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NURS246 OB > Exam 3- OB High Risk > Flashcards

Exam 3- OB High Risk Flashcards

1
Q

Spontaneous abortion

A

termination of pregnancy without action taken by woman or another person

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2
Q

Spontaneous abortion s/s

A

abd pain, late menses
Abstain intercourse, record amount/frequency bleeding, watch for passage, IV fluids, antibiotics, DNC

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3
Q

Threatened abortion

A

slight bleeding, cramping, no passage tissue/dilation
Bed rest, repetitive transvaginal ultrasounds, blood test

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4
Q

Inevitable abortion

A

moderate bleeding/cramping, cervical dilation
Prompt termination b/c of infective uterus

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5
Q

Incomplete abortion

A

heavy profuse bleeding, intense bad contraction, not everything has passed
Dilation encourage DNC- scrape inner lining
Nasal prosonole

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6
Q

Complete abortion

A

mild cramp, slight bleeding, pass all products
Transvaginal ultrasound
No interventions as long as no s/s hemorrhage or infection

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7
Q

Missed abortion

A

no bleeding/passage of tissue
DNC, medications

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8
Q

Recurrent abortion

A

3 or more

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9
Q

Ectopic pregnancy

A

fertilized ovum implantation somewhere else other than endo lining in uterus
Decreased maternal mortality

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10
Q

Ectopic pregnancy s/s

A

amenorrhea, positive preg test, abd pain, vag spotting, pain one sided/lower abd pain may be diffused, fainting/dizziness, can have right shoulder pain
Assessment last period, pelvic exams, HCG levels, ultrasound

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11
Q

Ectopic pregnancy- Rupture has occurred

A

right should pain, shock, no vaginal bleeding, may go to ER, HCG drawn every 48hr

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12
Q

Progesterone above 25

A

has pregnancy

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13
Q

Progesterone less than 5

A

suspicious ectopic/abnormal

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14
Q

Methotrexate

A

destroys rapidly dividing cells
PT stable, normal kidney functions
Hazardous drug!

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15
Q

Methotrexate administration

A

Before- height/weight, only given in hospital, IM
Drawing- two gloves, don’t expel air, dispose everything hazardous waste, wash hands

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16
Q

Methotrexate teaching

A

keep follow up appts, no analgesic stronger than acetaminophen/report abd pain

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17
Q

Methotrexate s/s

A

N/V, sore mouth dizziness, severe reversible hair loss
Surgical- removing tube/products at site, give Rhogam, discuss future fertility, contraceptives for 3 period cycles, contact provider if she thinks she’s pregnant to confirm placement

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18
Q

Placenta previa

A

placenta improperly implanted into lower uterus, bleeding scanty profuse
Marginal, Partial, or Total

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19
Q

Placenta previa s/s

A

classic s/s is painless vag bright red bleeding after 20wk

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20
Q

Placenta previa RF

A

multipara, recent abortion, large placenta, age, placenta accreta (placenta grows into wall of uterus), prior c-sec (worry about hemorrhage, fetal death due to pre-term

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21
Q

Placenta previa DX

A

u/s, not going to do digital vaginal exam until DX is made b/c you can touch placenta

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22
Q

Placenta previa Interventions

A

determine amount blood, FHR, corticosteroids (Betamethasone helps fetal lungs mature), pelvic rest/bed rest, teach warning signs, follow up assessment
PT stable 48 hours and comply to activity restrictions to be able to go home, keep all apt, bleeding resumes g back to hospital
Labor/baby compromised/bleeding- c-sec
Greatest concern postpartum hemorrhage, meds may not help

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23
Q

Abruptio placentae

A

placenta separates from uterine wall
Not always normally implanted
Mild, grade 1/2/3
Happens prior to birth, mom has pain disproportionate to pain on contractions, may or may not have bleeding
Always think of cocaine use in the back of your head!

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24
Q

Abruptio placentae RF

A

hypertension

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25
Q

Abruptio placentae causes

A

History of 2 prior abruptions, cocaine, smoking, multigravida, short umbilical cord

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26
Q

Abruptio placentae s/s

A

bleeding or concealed bleeding, uterus tender/board-like/rigid abd, uterine irritability, abd/low back pain, high uterine resting tone, bloody fluid, nonreassuring FHR, monitor s/s hypovolemic shock
Suspect abruption if intense localized uterine pain w/ or w/o bleeding, Pain is constant with complete bleeding, Get out baby in 4 minutes with complete bleeding, with complete separation mortality at 100%, baby needs no longer than 5min to get brain damage

