Exam 1: Pregnancy Flashcards

Question

What should you educate the patient about nutrition?

Answer 1

Increase calories: > 340 cal/day during 2nd trimester > 462 cal/day during 3rd trimester > 450-500/day during postpartum/breastfeeding Increase Protein: essential for growth: > Folic Acid: important for neuro development, prevention of neural tube defects > Leafy veggies, dry peas/beans, seeds, OB, breads, cereals, grains fortified with folic acid > 400 mcg folic acid: childbearing women > 600 mcg folic acid: pregnancy Iron: > facilitaties increase in maternal RBC >best absorbed between meals, with vitamin C > milk + caffeine interfere with absorption > Major side effects: constipation > Client education: take miralax, or increase fiber Calcium: > bone, teeth formation > milk, nuts, legumes, dark leafy greens > 1,000 mg/day for pregnant women + nonpregnant women > 1300 mg/day for younger than 19 Fluid: >8-10 (2.3 Liters) glasses Limit caffeine: > no more than 200 mg (8 ox of coffee) > fetal risk: spontatanous miscarriage

Answer 2

adolescent vegetarians, vegans nausea/vomiting anemia eating disorder PICA excessive weight gain FINANCIAL ISSUES, food insecurity

Answer 3

Palpating the abdomen to determine fetal position and presingtation in the 3rd trimester 1:palpate the fundus 2: palpate the side of the abdomen 3 :Palpating above the symphysis pubis: Locate the fetal presenting part and determine how far the fetus has descended make sure patient has empty the bladder

Answer 4

After 14 weeks, needle through abdomen into uterus Indications: > previous chrom. genetic anomaly, carrier >family hx> neural tube defects > abnormal first trimester testing > advanced maternal age > abnormal serum AFP Nursing Care: > give rhogam if client Rh - after > monitor VS & contractions > teach pt to report s/s of infection or PTL >rest & PO fluids after procedure AFP evaluation: > can be evaluated following abnormal serum AFP > can be used to detect chromosomal abnormalities or neural tube defects > High levels: associated with neural tube defects, can also indicate normal multifetal pregnancies > low levels: chromosomal abnormalities (down syndrome) or gestational trophoblastic disease (hydatidform mole)

Answer 5

Fetal lung testing less than 37 weeks gestation with rupture of membranes (ROM) preterm labor complications Lecithin/sphingomyelin (L/S) ratio: 2:1 ratio indicates lung maturity (2.5:1 or 3:1 for client with diabetes mellitus) presence of Phosphatidylglycerol (PG): absence of PG associated with respiratory distress

Answer 6

fetal blood sampling and transfusion (cordocentesis) obtains fetal blood cells from imbilical cord complications: cord laceration, PTL. amnionitis, hematoma, feto-maternal hemorrhage

Answer 7

assess of portion of developing placenta, examines genetic/chromosomal abnormalities can be done at 10-13 weeks Risk: SAB (higher risk than amnio.) infection (chlorioamnionitis) ROM

Answer 8

more reliable than serum AFP preferred at 16-18 weeks identifies risk for neonate with chromosomal abnormalities 1. human chorionic gonadotropin (hCG) hormone produced by placenta (High= down syn.) 2. Alpha fetoprotein (AFP) protein produced by fetus (low= down syn. High= neural tube defects) 3. Estriol: protein produced by fetus & placenta (low=down syn.) 4. Inhibin A: protein produced by ovaries & placenta (high= down syn>)

Answer 9

backache, abdominal tenderness rupture of membrane dilation of the cervix fever bleeding hypotension tachycardia

Answer 10

HgB & Hct clotting factors WBC serum hCG

Answer 11

ultrasound cervical exam dilation & curettage (D&C) dilation & evacuation (D&E) prostaglandins oxytocin

Answer 12

Nursing Care: pregnancy test pad count bedrest avoid vaginal exam meds blood products assist with termination/procedure use lay term "miscarriage" emotional support education: notify provider of s/s of infection/hemorrhage small d/c is okay 1-2 weeks no tub baths, sexual intercourse, tampons avoid pregnancy for at least 2 months seek support

