Health Conditions and Vulnerable Populations Flashcards
1
Q
What maternal conditions cause at-risk pregnancies?
A
Diabetes Cardiac and Respiratory Disorders Anemia Autoimmune Disorders Specific Infections
2
Q
Who are considered “vulnerable populations” for pregnancy?
A
Adolescents
Women 35 and older
Women HIV+
Women who substance abuse
3
Q
Diabetes Mellitus
A
chronic disease characterized by a relative lack of insulin or absence of the hormone that is necessary for glucose metabolism
4
Q
Type 1 Diabetes
A
absolute insulin deficiency due to an autoimmune process
-usually ages < 30
5
Q
Type 2 Diabetes
A
insulin resistance or deficiency related to obesity or sedentary lifestyle
-diagnosed primarily in older adults >30, but now being seen in children
6
Q
Impaired Fasting Glucose and Impaired Glucose Intolerance
A
characterized by hyperglycemia at a level lower than what qualifies as a diagnosis of diabetes
7
Q
Gestational Diabetes Mellitus
A
glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy
8
Q
What are the 2 classifications of diabetes during pregnancy?
A
Pregestational and Gestational
9
Q
Pregestational Diabetes
A
alteration in carbohydrate metabolism before conception which includes women with type 1 or 2 diabetes
10
Q
Gestational Diabetes
A
Develops during pregnancy
-associated with either neonatal complications or maternal complications
11
Q
What neonatal complications are associated with Gestational Diabetes?
A
macrosomia
hypoglycemia
birth trauma
12
Q
What maternal complications are associated with Gestational Diabetes?
A
preeclampsia and cesarean birth
13
Q
Patho for Gestational Diabetes
A
the existence of pancreatic beta-cell dysfunction before pregnancy and the unmasking of this problem by the development of insulin resistance during pregnancy
14
Q
What is a normal fasting blood glucose level?
A
92 mg/dL
15
Q
What is a normal oral glucose tolerance test result 1, 2, and 3 hours later?
A
1 hr- 180 mg/dL
2 hrs- 153 mg/dL
3 hrs- 140 mg/dL
16
Q
What placental hormones can cause insulin resistance?
A
hPL and growth hormone increase in direct correlation with the growth of placental tissue, rising throughout the last 20 weeks of pregnancy causing insulin resistance
17
Q
Gestational Diabetes effects on Mother
A
hydramnios gestational hypertension ketoacidosis preterm labor stillbirth hypoglycemia UTI's/Vaginitis Difficult labor; c/s; hemorrhage
18
Q
Gestational Diabetes effects on Baby
A
cord prolapse congenital anomalies macrosomia birth trauma fetal asphyxia childhood obesity death respiratory distress syndrome
19
Q
What should the moms HbA1C level be to so control?
A
< 7%
20
Q
What type of diet should a pregnant woman with diabetes be on?
A
low carbohydrate diet with a carbohydrate content of 40% of the calories
21
Q
Maternal Surveillance for Diabetes
A
- urine for protein, ketones, nitrates, and leukocyte esterase
- evaluation of renal function/trimester
- eye exam in first trimester
- Hba1c q 4-6 weeks
22
Q
Fetal Surveillance for Diabetes
A
ultrasound alpha-fetoprotein levels biophysical profile nonstress testing amniocentesis
23
Q
Congenital Heart Conditions
A
involves structural defects that are present at birth, but may not e identified at that time
24
Q
What are examples of congenital heart conditions that affect pregnancy?
A
Tetralogy of Fallot
Arterial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus arteriosus
25
What are some complications for baby associated with moms congenital heart condition?
growth restriction
preterm/premature births
fetal/neonatal mortality
26
Which conditional heart condition should you advise the mom to avoid pregnancy?
