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Maternal NCM 109 Flashcards

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1
Q

Every day, approximately __________ die from preventable causes related to pregnancy and childbirth.

A

830 women

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2
Q

___% of all maternal deaths occur in developing countries.

A

99%

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3
Q

True or False
Maternal mortality is lower in women living in rural areas and among poorer communities.

A

False (Higher)

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4
Q

True or False
Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.

A

True

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5
Q

True or False
Skilled care before, during and after childbirth can save the lives of women and newborn babies.

A

True

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6
Q

Between ____ and ____, maternal mortality worldwide dropped by about ____.

A

1990 and 2015, 44%

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7
Q

Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than __ per ________ live births.

A

70 per 100 000 live births.

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8
Q

True or False
Small disparities between countries, but also within countries, and between women with high and low income and those women living in rural versus urban areas.

A

False (Large)

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9
Q

measures the risk of dying from causes related to pregnancy, 1childbirth, and puerperium

A

MATERNAL MORTALITY RATE

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10
Q

What is the Maternal mortality ratio?

A

(Number of maternal deaths / Number of live births) X 1000

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11
Q

MMR= ? (what date)

A

1.1/1000 LB (FEB, 2008)

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12
Q

CAUSES of Maternal Mortality Rate (5)

A

● Hemorrhage
● Sepsis
● Obstructed Labor/ Labor Dystocia=due to representation of the fetus (shoulder presentation), due to locked twins or pelvic twins
● Hypertension
● Complication of unsafe abortion

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13
Q

measures the risk of dying during the first year of life.

A

Infant Mortality Rate

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14
Q

It is a good index of its general health because it measures the quality of pregnancy care, overall nutrition, and sanitation, as well as infant health and available care.

A

Infant Mortality Rate

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15
Q

What is the Infant Mortality Ratio?

A

the number of deaths in the first year of life divided by the number of live births, multiplied by 1000

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16
Q

IMR=?

A

13.2/1000LB

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17
Q

CAUSES of Infant Mortality Rate? (9)

A

● Bacterial Sepsis of newborn
● Respiratory distress of newborn
● Pneumonia
● Disorders related to short gestation to low birth weight
● Congenital Pneumonia
● Congenital Malformation
● Neonatal Aspiration syndrome
● Intrauterine hypoxia and birth asphyxia
● diarrhea and gastroenteritis of presumed infectious origin

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18
Q

measure pregnancy wastage

A

FETAL DEATH RATE

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19
Q

What is the Fetal Death Ratio?

A

total fetal death/total live birth X 1000

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20
Q

FDR=? (what date)

A

5.2/1000 LB feb, 2008

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21
Q

study of the way such disorders occur

A

Genetics

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22
Q

detailed family history

A

Genetic Assessment

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23
Q

How many family generations in Genetic Assessment?

A

Family history (3 generations)

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24
Q

Physical examination of both parents and any affected children

A

Genetic Assessment

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25
Q

series of laboratory assays of blood, amniotic fluid and maternal and fetal cells.

A

Genetic Assessment

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26
Q

Disorders that can be passed from one generation to the next because they result from some disorder in the gene of chromosome structure.

A

Genetic Disorder

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27
Q

study of chromosomes by light microscopy

A

Cytogenesis

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28
Q

GENETIC COUNSELING AND TESTING PURPOSES: (4)

A

● Provide concrete, accurate information about the process of inheritance and inherited disorders
● Reassure people who are concerned their child may inherit a particular disorder and the disorder may not occur
● Allow people who are affected by inherited disorders to make informed choices about future reproduction
● Allow people to begin preparation for a child with special needs.

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29
Q

concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, fetus or both.

A

High-risk pregnancy

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30
Q

Assessment that may categorize a pregnancy is at risk: (7)

A

OBSTETRICAL RECORD
MEDICAL HISTORY
CURRENT OBSTETRIC STATUS
PSYCHOSOCIAL FACTORS
DEMOGRAPHIC FACTORS
LIFERSTYLE
PHYSICAL ASSESSMENT

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31
Q

OBSTETRICAL RECORD of a HIGH RISK PRENATAL CLIENT (6)

A

● History Infertility
● Premature cervical dilation
● uterine cervical anomaly
● previous experience
● 2 or more abortion
● previous macrosomic infant