Answer 13

abnormal implantation of fertilized ovum outside of uterine cavity usually in fallopian tube can cause tubal rupture and fatal hemorrhage common cause of bleeding in pregnancy can lead to infertility risk factors: STI, assisted reproductive technology, tubal surgery, contraceptive IUDs

Answer 14

unilateral stabbing pain, lower abd delayed, light menses scant, dark red or brown spotting 6-8 weeks after normal menses red vaginal bleeding (ruptured) referred shoulder pain shock can develop > fainting > dizziness > pallor > hypotension > tachycardia

Answer 15

Labs: progesterone & hCG liver & renal function test CBC blood type/RH Procedures: medical management if rupture has not occurred (methotrexate) > inhibits cell division & embryo enlargement dissolving the pregnancy salpingostomy: to salvage unruptured fallopian tube Lap salpingetomy: with ruptured tube

Answer 16

replace fluids/electrolytes emotional support if on Methotrexate do not get pregnant for 6 months, avoid alcohol & vitamin containing folic acid to prevent toxic response avoid sun for photosensitivity

Answer 17

proliferation & degeneration of trophoblastic villi in placenta, become swollen, fluid fillled embryo fails to develop beyond primitive phase associated with choriocarcinoma

Answer 18

Complete: all genetic material paternally derived no fetus, placenta, amniotic fluid, membranes no placenta to recieve maternal blood-hemm into uterus, vaginal bleeding approx. 20% progress toward carcinoma Partial: genetic material maternally & paternally derived normal ovum fertilized by 2 sperm or 1 sperm in which mitosis (chromosimal reduction & division did not occur) often contains abnormal embryonic of fetal parts, an amniotic sac and fetal blood but congenital abnormalities are present approx. 6% progress toward carcinoma

Answer 19

prior molar pregnancy early teens (less than 40 years old)

Answer 20

rapid uterine growth bleeding( dark brown or bright red) anemia clinical finding of preeclampsia prior to 24 weeks

Answer 21

Procedure: ultrasound suction curettage to aspirate & evacuate mole RhoGam if rH negative baseline pelvic exam + USN post op serum hCG following molar pregnancy weekly x3, then monthly x 6-12 mons. if malgnant cells found, methotrexate given (no pregnancy for 1 year) Labs: hCG after 10-12 weeks

Answer 22

Nursing Care: measure fundal height assess bleeding assess GI status, appetite monitor s/s preeclampsia administer meds >rhogam if client Rh- >methotrexate for malignant cells advise client to save tissue or clots for evaulation Education: emotional support reliable birth control follow up care important due to risk of carcinoma

Answer 23

the placenta abnormally implants in the lower segment of the uterus near or over the cervical os results in bleeding in the third trimester as cervix begins to stretch, thin and open

Answer 24

Risk factors: previous previa uterine scarring age over 35 multiple gestation closely spaced pregnancy smoking Findings: painless, bright red bleeding in 2nd/3rd trimester soft, relaxed non-tender uterus fundal height greater than expected, fetus may be in unusual position normal VS, reassuring FHR decreasing urine output (good indicator of blood loss)

Answer 25

Hgb, Hct, blood type & Rh coagulation profile kleihauer-betke test ultrasound fetal monitoring = fetal well being

Answer 26

assess for bleeding, leaking, contraction, fundal height, leopoid maneuvers No vaginal exams, pelvic rest, bedrest IV fluids, blood, meds- Betamethasone (to promote fetal lung development) C-section delievery o2 PRN

Answer 27

premature separation of the placenta from the uterine wall (parital or complete) after 20 weeks, 3rd trimester significant maternal & fetal death DIC (disseminated intravacular coagulation) associated with moderate-severe abruption *signs of shock do not appear in pregnancy until 25-30% blood loss occurred* betamethasone may be given if preterm birth anticipated

Answer 28

maternal hypertension blunt external trauma cocaine use (causes vasoconstruction) previous abruption smoking PROM multiples

Answer 29

sudden intense pain, dark red vag, bleeding uterine tenderness diffse or localized contraction fetal distress can lead to hypovolemic shock

