Exam 2 Wk3 Obstetrics Flashcards
What are anatomic and physiologic changes associated with pregnancy?
Cardiovascular -
CO peaks to 30-50% above non-pregnant levels by end of 2nd trimester
Respiratory
Increase in tidal volume and respiratory rate, causes partially compromised alkalosis which leaves woman with a decreased buffering capacity after trauma
GI
↑ compartmentalization of the small intestine into the upper abd and a progesterone- induced ↓ in GI motility (constipation, regurgitation); nausea
Urinary
Dilation of the ureters and renal pelvises; Bladder is displaced anteriorly and superiorly by the enlarging uterus making it more vulnerable to injury
Reproductive
protruding abdomen causes ↑susceptibility to blunt and penetrating trauma
Hematology Dilutional anemia (due to ↑plasma volume); Physiologic leukocytosis (d/t hormones); Fibrinogen and coagulation factors ↑ causing a hypercoagulable state which may ↑risk of emboli
Supine Hypotension syndrome
compression of the abdominal aorta and inferior vena cava
turn left lateral position
An increase in tidal volume and respiratory rate causes partially compromised alkalosis which leaves the woman with a decreased buffering capacity after trauma. This puts her at risk for ___.
hypoxic insult
Supplemental oxygen is a priority
What is first-line therapy for nausea in pregnancy?
Doxylamine Succinate (Unisom) and Vitamin B6 (Pyridoxine)
Zofram used less often d/t risks
Peripartum Cardiomyopathy
Patients usually present with symptoms of congestive heart failure late in pregnancy or in the early postpartum period.
Treatment
1. Bed rest,
2. fluid and salt restrictions,
3. meds: diuretics, vasodilators, and blockers.
In addition, prophylactic anticoagulation during pregnancy and full anticoagulation for 1–2 weeks after delivery recommended (If Ejection fraction less than 30%)
Anticoagulants = Lovenox, heparin, NOT coumadin
Gestational Hypertension (preeclampsia and eclampsia): What are the risk factors, signs and symptoms, and complications?
Risk factors:
primigravida, anomalies, multifetal pregnancy, stress, pre-existing disease, poor nutrition, age extremes, obesity, chronic hypertension
S/S:
Vasospasm, hematologic changes, and endothelial damage causes tissue hypoxia and multiple organ involvement
Complications: seizure, cardiopulmonary failure, hepatic rupture, CVA, DIC, HELLP, retinal detachment
Gestational Hypertension (preeclampsia and eclampsia): What are the diagnostic criteria?
Blood pressure > 140/90mmHg
• on 2 occasions 4 hours or more apart
• After 20 weeks,
• without proteinuria
Pre-eclampsia (mild): BP >140/90
• with proteinuria (1+ or >300mg/24 hrs),
• edema and weight gain
Pre-eclampsia (severe): BP >160/110
• with proteinuria (>3+ or >500mg/24 hrs)
• Symptoms: hyperreflexia, headache, blurry vision, pulmonary edema, thrombocytopenia, RUQ pain (liver disfunction)
Eclampsia – grand mal seizures
• Resolved by delivery
Gestational Hypertension (preeclampsia and eclampsia): What are the nursing interventions and neonatal considerations?
Nursing Interventions: • • Primary goal is to prevent seizures. If a seizure occurs, provide support of the airway through suctioning and oxygen
• Intensive placental-fetal monitoring. Continuous electronic fetal monitoring, ultrasound, stress tests
• Antihypertensives as needed - Hydralazine (lower bp), labetalol (lower HR and BP)
• Administration of steroids to speed fetal lung development
• IV magnesium sulfate to depress the CNS
What is the antidote for magnesium toxicity? Calcium gluconate
Neonatal Considerations
Possible complications include growth restriction,
hypoxia, respiratory depression due to mag, preterm gestation, hypotension, hypoglycemia, bradycardia
• Obtain IV and provide respiratory support as needed
• Infant will usually be depressed first 24 hours of life
• May need to stimulate (rub) their back to get them breathing
Gestational Hypertension (preeclampsia and eclampsia):
IV Magnesium sulfate is used to _____.
depress the CNS
Note: Usually give IV mag and then prep for emergency c-section
Magnesium Administration
• Always use a pump to avoid tissue extravasation
• Loading dose 4-6g over 15-20 minutes. Then 2g/hr.
