYN history
medical history
nutritional history
reason for seeking care
medications/drugs currently being taken
family history
social and occupational history
mental health screening
intimate partner violence
review of symptoms
physical exam-Head-toe, pelvic exam, pap smear
lab test- urine, cervical, blood
STI test

118
Q

healthy pregnancy follow up visits entails what

A

interview
physical exam
fetal assessment
labs- glucose, MSAFP (screens for nueral tube defects), urine test for protein, glucose, GBS (checks for group B strep in vagina/anus- if not then antibiotics needed)
ultrasound
amniocentesis

119
Q

should pregnant moms receive live vaccines

A

No

119
Q

expected weight gain for underweight woman for pregnancy

A

12.5-18kg (28-40 lbs)

120
Q

expected weight gain for normal BMO woman for pregnancy

A

11.5-16 kg (25-35 lbs)

121
Q

expected weight gain for overweight woman for pregnancy

A

7-11.5 kg (15-25 lbs)

122
Q

expected weight gain for obese woman for pregnancy

A

5-9 kg (11-20 lbs)

123
Q

how much folic acid should woman in childbearing ages take

A

400mcg/day

pregnancies with low folic acid are more likely to develop neural tube defects like spina bifida

124
Q

how many kcal for 1st trimester

A

1800

125
Q

how many kcal for 2nd trimester

A

2200

126
Q

how many kcal for 3rd trimester

A

2400

127
Q

what direction should uterus rotate to

A

right

128
Q

braxton hicks

A

intermittent uterine contractions that may occur after 4 months

129
Q

biochemical assessment

A

uses blood, body fluid or tissue samples

130
Q

biophysical assessment

A

uses technology.
physical assessment of fetal well being

131
Q

factors that originate within the mother or fetus and affect the development or functioning of either one or both

ex- nutrition status

A

biophysical risks

132
Q

maternal behaviors and adverse lifestyle

ex- smoking

A

psychosocial risk

133
Q

arises from mother and her family

ex- poverty

A

sociodemographic risks

134
Q

hazards in work place and general environment

A

environmental factor risks

135
Q

daily fetal movement count

A

kick count
simple way to evaluate the condition of the fetus

several methods
- once a day for 60 mins
-2-3 times daily for 2 hours or until 10 movements are counted
-10 movements in 12 hour period

136
Q

ultrasound

A

can indicate fetal heart rate, gestational age, fetal growth, fetal anatomy, fetal genetic disorders, placental position

assesses doppler blood flow analysis, amniotic fluid volume, biophysical profile

137
Q

transvaginal vs abdominal ultrasound

A

Abdominal- mom needs full bladders

Transvaginal is done thru vaginal and can diagnose pregnancy earlier. Works better than abdominal for obese patients.

138
Q

decrease in amniotic fluid

A

oligohydramnios

139
Q

increase in amniotic fluid

A

polyhydramnios

140
Q

what can doppler blood flow analysis diagnose

A

fetal anemia and restricted growth, can measure amniotic fluid volume

141
Q

biophysical profile (BPP)

A

includes amniotic fluid volume, fetal breath movements, fetal movements, fetal tone, fetal heart rate reactivity from nonstress test.

measured bt ultrasound, done in late 2nd trimester or early 3rd

normal score is 8-10

142
Q

amniocentesis

A

used to look for genetic concerns or fetal lung maturity

done as early as 15 weeks gestation

143
Q

maternal risk amniocentesis

A

hemorrhage, infection, labor, abruptio placentae, damage to intestines/bladder, amniotic fluid embolism

144
Q

fetal risk amniocentesis

A

death, hemorrhage, infection (amnionitis), injury from needle, miscarriage or preterm labor, leakage of amniotic fluid

145
Q

chronic villus sampling (CVS)

A

performed between 10-13 weeks gestation

removes small tissue specimen from fetal portion of placenta

146
Q

percutaneous umbilical blood sampling (PUBS)

A

Offers direct access to fetal circulation.
insertion of needle directly into fetal umbilical vessel under ultrasound guidance.

used for fetal sampling and transfusion. can assess infection

147
Q

alpha fetoprotein (AFP)

A

Screens for neural tube defects

148
Q

Multiple marker screens

A

Detects chromosome abnormalities

149
Q

coombs test (indirect)

A

Screens for RH alloimmunization- if mom produces antibodies against RH pos blood

150
Q

cell free (DNA) screening

A

Non invasive prenatal genetic diagnosis test that can look at gender and more

151
Q

hydrops fetalis

A

baby is at risk for this is mom has positive coombs. Causes edema

152
Q

reactive NST vs nonreactive

A

Reactive- 2 accelerations in 20 mins

Nonreactive- if fetus doesn’t show 2 accelerations in the 20 min period. Is baby possibly sleeping?