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27
Q

Abruptio placentae Interventions

A

assess bleeding, level of discomfort, VS q5-15 min, type crossmatch, s/s hypovolemic shock, O2, empty bladder q2hr or foley, Rhogam

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28
Q

Gestational hypertension

A

onset HTN with no protein in urine
Not longer than 12 wks, above 140/90, take 4 hr apart with previous normal HR

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29
Q

Preeclampsia

A

HTN AND protein in urine after 12 wks, prior to seizure

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30
Q

Preeclampsia RF

A

1st pregnancy, men who father preeclampsia preg, older 35, obesity, diabetic, chronic HTN, renal disease

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31
Q

Eclampsia

A

have seizure with HX of preeclampsia
Convulsions or seizure before, during, after labor, can happen 24-48 hrs after delivery
No HX of preexisting pathology
Can develop in immediate postpartum
Results in vasoconstriction/vasospasms leading to multiple organ failure
Help by deliver placenta

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32
Q

Eclampsia prevention

A

monitor weight gain/BP/urine protein, aspirin 81mg/day to increase perfusion to placenta

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33
Q

Eclampsia without severe features

A

BP higher than 140/90 but lower than 160/110, proteinuria, possible edema
Education- activity restriction, daily BP/weight/proteinuria, fetal assessment, ample protein but don’t lower salt or fluid

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34
Q

Eclampsia with severe features

A

160/110, platelets decreased, liver enzymes high, renal insufficiency, cerebral disturbances, epigastric pain, pulmonary edema, fetal growth restriction

35
Q

Eclampsia with severe features interventions

A

platelet/UAP, quiet dark environ, seizure precautions(padded side rails, O2, suction, turn to side, call RR), fluid doesn’t go above 125 mL/hr, magnesium sulfate(antagonist- calcium)/anti HTN, fetal assessment, educate about meds
Seizure- 4-6 gm Mag sulfate over 5 min to break seizure, watch fetal bradycardia, q 15 min check for placental abruption, foley cath

36
Q

Magnesium Sulfate

A

blocks neuromuscular trans/relax smooth muscle, IV, given as loading dose 4-6gm over 15-20min followed by 1-2gm/hr, check with another nurse, never abbreviate

37
Q

Magnesium Sulfate s/s

A

lethargy, weakness, N/V, nasal congestion, can cross placenta, decrease FHR

38
Q

Magnesium Sulfate toxicity s/s

A

depressed/absent reflexes, decreased RR, cardiac arrest, decreased O2, disorientation, blurred vision
Turn mag off if any s/s present
Therapeutic 4-8 for Mg, can lead to cardiac arrest if too high

39
Q

Magnesium Sulfate interventions

A

VS q1hr, FHR, I&O, calcium gluconate
measure BP, assess edema, DTR, clonus, proteinuria, watch for headache/epigastric pain/RUQ abd pain/visual disturbances

40
Q

HELLP syndrome

A

Hemolysis, Elevated, Liver enzymes, Low, Platelet count
Pulmonary edema

41
Q

HELLP syndrome s/s

A

flu-like system, RUQ pain, worse at night

42
Q

HELLP syndrome interventions

A

Give magnesium sulfate, fluid replacement, may need betamethasone for preterm delivery

43
Q

Rh incompatibility

A

Maternal and fetal blood don’t mix
Mom negative and baby positive →sensitization; can happen during placental separation after delivery
Next pregnancy with RH positive baby antibodies will cross placenta and destroy fetal cells

44
Q

Rh incompatibility fetal s/s

A

decreased RBC, increased bilirubin, Kernicterus(brain damage) → bilirubin encephalopathy, hydrops
Give within 72 hours of event

45
Q

Gestational diabetes mellitus

A

carb intolerance of variable severity with onset or 1st recognition during preg, higher risk of getting Type 2 later in life

46
Q

Gestational diabetes mellitus causes

A

preexisting disease, unmasking compensated metabolic abnormalities, altered maternal metabolism

47
Q

Gestational diabetes mellitus goals

A

decrease fetal macrosomia, should dystocia, birth trauma, c-sec, vascular damage
Control circulating BG levels, pt goes from oral to insulin

48
Q

Gestational diabetes mellitus complications

A

hydramnios preeclampsia, dystocia

49
Q

Gestational diabetes mellitus- baby

A

HbA1C >10% higher risk for fetus with malformations (heart, CN, skeletal), LGA, macrosomia,
Check BG on baby heel and warm the stick, want to be greater than 40 first hr, then higher than 45