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32
Q

MEDICAL HISTORY of a HIGH RISK PRENATAL CLIENT (6)

A

● cardiac pulmonary disease
● metabolic diseases
● renal disease
● GI disorder
● Seizure disorders
● emotionally disable

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33
Q

CURRENT OBSTETRIC STATUS of a HIGH RISK PRENATAL CLIENT (6)

A

● inadequate prenatal care
● polyhydramnios
● placenta previa
● abnormal presentation
● RH sensitization
● preterm labor

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34
Q

PSYCHOSOCIAL FACTORS of a HIGH RISK PRENATAL CLIENT (6)

A

● inadequate finance
● lack of support system
● poor nutrition
● lack of acceptance of pregnancy
● father of baby uninvolved
● minority status

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35
Q

DEMOGRAPHIC FACTORS of a HIGH RISK PRENATAL CLIENT (2) pls memorize the ages and years

A

● Maternal age under 16 or over 35
● education; under 11 years

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36
Q

LIFERSTYLE of a HIGH RISK PRENATAL CLIENT (9)

A

● cigarette
● drug abuse
● pollution
● no seatbelts
● alcohol intake
● heavy lifting
● unusual stress
● long period of standing
● presence of smoke

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37
Q

PHYSICAL ASSESSMENT of a HIGH RISK PRENATAL CLIENT (8)

A

HAIR
EYES
MOUTH
NECK
SKIN
EXTREMITIES
FINGERS & TOENAILS
WEIGHT

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38
Q

HAIR
GOOD NUTRITION ?

A

shiny, strong with good body,

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39
Q

HAIR
BAD NUTRITION ?

A

lifeless, dull (possible protein deficit)

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40
Q

EYES
GOOD NUTRITION?

A

good eyesight, particularly at night, conjunctiva moist & pink

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41
Q

EYES
BAD NUTRITION?

A

difficulty with night vision (vit. A deficit), pale and dry conjunctiva (iron and fluid deficit)

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42
Q

MOUTH
GOOD NUTRITION?

A

no cavities, no gingivitis, no cracks/fissures, mucous membrane moist and pink, tongue is moist and non-tender

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43
Q

MOUTH
BAD NUTRITION?

A

there are fissures on the corners of the mouth (vit. A deficit), pale mucous membrane ( iron deficit)

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44
Q

NECK
GOOD NUTRITION?

A

normal contour of thyroid gland

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45
Q

NECK
BAD NUTRITION?

A

thyroid gland enlargement

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46
Q

SKIN
GOOD NUTRITION?

A

smooth, normal turgor

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47
Q

SKIN
BAD NUTRITION?

A

rough texture, poor turgor

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48
Q

EXTREMITIES
GOOD NUTRITION?
BAD NUTRITION:

A

normal muscle mass

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49
Q

EXTREMITIES
BAD NUTRITION?

A

poor muscle tone

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50
Q

FINGERS & TOENAILS
GOOD NUTRITION?

A

smooth, pink, normal contour

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51
Q

FINGERS & TOENAILS
BAD NUTRITION?

A

pale. breaks easily

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52
Q

WEIGHT
GOOD NUTRITION?

A

normal weight

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53
Q

DIAGNOSTIC TEST IN HIGH-RISK PREGNANCY/PRENATAL
DETERMINATION OF FETAL STATUS

● process of identifying apparently healthy people who may be at increased risk of a disease or condition.

A

SCREENING

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54
Q

DIAGNOSTIC TEST IN HIGH-RISK PREGNANCY/PRENATAL
DETERMINATION OF FETAL STATUS

● test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test)

A

DIAGNOSTIC TEST

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55
Q

DIAGNOSTIC TESTS FOR HIGH-RISK PREGNANCY (2)

A

INVASIVE
NON-INVASIVE

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56
Q

DIAGNOSTIC TESTS FOR HIGH-RISK PREGNANCY
NON-INVASIVE TESTS? (4)

A

● Fetal ultrasound or ultrasonic testing
● Cardiotocography
● Non stress test (NST)
● Contraction stress test (CST)

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57
Q

A non-invasive diagnosis procedure utilizing high-frequency sound waves to detect intrabody structures.