153
Q

Nonstress Test (NST)

A

Noninvasive, easy to perform, no contraindications, inexpensive

Determines if interoutero environment is supportive to fetus

Mom is put on monitor and we monitor fetal HR. testing starts 32 weeks if needed. Mom presses a button when she feels fetal movement

154
Q

Contraction Stress Test (CST)

A

May also be called oxytocin stress test (OCT)

Identifies if fetus is compromised when put under stress- contractions
uses fetal monitoring

DONT PERFORM THIS IF PATIENT IS PRETERM OR DOING C SECTION BIRTH

155
Q

Positive CST

A

baby has late decelerations after contraction,

156
Q

pregestational diabetes

A

type 1 or 2 diabetes prior to pregnancy

157
Q

gestational diabetes

A

carbohydrate intolerance that develops during pregnancy

158
Q

metabolic changes with pregnancy

A

1st trimester- insulin sensitivity- Body will require smaller amounts of insulin to lower BG

2nd & 3rd trimester- insulin resistance- Hormones act as insulin antagonist, leading to insulin resistance

159
Q

why does insulin needs drop after birth

A

the placenta was the source of need

160
Q

does most pregestational woman need insulin

A

yes

161
Q

maternal risks of pregestational diabetes

A

fetal macrosomia
spontaneous abortion
preterm labor/birth
HTN/preeclampsia
polyhydramnios
infections
DKA
hypoglycemia

162
Q

fetal macrosomia

A

Baby is larger, greater than 4000g

163
Q

fetal complications of pregestational diabetes

A

congenital anomalies
hypoglycemia
fetal macrosomia
IUGR- intrauterine growth hormone
prematurity
stillbirth

164
Q

why is fetus at risk for hypoglycemia when mother is hyperglycemic

A

because baby is producing insulin due to moms hyperglycemic state

165
Q

LGA

A

large for gestational age

Risk for shoulder dystocia

166
Q

IUGR

A

Intrauterine growth restriction, also called FGR. From placental insufficiency

167
Q

Hypoglycemic symptoms

A

nervousness, headache, shaking, hunger, blurred vision, sweaty, irritability

168
Q

hyperglycemia symptoms

A

increased thirst, difficulty concentrating, fruity breath, increased hunger, N/V

169
Q

Intrapartum management of diabetes

A

Labor causes stress, can increase BG. We monitor them very closely
We try to keep there blood sugar between 90-100

170
Q

what could GDM lead to

A

preeclampsia, C section, developing type 2 diabetes

171
Q

risk factors for developing GDM

A

HTN, family history, obesity, diet

172
Q

BG levels we want to see for GDM

A

Fasting- 60-105
1hr post meal <140
2hr post meal <120
2am-6am >60

173
Q

Glucose test

A

First glucose test- 1 hour, 50g glucose
If they fail that,
Second test (days later)- 3hr test, 150g glucose

174
Q

fetal macrosomia effects that could happen to baby

A

brachial plexus palsy
facial nerve injury
humerus/clavicle
cephalhematoma

175
Q

antepartum care for GDM

A

Insulin therapy
Urine testing-looking for ketones
Diet and exercise
Fetal surveillance - NST, ultrasound, fetal monitoring
Moms should be checking their BG 4x daily

176
Q

antepartum

A

before birth phase

177
Q

intrapartum

A

during birth phase

178
Q

cardiac disorder management

A

focused on minimizing stress on the heart
treat infections asap
high protein, adequate calories, fluid and fiber, balanced diet with iron & folic acid supplements

meds
cardiac meds
stool softeners
anticoagulant therapy

If mom doesn’t have cardiac output baby wont get good oxygen

Moms are in a hypercoagulative state- blood thinners

179
Q

gestational HTN

A

Systolic BP of 140 or more; or diastolic of 90 or more. It can be one or the either, or both

this needs to occur after 20 weeks gestation in a woman with a previously normal BP.

needs to have 2 separate occasions at least 4 hours apart

180
Q

preeclampsia

A

HTN and proteinuria develops in a pregnant, greater than 20 weeks gestation

181
Q

proteinuria diagnostics

A

300 mg of protein in a 24hr urine
Protein creatinine ratio- 0.3
protein on dipstick

182
Q

Eclampsia

A

onset of seizure activity or coma in a woman with preeclampsia who has no history of pre-existing pathology that can result in seizure activity

183
Q

chronic HTN disorder

A

defined as HTN that is present before pregnancy or before 20 weeks gestation

women with this are more at risk for superimposed preeclampsia with a greater risk for fetal mortality

184
Q

etiology of preeclampsia

A

BP is increased, arteries are constricted not allowing much blood, causing decreased placental effusion. Epithelial cell activation- blood vessels are leaking, causing 3rd spacing. Low platelet levels occurs because platelets are trying to fix damaged cells. overall this leads to decreased organ perfusion

