Exam 3 OB Flashcards
With DM what are optimum specific blood glucose and A1C levels?
70-110
6% or less
When do high-risk mothers start checking kick counts for fetal well-being?
around 28 weeks
What are infants born to diabetic mothers chubby at birth?
insulin does not pass the placental barriers, but glucose does
glucose is managed by the baby and their insulin levels. the glucose store up
Why do women have more frequent UTIs?
estrogen causes polyuria
urine retention and stasis
fever undiagnosed as infection because higher temp is expected with pregnancy
What is an incompetant cervix?
cervix dilates prior to labor
What are some of the interventions a nurse can expect with maternal heart failure?
serial ultrasound and nonstress tests after weeks 30 to 32 of pregnancy to monitor fetal health and to rule out poor placental perfusion
What additional complications might a pregnant person experience with hepatomegaly from right-sided heart failure?
Extreme liver enlargement can cause dyspnea and pain in a pregnant patient because the enlarged liver, as it is pressed upward by the enlarged uterus, puts extreme pressure on the diaphragm.
ascites and peripheral edema can be exacerbated d/t the pressure as well.
What might a nurse see with late-term treatment of a pregnant person with right-sided heart failure?
oxygen administration and frequent arterial blood gas assessments to ensure fetal growth
potential hospitalization for monitoring
During labor, they may need a pulmonary artery catheter inserted to monitor pulmonary pressure
Patients with this condition also need extremely close monitoring after epidural anesthesia to minimize the risk of hypotension.
What is peripartal cardiomyopathy? What are risk factors? S/S? Treatment? What are recommendations if it persists after pregnancy?
originates in pregnancy in those with no previous history of heart disease
stress of the pregnancy on the circulatory system
Black multiparas
conjunction with gestational hypertension
shortness of breath
chest pain
nondependent edema
cardiomegaly
sharply reduce their physical activity
diuretic
arrhythmia agent
digitalis therapy to maintain heart function
LMWH
not attempt any further pregnancies because the condition tends to recur or worsen in additional pregnancies
oral contraceptives are contraindicated because of the danger of thromboembolism heart transplant
Why is documenting edema important, especially with heart failure? What is the difference? What may also be present and should be compared to baseline?
usual innocent edema of pregnancy must be distinguished from the beginning of edema from heart failure
usual edema of pregnancy involves only the feet and ankles but becomes systemic with heart failure. It can begin as early as the first trimester
other symptoms such as irregular pulse, rapid or difficult respirations, and chest pain on exertion will likely be present
What is the impact of lowered blood pressure due to heart disease on the fetus?
BP becomes insufficient to provide an adequate supply of blood and nutrients to the placenta, fetal health can be compromised
low birth weights or be small for gestational age because of acidosis
preterm labor
fetus may not respond well to labor (evidenced by late deceleration patterns on a fetal heart monitor)
potential for cesarean birth
What are interventions during labor with heart disease?
side-lying position during labor to reduce the possibility of supine hypotension syndrome
elevate their head and chest (a semi-Fowler position) to ease the work of breathing
place a towel under the right hip to shift the uterus off the vena cava
Evaluate for fatigue
oxygen therapy
Why is the period immediately after giving birth a critical time for heart patients? How can the increase be compensated for?
with delivery of the placenta, the blood that supplied the placenta is released into the general circulation, increasing the blood volume by 20% to 40%. During pregnancy, the increase in blood volume that occurred did so over a 6-month period, so the heart had time to gradually adjust to this change. After birth, the increase in pressure takes place within 5 minutes, so the heart must make a rapid and major adjustment
decreased activity
anticoagulant and digoxin therapy until the circulation stabilizes
Antiembolic stockings or intermittent pneumatic compression (IPC) boots
prophylactic antibiotics for subacute bacterial endocarditis caused by the introduction of microorganisms through the placental site
Why is it more difficult to manage insulin/glucose levels during pregnancy with type 1 or 2 DM? What occurs with glucose and insulin filtration during pregnancy in all pregnancies? How is the natural resistance of the destruction of insulin beneficial in healthy pregnancies? What difficulty does it cause in diabetics?
all individuals experience several changes in the glucose–insulin regulatory system as pregnancy progresses
- glomerular filtration of glucose is increased causing slight glycosuria
- rate of insulin secretion is increased, and the fasting blood sugar level is lowered
- All patients appear to develop an insulin resistance as insulin does not seem as effective during pregnancy
prevents the patient’s blood glucose from falling to dangerous limits.
they must then increase their insulin dosage beginning at about week 24 of pregnancy to prevent hyperglycemia.