A

Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing

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58
Q

Purposes of Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing (4)

A
  1. In early pregnancy; to confirm pregnancy
  2. To detect the fetus’
  3. Detects placental location (placenta previa) or placental abnormality (H-mole)
  4. An important aid in high-risk procedures like amniocentesis
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59
Q

Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing
To detect the fetus’ (6)

A

● Viability, growth
● Number (multiple pregnancy
● Position, presentation
● Abnormalities (structural)
● Fetal Heart Tone (FHT)
● Age of gestation; most accurate at 12-24 weeks; biparietal diameter of 9.5 cm= mature fetus

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60
Q

Preparation of Ultrasonography/ Fetal Ultrasound/Ultrasonic Testing? (4 steps)

A
  1. Advice mother:
  2. Instruct NOT TO VOID
  3. Transmission gel is spread over maternal abdomen
  4. Psychological support is given to the mother/father (couple)
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61
Q

What to do when “Advice mother” in preparation of Ultrasonography

A

Drink one quart of water 2 hours before the procedure

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62
Q

What to do when “Instruct NOT TO VOID” in preparation of Ultrasonography

A

In amniocentesis with ultrasound to offer visualization= mother should to prevent injuring the distended bladder with needle insertion

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63
Q

What to do when “Psychological support is given to the mother/father (couple)” in preparation of Ultrasonography

A

● Explain the reason for the procedure, benefits, and the preparation
● Explain that there is no known risk with infrequent sound waves
● Encourage verbalization of fears and concerns. Explain further that:

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64
Q

In Ultrasonography, are all these statements correct?

➔ Confinement is needed
➔ No need for dye and there is noX-ray irradiation
➔ Procedure takes a short time (about 30 minutes) to accomplish

A

2 and 3 statements are correct. Statement 1 is incorrect

Confinement is NOT needed

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65
Q

is a technical means of recording (-graphy) the fetal heartbeat (-cardio) and the uterine contractions (-toco) during pregnancy, typically in the third trimester.

A

CARDIOTOCOGRAPHY (CTC)

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66
Q

The machine used to perform the monitoring is called a cardiography, more commonly known as an electronic fetal monitor (EFM).

A

CARDIOTOCOGRAPHY (CTC)

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67
Q

Interpretation of a CTG tracing requires both qualitative and quantitative description of: (3)

A
  1. Uterine activity (contractions)
  2. baseline fetal heart rate (FHR)
  3. Baseline FHR variability
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68
Q

CTC
A ______ test result indicates that your baby’s heart rate increases by the expected amount after each of his movements

A

reactive

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69
Q

CTC
If your baby’s heart rate does not increase after his movements, the test will be __________

A

non reactive

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70
Q

CTC
A _______ result does npt necessarily indicate a problem.

A

non reactive

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71
Q

True or False
If the result is still ‘reactive’, your doctor might ask you to come back for another test after an hour.

A

False (Non Reactive)

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72
Q

a. Observation of FHT related to fetal movement
b. A test of fetal well-being
c. Usually done after week 26 of pregnancy

A

NON-STRESS TEST (NST)

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73
Q

NON-STRESS TEST (NST) is done after week __ of pregnancy?

A

week 26

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74
Q

Preparation of NON-STRESS TEST (NST)

A

a. Position: semi-fowler’s or left lateral position slightly turned to the left
b. BP is checked first
c. Explain:
● procedure takes 30 to 60 minutes to finish
● mother needs to activate “mark button” with each fetal movement
● does jot need hospitalization-ambulatory basis
d. Requires external electronic monitoring in FHT with ultrasound to trace fetal activity and or uterine activity

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75
Q

Interpretation of NST?
NORMAL?

A

Reactive

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76
Q

Interpretation of NST
(Normal) Increased FHT (accelerating) greater than 15 bpm above baseline?

A

lasting 15 seconds or more in a 10 to 20-minute period with fetal movement.

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77
Q

Interpretation of NST
Abnormal?

A

NON-REACTIVE
● No FHR acceleration with fetal movement

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78
Q

Implication of Results of NST

Abnormal results?