50
Q

Gestational diabetes mellitus- Glucose Challenge Test

A

1-hr
24-28wks, RF should be screened earlier
1hr GCT high, then 3hr Gtt
DX based on 2 or more elevated levels
1-hour GCT- 50 g oral glucose
Abnormal if 1 hr glucose 140 or greater
3-hr HTT- 100 g oral glucose
Fasting- 95
1 hr- 180
2 hr- 155
3 hr- 140
Failed 2 or more= gestational diabetes
Work w dietician, exercise, BG monitoring(fasting, 2hr after eating), fetal surveillance

51
Q

Gestational diabetes mellitus- Evaluate fetus

A

U/S gestational age, fetal growth, amniotic fluid

52
Q

Perinatal loss

A

death of fetus before birth or during first year of life
After deliver up to 1 yr
Mother feels alone, different type of loss

53
Q

Early loss

A

before 20 wks

54
Q

Late loss

A

after 20 wks

55
Q

Perinatal loss interventions

A

Initial reactions- crying, anger, guilt, watch for postpartum depression esp in father
Recognize baby, use their name, mom see/touch/hold baby, put baby to rest w dignity
Present infant to parents- be positive, wrap baby in blanket, allow privacy

56
Q

PROM

A

spontaneous rupture of membranes prior to onset of labor

57
Q

PROM RF

A
58
Q

PROM fetal effects

A

neonatal morbidity, facial, anomalies, fetal growth restriction, umbilical cord compression, sepsis, pre-term
Ask complaint about vaginal fluid loss or continuous peeing

59
Q

PROM DX

A

Nitrazine paper, Ferning Test

60
Q

PPROM

A

preterm premature rupture of membranes before 37 wks

61
Q

PPROM Interventions

A

Prevent contractions!
Bed rest, kick counts, betamethasone, avoid breast stimulation/anything into vag
Prevent chorioamnionitis
CBC, urinalysis, GBS, VSq4hr, antibiotics
Tocolytics not used except where you want to delay labor

62
Q

Preterm Labor

A

20-37 wks
RF pg. 438

63
Q

Preterm Labor s/s

A

ctx w/wo pain, back pain, balling up, pelvic pain/pressure, period-like cramps, vag bleeding, increased vag discharge, frequency, diarrhea, “feeling bad”

64
Q

Preterm Labor- when not to stop

A

demise, nonviable fetal anomaly, severe preeclampsia, hemorrhage, chorioamnionitis, fetal maturity

65
Q

Preterm Labor- predicting

A

cervical length <25 mm, fetal fibronectin

66
Q

Preterm Labor- Fetal Fibronectin

A

protein normally found in fetal membranes and decidua
Found after 20 wks is abnormal until term, can indicate labor will be early
Negative- less chance to deliver in the next 2 wks

67
Q

Preterm Labor interventions

A

dilation >3cm, assess contractions, bedrest, uterine perfusion, hydration, tocolytics

68
Q

Terbutaline

A

relax smooth muscle

69
Q

Terbutaline dosage

A

PO 2.5-5 mg TID(don’t use more than 48-72 hr), SQ 0.25 mg q1hr until contractions cease

70
Q

Terbutaline s/s

A

increased pulse, tremors, shakiness, N, flushing, palpitations, edema, tachycardia, CP, chills, sweating

71
Q

Terbutaline interventions

A

Educate mom on s/s
Assess contractions/FHR, VS, BG, fluids

72
Q

Indomethacin

A

premature infants with cardiac disorders

73
Q

Indomethacin- dosage

A

Loading dose- 100 mg rectal or 50 mg PO
Maintenance- 25-50 mg q6hr PO

74
Q

Indomethacin- s/s

A

epigastric pain, N, gi bleeding, worsening asthma, elevated BP, closure of ductus arteriosus, impairs renal function

75
Q

Nifedipine

A

treats severe HTN
CAN’T GIVE SAME TIME AS MG SULFATE

76
Q

Nifedipine dosage

A

Loading- 10-20 mg PO
Maintenance- 10-20 mg PO q3-6hr

77
Q

Nifedipine s/s

A

flushing, dizziness, headache, tachycardia, hypotension, increased BG

78
Q

Betamethasone

A

glucocorticoid ONLY IM

79
Q

Betamethasone dose

A

Dose- 1mg IM q24hr X2

80
Q

Betamethasone contraindications

A

maternal infection, diabetes

81
Q

Betamethasone s/s

A

increased infection, maternal hyperglycemia

82
Q

Betamethasone interventions

A

Give deep in gluteal, avoid deltoid, assess BP/P/weight/edema, labs

83
Q

When contractions start at home

A

empty bladder, lie on side, 3-4c water, palpate for ctx, rest for 30 min after s/s leave, call if s/s persist

NURS246 OB (1 decks)

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