Exam 3 Flashcards
What is the best plan of care for management of an ectopic pregnancy?
methotrexate until 8 weeks then salpingectomy
What are the adverse effects of magnesium sulfate?
boggy uterus and other smooth muscles
absent patellar reflexes
respiratory depression
TURN MAG off—-
BLURR blood pressure low LOC diminishes urine output reduced reflexes reduced respirations reduced
What are the normal expected outcomes with magnesium sulfate?
decreased reflexed to reduce clonus prevent seizures smooth muscle relaxation reduced scotoma reduced HA reduced BP
Explain the warning signs you may see with a patient with a cerclage?
symptoms of labor
back pain
abdominal cramping, pain
With incomplete abortions, what are some complications?
fever , chills, heavy bleeding, severe cramping - s/s infection
What are some potential complications of a placenta previa?
What are some contraindications with a previa?
bleeding/ hemorrhage - >HR
Describe the most concerning symptoms of pre-eclampsia
HTN over 140/90 hype reflexive upper right abdominal pain increased liver enzymes facial and hand edema pulmonary edema
Know important labs that are associated with pre-eclampsia and HELLP syndrome.
labs platelets <100,000 Increased liver enzymes increased uric acid increased creatinine decreased GFR proteinuria
Understand the logistics of a CST.
positive means positive for stress its a bad thing
negative means no late decelerations
Develop a plan of discharge for a 28 week pregnant patient with pre-eclampsia.
diet - increase protein, low sodium - do not restrict fluid bedrest monitor BP NO ACE inhibitors I and O's monitor for swelling
How do you know that Magnesium Sulfate is effective and therapeutic?
no seizures
no beats of clonus
less HA
respiratory rate is ok
What are some nursing interventions for patient’s with pre-eclampsia?
seizure precautions
dim the lights
cluster care
vitals q4
I& o, daily wts
Develop a chart for the different types of abortions and treatments. Be sure to pay attention to weeks gestation.
threatened -up to 20 weeks, cervix closed, no tissue passed - bedrest
inevitable- up to 20 weeks, cervix dilated, no passage of tissue, may need D&C
incomplete - up to 20 weeks, cervix is open some content passes, lots of bleeding and cramping may need removal
complete - up to 20 weeks, cervix opens, content passes, cervix closes, no intervention needed
missed - no heart beat, will need intervention oral or D&C
Septic- incomplete or missed becomes infected
recurrent
Think about important interventions for preterm pregnancies with placenta previa.
pelvic rest activity restrictions betamethasone for lung development plan for C-section at 36 weeks continuous fetal hr monitoring no cst's
prepare for blood transfusion
get cbc and type and cross match, start an IV
Explain the signs and symptoms of molar pregnancy.
high HCg dark red bleeding- prune juice anemia hyperemesis fundal height greater than expected pre eclampsia s/s before 20 weeks
What all is included in a BPP?
breathing tone -flexion gross movements fluid reactive fetal heart tones
Understand the ins and outs of MSAFP
screening—
decreased is indicative of malformation
follow up with fetal ultrasound
does not screen for turners of Klinefelter’s
What are symptoms of concealed placental abruption?
rigid board like abdomen
extreme pain
What are the symptoms of magnesium toxicity?
BLURR
decreased blood pressure, LOC, urine output, reflexes, respirations
turn off the mag
What types of diagnostic tests are available for abnormal screening genetic tests in pregnancy?
amniocentesis and chorionic villi sampling
after an abnormal quad screen get an ultrasound to look for nuchal translucency
What labs can we test to see if a woman ovulated?
progesterone
Familiarize yourself with the contraceptive efficacy list. Be able to list in order.
Nexplanon male sterilization Mirena female sterilization ParaGard depo est-prog pills
Think about interventions for hypoglycemia in labor
STOP the insulin drip if too low
monitor glucose to stay between 90-110
<70 ad D5 as IV fluid
What are some important instructions for one hour gtt? What about three hour gtt?
one hour non fasting 50 grams more than 130-140 leads to taking the three hour test
three hour glucose FASTING 100 grams
after 3 days of unrestricted exercise and diet
avoid smoking and caffeine for 12 hours
OGTT serum blood drawn, then drink 100 grams, then check blood at 1 2 3 hours, 2 out of 3 abnormal =GDM
Which methods of birth control are not recommended in breastfeeding women?
anything with estrogen
- xulane
- nuvaring
- annovera ring
- twirla
What are some ways that you can tell if a woman is ovulating?
bleeds regularly
normal bleeding
cramping- painful periods - dysmenorrhea
spinnbarkeit mucus thinning like egg whites- cloudy, scant
Explain the pneumonic for ACHES/PAINS.
A abdominal pain C chest pain SOA H headache E eye pain or vision disturbances S severe leg pain DVTs
P period is late A abdominal pain or pain with intercourse I infectious exposure, STI N not feeling well S strings missing
What are some contraindications for CHC?
migraine HA with aura
clotting disorders
smoking
HTN
Explain the pathophysiology of GDM. What is important about insulin needs during pregnancy?
glucose crosses placenta not insulin
decreased need 1st trimester
increased need 2 & 3 trimester
Important to control glucose
The placenta stimulates hormones that cause insulin resistance
Develop a chart for emergency contraception. What is important to know about emergency contraception?
paragard is the most effective -up to 5 days
Ella up to 5 days
plan B up to 3 days
What can hyperglycemia in the first trimester cause?
congenital malformations
CV and CNS
Develop a chart of male infertility and which disorder causes low sperm count versus poor sperm quality.
k
Know ALL of the normal levels for maternal glucose
60 -105 mg/dl before meals
< or = 140 one hour after meals
< or = 120 two hours after meals
> 60 between 2-6 am
target range during labor is 90-110,
will likely have an insulin drip, if hypoglycemic stop the drip
<70 D5 is added as maintenance fluid
hypoglycemia will delay lactogenesis
What is the main reason for treating opiate use in pregnancy?
to prevent prenatal seizures
Make a list of all of the infertility medications and HOW they work.
perganol - stimulate ovulation - makes multiple eggs mature
clomid - binds to estrogen receptors to increase GNrh
What is a priority intervention for a patient with postpartum psychosis? What are some things to think about with visitation of baby?
mom cannot be with baby,
call 911
supervised never alone with baby after treatment
What are the complications of hyperemesis gravidarum- maternal and fetal. What lab tests would help to identify complications?
maternal - esophageal rupture
pneumomediastinum
decreased vitamin K
< thiamine-wernicke encephalopathies
fetal - SGA, premature, low gestational age
labs - UA, CBC, electrolytes, liver enzymes, bilirubin, and thyroid
What are some important education points for a patient with GDM who is in the postpartum period?
increased risk of type 2 DM
glucose levels return to normal around 7 days
resolves on own after pregnancy
