Exam 3 Flashcards
what is the best plan of care for an ectopic pregnancy?
methotrexate less than 8 weeks
salpingectomy to remove part of the tube
what are the adverse effects of mag sulfate
respiratory depression low BP uterine bogginess in postpartum absent DTR's decreased urine output
what are the expected outcomes of mag sulfate?
therapeutic range 4-7
decreased BP
relaxed smooth muscle
explain the warning signs you may see with a pt with cerclage
discharge
complications of incomplete abortions
sepsis (profuse bleeding, cramping, fever, chills)
potential complications of placenta previa?
bleeding and hemorrhade
contraindications with a placenta previa?
hypotension, tachycardia are signs for bleeding
Trendelenburg and oxygen
important labs associated with pre-eclampsia and HELLP
elevated liver enzymes
low platelets
most concerning symptoms of pre-eclampsia
swelling of face and hands
CST
contraction stress test stimulate contractions with oxytocin over 10 min to look at FHR Positive = BAD for late decelerations do UNCOIL done for abnormal Biophysical profile
plan of discharge for a 28 wk pregnant patient with pre-eclampsia
no ace inhibitors monitor bp measure I&O kick counts edema diet control ( increase protein, low sodium) NO fluid restriction bedrest
how do you know if mag sulfate is effective?
no seizures, monitor DTR’s (2+, 0 Clonus is normal), serum levels therapeutic 4-7, no pulmonary edema
nursing interventions for patients with pre-eclampsia
anti-hypertensive meds
minimize environmental stimulation
seizure precautions
inevitable abortions
dilated cervix without passage of tissue, first 20 weeks, no bleeding manage symptoms, if bleeding d&c
incomplete abortions
open cervix with tissue in cervix, heavy and profuse bleeding, maybe D&C, suction or cytotec
risk of sepsis
important interventions for preterm pregnancies with placenta previa
2 doses of betamethasone
no pelvic exams and complete pelvic rest
signs and symptoms of molar pregnancy
dark red vaginal bleeding
increased fundal height
hyperemesis
preeclampsia prior to 20 weeks
what’s included in a biophysical profile
US measurement of amniotic fluid, fetal movements, fetal tone, NST, and fetal breathing movements
MSAFP
screens for opening of neural tube
occurs 15-20 weeks
low MSAFP = trisomy
Does not screen for turners or kleinfelters
what symptoms are associated with concealed placental abruption?
increased fundal height
board like, rigid uterine atony
painful
symptoms of mag toxicity
BLURR( low BP, decreased LOC, Decreased urine output, Low RR, Decreased DTR)
TURN OFF THE MAG
diagnostic tests available for genetic testing in pregnancy
amniocentesis
chorionic vili sampling
if abnormal quad screening at 18 weeks, nuchal scan test ultrasound
what labs test to see if woman is ovulating?
progesterone
contraceptive efficacy best to least?
nexplanon male sterilzation mirena IUD (skyla, Kyla) female sterilization paraguard IUD depro provera estrogen pills, patches, and rings
interventions of hypoglycemia in labor
if on insulin drip and hypoglycemic stop the insulin
what’s important about 1 hour glucose test
no fasting
130-140 elevated and requires 3 hours test
SCREENING
what’s important about 3 hour glucose test
3 days unrestricted diet and exercise
FASTING after midnight night before
DIAGNOSTIC
avoid caffeine and tobacco 12 hours prior
type of birth control NOT recommended for breast feeding
anything with estrogen
xulane, nuvaring, orala, anovera, twirla, pills
ways you can tell a woman is ovulating
regular predictable periods
cramping
dysmenorrhea
spinbarcet mucous (egg white, cloudy, scant)
ACHES (CHC)
abdominal pain chest pain/shortness of breath severe headache eye pain, visual disturbances severe leg pain
PAINS (IUD)
period late, pregnant, abnormal bleeding abdominal pain with intercourse infection, abnormal discharge not feeling well, fever, chills, malaise string missing, short, long
contraindications for CHC
migraine with aura
clotting disorders
smoking
HTN
pathophysiology of GDM
glucose crosses placenta not insulin
pregnancy with pre-existing DM the placenta is the problem
emergency contaception
paraguard- up to 5 days after
ella- 5 days after
plan b- 3 days after
hyperglycemia in 1st trimester can cause
congenital malformations especially CVD and CNS anomalies
causes of poor quality sperm
age obesity hot testicles sti exposure to radiation/toxins anti-sperm antibodies
low sperm count
hypospadias undescended testicles variceal decreased testosterone substances, tobacco, anabolic steroids
maternal glucose
before meals 60-105
one hour after < 140
two hours after 120
2-6am- 60
what is the main reason for treating opiate usage in pregnancy
to prevent intrauterine seizures during withdraw
clomid
stimulates GnRH, binds to estrogen
perginol
stimulates ovulation, has FSH/LH
priority intervention with postpartum psychosis
never leave mom alone with baby
medical emergency/ hospitalization
supervise mom with baby
complications for hyperemesis gravidarum- mom
esophageal rupture
pneumomediastinum
vitamin k and thiamine deficiencies
complications of hyperemesis gravidarum- fetus
SGA
prematurity
low birth weight
labs for hyperemesis gravidarum
ua cbc electrolytes LFT's bilirubin thyroid
important education points for GDM postpartum
most likely to resolve after delivery of infant
likely to have in subsequent pregnancies