A

mother needs another test, maybe biophysical profile

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79
Q

Purpose
a. Observation of response of the fetus to induced uterine contractions
b. A test of feto-placental well-being

A

OXYTOCIN CHALLENGE TEST (OCT)/ CONTRACTION STRESS TEST (CST)

80
Q

Preparation of OCT/CST (4)

A

a. Semi-fowler’s or left lateral position
b. BP is checked priorly and q15 minutes during the test
c. Explain:
d. Requires external electronic FHT monitoring with ultrasound transducer and tocodynamometer to detect uterine activity

81
Q

Preparation of OCT/CST
“Explain” ★ Procedure takes __ to ___ hours to finish

A

1 to 3

82
Q

Preparation of OCT/CST
“Explain” Mother receives oxytocin of increasing dosage “__________” to the mainline and aimed to cause 3 uterine contractions in 10 minutes.

A

piggybacked

83
Q

Preparation of OCT/CST
“Explain” May be done on __________ basis

A

outpatient

84
Q

Interpretation of OCT/CST

A. Normal:

A

Negative
NO late decelerations of FHR which each of 3 contractions during a 10-minute interval

85
Q

Interpretation of OCT/CST
B. Abnormal:

A

Positive
WITH late deceleration of FHR with 3 contractions in 10 minutes

86
Q

Implication of Results of OCT/CST

a. Normal:

A

● Pregnancy continues;
● normal result of OCT may require weekly tests

87
Q

Implication of Results of OCT/CST

a. Abnormal:

A

● may indicate a need to terminate pregnancy

88
Q

INVASIVE DIAGNOSTIC TESTS (7)

A

● Chorionic Villus Sampling
● Amniocentesis
● Embryoscopy
● Fetoscopy
● Cordocentesis/ Percutaneous Umbilical Cord Blood Sampling
● Biophysical Profile (BPP)

89
Q

are small structures in the placenta that act like blood vessels

A

CHORIONIC VILLUS SAMPLING (Chronic Villi)

90
Q

These structures contain cells from the developing fetus

A

CHORIONIC VILLUS

91
Q

A test that removes a sample of these cells through a needle is called

A

chorionic sampling (CVS)

92
Q

In CVS
The sample can be taken through the ___________ or the ______________

A

Cervix (transcervical) or the abdominal wall (transabdominal)

93
Q

is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus.

A

CHORIONIC VILLUS SAMPLING

94
Q

CVS usually takes place at __-__ weeks’ gestation earlier than amniocentesis or percutaneous umbilical cord blood sampling.

A

10-12 weeks’

95
Q

CVS
It is the preferred technique before _ weeks.

A

BEFORE 15 WEEKS

96
Q

Preparation CVS (3)

A

● You might need to have a full bladder for chorionic villus sampling, so drink plenty of fluids before your appointment
● Sign a consent form before the procedure begins
● Consider asking someone to accompany you to the appointment for emotional support or to drive you home afterward

97
Q

is a test that can be done during pregnancy to look for birth defects and genetic problems in the developing baby.

A

AMNIOCENTESIS

98
Q

removes a small amount of fluid from sac around the baby in the womb(uterus)

A

AMNIOCENTESIS

99
Q

It is most often done in a doctor’s office or medical center. You do not need to stay in the hospital

A

AMNIOCENTESIS

100
Q

done in the second trimester (4th-6th month) of pregnancy

A

AMNIOCENTESIS

101
Q

is most often offered to women who are at increased risk for bearing a child with birth defects

A

AMNIOCENTESIS

102
Q

You may choose genetic counseling before the procedure

A

AMNIOCENTESIS

103
Q

AMNIOCENTESIS
This include who?? (4)

A

● will be 35 or older when they give birth
● had a screening test result that shows there may be a birth defect or other problem
● Have had babies with birth defects in other pregnancies
● have a family history of genetic disorder

104
Q

AMNIOCENTESIS will allow you to:

A

● Learn about the prenatal tests
● Make an informed decision regarding options for prenatal diagnosis

105
Q

is a diagnostic test, not a screening test

A

AMNIOCENTESIS

106
Q

is 99% accurate for diagnosing Down Syndrome

A

AMNIOCENTESIS

107
Q

is usually done between 14 and 20 weeks

A

AMNIOCENTESIS

108
Q

can be used to diagnose many different gene and chromosome problems in the baby

A

AMNIOCENTESIS

109
Q

Amniocentesis can be used to diagnose many different gene and chromosome problems in the baby, including: (4)

A

● anencephaly
● rare, metabolic disorders that are passed down through families
● other genetic abnormalities, like trisomy 18
● Down Syndrome