Answer 30

H&H coagulation factor (decrease) clotting defects (can lead to DIC) cross & type for possible transfusion Kleihauer - Betke test NST, ultrasound & biophysical profile

Answer 31

palpate uterus assess FHR IV (fluid, blood, medication) oxygen (8-10L) VS monitor urine output and fluid balance family support & education

Answer 32

fetal umbilical vessels implant into the fetal membranes rather than the placenta Ultrasound for fetal well being Monitor L/D for excessive bleeding 1. velamentous insertion: cord exposed, not protected by whartons jelly vulnerable to rupture, cord vessels begin in the branch at the membrane & then course to placenta 2. Succenturiate insertion: placenta divided into 2 (or more) lobes 3. Battledore insertion: marginal insertion, higher risk of fetal hemorrhage

Answer 33

expulsion of products of conception r/t tissue changes & alterations in cervical length of cervix

Answer 34

hx of cervical trauma short labors pregnancy loss in early gestation early advanced cervical dilation in utero exposure to diethylstilbestrol, ingested by client mother in pregnancy congenital structural defect of cervix or uterus

Answer 35

pink-tinged vaginal discharge/bleeding or pelvic pressure cervical shortening via transvaginal ultrasound gush of fluid/possible ROM uterine contraction (with expulsion of fetus)

Answer 36

Procedure: ultrasound shows a shortened cervix, presence of cervical funneling or effacement of the cervix Therapeutic: bed rest, pelvic rest, avoidance of heavy finding prophylactic cervical cerciage ( done 12-14 wks, removed @ 37 wks)

Answer 37

bedrest evaluate pt support system assess vaginal discharge vital signs monitor client for contractions & vaginal pressure administer tocolytics prophylactically to stop contractions

Answer 38

activity restricition/bedrest pelvic rest report s/s labor ROM & infection home health care removal of cerslage at 37 wks

Answer 39

excessive N&V, prolonged past 12 weeks 5% weight loss from pre-pregancy weight risk for fetal intrauterine growth restriction (IUGR) or preterm labor

Answer 40

younger than 30 history of migraines obesity primigravida multiple gestation molar pregnancy or fetus with chromonosomal anomaly psy issue, high emotional stress hypothryoid diabetes GI disorder family hx

Answer 41

Physical assessment: excessive N/V, dehydration, electrolyte imbalance, weight loss increased pulse, decreased BP signs of dehydration: poor skin turgor, dry mucous membranes Lab test: urinalysis, chemistry, thyroid test, CBC

Answer 42

monitor I&O s/s dehydration VS weight NPO for 24-48 hrs.

Answer 43

IV fluids, pyridoxine (vitamin B), antiemetic meds)

Answer 44

with no vomiting, advance to clear liquids at 24 hrs. advance diet as tolerated small, frequent meals separate meals from liquids start with dry toast, cracker etc and advance to regular diet as tolerated in severe cases or if vomiting returns, enteral nutrition may be indicated

Answer 45

impaired tolerance to glucose with first onset during pregnancy ideal blood sugar during pregnancy: 70-110 symptoms usually disappear within a few weeks following delivery 50% develop type 2 diabetes within 5 years

Answer 46

spontaneous abortion infection:r/t increased glucose in urine hydraamnios: PROM, preterm labor ketoacidosis: from increased insulin resistance hypoglycemia or Hyperglycemia

Answer 47

obesity increased BP glycosuria maternal age older than 25 fx history pervious delivery of GA baby or previous stillborn baby

Answer 48

hypoglycemia or hyperglycemia diabete in pregnancy: unstable blood sugar, shaking, clammy pale skin, shallow respirations rapid pulse, vomiting, excess weight gain

Answer 49

Routine urinalysis, glycosuria, test for ketones 1 hour GTT: (Glucola screening/Non fasting) Screen @ 24-28 weeks, 50 g oral glucose given, Plasma glucose level in 1 hr, + screen = 130-140+, follow up with 3 hour test 3 hour GTT: (Oral glucose tolerance test) Oral glucose tolerance test (OGTT) Fasting for 12 hours, FBS obtained (92 or <) 100 g Glucose given Serum glucose levels done at 1, 2 & 3 hours (1 hr 180 or<, 2 hr 153 or <, 3 hr 140 or <)