Tetralogy of Fallot
27
Tetralogy of Fallot
- Hospitalization and bedrest possible after the 20th week with hemodynamic monitoring via a pulmonary artery catheter to monitor volume status
- Oxygen may be necessary during birth and labor
28
Arterial Septal Defect
treatment with atrioventricular nodal blocking agents and at times with electrical cardioversion
29
Ventricular Septal Defect
rest with limited activity if symptomatic
30
Patent Ductus Arteriosus
Surgical ligation of the open ductus during infancy; subsequent problems minimal after surgical correction
31
Acquired Heart Conditions
conditions affecting the heart and its associated blood vessels that develop during a person's lifetime
32
What are examples of acquired heart conditions =?
```
Mitral valve prolapse
Mitral valve stenosis
Aortic stenosis
Peripartum cardiomyopathy
Myocardial infarction
```
33
Mitral Valve Prolapse
most asymptomatic--diagnosis is made incidentally
occasional palpations, chest pain or arrhythmias
possibly need beta blockers
usually no special precautions
34
Mitral Valve Stenosis
general symptomatic improvement with medical management involving diuretics, beta blockers, and anticoagulant therapy
-activity restriction, reduce sodium, and potentially bedrest if condition is severe
35
Aortic Stenosis
Diagnosed w/ echocardiography
beta blockers, antiarrhythmic agents to reduce risk of heart failure or dysrhythmias
bedrest, limited activity, and close monitoring
36
Peripartum Cardiomyopathy
preload reduction w/ diuretic therapy
afterload reduction w/ vasodilators
inotropic agents
salt restriction, daily exercise
37
Myocardial Infarction
anticoagulant therapy, rest, and lifestyle changes
38
Class I
asymptomatic w/ no limitation of physical activity
39
Class II
symptomatic: dyspnea, chest pain w/ increased activity
40
Class III
symptomatic: fatigue, palpitations w/ normal activity
41
Class IV
symptomatic at rest or with any activity
42
Patho for Congenital/Acquired heart conditions
hemodynamic changes overstressing women's cardiovascular system
43
Therapeutic Management for Heart Conditions
risk assessment
prenatal counseling
increased frequency of prenatal visits
44
Nursing Assessment for Heart Conditions
```
vital signs
heart sounds-murmurs, irregular rhythms, heart rate
weight
fetal activity
lifestyle
```
45
Cardiac Decompensation
the heart's inability to maintain adequate circulation
46
When is the pregnant women most vulnerable to cardiac decompensation?
28-32 weeks gestation and in the first 48 hours postpartum
47
Signs and Symptoms of Cardiac Decompensation
```
shortness of breath/dyspnea
cyanosis
swelling of hands, feet, and face
jugular vein engorgement
rapid respirations
abnormal heartbeats
chest pain
syncope
fatigue
cough
```
48
Nursing Management Heart Conditions
```
stabilization of hemodynamic status
risk reduction
cardiac medications
energy conservation/nutrition
fetal activity monitoring
S/S of cardiac decompensation
monitor during labor
```
49
Chronic Hypertension
hypertension before pregnancy or before 20th week gestation or persistence > 12 weeks postpartum
50
Therapeutic Management Hypertension
```
preconception counseling
lifestyle changes
antihypertensive agents if severe
fetal movement monitoring
serial ultrasounds
```
51
Nursing Management Hypertension
lifestyle changes=DASH diet
frequent antepartal visits
monitoring for abruptio placentae, preeclampsia
daily rest periods
home BP monitoring
close monitoring during labor, birth, and postpartum
52
DASH Diet
adequate intake of potassium, magnesium, and calcium and limits sodium to 2.4 g
53
Why is asthma treated aggressively in pregnant women?
because the benefits of averting an asthma attack outweigh the risks of medication
54
What is the ultimate goal of asthma therapy?
prevent hypoxia
55
What are the 3 specific drugs chosen to treat asthma during pregnancy?
budesonide
albuterol
salmeterol
56
Nursing assessment for asthma includes?
asthma triggers and lung auscultation
57
Should treatment of TB be the same for pregnant women as nonpregnant women? What is the exception?
yes
| streptomycin is the exception because it is ototoxic to fetus
58
What are the medications used to treat TB?
isoniazid, rifampin, ethambutol
59
Risk factors for TB
immunocompromised
recent immigration status
homeless or overcrowded living conditions
injectable drug use
60
Signs and Symptoms of TB
```
fatigue
fever
night sweats
nonproductive cough
weakness
slow weight loss
anemia
hemoptysis
anorexia
```
61
Screening for TB includes?
