High risk pregnancy Flashcards
What is the biggest concern of PPROM?
Infection
How can we tell if there is an active infection in a mom who had a PPROM?
Mother → febrile
WBC elevated
Abdomen tenderness
Any of these warrant need for delivery
How long after PPROM does delivery usually follow?
Within 48 hrs
What lab values do we look at / what method do we use for PPROM?
Bowtie → looks at Hgb, Hct, WBC, & PLTs
What should HC providers minimize in someone who had PPROM?
Minimize vaginal exams → higher risk for infection
What is another concern associated with PPROM?
Preterm birth
→ think use of steroids; mag sulfate; monitor baby b/c less cushion around the cord & possibly more uterine activity
List S&S of preterm labor
More than 6 uterine contractions in an hour, w/ or w/o pain
Cramping
Pressure
Leaking of fluid
Backache
↑ discharge, pink tinged
“Just not feeling well”
Preterm labor backache does not improve with?
Stretching; Tyleonl; heat; rest; or position changes
List signs of preeclampsia WITHOUT severe feature
BP elevated (140/90)
Proteinuria
Normal Labs (AST, ALT, LDH, Creatinine)
Edema
List signs of preeclampsia WITH severe features
Gaining weight (i.e 12lbs in week)
H/A
Blurred vision/ double vision
Epigastric pain (RUQ)
Severe N/V
Edema (hands, feet, face)
DTRs → hyperreflexia
Clonus → tapping movement when dorsiflexing foot
Most common medication used for preeclampsia?
Magnesium sulfate → electrolyte that reduces CNS excitability
What is the antidote for magnesium sulfate that MUST be available on the unit?
Calcium gluconate
What precaution should a patient on magnesium sulfate be put on?
Falls precautions
What do hourly “mag checks” consist of?
I&O
DTRs
LOC
Respiratory assessment
BP
Placenta Previa Characterisitcs
Painless, bright red bleeding
Large amount of blood loss
Maternal condition consistent w/ blood loss
Apparent on u/s
Unsafe to perform vaginal exam
Placental abruption characteristics
Dark red bleeding
Smaller amounts
Moderate to severe pain
Maternal VS may deteriorate even when blood loss is small
u/s is unreliable
Test review: Patient presents with dark red bleeding, rigid board like abdomen, tetanic contractions & severe abd pain. What is she likely having?
Placental abruption
Previa or abruption:
What is priority or biggest concern with bleeding in pregnancy?
STOP the bleeding
Previa or abruption:
After bleeding is stopped what are the next steps?
When provider is on the way → IV access w/ fluid volume replacements
Support circulation → O2; positioning (relatively flat w/ uterine displacement)
Lastly think about the baby
How can gestational diabetes be controlled?
Carbohydrate-controlled diet (3 small meals & 3 snacks)
Insulin → combo of SA & LA
What are the target blood glucose values to ensure Tx is effective?
Fasting → < 90-95 mg/dL
2 hrs postprandial → < 120 mg/dL
Mothers with GD should monitor ____ ____ ____ daily
Fetal kick counts
What is the goal of GD Tx?
Manage blood sugar levels to reduce risk of complications for mother & baby
GD mother is at risk for delivering?
A macrosomic (very large) infant