110
Q

Preparation of Amniocentesis (5)

A

● bladder should be empty during amniocentesis to minimize the chance of puncture
● sign a consent form before the procedure begins. Consider asking someone to accompany you to the appointment for emotional support
● you would have to be anesthetized
● the needle will start from the abdominal wall and move to the uterus after a local anesthesia is administered
● specific amount of amniotic fluid
withdrawn depends on the number of weeks the pregnancy has progressed

111
Q

After the procedure of Amniocentesis (3)

A

● After the amniocentesis, your health care provider will continue using the ultrasound to monitor the baby’s heart rate. You might experience cramping or mild pelvic discomfort after an amniocentesis
● You can resume your normal activity level after the procedure. However, you might consider avoiding strenuous exercise and sexual activity for a day or two.
● Contact your health care provider

112
Q

Amniocentesis
Contact your health care provider if you have: (5)

A

a. loss of vaginal fluid or vaginal bleeding
b. severe uterine cramping that lasts more than a few hours
c. fever
d. redness and inflammation where the needle was inserted
e. unusual fetal activity or a lack of fetal movement

113
Q

Examination of the embryo at 9-10 weeks gestation through the intact membranes

A

EMBROSCOPY

114
Q

Done by introducing an endoscope into the exocoelomic space transcervically or transabdominally

A

EMBROSCOPY

115
Q

This is likely to remain confined to the management of early pregnancy in selected families affected by external fetal abnormalities.

A

EMBROSCOPY

116
Q

The procedure-related risk of fetal loss is around a percent.

A

EMBROSCOPY

117
Q

examination of the fetus after 11 weeks gestation

A

FETOSCOPY

118
Q

performed transabdominally in the amniotic fluid

A

FETOSCOPY

119
Q

The technique has evolved with the miniaturization of the optical device by using fibre-optics technology

A

FETOSCOPY

120
Q

This procedure is likely to find new applications with the development of ultrasound examination at 10-14 weeks gestation in order to either confirm, or rule out suspected external fetal abnormalities.

A

FETOSCOPY

121
Q

In FETOSCOPY, This procedure is likely to find new applications with the development of ultrasound examination at ___-___ weeks gestation in order to either confirm, or rule out suspected external fetal abnormalities.

A

10-14 weeks

122
Q

In FETOSCOPY, The technique has evolved with the miniaturization of the optical device by using ___________ technology

A

fibre-optics technology

123
Q

is a diagnostic test that examines blood from the fetus to detect fetal abnormalities

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

124
Q

An advanced imaging ultrasound determines the location where the umbilical cord inserts into the placenta. The ultrasound guides a thin needle through the abdomen and uterine walls to the umbilical cord.

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

125
Q

The needle is inserted into the umbilical cord to retrieve a small sample of fetal blood

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

126
Q

The procedure is similar to amniocentesis except the objective is to retrieve blood from the fetus versus amniotic fluid

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

127
Q

The needle is inserted into the umbilical cord to retrieve a small sample of fetal blood

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

128
Q

is usually done when diagnostic information can not be obtained through amniocentesis, CVS, ultrasound or the result of these tests were inconclusive

A

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

129
Q

PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING/ CORDOCENTESIS

The sample is sent to the laboratory for analysis, and results are usually available within __hours.

A

72 hours

130
Q

Cordocentesis is performed after __ weeks into pregnancy

A

17 weeks

131
Q

True or False
Cordocentesis detects chromosomal abnormalities (i.e. DOWN SYNDROME) and blood disorders (i.e. feta hemolytic disease)

A

True

132
Q

Cordocentesis may be performed to help diagnose any of the following concerns:

A

a. malformation of the fetus
b. fetal infection ( i.e. toxoplasmosis or rubella)
c. fetal platelet count in the mother
d. fetal anemia
e. isoimmunization

133
Q

BIOPHYSICAL PROFILE (BPP)
A scoring combining ultrasound assessment of: (5)

A

a. fetal breathing
b. fetal movement
c. fetal tone
d. reactivity of the heart rate
e. amniotic fluid volume BPP could have used to predict fetal well-being in high risk pregnancy

134
Q

BPP Scores
8-10?

A

8-10: Normal, low risk for chronic asphyxia

135
Q

BPP Scores
4-6?

