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High risk pregnancy & complications Flashcards

Test #3

1
Q

What is high risk pregnancy?

A

Already sick, then pregnant

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2
Q

What are pregnancy complications?

A

Complications caused by pregnancy

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3
Q

Common factors of high risk pregnancy

A 
Age
Poverty
Homelessness
Late prenatal care
Genetics
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4
Q

Most common group to have premies?

A

Teenage girls

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5
Q

1 in __ newborns has an inherited genetic disorder

A

20

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6
Q

Is left handed considered genetic?

A

Yes

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7
Q

Assessing genetic disorders

A 
Physical assessment
Diagnostic testing (blood test)
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8
Q

Genetic diagnostic testing types

A
  • Karyotyping
  • Maternal Serum Screening (MSAFP)
  • Chronic villi sampling (CVS)
  • Amniocentesis
  • Percutaneous umbilical blood sampling
  • Fetal imaging
  • Fetoscopy
  • Preimplantation diagnosis
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9
Q

Genetic diagnostic testing:

Karyotyping

A

Look at chromosomes and genes

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10
Q

Genetic diagnostic testing:

Chronic villi sampling (CVS)

A

tissue under placenta-belongs to baby!

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11
Q

Genetic diagnostic testing:

Amnocentesis

A

Genetic study after 14 weeks

  • check chromosomes
  • bilirubin with baby
  • relieve pressure from excess fluid (polyhydramnios)
  • measure surfactant
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12
Q

Surfactant

A

needed for baby’s lungs

1-normal

3: 1-diabetic mom
1: 1-premie

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13
Q

Common chromosomal Disorders

A

1 Down syndrome (trisomy 21)

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14
Q

What are teratogens?

A

-Environmental (maternal stress),
-Infectious agents, or
-Therapeutic agents (Dilantin, live viruses)
causing malformation of an embryo.

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15
Q

What 3 factors determine the results of exposure?

A
  • timing
  • strength
  • affinity (organ specific)
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16
Q

What is TORCH?

A 
Toxoplasmosis-uncooked meat, cat litter
Others, to include-STDs, beta strep
Rubella
Cytomeglovirus
Herpes-If active, C-section.
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17
Q

Which STIs (teratogens) have an effect on baby?

A

Chlamydia and gonorrhea-eyes

Syphilis-shingles

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18
Q

Rubella

A

Titer is done when pregnant to check if immune or not.
If not immune, vaccine is given after delivery.

Can effect eyes, ears and heart of baby

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19
Q

Other important teratogens

A

DE5 (prevent miscarriage)-girl babies-vagina, ovary or breast cancer

Vitamin A-accutane

Lead-brain

Tetracycline-teeth brown

Thylitamine-arms and legs

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20
Q

Most important treatment of STIs

A

Prevent reinfection
Treat partner
Teach mode of transmission

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21
Q

What would we give to cardiac OB patient in labor?

A

Prophylactic antibiotics

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22
Q

Classifications of heart disease in pregnant woman

A

1 or 2: normal pregnancy and birth

3: complete pregnancy with complete bed rest
4: poor candidate, in cardiac failure even at rest

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23
Q

Most dangerous time for cardiac pregnant woman

A

28-32 weeks

Peak blood volume

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24
Q

What do you need to watch for a cardiac pregnant woman in labor?

A

Signs of ischemia

Check lung sounds-pulmonary edema

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25
Q

Assessment of cardiac pregnant patient?

A 
Dyspnea
Rapid RR
Cough
Cyanosis 
Cap refill >5 sec
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26
Q

What size baby will cardiac patient have?

A

Small

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27
Q

Nursing interventions during L&D for cardiac patient

A 
Epidural with 400 mL bolus
IV-not running fast
NO pushing!
Watch for water intoxication
Head of bed needs to be up!
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28
Q

What meds do you need on hand for cardiac patient?

A
  • Beta blocker
  • Nitroglycerine
  • Dig
  • stool softener
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29
Q

Most common signs of anemia (below 10)

A

**Pica

  • tired
  • activity intolerance
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30
Q

What to do for anemic patient?

A

Special diet-increase protein-meat and spinach

Take iron with OJ and food (GI upset)

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31
Q

Folic acid deficiency in pregnant patient

A

More volume due to enlarged RBCs

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32
Q

When is baby impacted by folic acid deficiency in mom?

