Exam 3 Flashcards by Alice Camp

What is the best plan of care for management of an ectopic pregnancy?

methotrexate until 8 weeks then salpingectomy

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Explain the warning signs you may see with a patient with a cerclage?

symptoms of labor
back pain
abdominal cramping, pain

How well did you know this?

Not at all

Perfectly

With incomplete abortions, what are some complications?

fever , chills, heavy bleeding, severe cramping - s/s infection

How well did you know this?

Not at all

Perfectly

What are some potential complications of a placenta previa?

What are some contraindications with a previa?

bleeding/ hemorrhage - >HR

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Understand the logistics of a CST.

positive means positive for stress its a bad thing

negative means no late decelerations

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How do you know that Magnesium Sulfate is effective and therapeutic?

no seizures
no beats of clonus
less HA
respiratory rate is ok

How well did you know this?

Not at all

Perfectly

What are some nursing interventions for patient’s with pre-eclampsia?

seizure precautions
dim the lights
cluster care

vitals q4
I& o, daily wts

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

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