A

4-6: Suspected chronic asphyxia

136
Q

BPP Scores
0-2?

A

0-2: Strong suspicion of chronic asphyxia

137
Q

MEDICAL CONDITIONS AFFECTING PREGNANCY OUTCOMES (3)

A
  1. Cardiovascular Disorders (Rheumatic Heart Disease)
  2. Diabetes Mellitus
  3. Substance Abuse
138
Q

● are disease affecting the heart

A

CARDIOVASCULAR DISORDERS

139
Q

● involve some type of impaired cardiac function of all pregnancies

A

CARDIOVASCULAR DISORDERS

140
Q

● complicates approximately only 1% of all pregnancy

A

CARDIOVASCULAR DISORDERS

141
Q

● responsible for the 5% of maternal death during pregnancy

A

CARDIOVASCULAR DISORDERS

142
Q

Cardiovascular Disorders commonly cause difficulty during pregnancy.

______________ (characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary)

A

VALVULAR DAMAGE

143
Q

_____ and _____valves control the flow of blood between the atria and the ventricles (the upper and lower chambers of the heart)

A

● mitral and tricuspid valves

144
Q

________ valve controls the flow of blood from the heart to the lungs

A

Pulmonary valve

145
Q

______ valve governs blood flow between the heart and the aorta, and thereby the blood vessels to the rest of the body.

A

Aortic valve

146
Q

_______ and ______ valves are the ones most frequently affected by the valvular heart disease

A

Mitral and aortic valves

147
Q

A complication of Rheumatic Fever in which the heart valves have been permanently damaged.

A

RHEUMATIC HEART DISEASE

148
Q

may not exhibit noticeable symptoms, it is often undiagnosed until reaching certain period of time that aggravates the manifestations such as pregnancy

A

RHEUMATIC HEART DISEASE

149
Q

an inflammatory disease that may develop after an infection with a group.

A

RHEUMATIC HEART DISEASE

150
Q

What bacteria is found in RHEUMATIC HEART DISEASE?

A

A Streptococcus bacteria ( such as strep throat or scarlet fever)

151
Q

The disease can affect the heart, joints, skin and brain.

A

RHEUMATIC HEART DISEASE

152
Q

COMPLICATIONS OF RHF DURING PREGNANCY (3 process)

A

During pregnancy there is an increase in blood volume
⇩

Increases pressure on heart valves

⇩

Leading to increased maternal and fetal risks

153
Q

COMPLICATIONS OF RHF DURING PREGNANCY (3)

A

● Death of mother and baby
● Increased risk of preterm delivery (may affect baby & mother’s health)
● In some cases, serious complications are associated with a greater risk of heart failure before, during, and after delivery.

154
Q

DIAGNOSTIC TEST of RHF (5)

A
  1. Electrocardiogram (ECG)
  2. Echocardiography
  3. Chest Radiography (CXR)
  4. Ultrasound
  5. Late deceleration on fetal monitors
155
Q

RHF
reveals cardiac changes in the mother

A

Electrocardiogram (ECG)

156
Q

RHF
a test that uses sound waves to create a moving picture of the heart

A

Echocardiography

157
Q

RHF
reveals cardiomegaly (enlarged heart)/ hepatomegaly.

A

Chest Radiography (CXR)

158
Q

RHF
shows fetal growth restrictions

A

Ultrasound

159
Q

RHF
is possible if the mother’s cardiac decompression causes placental incompetency.

A

Late deceleration on fetal monitors

160
Q

TREATMENT OF RHD (10)

A

● Hospital admission to treat heart failure
● Antibiotics (Penicillin) for infection of the heart valves
● Blood-thinning meds to prevent stroke
● Heart valve surgery to repair or replace damaged heart valves
● Close medical supervision w/ more frequent prenatal visits and adjustments in pregnancy drug therapy
● REST.
● Limited sodium and increased protein and iron intake.
● Prophylactic antibiotics as indicated
● Serial ultrasounds, non stress test, and biophysical profile to evaluate fetal status.
● Prophylactic antibiotic during labor for women with mitral valve prolapse to protect the valve

161
Q

KEY PATIENT OUTCOMES of RHD (6)

A

● Maintain adequate cardiac output and placental perfusion
● Maintain hemodynamic stability
● Perform activities of daily living within limitation of disease
● Maintain adequate fluid balance
● Maintain adequate ventilation
● Give birth to a viable neonate

162
Q

NURSING INTERVENTION of RHD (4)

A

● Assess maternal vital signs and cardiopulmonary status closely for changes
● Monitor fetal heart rate for changes
● Reinforce the need for more frequent prenatal visits, and assist with arranging follow up visits
● Alert the pt. to danger signs & symptoms that should be reported immediately

163
Q

is a group of metabolic disorders characterized by elevated levels of blood glucose (hyperglycemia) resulting from defects in insulin production and secretion, decreased cellular response to insulin or both.