TB test and if positive chest x-rays
62
Nursing Management for TB
compliance w/ drug therapy
education; health promotion
transmission prevention
63
Should moms with TB be encouraged to breastfeed?
yes as long as they are compliant with their medication
64
If the mother is untreated for TB at birth or is NOT compliant with medication what will happen?
they will not be allowed to breastfeed and should not be in direct contact with their newborn until at least 2 weeks after starting medications
65
What is the most common pathological cause of anemia during pregnancy?
Iron Deficiency
66
Anemia
reduction in red blood cell volume
67
What are some consequences of iron-deficiency anemia in pregnancy?
```
preterm delivery
perinatal mortality
low birth weight
poor mental and psychomotor performance
postpartum depression
```
68
Signs and Symptoms of Iron Deficiency
```
fatigue
pica
weakness
malaise
anorexia
susceptibility to infections
pale mucus membranes
tachycardia
pallor
```
69
What abnormal lab results are usually present with iron deficiency?
low hemoglobin, hematocrit, serum, iron, microcytic and hypochromic cells, and low serum ferritin
70
Why should you encourage taking iron supplements with orange juice instead of milk?
Orange juice will promote absorption while milk can inhibit absorption
71
Nursing Management for Iron Deficiency
- encourage compliance w/ drug therapy: prenatal vitamins and iron supplements
- dietary instruction and counseling
- education for drug therapy
72
What foods are recommended for iron deficiency?
foods high in iron such as: dried fruits, whole grains, green leafy vegetables, meats, peanut butter, and iron fortified cereals
73
Thalassemia
group of hereditary anemic disorders in which synthesis of one or both chains of hemoglobin molecules alpha and beta are defective
74
Alpha (Minor)
little effect on pregnancy except for mild anemia
75
Beta (Major)
usually no pregnancy due to lifelong, severe hemolysis, anemia, and premature death
76
What does the management for Thalassemia depend on?
severity of disease
77
Sickle Cell Anemia
an autosomal recessive inherited condition that results from a defective hemoglobin molecule
78
What adverse maternal outcomes are associated with Sickle Cell?
```
preeclampsia
eclampsia
preterm labor
placental abruption
intrauterine growth restriction
low birth weight
mortality
```
79
Therapeutic Management for Sickle Cell
dependent on status
- supportive therapy
- blood transfusions if severe
- analgesics for pain
- antibiotics for infections
80
Sickle Cell Crisis
```
severe abdominal pain
muscle spasms
leg pain
joint pain
fever
stiff neck
nausea/vomiting
seizures
```
81
Nursing management for sickle cell during labor
rest
pain management
oxygen and IV fluids
close FHR monitoring
82
Nursing management for sickle cell postpartum
antiembolism stockings and family planning options
83
Localized Autoimmune Disease
targets specific organ
| -thyroid gland in Hashimoto's thyroiditis and Grave's disease
84
Systemic Autoimmune Disease
target multiple organs
| -Systemic Lupus Erythematosus targets lungs, heart, joints, kidneys, brain, and red blood cells
85
What is the focus of therapy for Systemic Autoimmune Diseases (Lupus)?
