Exam 2 - Ch. 19 Flashcards by Cindy Falteich

Does asthma symptoms increase or decrease with pregnancy?

Can do both.

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Complications from asthma during pregnancy

Hemorrhage
Pulmonary embolism
Miscarriage

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Dyspnea during pregnancy is normal or abnormal?

Normal

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How is dyspnea during pregnancy different than asthma during pregnancy?

Asthma during pregnancy will present with wheezing and coughing.

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A pregnant woman with asthma tells the nurse she stopped taking her meds because she didn’t want it to affect her baby. What is the best response?

Continue taking your asthma meds during pregnancy regardless of whether exacerbations occur.

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Children of mothers with epilepsy are at increased or decreased chance of developing epilepsy?

Increased chance of developing epilepsy.

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Complications of epilepsy during pregnancy include…

Preeclampsia
Preterm birth
Fetal death

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What is the risk to the fetus for a pregnant woman who takes antiseizure meds?

Congenital anomalies, bleeding

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What should a nurse include in education to a pregnant woman with epilepsy who is on meds to control it?

Continue taking the meds regardless of the risks and avoid seizure triggers.

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What should the folic acid recommendation be for women with epilepsy?

Take 4 mg folic acid daily 3 months before conception.

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What is the fetus at risk for when born to a mother with epilepsy who is taking anti-seizure meds?

Risk of bleeding, Congenital anomalies

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Risks to pregnant mother with hypothyroidism …

Preeclampsia
Postpartum hemorrhage
Early pregnancy loss

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How often should thyroid levels be checked in a pregnant woman?

Every 4 weeks to 3 months

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What level is checked to establish thyroid levels in hypothyroidism in pregnant woman?

TSH

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When are medication adjustments for hypothyroidism usually more adjusted during pregnancy?

Early in pregnancy

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Hyperthyroidism in pregnant mother causes…

Maternal heart failure
Low birth weight
Pregnancy loss

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Class of medications that cause thyroid suppression in hyperthyroidism in pregnant women?

Thioamides

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What is the effect of thioamides on the fetus?

Cross the placenta
Suppress fetal thyroid hormone synthesis
Associated with fetal anomalies

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Nursing education to pregnant mother with thyroid disorder

Medication compliance

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What is the one goal of woman with pregestational diabetes who get pregnant?

Glycemic control

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Pregestational diabetes complications…

Preeclampsia
Macrosomic fetus
Polyhydramnios
Fetal congenital anomalies
Spontaneous abortion
Perinatal death

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Pregestational diabetes 1st trimester interventions (labs/screenings)

H1C
24-hr urine collection
Eye, Thyroid, Heart screenings

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Pregestational diabetes 2nd trimester interventions

Vasculopathy may be evidenced by fetal growth restriction
Between 32-34 weeks:
nonstress test
biophysical profile
contraction stress test

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Is vaginal delivery contraindicated in a pregnant woman with pregestational diabetes?

No, vaginal birth is not contraindicated

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When would a c-section be advised for a pregnant woman with pregestational diabetes?

Macrosomia fetus diagnosed by ultrasound

At what time in gestation would a woman with pregestational diabetes be induced for a macrosomia fetus?

Between 39 and 40 weeks

Diet, exercise and medications are important considerations for what condition before pregnancy?

Pregestational diabetes

Which test, nonstress or contraction stress test, requires the pregnant woman to stimulate her nipples or administer oxytocin?

Contraction stress test

What is a reactive nonstress test in a fetus 32 weeks or older?

2 accelerations of 15 bpm for 15 sec each within 20 minutes.

What is a reactive nonstress test in a fetus younger than 32 weeks?

2 accelerations of 10 bpm for 10 sec each within 20 minutes.

How is a contraction test induced?

Use dilute oxytocin or have the woman stimulate her breasts until 3 contractions occur in 10 minutes.

What is a negative contraction test?

No late decels (placental insufficiency) or frequent variable decelerations (cord compression).

Recommendations to woman with diabetes who wants to get pregnant?

Achieve excellent glycemic control now.

What is a chronic immune-modulated dymyelinating disease of the CNS that includes relapses and remissions?

Multiple Sclerosis

When will a woman most likely experience remission of MS?

During pregnancy

When will a pregnant woman most likely experience a relapse of MS symptoms?

After birth (postpartum)

What risk factors are associated with MS in a pregnant woman and to the fetus?

Increased risk for cesarian birth and decrease in neonatal birth weight

Are medications for MS considered teratogenic?

Some are teratogenic. Others have limited info available.

Is breastfeeding contraindicated in women with MS?

No.

Are medications for treating MS safe to take while breastfeeding?

They may not be.

Can women with MS choose not to take their meds while breastfeeding?

Yes, they choose to not take their meds while breastfeeding.

T/F: CVD is a significant cause of maternal morbidity and mortality in pregnancy?

True

Cardiac output increases by what % during pregnancy that exacerbates cardiac conditions?

50%

What tests exist to complete fetal testing of pregnant woman with CVD?

Nonstress, BPP, contraction test

Signs of cardiac decompensation

Progressive edema (esp of face) Cough Crackles Cyanosis (esp fingertips) Tachypnea (>25 breaths/min) Tachycardia (>125 bpm)

What condition do these signs indicate? Progressive edema (esp of face) Cough Crackles Cyanosis (esp fingertips) Tachypnea (>25 breaths/min) Tachycardia (>125 bpm)

Cardiac decompensation

What are the BP levels for chronic hypertension?

BP >140 over >90 before pregnancy or before 20th month.

What is mild to moderate high bp in a pregnant woman?

Mild to moderate hypertension is a systolic blood pressure between 140 and 159 mm Hg and/or a diastolic between 90 and 109 mm Hg

What is severe hypertension in a pregnant woman?