A

DIABETES MELLITUS

164
Q

True or False
Is DIABETES MELLITUS characterized by elevated levels of blood glucose (hypoglycemia)?

A

False (hyperglycemia)

165
Q

THREE TYPES OF DIABETES MELLITUS (DM)

A

Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)

Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)

Gestational Diabetes Mellitus

166
Q

● accounts 5% to 10% of diabetic patient

A

Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)

167
Q

● Beta cells of the pancreas that normally produce insulin are destroyed by an autoimmune process

A

Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)

168
Q

● Insulin injections are needed to control the blood pressure glucose level

A

Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)

169
Q

● Has a sudden onset usually before the age of 30 years

A

Type 1 (formerly Insulin Dependent Diabetes Mellitus IDDM)

170
Q

● about 90% to 95% of diabetics have this type of diabetes

A

Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)

171
Q

● occurs most frequently in patient older than 30 years of age and obese

A

Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)

172
Q

● results from a decreased sensitivity to insulin (insulin resistance) or from a decrease amount of insulin production

A

Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)

173
Q

● can be first treated with diet and exercise, then oral hypoglycemic agents as needed

A

Type 2 (formerly NON-INSULIN) Dependent Diabetes Mellitus (NDDM)

174
Q

● is characterized by any degree of glucose intolerance with onset during pregnancy (2nd or 3rd Trimester), in clients not previously diagnosed as diabetic.

A

Gestational Diabetes Mellitus

175
Q

● occurs when the pancreas cannot respond to the demand for more insulin

A

Gestational Diabetes Mellitus

176
Q

● Pregnant women should be screened for glucose levels at the 26th week of gestation

A

Gestational Diabetes Mellitus

177
Q

● A 3 hour glucose tolerance test will be performed to confirm diabetes mellitus

A

Gestational Diabetes Mellitus

178
Q

● Oral hypoglycemic agents are never used during pregnancy

A

Gestational Diabetes Mellitus

179
Q

● Frequently can be treated by diet alone, however, insulin may be needed for some clients.

A

Gestational Diabetes Mellitus

180
Q

● Most gestational diabetes convert to normal after delivery, however, these individuals have an increased risk for developing diabetes mellitus in their lifetime.

A

Gestational Diabetes Mellitus

181
Q

PREDISPOSING FACTORS of Diabetes Mellitus (11)

A

● women 35 years of age or older
● younger than 25 years of age
● obese
● with family in diabetes in 1st degree relatives
● members of a certain ethnic racial groups
● Americans, native americans, americans-african, americans or pacific islanders.
● delivering large neonate (usually 10lbs or 4kgs)
● Hx od unexplained fetal or perinatal loss
● Hx of polycystic ovary syndrome
● Hx of congenital anomalies in previous pregnancy
● Increases the risk for hypertensive disorders in pregnancy

182
Q

ASSESSMENT FINDINGS OR CLINICAL MANIFESTATIONS of Diabetes Mellitus (18)

A

● Polyuria
● Polydipsia
● Polyphagia
● Fatigue and weakness
● Sudden vision changes
● Tingling or numbness in the hands or feet
● Dry skin
● Dizziness
● Confusion (hypoglycemic)
● Congenital anomalies
● macrosomic or large babies (>10 lbs)
● increase risk of PIH
● poor fetal heart tone and rate (from poor tissue perfusion)
● glycosuria
● ketonuria
● hydramnios
● possibility of increased infection (monilial and yeast infection)
● fetal death

183
Q

DIABETES MELLITUS IN PREGNANCY: (4)

A
  1. DM is more difficult to control during pregnancy
  2. Premature delivery is more frequent
  3. The newborn infant of a diabetic mother is subject to hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and congenital anomalies
  4. Stillborn and neonatal mortality rates are higher
184
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS (4)

A
  1. Fasting Blood Sugar (FBS) or FASTING PLASMA GLUCOSE/ NON FASTING PLASMA GLUCOSE (RBS)
  2. Oral Glucose Challenge Test (50-g)
  3. Glycosylated Hemoglobin Measurement
  4. Ophthalmic examination
  5. Urine Culture
185
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS
● fasting plasma glucose of 136 mg/dl or more or a NON fasting plasma glucose of 200 mg/dl or more meets the threshold for the diaphysis of DIABETES.