A

first few weeks of pregnancy

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33
Q

What is folic acid deficiency associated with?

A

neural tube defects

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34
Q

What food should you eat to get folic acid?

A
  • oranges
  • dried beans
  • green, leafy veggies
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35
Q

Sickle cell anemia management

A

O2 and fluids to prevent hypoxia and dehydration to keep mom out of crisis

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36
Q

Sickling of blood in sickle cell mom can impact what?

A

Placenta

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37
Q

What is a diabetes mellitus mom prone to having?

A

Preeclampsia (kidney) and polydramnios

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38
Q

What is important for diabetes mellitus mom to do?

A
  • diet
  • exercise
  • check CBG (goes back to normal after delivery)
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39
Q

The need for insulin goes ____ at first in pregnancy, then gradually _________.

A

down; increases

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40
Q

Does baby or mom manufacture insulin?

A

baby

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41
Q

Insulin is ____ effective due to placental lactogen

A

less

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42
Q

What would you do if baby’s CBG is below 40?

A

Feed baby!

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43
Q

What is the #1 and #2 cause for abdominal trauma in pregnant mom?

A

1 car accident

44
Q

What is the first and last vital signs to go when in shock?

A

First-pulse

Last-blood pressure

45
Q

Rhogam needs to be given after what?

How many hours after?

A

Delivery, car wreck, miscarriage, amniocentesis

72 hours

46
Q

CPR in pregnant woman

A

Higher on chest.
More forceful.

*Call for help

47
Q

When does a spontaneous abortion usually happen?

A

Within first 12-16 weeks

48
Q

Types of abortions

A
  • threatened
  • inevitable
  • incomplete
  • complete (everything comes out)
  • missed (DIC)
  • habitual (constant-incompetent cervix/endocrine)
  • septic (unclean abortion)
49
Q

S/S of spontaneous abortions

A
  • cramps

- little spotting (bleeding will continue if something was left in there)

50
Q

Bleeding heavy

A

IV started with big gauge (18 or above)

51
Q

Ecoptic pregnancy

A
  • unilateral pain
  • burning in belly and shoulder with pain=ruptured

surgery is needed

52
Q

As a nurse, what will you ask woman with belly pain?

A

When was your last period?

53
Q

Hyperemesis Gravidarium aka what?

A

Morning sickness gone wild

54
Q

What are the main things to worry about with Hyperemesis Gravidarium?

A

Dehydration and screwed up electrolytes from vomiting.

55
Q

What is the first thing to do when a patient with Hyperemesis Gravidarium comes in?

A

Start IV

56
Q

What is a molar pregnancy?

A

Abnormal rapid production of chorionic villi (Rapid and HIGH HCG)

57
Q

Risk factors for molar pregnancies

A
  • older women

- low protein diets

58
Q

S/S molar pregnancy

A

Normal at first

  • some bleeding early
  • exaggerated uterine growth
  • NO FHT
  • Cranberry sauce-like
59
Q

What is premature cervical dilation?

A
  • Cannot hold fetus until term
  • Incompetent cervix
  • Habitual abortion
60
Q

What is the procedure for a premature cervical dilation?

A

McDonalds or Schirodkar cervical cerclage

61
Q

When is the cervical cerclage procedure done?

A

Approximately 12 weeks.

Removed at 37 weeks or if in labor (cut strings or csection)

62
Q

What is the main goal for cervical cerclage?

A

To keep baby in until after 38 weeks

63
Q

What is placenta previa?

A

When the placenta covers the cervix

-complete, partial or marginal

64
Q

S/S of placenta previa

A

Painless bleeding-usually starts about 28 weeks.

65
Q

What is placental abruption?

A

Premature separation of placenta from uterine wall

-Marginal, central, complete

66
Q

Risk factors of abruption

A
  • Older woman
  • short cord
  • HTN
  • trauma
  • cocaine
  • smoking
  • thrombosis
67
Q

Is abruption painful?

A

YES-uterus will grow within hours

68
Q

What is DIC associated with?

A
  • Intrauterine fetal demise
  • Abruption
  • Previa
  • PIH
  • HELLP
  • Sepsis
  • Fluid embolism
69
Q

S/S of DIC

A

massive hemorrhage

70
Q

Treatment of DIC

A

Correct underlying issues, transfuse, heparin!