>160 mm Hg / > 110 mm Hg.

Ranges for: Mild hypertension Moderate hypertension Severe hypertension

Mild - BP >140 over >90 Moderate - Be/ 140 and 159 mm Hg and/or a diastolic be/ 90 and 109 mm Hg Severe - > 160 mm Hg and diastolic blood pressure > 110 mm Hg.

T/F: NSAIDS should be used to treat hypertension postpartum.

False, NSAIDs such as ibuprofen should be used cautiously for these patients postpartum as they are associated with increased blood pressure readings.

T/F: NSAIDS should be used to treat hypertension postpartum.

False, NSAIDs such as ibuprofen should be used cautiously for these patients postpartum as they are associated with increased blood pressure readings.

Intrauterine growth restriction, stillbirth, preeclampsia, and stroke are associated with what chronic condition?

Hypertension

Hypertension is associated with what 4 conditions of pregnancy?

Intrauterine growth restriction, stillbirth, preeclampsia and stroke.

No clear benefit of treating pregnant woman for what level of hypertension?

Mild to moderate (BP < 160 mm Hg and < 110 mm Hg.

T/F: Fat has endocrine function

True

T/F: Fat can have a detrimental effect on inflammatory pathways, vasculature, and metabolism.

True.

What condition has the following complications? Higher risk for gestational diabetes Preeclampsia Labor induction and induction failure Slower first stage of labor Macrosomic infants Postpartum thromboembolism

Obesity

Prepregnancy weight loss can do what?

Improve outcomes

Is pregnancy challenging for a woman with eating disorder?

Yes

Can women with an eating disorder who are not menstruating still get pregnant?

Yes

What eating disorder is defined as follows: - Restricted energy intake leading to significantly low body weight - intense fear of weight gain - Disturbed self-perception of one's body, heavily influenced by weight - Minimization of risk of low weight

Anorexia Nervosa

What eating disorder is defined as follows: - Recurrent binge eating with a feeling of loss of control - Compensatory actions (vomiting, laxatives, extreme exercise) - Self-perception heavily influenced by weight

Bulimia Nervosa

What eating disorder is defined as follows: - Binge eating with feeling of loss of control - No compensatory actions

Binge Eating Disorder

These are warning signs of what type of disorder: History of eating disorder Abnormally low body mass index Lack of weight gain over two prenatal visits Electrolyte abnormalities Tooth enamel problems from vomiting Hyperemesis gravidarum Anxiety or mood disorder

Eating disorder

Severe anemia leads to what conditions?

Nonreassuring fetal heart rate Prematurity Fetal loss Maternal death

T/F: Severe anemia is rare in developed countries.

True

T/F: Physiologic anemia is an expected finding during pregnancy.

True

A normal hemoglobin level in pregnancy is...

11 to 14 g/dL

T/F: A hemoglobin level below 10.5 g/dL is considered diagnostic in pregnancy.

True

What improves maternal hemoglobin and hematocrit levels?

Supplementing with iron

Supplemental iron can cause what conditions?

Pruritus, rash, and gastrointestinal symptoms.

How should iron be taken?

On an empty stomach but this can cause gastrointestinal distress.

What is IPV?

Intimate partner violence

At what points should pregnant women be screened for IPV?

Women should be screened for IPV during prenatal visits, hospitalizations, and during postpartum appointments.

What tool is used in questioning women about IPV?

A standardized screening tool

When should the nurse question someone about IPV?

When they are alone

Infants exposed to opioids and opioid replacement drugs are at a high risk to undergo what syndrome at birth?

Neonatal abstinence syndrome.

T/F: Alcohol is a teratogen

True

What is the safe level of alcohol consumption during pregnancy?

There is no known safe amount of alcohol that can be consumed in pregnancy.

Smoking can cause what conditions in pregnancy?

Preterm birth, intrauterine growth restriction, and stillbirth.

Preterm birth, intrauterine growth restriction, and stillbirth occur with what substance abuse in pregnancy?

Smoking

Outcomes from smoking and alcohol consumption in pregnancy can be improved by doing what?

Stopping consumption of alcohol or drugs at any point during pregnancy can improve outcomes.

With which substance abuse are the following obstetric risks associated? Subfertility Pregnancy loss Chorioamnionitis Placental abruption Preeclampsia PROM Preterm birth Fetal growth restriction Postpartum hemorrhage Meconium-stained amniotic fluid

Opioid abuse

With which substance abuse are the following risks associated? Subfertility Ectopic pregnancy Pregnancy loss PROM Preterm birth Preeclampsia Decreased milk volume

Smoking

With which substance abuse are the following risks associated? Preterm birth Low birth weight Short for gestational age Small for gestational age Miscarriage Placental abruption

Cocaine

With which substance abuse are the following risks associated? Fetal growth restriction Gestational hypertension Preeclampsia Neonatal death Fetal demise Preterm birth

Methamphetamines

Are antidepressants contraindicated in pregnancy?

What do SSRIs cause in the neonate?

Possibly low APGAR scores

What is depression in pregnant women usually treated with?

SSRIs

Substance abuse, poor adherence to care, less prenatal care and suicidal tendencies are the result of what untreated condition in pregnancy?

Depression

People with what condition report fatigue, tension, irritability, and a pervasive sense of apprehension?

Generalized anxiety disorder (GAD)

GAD can be assessed with what scale?

A seven-item scale (GAD-7).

Treatment for GAD includes...

Antidepressants (particularly SSRIs), counseling, and, occasionally, benzodiazepines.

What conditions can benzodiazepines cause in pregnancy?

Withdrawal in the neonate Preterm birth Fetal loss