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N332 > Maternity Part 1 Workbook > Flashcards

Maternity Part 1 Workbook Flashcards

1
Q

Iron Deficiency Anemia
Why does the mom have it?
Effect on mom + babe?

A
  • Often go into preg w IDA as result of poor diet, heavy periods, unwise weight reducing programs; inc risk if last birth <2 years prior, low SE status
  • Woman fatigued; may have pica as body craves nutrients
  • Mild assoc w low birth weight (IUGR) + preterm birt as placenta not perfused well
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2
Q

Why is preg woman at greater risk of clotting?

A
  • Estrogen, pelvic congestion, blood stasis inc coag, inc risk of DVT
  • E makes us clot!
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3
Q

What sort of treatment do pregnwomen with iron deficiency get?

A
  • Iron (w Vit C bc absorbed if acidic enviro) – 27mg OD
  • IV Iron if oral not enough- come into sx daycare for this
  • Blood tranfusions – pretty rare these days but may happen
  • SW appropiate referral b/c often has to do w socioeconomic status
  • Nutritionist if needs dietary teaching
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4
Q

Folic-acid deficiency anemia (megaloblastic anemia)

  • What is Folic acid for?
  • What defects/complications occur?
A
  • Needed for RBC fx in women
  • Assoc w neural tube + adb wall defects in fetus
  • May contribute to early miscarriage or premature sep of placenta
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5
Q

How much folic acid should preg woman take?

A
  • Woman to take 400 ug’s Folic Acid OD - ensure prenatal vitamin as need larger than normal dose
    (and eat foods rich in folic acid)
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6
Q

GERD-“Why is this worse now that I am pregnant? What do you recommend to help me manage my symptoms?”

A

• Inc P from uterus pushes stomach against esophageal valve + inc reflux of acid or extent of hernia
• In most women, PPI or antacid will work
Advise to wear clothing loose around waste + sleep with head elevated (2 or more pillows)

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7
Q

How is Hep transmitted?

Symptoms?

A

• Hep A not thought to be transmitted to fetus
• Hep B + C can transmit through placenta
• Woman experiences NV, liver tenderness, jaundice, hepatomegaly, elev liver + bilirubin
•

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8
Q

What effect will hepatitis have on my growing fetus?

A

Can lead to spontaneous miscarriage or preterm labour
• Unlike other disease, later in preg you contract hep B the greater the chances of fetus getting it
• Hep-B Ag positive infants may develop liver cirrhosis or carcinoma later in life

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9
Q

What, if anything, do I need to be concerned about because I have hepatitis and am pregnant?

A

???

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10
Q

What special nursing care will I and my baby receive because I have hepatitis?

A

Mom on bed rest, encouraged to eat high-calorie diet to keep sugars up (liver haven’t hard time converting glycogen)
• C-sec may be planned to red possibility of blood exchange
• Avoid exposure to maternal blood during birthing process
• Baby washed well to remove blood, given first hep B shot; watched carefully for signs of infection + liver disease later in life

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11
Q

Can woman with hep breastfeed?

A

Yes, Hep not transmitted in breast milk

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12
Q

Cholecystitis-

Why did I develop this condition?

A

• Assoc w women >40yrs, obese, multiparas, injest high-fibre diet
Hypercholesterolemia naturally occurs in preg – gallstones formed from this

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13
Q

What kind of nursing and medical care can I expect to receive because I have cholecystitis?

A
  • Limit fat intake, but don’t eliminate because need linoleic acid for fetal brain growth
  • If occurs, often made NPO to rest bowels, IV fluids + pain meds
  • Gallbladder removal can be done during preg if needed
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14
Q

-“Why have my mental illness symptoms gotten worse now that I am pregnant? I heard the doctor talking about my regular medication possibly being teratogenic. I am scared of getting really sick again, but I am scared about taking medications if they might harm my baby. Do you have any ideas about who I can talk with to get some advice?”

A
  • Inc stress = inc mental illness
  • Best treated with team approach (psychiatric + prenatal care teams) to ensure is managed
  • Need to ensure evaluate psych meds if preg lithium + SSRIs potentially teratogenic
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15
Q

Spontaneous miscarriage
WHat time frame is considered early and late?
When is bleeding usually not a problem or life threatening?

