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NUR 435 Exam 2 > High Risk Pregnancy > Flashcards

High Risk Pregnancy Flashcards

1
Q

High Risk Pregnancy Risk Factors

A

Age, Race, Poverty, Marital Status
Drug Use, Alcohol, Smoking
High BP, Overweight, Infection, Nutrition

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2
Q

Non Stress Test

A

NST
On a monitor, mother pushes a button when the baby moves- the heart rate should increase
Reactive = a positive result
Non- Reactive = a negative result

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3
Q

Contraction Stress Test

A

CST
Start Pitocin- look at HR response to contractions
Negative = no late or significant variable decels
Positive = Late decals with >50% of contractions
Equivocal = Suspicious, intermittent late decals or significant variable decels

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4
Q

Biophysical Profile

A

BPP
0 = present, 2 = not present
1. NST
2. Fetal breathing movements on ultrasound
3. Fetal Movement
4. Fetal Tone
5. Amniotic fluid index- looking for pockets

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5
Q

BPP Scoring

A

8-10 = Normal
6 = Equivocal
< 4 = DELIVER NOW

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6
Q

Hypertensive Disorders

A

Gestational HTN - High BP - NO Protein
Pre-eclampsia - High BP - + Protein
Eclampsia - Seizures
Chronic HTN - High BP pre-pregnancy

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7
Q

Maternal HTN Complications

A

Placental abruption, ARDS, Stroke, Cerebral Hemorrhage, Hepatic or Renal Failure, DIC, Pulmonary Edema
Cerebral edema- swelling in the eyes
Edema- Strict I/O’s

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8
Q

Fetal HTN Complication

A

Related to placental insufficiency

IUGR, Prematurity, Hypoxia

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9
Q

Mild Pre-eclampsia

A

BP > 140/90
>1+ Proteinuria
>300 mg Protein in 24hr urine
Output = Input

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10
Q

Severe Pre-eclampsia

A

BP > 160/110
>3+ Proteinuria
Output <400-500 ml in 24hr urine

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11
Q

Pre-eclampsia Risk Factors

A 
First pregnancy or new partner
< 19 or > 40
Obesity 
History
Multifetal pregnancy or mole
Poor outcome in previous pregnancy

Don’t know the exact cause

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12
Q

HELLP Syndrome

A

Severe pre-eclampsia involving liver dysfunction

H: Hemolysis
EL: Elevated liver enzymes
LP: Low platelet count

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13
Q

Diagnosis of HELLP

A

Increased risk of adverse outcomes including:

Pulmonary edema, acute renal failure, DIC, liver hemorrhage or failure, ARDS, sepsis or stroke

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14
Q

Assessment of Pre-eclampsia

A

BP
Edema
DTR’s and clonus

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15
Q

Severe Pre- eclampsia Treatment

A

Dark quiet room
Seizure precautions: bedrest and side rails up, emergency drugs, O2, and suction
Magnesium Sulfate
Limit intake - 125 ml/hr

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16
Q

Magnesium Sulfate

A

2-4 gram bolus over 20 minutes
FEEL AWFUL- N/V, HA, red
DO NOT leave your patient!
Calms CNS- reflexes are minimal if taken for a long time

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17
Q

Magnesium Sulfate Toxicity

A

Order blood levels
4-7 = Therapeutic
8 or 9 + = STOP NOW!!
TOO much = breathing stops, pp hemorrhage
Calcium glucanate or calcium chloride reverse this!

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18
Q

Miscarriage Causes

A

10-15% of all pregnancies, mostly before 12 weeks

Chromosomal abnormalities, endocrine imbalances, hypothyroidism, varicella, parvovirus, IDDM with high glucose levels, immunologic factors, systemic disorders, genetic.

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19
Q

Ectopic Pregnancy

A

9% of all maternal deaths

Fertilized ovum implanted outside the uterine cavity

20
Q

Ectopic Pregnancy Classic Symptoms

A

Abdominal pain
Delayed menses- when was their last one??
Abnormal vaginal bleeding
Rupture!! Referred shoulder pain
Signs of shock: fainting, dizziness, not necessarily vaginal bleeding
HIGH SUSPICION

21
Q

Ectopic Pregnancy Treatment

A

Methotrexate- safe, effective, low cost

Surgery- Salpingotomy if not ruptured, Salpingectomy if ruptured

22
Q

Hydatiform Mole

A

Benign proliferation growth of the placental trophoblast
No viable fetus
Contraception for up to a year
High risk for cancer and another molar pregnancy
Treatment: Remove with D&C

