Maternity Flashcards
Pre-eclampsia vs Eclampsia: diastolic BP
Mild - >90 but 110
Pre-eclampsia vs Eclampsia: proteinuria
Mild >o.3 but 5g in 24 HR specimen >3 on random dipstick
Pre-eclampsia vs Eclampsia: serum creatinine
Mild: normal
Severe: elevated
Pre-eclampsia vs Eclampsia: platelets
Mild : normal
Severe : elevated - more than 1.2 mg/do
Pre-eclampsia vs Eclampsia: liver enzymes (ALT AST)
Mild normal or minimal increase
Severe elevated levels
Pre-eclampsia vs Eclampsia: urine output
Mild normal
Severe : oliguria common decreased 500ml
Pre-eclampsia vs Eclampsia: severe unrelenting headache not attributable to another cause
Mild absent
Severe often present
Pre-eclampsia vs Eclampsia: persistent RUQ or epigastric pain or pain penetrating to the lower back; nausea and vomiting
Mild absent
Severe - maybe present and often precedes seizure
Pre-eclampsia vs Eclampsia: visual disturbances
Mild absent to minimal
Severe common
Pre-eclampsia vs Eclampsia: pulmonary edema, heart failure, cyanosis
Mild absent
Severe may be present
Pre-eclampsia vs Eclampsia: fetal growth restriction
Mild - normal growth
Severe - growth restriction , reduced amniotic fluid volume
What are signs of magnesium toxicity
Flushing
Sweating
Hypotension
Depressed deep tendon reflexes and CNS depression including respiratory depression
What is the antidote for magnesium?
Calcium gluconate
Signs of true labour
Contractions occur regularly, become stronger last longer and occur closer together
Cervical dilation and effacement is progressive
The fetus usually becomes engaged in the pelvis and begins to descend
Signs of false labour
Does not produce dilation effacement or descent
Contractions are irregular without progression
Activity such as walking often relieves false labour
Name the different breathing techniques
Cleansing breathing Slow paced breathing Modified paced breathing Pattern paced breathing Breathing to prevent pushing Second stage breathing - several variations
Where is the epidural placed for a subarachnoid block
Spinal subarachnoid space at L3-L5
Administered just before birth
May cause maternal hypotension
Must lie flat for 8-12 hrs post injection
Describe a total placenta PREVIA
Internal cervical os is covered entirely by the placenta when the cervix is dilated fully
Describe partial placenta PREVIA
The lower border of the placenta is within 3 cm of the internal so but does not fully cover it
What is a marginal placenta PREVIA
Placenta is implanted in the lower uterus but it’s lower border is more than 3 cm from the cervical is
Placenta PREVIA assessment
Sudden onset
Painless bright vaginal bleeding in the last half of the pregnancy
Uterus is soft relaxed and nontender
Fundal height may be more than expected for gestational age
What should be avoided with placenta PREVIA
Any sort of vaginal manipulation or vaginal examination
Treatment of placenta PREVIA
IV fluids
Blood products
Tocolytic medications
Rhogam may be prescribed
If heavy bleeding c-section may be performed
What is abruptly placentae
Premature separation of the placenta from the uterine wall
After the twentieth week and before the fetus is delivered
Abruptio placentae assessment
Dark red vaginal bleeding - if bleeding is high in the uterus there can be an absence of visual blood
Uterine pain or tenderness or both
Uterine rigidity
Severe abdominal pain
Signs of fetal distress
Signs of maternal shock if bleeding is excessive
Positions for abruptio placentae
Trendelenburgs position if indicated to decrease the pressure of the fetus on the placenta
Lateral position with head of the bed flat if hypovolemic Shock occurs
In the postpartum period of a client with abruptio placentae what should you monitor for
Disseminated intravascular coagulation
Pre-eclampsia vs Eclampsia - systolic blood pressure
Mild - >140 160 based on two readings 6 hours apart
What are the causes of a vaginal hematoma
Operative delivery
Forceps
Injury to a blood vessel
Can be life threatening
What is the assessment of a postpartum hematoma
Abnormal severe pain
Pressure in the perineal area
Sensitive bulging mass in the perineal area with discoloured skin
Inability to void
Decreased hemoglobin and hematocrit levels
Monitor for signs of shock
What are the signs of shock due to hematoma
Pallor
Tachycardia
Hypotension if significant blood loss has occurred
What is the description of wilms tumour
Most common intraabdominal and kidney tumour of childhood
Unilaterally and localized or bilaterally
Sometimes metastasizes
Peak is 3 years
Assessment of a child with wilms tumour
Swelling or mass within the abdomen - firm nontender confined to one side and deep within the flank
Urinary retention or hematuria or both Anemia Pallor anorexia and lethargy - anemia Hypertension Weight loss and fever Symptoms of lung involvement - dyspnea shortness of breath and pain in the chest if metastasis has occurred
DO NOT PALPATE THE ABDOMEN
What is Reye’s syndrome
Acute encephalopathye
Follows a VIRAL illness
Characterized - cerebral edema and fatty changes in the liver
How is a diagnosis made for Reye’s syndrome
Liver biopsy
Cause of Reye’s syndrome
Unknown
Most commonly follows an illness - influenza or varicella
What should be avoided in Reye’s syndrome
Administration of aspirin and aspirin containing products
What can be prescribed for Reye’s syndrome
Ibuprofen Motrin iB
What is the goal of Reye’s syndrome
Early diagnosis
Early treatment - aggressive
Maintain effective cerebral perfusion and control increasing ICP
Assessment of Reye’s syndrome
History of systemic viral illness 4-7 days before the onset of symptoms
Fever
Nausea and vomiting
Signs of altered hepatic function such as lethargy
Progressive Neurological deterioration
Increased blood ammonia levels
What is kwasaki disease
Acute systemic inflammatory disease
Cause of kwasaki disease
Unknown may be associated with an infection from an organism or a toxin
Cardiac complication is the most serious - as aneurisms can develop
Acute phase symptoms of Kawasaki disease
Fever
Conjunctival hyperemia
Red throat
Swollen hands rash and en,argument of cervical lymph nodes
Subacute stage of Kawasaki disease symptoms
Cracking lips and fissures Desquamination of the skin on the tips of the fingers and toes Joint pain Clinical manifestations Thrombocytosis
Symptoms of convalescent stage of Kawasaki disease
Child appears normal but signs of inflammation may be present
Medications to give those with Kawasaki disease
Aspirin for its antipyretic and anti platelet effects
Immunoglobulin IV to reduce the duration of the fever and the incidence of coronary artery lesions and aneurysms - IV Immunoglobulin is a blood product so blood precautions when given
Description of fifths disease
- agent
- incubation
- communicable period
- source
- transmission
- agent: human parovirus
- incubation - 4 to 14 days; maybe 20 days
- communicable period: uncertain but before the onset of symptoms in most persons
- source: infected persons
- transmission unknown possibly respiratory secretions and blood
Assessment of fifths disease
Before rash: asymptomatic or mild fever, malaise, headache, runny nose
Stage of rash
Erythema of the face slapped check appearance devlops and dissapears by 1-4 days
1 day after the rash on the face - maculopapular red spots appear symmetrically on the extremities; rash progresses from proximal to distal surfaces and may last a week or more
Rash subsides but may reappear if the skin becomes irritated by the sun heat cold exercise or friction
