Final Exam - Powerpoints Flashcards
1
Q
When is it gestational DM vs just normal DM1 or DM2
A
if it develops after 20 weeks it is gDM
if it develops before 20 weeks its just DM
2
Q
Gestational DM (gDM) cycle in pregnancy
A
high BG in mom –> extra weight gain in baby (RF macrosomia) –> extra glucose to baby –> 39 week induction
3
Q
why do gDM babies need to be induced at 39 weeks
what are they at risk for
A
because of their rapid growth rate they are at RF shoulder dystocia and macrosomia
4
Q
Risk factors for gDM
A
BMI > 25 Age >25 Hx of gDM, abn glucose tolerance, Family Hx of DM High risk ethnic group
5
Q
gDM care focuses mainly on …
A
Managing normal BG levels
6
Q
gDM baby be more likely to have
A
Laboured breathing and hypoglycemia
(NTD, RDS, CHD)?
7
Q
Glucose challenge test values
A
Fasting: >126
Nonfasting: >200
8
Q
Oral glucose tolerance test
A
Fasting: >95
1 hr: >180
2 hr: >155
3 hr: >140
9
Q
? good sources of sugars
A
6 saltine crackers
4-6 oz of juice
3 glucose tablets
1 tbsp of honey or syrup
10
Q
The need for folic acid … during pregnancy.
A
doubles
11
Q
folic acid deficiency related to what defect
A
spinal bifida
12
Q
foods with folic acid
A
leafy greens
vegetables
legumes
13
Q
Thalassemia common in …
A
Mediterranean and Asian peoples
14
Q
Thalassemia causes what
A
less hgb and less RBCs
15
Q
Sickle cell disease (SCD)
A
abn hgb, most common in AA
16
Q
SCD pts should avoid
A
infection, exertion
17
Q
SCD pts should stay
A
hydrated, maintain good oxygenation, take prophylactic ATB and take folic acid supplements
18
Q
Anemia hgb minimum in 1st and 3rd trimester
A
hgb < 11
19
Q
Anemia hgb minimum in 2nd
A
hgb < 10.5
20
Q
Fe deficiencies are common in … of pregnancies
A
75%
21
Q
Classification of gestational HT (gHT)
A
develops after 20 weeks
otherwise is considered chronic HT
22
Q
Pathophysiology of Preeclampsia
A
increase in peripheral vascular resistance decreasing circulation to all organs resulting in a generalized vasospasms
23
Q
Preeclampsia prevention
A
early/regular prenatal visits
controlled wt gain
deceased stressors
24
Q
Risk factors of Preeclampsia
A
Primigravidia or Multifetal pregnancy Family Hx Obesity AA Teen or >35 Vascular disease, chronic renal disease, diabetes
25
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
```
26
Preeclampsia (preE) usually occurs in what trimester(s)? In which trimester(s) is it most severe?
usually in 3rd
| severe 2nd
27
For how long is a pt preE after delivery
48 hr and is still at RF seizure
28
during preE urine would have WHAT in it
trace protein
29
for a preE pt do not palpate what
the liver as it is excreting proteins
30
interventions for pt with severe preE
keep pt calm, track I/O and give MgSO4 promptly
31
severe preE would cause what with the lungs
collection of fluids --> pulmonary edema --> respiratory distress (<12 Breaths/min and <95%)
32
MgSO4 purpose
prevents seizures and has a side effect of lowering BP
33
Therapeutic range of MgSO4
4-8 mg/dl
34
SS of MgSO4 toxicity
```
<12 Breaths/min
<95%
absence of DTRs
sweating and flushing
altered LoC
HoT
MgSO4 > 8 mg/dL
```
35
antidote for MgSO4
1g calcium gluconate at 1 ml/min
36
Hydralazine
HT drug for during pregnancy
37
Labetalol
HT for postpartum
38
HELLP meaning
```
Hemolysis
Elevated
Liver Enzymes
Low
Platelets
```
39
assessments of HELLP syndrome
bleeding out of IV and all orifices
40
1 Ix for HELLP syndrome during delivery and after
keep blood on had and mother would go to ICU after birth
41
Ix for decreasing heart workload
```
low cholesterol diet
no caffeine
prevent anemia
low salt
prevent infection
prophylactic ATB
limit pain
```
42
Med types for decreasing heart workload
diuretics
heparin
Antidysrhythmics
43
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
44
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
45
What changes for pregnant woman for CPR
have hands under breast not under umbilicus
46
Are asthma meds safe for breastfeeding
yes
47
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
48
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
49
Hep B considerations on baby and mother
wash baby before injection
mothers be tested
newborns receive IgG at birth
50
Lupus
rt
and common in
Joint pain
SAB, premature birth, fetal demise, preterm rupture of membranes
Pre-eclampsia
African or Hispanic ancestry
51
Key thing to remember regarding pregnant women and substance abuse
do not judge or they will stop getting care
52
common stimulants
cocaine
nicotine
amphetamines
methamphetamines
53
common depressant
etoh
54
common narcotics
heroin
methadone
opioids
55
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)
```
56
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
57
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
58
Cycle of violence
Tension Building --> Abusive Incident --> Honeymoon Phase
59
ABCDEs of caring for the abused
```
ALONE
BELIEF
CONFIDENTIALITY
DOCUMENTATION - important to help establish a pattern
EDUCATION
```
60
Birth control options
```
IUD
Oral contraceptives
Condoms
Diaphragm/spermicide
Natural family planning
```
61
IUD
invasive device inserted into uterus to prevent pregnancy, can cause PID
62
Oral contraceptives
need to be taken at the same time daily
63
condoms
most reliable for preventing STDs (need to be aware of allergies against latex, expiration dates, heat)
64
diaphragm
weight fluctuations and must be refitted
65
natural family planning
must know ovulation cycle and must have regular menses cylce
66
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
67
HIV mother delivers?
by c-s no vaginally bc of bodily fluids
68
can HIV mom breastfeed
no
69
HPV causes
warts
70
Herpes types cause
Simplex 1 = canker sores
| simplex 2 = genital warts
71
Herpes treatment
Acyclovir or Valtrex
72
delivery options for HPV and herpes with active lesions
c-s
| vaginal ok if none
73
herpes (HSV) effects on neonate
eyes, mouth, skin, encephalitis
74
bacterial STI
chlamydia
gonorrhea
syphillis
75
bacterial STI risks in pregnancy
premature labor/birth
low birth weight
PROM
76
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
77
syphilis with no tx
long term brain dmg/ death to child
78
Menopause is considered
climacteric
| change of life
79
age of menopause
45-50
80
menopause definition
final menstral period for 1 year
| combo of endocrine, body, and phys changes occuring at the end of the reproductive cycle
81
menopause causes what damage
osteoporosis via estrogen deficit
82
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
```
83
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 ~
84
Pelvis examinatoin aka
pap smear
85
pap smear involves
collection of squamous glandular tissue cellsfrom cervix to detect precancerous and cancerous cells shed by the cervex
86
self breast exam frequency
done monthly
87
clinical breast exams frequency
routinely done every 3 yrs from 20-39
88
mammograms frequency
after 40 yearly
89
mammograms should be done with
self breast exams
90
warning signs of breast cancer
palpable mass
dimpling of tissue
nipple retraction
changes in skin or shape of breast
91
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
```
