Final Exam - Powerpoints Flashcards
When is it gestational DM vs just normal DM1 or DM2
if it develops after 20 weeks it is gDM
if it develops before 20 weeks its just DM
Gestational DM (gDM) cycle in pregnancy
high BG in mom –> extra weight gain in baby (RF macrosomia) –> extra glucose to baby –> 39 week induction
why do gDM babies need to be induced at 39 weeks
what are they at risk for
because of their rapid growth rate they are at RF shoulder dystocia and macrosomia
Risk factors for gDM
BMI > 25 Age >25 Hx of gDM, abn glucose tolerance, Family Hx of DM High risk ethnic group
gDM care focuses mainly on …
Managing normal BG levels
gDM baby be more likely to have
Laboured breathing and hypoglycemia
(NTD, RDS, CHD)?
Glucose challenge test values
Fasting: >126
Nonfasting: >200
Oral glucose tolerance test
Fasting: >95
1 hr: >180
2 hr: >155
3 hr: >140
? good sources of sugars
6 saltine crackers
4-6 oz of juice
3 glucose tablets
1 tbsp of honey or syrup
The need for folic acid … during pregnancy.
doubles
folic acid deficiency related to what defect
spinal bifida
foods with folic acid
leafy greens
vegetables
legumes
Thalassemia common in …
Mediterranean and Asian peoples
Thalassemia causes what
less hgb and less RBCs
Sickle cell disease (SCD)
abn hgb, most common in AA
SCD pts should avoid
infection, exertion
SCD pts should stay
hydrated, maintain good oxygenation, take prophylactic ATB and take folic acid supplements
Anemia hgb minimum in 1st and 3rd trimester
hgb < 11
Anemia hgb minimum in 2nd
hgb < 10.5
Fe deficiencies are common in … of pregnancies
75%
Classification of gestational HT (gHT)
develops after 20 weeks
otherwise is considered chronic HT
Pathophysiology of Preeclampsia
increase in peripheral vascular resistance decreasing circulation to all organs resulting in a generalized vasospasms
Preeclampsia prevention
early/regular prenatal visits
controlled wt gain
deceased stressors
Risk factors of Preeclampsia
Primigravidia or Multifetal pregnancy Family Hx Obesity AA Teen or >35 Vascular disease, chronic renal disease, diabetes
What would the nurse be monitoring in a pt with preeclampsia
BP ALT, AST platelets for DIC Kidneys for urine output of >30ml/hr pulse ox pulmonary edema reflexes (2+ normal, 3+ = impending seizure) HA blurred vision
Preeclampsia (preE) usually occurs in what trimester(s)? In which trimester(s) is it most severe?
usually in 3rd
severe 2nd
For how long is a pt preE after delivery
48 hr and is still at RF seizure
during preE urine would have WHAT in it
trace protein
for a preE pt do not palpate what
the liver as it is excreting proteins
interventions for pt with severe preE
keep pt calm, track I/O and give MgSO4 promptly
severe preE would cause what with the lungs
collection of fluids –> pulmonary edema –> respiratory distress (<12 Breaths/min and <95%)
MgSO4 purpose
prevents seizures and has a side effect of lowering BP
Therapeutic range of MgSO4
4-8 mg/dl
SS of MgSO4 toxicity
<12 Breaths/min <95% absence of DTRs sweating and flushing altered LoC HoT MgSO4 > 8 mg/dL
antidote for MgSO4
1g calcium gluconate at 1 ml/min
Hydralazine
HT drug for during pregnancy
Labetalol
HT for postpartum
HELLP meaning
Hemolysis Elevated Liver Enzymes Low Platelets
assessments of HELLP syndrome
bleeding out of IV and all orifices
1 Ix for HELLP syndrome during delivery and after
keep blood on had and mother would go to ICU after birth
Ix for decreasing heart workload
low cholesterol diet no caffeine prevent anemia low salt prevent infection prophylactic ATB limit pain
Med types for decreasing heart workload
diuretics
heparin
Antidysrhythmics
how to minimize effects of labor and delivery on CV
vaginal birth bc body does all the work then it can be one via assisted delivery
C-S would be worse bc it would increase the RF infection, fluid overolad
first 24-48 hrs after PP that increases work on the heart
RF decompensation bc sudden wt loss (cough, crackles, pitting edema, chest pain)
cardiac arrest , pallor, exhaustion
What changes for pregnant woman for CPR
have hands under breast not under umbilicus
Are asthma meds safe for breastfeeding
yes
should pregnant woman have asthma meds at all times even if they havent had any symptoms