Monitor
• reflexes and clonus
• for signs of toxicity: flushing, diaphoresis, hypotension, CNS depression (lower LOC), cardiac depression
• Foley to watch I/O (if pressure too low)
What is the antidote for magnesium toxicity?
Calcium gluconate
Gestational Hypertension (preeclampsia and eclampsia):
HELLP
Hemolysis, Elevated Liver enzymes, Low Platelets
- Microangiopathic hemolytic anemia (anemia)
- Liver damage secondary to fibrin obstruction of blood flow (elevated liver enzymes)
- Vascular damage causes platelets to aggregate
a. thrombocytopenia & thrombosis/ congregating and clotting similar to DIC - Renal damage due to decreased blood flow
a. elevated BUN, Creatinine
Nursing Interventions
- Aggressive blood pressure control
- Prevention of seizures
- Replacement of blood products: FFP (has clotting factors), PRBCs, Platelets
- Fetal lung maturation (steroids) and delivery (possible c-section)
- May need a liver transplant in mother
Placenta Previa:
What is it? Risk Factors?
The implantation of placenta in lower uterus near the cervix. It can be low lying or marginal or partially or complete covering cervix
Key finding: Painless bright red vaginal bleeding in 2nd half of pregnancy
Risk factors:
advanced age, multiparous, previous C-section, smoking, multifetal gestations, previous previa,
living in high altitudes
Diagnosed by transvaginal ultrasound, MRI
Placenta Previa:
What are the nursing interventions? Neonatal considerations?
Nursing Interventions
• Provide oxygen
• Establish IV access
• Type and cross
• Assess the abdomen, watch for bleeding
• Administer tocolytics (anti-contraction) if ordered
• Monitor fetal heart rate, movement
• Avoid digital vaginal exams! (HCP does this)
• Encourage bed rest. Why? Don’t want it to bleed! Decreases chance of labor and cervix open up.
Neonatal Considerations
• The fetus may experience poor blood flow resulting in growth restriction (assess for this via ultrasonography)
• Risks to fetus include hypoxia, asphyxia, infection, premature birth, hemorrhage, and anemia
Interventions for baby are similar to the Mother
- IV access,
- type and cross,
- frequent clinical assessment,
- and close monitoring of CBC
- May require mechanical ventilation
- Transfusion of PRBCs may be necessary
What indicates distress in a fetus?
Less movement!! Decels of heart rate and decrease fetal movement indicate stress
Abruptio Placentae:
What is it? key findings and risk factors include?
Separation of placenta from the myometrium. Can be partial or complete and is graded I-III.
Key findings:
• Large volume either dark or bright red vaginal bleeding
• Tender board-like abdomen with uterine hyperactivity
• Abdominal pain with vaginal bleeding is always an emergency!**
Risk factors :
Hypertension, drug use, trauma, placenta abnormalities (previa), uterine malformations, polyhydramnios, multifetal pregnancy, multiparous, chorio, smoking, poor nutrition, premature rupture of membranes
Abruptio Placentae:
What are the nursing interventions? Neonatal considerations?
Nursing Interventions • Provide oxygen • Establish IV access • Type and cross • Assess the abdomen, watch for bleeding • Position left lateral • Monitor maternal vital signs (note: 40% volume may be lost before symptoms occur) • Watch labs for DIC including CBC, coag studies-INR, PT, PTT
Neonatal Considerations
• Monitor for signs of fetal distress
• Prep for c-section if any late or variable decels, tachycardia, loss of fetal heart tones or movement
Interventions for baby are similar to Mother
- IV access,
- type and cross,
- frequent clinical assessment,
- and close monitoring of CBC
- May require mechanical ventilation
Risks for fetus:
anemia, preterm birth, hypoxia, asphyxia, hypovolemia, higher risk of SIDs, growth restriction
Note: Hypoxia can result in ischemia to the brain and may require cooling to prevent severe brain damage