A

Fasting Blood Sugar (FBS) or FASTING PLASMA GLUCOSE/ NON FASTING PLASMA GLUCOSE (RBS)

186
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS

● After 60 mins or 1 hr, ingestion of the 50-g glucose load, a venous blood sample is taken for glucose determination.
● If the result is 140 mg/dl or more the woman is scheduled for a 100-g 3-hour fasting. Glucose Tolerance Test. If 2 out of the 4 blood samples are abnormal or the fasting blood values is above 95-mg/dl then, a diagnosis of DIABETES is made.

A

Oral Glucose Challenge Test (50-g)

187
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS
● use to detect the degree of hyperglycemia present or the amount of glucose attached to hemoglobin
● This is advantageous because it reflects the average blood glucose level over the past 4 to 6 weeks ( the time the RBC were picking up the glucose) not just the
level on the day of resting.

A

Glycosylated Hemoglobin Measurement

188
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS
● should be done once per trimester

A

Ophthalmic examination

189
Q

DIAGNOSTIC TESTS for DIABETES MELLITUS
● should be done each trimester to detect asymptomatic UTI

A

Urine Culture

190
Q

Normal blood glucose level is ???

A

80-129 mg/dl

191
Q

Normal level of HbA is ???

A

3.0% - 6.9% of the total hemoglobin

192
Q

IMPLEMENTATION of DIABETES MELLITUS Patients (17)

A

● Screen clients between the 24th and 28th weeks of pregnancy
● Prenatal visits bimonthly for 6 months and weekly thereafter
● The goal of therapy is to maintain the blood glucose in a narrow low range of 65 - 130 mg/dl
● Monitor for signs of hypoglycemia ; episodes of mild or moderate hypoglycemia can be treated with oral intake of 10 - 15 g of simple carbohydrates
● Observe for signs of hyperglycemia
● Assess insulin needs
● Monitor and maintain blood glucose levels according to gestational week
● Monitor for glycosuria and ketonuria
● Monitor weight
● Insulin administration if diet cannot control blood glucose levels
● Assess for signs of pre eclampsia, which includes HPN, proteinuria, and edema
● Check for increase temperature and signs of infections
● Instruct the client to report burning and pain on urination or vaginal or itching
● Assess fetal status and monitor for signs of premature labor
● Assess for signs of polyhydramnios
● Increase caloric intake to 2200 - 2500 daily or as prescribed, with adequate insulin therapy so that glucose will move into the cells
● Calories in diet consist of 50% to 60% carbohydrates, 12% to 20% protein, 20% to 30% fat.

193
Q

IMPLEMENTATION of DIABETES MELLITUS Patients

Screen clients between the __th and __th weeks of pregnancy

A

24th and 28th

194
Q

IMPLEMENTATION of DIABETES MELLITUS Patients

The goal of therapy is to maintain the blood glucose in a narrow low range of __ - ___ mg/dl

A

65 - 130 mg/dl

195
Q

IMPLEMENTATION of DIABETES MELLITUS Patients

Monitor for signs of hypoglycemia ; episodes of mild or moderate hypoglycemia can be treated with oral intake of __- __ g of simple carbohydrates

A

10 - 15 g

196
Q

IMPLEMENTATION of DIABETES MELLITUS Patients

Increase caloric intake to ____- ____daily or as prescribed, with adequate insulin therapy so that glucose will move into the cells

A

2200 - 2500

197
Q

IMPLEMENTATION of DIABETES MELLITUS Patients

Calories in diet consist of __% to __% carbohydrates, __% to __% protein, __% to __% fat.

A

50% to 60% carbohydrates, 12% to 20% protein, 20% to 30% fat respectively.

Nursing Maternal (Finals) (9 decks)

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