yes bc being pregnant is different than not being
hypothyroidism considerations
RF SAB=spont abortion, PT birth, low birth wt, preE,
need to make sure they get their thyroid meds at the right time daily
Hep B considerations on baby and mother
wash baby before injection
mothers be tested
newborns receive IgG at birth
Lupus
rt
and common in
Joint pain
SAB, premature birth, fetal demise, preterm rupture of membranes
Pre-eclampsia
African or Hispanic ancestry
Key thing to remember regarding pregnant women and substance abuse
do not judge or they will stop getting care
common stimulants
cocaine
nicotine
amphetamines
methamphetamines
common depressant
etoh
common narcotics
heroin
methadone
opioids
Drug effects on fetus caused by withdrawao
Preterm labor Preterm birth Spontaneous abortion Abruption IUGR – intrauterine growth restriction Hypoxia Fetal Alcohol Syndrome CNS impairment Tremors (jitters-like)
On how many separate occasions do women need to be asked about abuse
7 and make sure they are alone; true abuser will be afraid to leave, make sure they take the kids
what is domestic violence
It is a pattern of behavior in which one intimate partner uses physical violence, coercion, threats, intimidation, isolation and emotional, sexual or economic abuse to control and change the behavior of the other partner
Cycle of violence
Tension Building –> Abusive Incident –> Honeymoon Phase
ABCDEs of caring for the abused
ALONE BELIEF CONFIDENTIALITY DOCUMENTATION - important to help establish a pattern EDUCATION
Birth control options
IUD Oral contraceptives Condoms Diaphragm/spermicide Natural family planning
IUD
invasive device inserted into uterus to prevent pregnancy, can cause PID
Oral contraceptives
need to be taken at the same time daily
condoms
most reliable for preventing STDs (need to be aware of allergies against latex, expiration dates, heat)
diaphragm
weight fluctuations and must be refitted
natural family planning
must know ovulation cycle and must have regular menses cylce
HIV positive mother tx during pregnancy
prenatally and during labor mom will need to take retroviral drugs orally and IV - importance of strict adherence to drugs
– baby maybe protected from HIV but will need them prophylactically
HIV mother delivers?
by c-s no vaginally bc of bodily fluids
can HIV mom breastfeed
no
HPV causes
warts
Herpes types cause
Simplex 1 = canker sores
simplex 2 = genital warts
Herpes treatment
Acyclovir or Valtrex
delivery options for HPV and herpes with active lesions
c-s
vaginal ok if none
herpes (HSV) effects on neonate
eyes, mouth, skin, encephalitis
bacterial STI
chlamydia
gonorrhea
syphillis
bacterial STI risks in pregnancy
premature labor/birth
low birth weight
PROM
bacterial STI tx
Azithromycin
Ceftriaxone
Penicillin G
both partners need to be treated or will reinfect each other - untreated will lead to PID –> scarring and infert
syphilis with no tx
long term brain dmg/ death to child
Menopause is considered
climacteric
change of life
age of menopause
45-50
menopause definition
final menstral period for 1 year
combo of endocrine, body, and phys changes occuring at the end of the reproductive cycle
menopause causes what damage
osteoporosis via estrogen deficit
45-50 yo women education
hormone therapy increased Ca and vit D exercise 30 min/day with wt bearing kegel exercisese drink 8 glasses of water use lubricants
Hormone therapy considerations (E/P or EP)
women with hx of breast cancer or coagulation disorders; smoking, HT, DM, CV, renal/liver disease are CI for ~
Pelvis examinatoin aka
pap smear
pap smear involves
collection of squamous glandular tissue cellsfrom cervix to detect precancerous and cancerous cells shed by the cervex
self breast exam frequency
done monthly
clinical breast exams frequency
routinely done every 3 yrs from 20-39
mammograms frequency
after 40 yearly
mammograms should be done with
self breast exams
warning signs of breast cancer
palpable mass
dimpling of tissue
nipple retraction
changes in skin or shape of breast
risk factors breast cancer
female over 55 family Hx nulliparity or first pregnancy after 30 early menarchy or late menopause (1255) LT hormone replacement after menopause overwt physical inactivity