* they must guard against hypoglycemia and ketoacidosis caused by the constant use of glucose by the fetus
Why are infants born to patients with poorly controlled diabetes tend to be LGA?
because the increased insulin the fetus must produce to counteract the overload of glucose they receive acts as a growth stimulant
Polyhydramnios may develop because a high glucose concentration causes extra fluid to shift and enlarge the amount of amniotic fluid
What are negative outcomes in pregancy with poorly controlled diabetes?
congenital anomalies
caudal regression syndrome (failure of the lower extremities to develop)
spontaneous miscarriage
stillbirth
hypoglycemia developing at birth
respiratory distress syndrome, hypocalcemia
hyperbilirubinemia
What are risk factors for developing gestational diabetes?
Obesity
Age over 25 years
History of large babies (10 lb or more)
History of unexplained fetal or perinatal loss
History of congenital anomalies in previous pregnancies
History of polycystic ovary syndrome
Family history of diabetes (one close relative or two distant ones)
Member of a population with a high risk of diabetes
What is test do all patients take between 24-28 weeks to identify gestational diabetes? What is the threshold to need a 3 hour test? How is it administered and interpretted?
50-g glucose challenge test between
result of that test is 140 mg/dL (some providers use 130 mg/dL as the cutoff) at 3 hours
after a fasting glucose sample, patient drinks an oral 100-g glucose solution; a venous blood sample is then taken for glucose determination at 1, 2, and 3 hours later. If two of the four blood samples collected for this test are abnormal or the fasting value is above 95 mg/dL, a diagnosis of diabetes is made
Fasting: 95
1 hour: 180
2 hours: 155
3 hours: 140
Is bleeding normal in pregnancy? How should it be treated and why? What is the risk of undiscovered bleeding? What is the risk specific to pregnancy with hypovolemic shock?
No
potential emergency because it may mean the placenta has loosened and cut off nourishment to the fetus
* the amount of blood visualized may be only a fraction of the blood actually being lost because an undilated cervix and intact membranes contain blood within the uterus
significant blood loss or developing hypovolemic shock.
fetal distress
What 7 findings are assessed with blood loss and their significance?
Increased pulse rate: Heart attempts to circulate decreased blood volume.
Decreased blood pressure: Less peripheral resistance is present because of decreased blood volume.
Increased respiratory rate: Respiratory system attempts to increase gas exchange to better oxygenate decreased red blood cell volume.
Cold, clammy skin: Vasoconstriction occurs to maintain blood volume in central body core.
Decreased urine output: Inadequate blood is entering kidneys because of decreased blood volume.
Dizziness or decreased level of consciousness: Inadequate blood is reaching cerebrum because of decreased blood volume.
Decreased central venous pressure: Decreased blood is returning to heart because of reduced blood volume.
What is the most common reason for miscarriage in the 1st trimester? Other causes?
abnormal fetal development, due either to a teratogenic factor or to a chromosomal aberration
rejection of the embryo through an immune response
implantation abnormalities
corpus luteum on the ovary fails to produce enough progesterone
alcohol use
What is a threatened misscarriage? How is it monitored? If hCG doesn’t increase in 48hrs what does it likely indicate?
vaginal bleeding, initially only scant and usually bright red. A patient may notice slight cramping, but no cervical dilatation is present on vaginal examination
check fetal viability
test for human chorionic gonadotropin (hCG) hormone at the start of bleeding and again in 48 hours
pregnancy is more likely to be a miscarriage
What is an imminent miscarriage? What will tissue be analyzed for? What may occur is fetus is determined not viable, no heart sounds or an empty sac?
A threatened miscarriage becomes an imminent (i.e., inevitable) miscarriage if uterine contractions and cervical dilatation occur
gestational trophoblastic disease (hydatidiform mole)
medication to help the pregnancy pass or perform a dilatation and curettage (D&C) or a dilatation and evacuation (D&E)