71
Q

What is a pregnant patient always at risk for?

A

DVT and PE

72
Q

S/S of Pre-eclampsia

A
  • Elevated B/P
  • Proteinuria
  • Rapid weight gain
  • Facial/hand edema
  • Hyperreflexia
  • Headache
  • Visual disturbances
  • Epigastric pain
  • Facial twitch
  • Seizures

(if <20 wks, probably molar pregnancy)

73
Q

Where would you put patient with PIH?

A

at the end of the hall, because it’s quiet.

Pad side rails and place fetal monitors in case of seizures.

74
Q

What must you check for protein?

A

URINE

75
Q

What medication must you have on hand?

A

Magnesium sulfate

76
Q

If on mag drip, how often should you check pt?

A

every hour

77
Q

What should you assess with PIH?

A
  • reflexes
  • resp rate
  • epigastric pain
  • hand strength
78
Q

Signs of Mag sulfate toxicity

A

Slurred speech, muscle weakness, reflex decrease

79
Q

If pt has seizure, what would you check because what could happen?

A

Mom and baby for injury-could abrupt

80
Q

What does HELLP stand for?

A 
Hemolysis (destruction of RBCs)
Elevated
Liver enzymes
Low
Platelets
81
Q

What would you do for HELLP?

A

Give platelets and glucose

82
Q

What would you check on a pt with HELLP?

A

Stool, IV and urine for blood

83
Q

When can you give an epidural to a pt with HELLP?

A

ONLY AFTER platelets are given

84
Q

Toxic level of Mag sulfate

A

Above 10

85
Q

Antidote for mag sulfate

A

Calcium gluconate

86
Q

Mag sulfate doses

A

4 gram loading dose

1-2 gram/hour

87
Q

First trimester bleeding

A

Spontaneous abortions

Ectopic pregnancies

Hyperemesis Gravidarium

88
Q

Second trimester bleeding

A

Molar pregnancy

Premature cervical dilation

89
Q

Third trimester bleeding

A

Placenta Previa

Placenta Abruption

DIC

PIH

HELLP

90
Q

Complications in 3rd trimester

A

Preterm labor-20-37 weeks

Post term pregnancy-beyond 42 weeks

PROM

91
Q

What med is given to try to stop preterm labor?

A

Terbutaline (beta blocker)-it helps to prevent and slow contractions

92
Q

Side effects of Terbutaline

A

Hyperglycemia

Chest pain

PC-pulmonary edema

93
Q

What to do when mom has contractions due to dehydration?

A

Give 1000mL fluids via IV, send home

If 6cm with contractions every 10 minutes, give steroids (hopefully 2 doses)

Could do amniocentesis to check baby’s condition, especially lung

94
Q

What to do if PROM?

A

keep in hospital

Check temp q2hr, risk for infection

95
Q

What is post term baby at risk for?

A

Aphyxia

Hypoxic ischemic encephalopathy

Meconium aspiration

Hypoglycemia

Hypocalcemia

Hypothermia

96
Q

What is common for post term moms?

A

Daily kick counts

Extra OB visits

NST

97
Q

Post term baby

A

Minimal fat-long, skinny

No vernix-peeling skin

Long nails, lots of hair, low glucose, wide eyed, temp regulation problems

98
Q

DANGER SIGNS

-preeclampsia signs

A
  • visual disturbances
  • edema-hands/face/over sacrum
  • headaches
  • muscular irritability
  • epigastric pain
99
Q

DANGER SIGNS

-persistent vomiting

A

possible molar pregnancy

100
Q

DANGER SIGNS

-Fluid discharge from vagina

A

Possible placenta previa or miscarriage

101
Q

DANGER SIGNS

-Elevated temp

A

possible infection

102
Q

DANGER SIGNS

-abdominal pain

A

possible abruption

103
Q

DANGER SIGNS

-decrease in fetal movement

A

fetal distress

104
Q

What is isoimmunization given for?

A

Rh-negative carrying Rh-positive baby

Rh, ABO incompatibility

105
Q

What to do when coomb’s test is negative?

A

Give rhogam

106
Q

Coomb’s test positive and baby positive=

A

baby jaundice

OB (2 decks)

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