Answer 50

BPP, Fetal monitoring, glucose monitoring diet control

Answer 51

Oral meds- Metformin & Glyburide (less common) Insulin more common rx than oral meds

Answer 52

preconception counseling, dietary education blood glucose level control (A1C: less than 7%) glycemic control nutritionional managemen hypoglycemic agents close maternal and fetal surveillance kick counts daily management during labor and birth plan for pospartum care

Answer 53

maternal age less than 19, older than 40 first pregnancy obesity multifetal gestation chronic renal disease or hypertension family hx preeclampsia diabete rheymatoid arthritis lupus

Answer 54

headache blurry vision, visual changes high BP proteinuria edema vomiting oliguria, jaundice, seizure, decreased breath sound, epigastric pain, hyperreflexia

Answer 55

liver enzymes (LDH, AST) serum creatinine, BUN, uric acid, Mg CBC clotting studies 24 hr urine (protein & creatinine clearance) NST, BPP, Doppler flow analysis

Answer 56

elevated liver enzymes increased creatinine increased plasma uric acid thrombocytopenia decreased Hgb hyperbillirubinemia renal function, liver function decrease

Answer 57

(20 + wks, 140/90) no proteinuria Mild preeclampsia: 1 + proteinuria > bed rest, daily BP monitoring and fetal movement counts >home for mild, hospitalization as disease progresses: Iv magnesium sulfate during labor >nursing assessment: risk factors, BP, nutritional intake, weight, edema: urine for protein; other lab test if indicated Severe Preeclampsia management: > 160/110 3+ proteinuria, oliguria, creatinine >1.1, visual disturbances, hyperreflexia, clonus, edema, hepatic dysfunction, epigastic pain, thrombocytopenia >hospitalization: oxytocin + magnesium sulfate: preparation for birth Eclampsia management: seizure management, magnesium sulfate, antihypertensive agent; quiet environment, birth once seizure controlled, DTR

Answer 58

Goal: control BP, prevent seizure & cerebral hemorrhage MgSO4: CNS depressant, reduces seizure activity Antihypertensive: hydralazine: vasodilator in severe cases. use with caution, rapid decrease BP can cause fetal O2 and decrease uteroplacental perfusion Methydopa: mechanism unknown, may take a few days Labetolol: beta blocker slow HR and decreases systemic vascular resistance Nifedapine: calcium channel blocker control hypertension outpatient care for mild preeclampsia: activity restriction + frequent monitoring

Answer 59

VS before giving, q 5-15 minutes during loading dose, q30-60 minutes until patient is stable assess DTRs every 2 hrs >decreased reflexes can predict impending respiratory depression strict I/O monitor serum Mg levels every 4-6 hrs. (4-7 is therapeutic) if toxicity suspected, stop the infusion and notify provider keep calcium gluconate available (antidote) maintain seizure precautions Mg continued for 24 hrs after delivery

Answer 60

anticonvulsant pt feels flushed, hot, sedated monitor resp rate (VS), DTR, LOC, I+Os, headache, epigastric pain, contractions, FHR, fetal movement Monitor signs of Mg tox: decrease or absent DTR decrease urine output decrease respiratory rate decrease LOC

Answer 61

Preeclampsia: elevated BP with proteinuria after 20wks. >mild: transient headache may occur > severe: higher than 160/110, urine protein greater than 3, oliguria, creatinine more than 1.1, visual disturbance, hyperrflexia, ankle clonus, epigastric pain.... indicating multi-system dysfunction Eclampsia: > seizure preeclampsia symptom >symptoms indicate seizure HELLP syndrome: > diagnosed by lab results not clinical symptoms

Answer 62

Hemolysis (anemia + juandice), elevated liver enzyme (ALT, AST, epigastric pain, V/N) low platelet (less than 100,000 resulting in thrombocytopenia, abnormal bleeding & clotting time, bleeding from gum, petechiae, possible DIC Nursing assessment: similar to that for severe preeclampsia: lab test results Nursing management: same as for severe preeclampsia