23
Q

Placenta Previa

A

Completely or partially covering the cervix or enough to the cervix to cause bleeding with dilation
1 in 200

24
Q

Placenta Previa Risk Factors

A 
Previous c section with a scar
>35 years old
Multipartiy
History of curettage
Smoking
25
Q

Placenta Previa Symptoms

A

PAINLESS bright red bleeding- 2nd and 3rd trimester
Non-tender uterus with normal tone
Fetal mal-presentation
Hemorrhage- complication
Preterm birth, stillbirth, fetal anemia, IUGR

26
Q

Placenta Previa Treatment

A

At or beyond 36 weeks - c section
More than 2cm from cervical os, asymptomatic = labor safely
PP HEMORRHAGE CAN OCCUR

27
Q

Placental Abruption

A

Detachment of all or part of a normally implanted placenta before the baby is born
1 in 75- 1 in 226

28
Q

Placental Abruption Risk Factors

A

Smoking
HTN
Drug Use

29
Q

Placental Abruption Symptoms

A

Dark red blood 70-80%, 10-20% hidden
Abdominal pain- intense
Board like placenta
More likely twins

30
Q

Placental Abruption Complications

A

Can lead to DIC! Low platelets, prolonged PT and PTT, d-dimer test.
More then 50% abruption- fetal death likely
IUGR, Preterm birth, SIDS, CP, Neuro decifits

31
Q

Placental Abruption Management

A

< 34 weeks and stable mother and fetus- monitor closely, assessments of fetal well being, corticosteriods to accelerate lung development

*Will try to keep the baby in-utero as long as possible

Term gestation or moderate bleeding- IMMEDIATE DELIVERY

Large bore IV, labs, VS, catheter, vaginal birth preferred

32
Q

Diabetes Mellitus

A

Most common endocrine disorder with pregnancy
4-14% of pregnant women
High risk pregnancy
Can be managed!

33
Q

Diabetes Mellitus Classifications

A

Type 1- lack of insulin
Type 2- insuline resistance
Gestational Diabetes- any degree of glucose intolerance with onset of pregnancy

34
Q

Fetal Risks with DM

A 
Death
Congenital malformations
Hyperglycemia 1st trimester
Severe hypoglycemic 1/2 hr after birth
Big baby- macrosomia
Brachial plexus palsy, facial nerve injury, humerus or clavicle fracture, cephalahematoma
35
Q

Fetal Movement Counts

A

Counts begin at 28 weeks- 10 movements within 24 hours, 2 accelerations in 20 minutes

Acceleration is up 15beats in 15 sec

NST, CST, BPP around 34 weeks

36
Q

Intrapartum Diabetes

A

Hourly blood sugars
D5W IV Fluid
Maintain at 140 or less

37
Q

Postpartum Diabetes

A

Rapidly decreases after birth

May only require 1/3 to 1/2 as much insulin

38
Q

Gestational Diabetes Risk Factors

A 
> 25 yrs
Previous infant
Previous IUFD, GDM
Strong family history of GDM or Type 2
Obesity 
Fasting blood glucose > 140
39
Q

Gestational Diabetes

A 
Test at 26 weeks
Insulin demands as much as 3-4 times
No increase risk in birth defects
Controlled with diet and exercise
Up to 20% need insulin, return to normal after birth
Higher risk for GDM in future AND Type 2
Children born are at risk for obesity
40
Q

Anemia

A

Iron deficiency is most common
Fetus receives enough- but takes from mom
Easily treated with iron supplements- hard to adhere to
Supplement side effects: constipated, dark stool, nausea

41
Q

Asthma

A

4-8% of pregnant women have asthma
1/3 improve, 1/3 stay the same, 1/3 get worse
Associated with placental insufficiency, IUGR, preterm birth

42
Q

Asthma Treatments

A 
Maintain O2
Prevent Hypoxic episodes 
Avoid triggers and inhaled steroids
Epidural are recommended 
Avoid morphine
43
Q

UTI’s

A 
Most common complication
Screen women!
Associated with preterm birth and LBW
Follow up is important! 
Safe antibiotics- take more often, harder adherence
44
Q

TORCH

A 
Toxoplasmosis- cat liter
Other- Hep a & b
Rubella- blindness
Cytomegalovirus- herpes family
Herpes- Type 1 or 2, outbreak can transmit to a baby`
45
Q

Surgery during Pregnancy

A

Monitor the fetus!!

46
Q

Trauma during Pregnancy

A

MVA, falls, blunt trauma, abuse
Observe for at least 4 to 6 hours
MAKE SURE HEART RATE IS OKAY!

NUR 435 Exam 2 (4 decks)

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