control disease flare-ups, suppress symptoms, and prevent organ damage
86
Cytomegalovirus
Most common congenital and perinatal viral infection in the world
- transmitted via body fluids
- typically asymptomatic
87
Rubella
German measles
| -spread by droplets or direct contact w/ contaminated object
88
Herpes Simplex Virus
Genital Herpes
| -greatest risk of infection is developing primary infection right before birth
89
Hep B Virus
Everyone should be tested
| -If mom is Hep B positive expect to administer HBIG and Hep B vaccine within 12 hours of birth
90
Varicella Zoster Virus
Transmitted to fetus through placenta resulting in congenital varicella syndrome
91
Parvovirus B19
common, self-limiting, benign childhood virus that causes erythema infectiosum, also known as Fifth's Disease
- severe anemia in fetus
- infected child will have flaming red cheeks and rash
- contagious before rash
92
Group B Streptococcus
Most common cause of sepsis, meningitis, and pneumonia in newborns
-mother will be given PENG and IV antibiotics 4 hours before birth
93
Toxoplasmosis
Parasitic infection
| -transmitted from cat feces, undercooked meat, and contaminated water
94
HIV
Mothers can NOT breastfeed
| at risk for preterm delivery, fetal growth restriction, PROM, hemorrhage, infection, poor wound healing, UTI
95
Therapeutic Management for HIV
Oral antiviral drugs twice daily from 14 weeks until birth; IV administration during labor; oral syrup for newborn in first 6 weeks of life; decision for birthing method
96
Nursing Assessment for HIV
history and physical exam
HIV antibody testing
STI screens
97
Nursing Management HIV
pretest and posttest counseling
education
support
98
What should you offer support for with HIV?
Preparation for labor, birth, and afterward
Elective c/s
Compliance with antiretroviral therapy
Family Planning methods
99
Nursing Assessment for Pregnant Adolescent
- vision of future
- realistic role models; emotional support
- level of education
- financial and resource management
- anger and conflict resolution skills
- knowledge of health/nutrition for self and baby
- challenges of parenthood
- community resources
100
Nursing Management for Pregnant Adolescent
- Support
- Future planning: return to school; career/job counseling; options for pregnancy
- Frequent evaluation of physical and emotional well being
- Stress management/self care
- Education
101
Nursing Assessment for pregnant women 35 and Older
- preconception counseling
- lifestyle changes-beginning in optimal health
- labs/diagnostic testing for baseline
- amniocentesis
- quadruple blood test screen
102
Nursing Management for Women 35 and Older
```
promote healthy pregnancy
education
early and regular prenatal care
dietary teaching
continued surveillance
```
103
Substance Abuse Impact on Pregnancy
fetal vulnerability
teratogenic effect
addiction consequences
104
Alcohol and Pregnancy
fetal alcohol syndrome/spectrum disorder
abortion
inadequate weight gain
105
Caffeine and Pregnancy
vasoconstriction and mild diuresis in mom
fetal stimulation
should not consume more than 300 mg a day
106
Nicotine and Pregnancy
```
vasoconstriction
reduced uteroplacental blood flow
decreased birth weight
abortion/premature
abruptio placentae
```
107
Cocaine and Pregnancy
```
vasoconstriction
gestational hypertension
abruptio placentae
snow baby syndrome
CNS defects
```
108
Marijuana and Pregnancy
```
anemia
inadequate weight gain
amotivational syndrome
hyperactive startle reflex
tremors
premature
```
109
Opiates and Narcotics (Heroine)
```
withdrawal
abruptio placentae
preterm labor
PROM
perinatal asphyxia
sepsis and death
intellectual impairment
malnutrition
```
110
Sedatives
```
CNS depression
newborn withdrawal
maternal seizures in labor
newborn abstinence syndrome
delayed lung maturity
```
111
Nursing management for Substance Abuse
- nonjudgmental approach
- state protection agency investigation for positive newborn drug screen
- counseling
- education
112
Nursing Assessment for Substance Abuse
history and physical exam
| urine toxicology
113
The most common harmful effect of heroin and other narcotics is what?
withdrawal and neonatal abstinence syndrome