185
Q

preeclampsia without severe features

A

HTN >140/90
proteinuria of >300mg in 24 hr specimen
low platelet count under 100
elevated ALT, AST
creatine above >1.1
pulmonary edema
cerebral/visual disturbances

at home care
monitor daily weight, BP, kick counts

186
Q

severe preeclampsia

A

worsening symptoms overall
BP >160/110
abnormal liver function with RUQ pain unresponsive to meds

and same symptoms of preeclampsia but worse

hospitalization occurs.
mag sulfate, & hydralazine or labetalol or nifedipine given

pad side rails in case of seizure

187
Q

HELLP syndrome

A

hemolysis- increased RBC bc trying to make more bc of damage
elevated liver enzymes (AST, ALTL
low platelets

delivery will occur no matter the fetus age with this syndrome

If they develop this they are most at risk for DIC (disseminated intravascular coagulation) which could cause them to bleed out

188
Q

what can happen with increasing liver enzymes

A

risk for liver rupture

assess for RUQ pain.
they may describe it as epigastric

189
Q

what to monitor for with mag sulfate

A

refluxes, RR, pulse ox, mag tox

190
Q

normal dosing of mag sulfate and antidote

A

Bolus- 4g over 30 mins
Maintence- 2g/hr
antidote- calcium gluconate

191
Q

eclampsia management

A

call for assistance- dont leave bedside
maintain airway
assist to side laying
suction
O2 at 10L/min
monitor vitals
insert foley
admin mag sulfate
maintain quiet environment
prepare for delivery

192
Q

hyperemesis gravidarum

A

excessive vomiting causing weight loss, electrolyte imbalance, nutritional deficiencies, ketonuria

possible TPN needed
NPO for 24-48 hrs
administer pyridoxine (vitamin B6) and doxylamine (unisom)

assess nutritional status, emotional status, FHR, daily weight, I&O

labs to monitor- CBC, UA, liver function, bilirubin levels, electrolytes

193
Q

causes of early pregnancy bleeding

A

miscarriage
ectopic pregnancy
molar pregnancy

194
Q

miscarriage (spontaneous abortion)

A

unintended loss of pregnancy before viability of fetus (<20 weeks gestation), or weight of <500g

caused by chromosomal abnormalities or from medical conditions

provide emotional support
assess vaginal bleeding
assess for s/s of hypovolemic shock
monitor I&O
refer to social support

195
Q

threatened abortion

A

Bleeding and cervix remains closed. May subside and pregnancy could be fine

196
Q

inevitable/imminent abortion

A

Bleeding and cervical dilation. Typically pregnancy can’t continue

197
Q

incomplete abortion

A

Products of conception still left. Causes heavy bleeding

198
Q

missed abortion

A

Baby no longer has heart beat

199
Q

complete abortion

A

no products of conception left in body

200
Q

cervical insufficiecy

A

asymptomatic, back pain, heavy discharge

manages by cerclage placement

201
Q

ectopic pregnancy

A

pregnancy occurs outside uterus

before rupture may go unnoticed but after rupture is a lot of pain and bleeding

diagnosed by ultrasound

202
Q

hydatidiform mole (molar pregnancy)

A

fertilized egg with no nucleus

could lead to choriocarcinoma
HCG levels should drop, not increase

after this occurs pregnancy should be avoided for at least a year to avoid the cancer risk

203
Q

placenta previa

A

placenta is implanted in uterine segment near cervix

these patients must deliver via C section

204
Q

different types of placenta previa

A

Marginal- less than 2cm away then cervix
Partial- covers part of cervix
Complete- covers entire cervix

205
Q

PREVIA- symptoms

A

P=painless bright red bleeding
R=relaxed soft uterus non tender
E= episodes of bleeding
V= visible bleeding
I= intercourse post bleeding
A= abnormal fetal position

206
Q

abruptio placentae

A

premature separation of placenta
-serious complication that accounts for significant morbidity or mortality

riskfactor - HTN

207
Q

placenta abruptio symtoms- DETACHED

A

D= dark red bleeding
E= extended fundal height
T=tender uterus
A= abdominal pain
C= concealed bleeding
H= hard abdomen
E= experience DIC
D= distressed baby

208
Q

what anemia is most common in pregnancy

A

iron deficiency

209
Q

intrahapatic cholestasis of pregnancy

A

common liver disease of pregnancy. It is characterized by generalized pruritus that usually begins in the third trimester of pregnancy.

cause is unknown

jaundice may be present

210
Q

Antidote for magnesium sulfate

A

Calcium gluconate

211
Q

APGAR

A

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maternity (4 decks)

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