A

Early <16 weeks
Late16-20 weeks

bleeding from 6-12 weeks is rarely a problem, bleeding after 12 weeks can be profuse and life threatening (placenta deeply implanted)

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16
Q

What risks exist with spontaneous miscarriage?

A
  • All bleeding in pregnancy needs assessment and may indicate an impending SA
  • Be prepared for hemorrhage and shock protocols
  • Infection d/t retained POC a concern
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17
Q

• Causes of spontaneous miscarriages:

A

o abnormal fetal development d/t teratogenic factor or a chromosomal aberration
o Immunologic factors
o Implantation abnormalities
o UTI can be but more so associated with preterm birth
o Systemic infections

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18
Q

What is placenta previa? What is the danger for the fetus and mom here?

A
  • Placenta is implanted abnormally in the lower part of the uterus, most common cause of painless bleeding in the3rd trimester of preg
  • Placenta should be at fundus (top of uterus) 1L/min blood reaching this area
  • In placenta previa, sitting near Os (can cover it)
  • less perfusion for placenta: • possibility of inc in congential fetal anomalies or fetal restricted growth if no optimal oxygenation
  • Mom at risk of hem
  • Inc risk of infection
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19
Q

How is a baby birthed with placenta previa?

A

• Gen need C section (if partial, may be able to do vag)

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20
Q

Why is the risk of hem so high with placenta previa?

A
  • Muscle Fibres in the Uterus
  • More up near fundus, less at base
  • If placenta at base and comes away, all muscle fibres will try to clamp down (Living Ligature) + pinch off all of big vessels to cut off blood supply – if placenta at top, this works out really well and you don’t lose blood. If down at base, have high risk of bleeding
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21
Q

What drug is given to the fetus with placenta previa?

A

• METAMETHASONE IM given as preterm birth common for those with placenta previa = Inc fetal surfactant! so that if baby comes early, has ability to breath

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22
Q

How does placenta previa result in preterm birth?

A
  • Bc the placenta is unable to stretch to accommodate the differing shape of the lower uterine segment or the cervix, small portion loosens and damaged blood vessels begin to bleed.
  • W the placental loosening, preterm labor may begin
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23
Q

Why does placenta previa inc risk of infection?

A

• more likely to develop endometritis bc placental site close to cervix- portal for pathogens

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24
Q

What is Abruptio placentae

A

(premature separation of the placenta)
• Part of placenta peels away, causing bleeding
• May be occult (hidden) or coming out of vagina

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25
Q

Causes of Abruptio placentae

A
  • Car accidents, cocaine use (inc BP), inducing labour too strongly, pre-eclampsia/gestation HTN
  • Pathophysiology: unknown causes, correlation with increased parity, HTN, older mothers, short cord, PIH, trauma, vasoconstriction from cocaine use or cigarette use, chorioamnionitis, sudden decrease in uterine volume (ROM, delivery of one twin), there is a DIC risk
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26
Q

How is preg dealt with if abruptio placentae occurs?

medical management

A
  • Will often deliver baby very quickly.
  • Bloodwork should include platelets, clotting time, prepare for infusion of blood products (X-match)
  • Emergency for fetus-delivery usually progresses rapidly (fetus has no nutrients or O2)
  • Check for neonatal hypoxia at birth (pH levels)
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27
Q

Signs + symptoms of abruptio placentae?

A

S+S: usually occurs late in pregnancy or during labour, sharp, stabbing pain at fundus, tender uterus on palpation, heavy bleeding unless concealed, may be dark in colour, uterus becomes rigid, boardlike (COUVELAIRE uterus)

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28
Q

Preterm labour
When is this?
Assocs/causes?

A

• Occurs before 37 weeks gestation

dehydration, UTI’s (biggest cause), periodontal disease (gums friable during pregnancy), chorioamnionitis, low SE status, partner violence/abuse

29
Q

What to look for with preterm labour? Do women know it’s happening?

A
  • Often women don’t realize they’re having preterm labour…may feel just like baby moving around, a menstrual cramp, a Braxton Hicks contraction
  • Look for contractions 4/20 minutes or more, cervical changes,persistent, dull, low backache, spotting, feeling of pelvic pressure, abdominal tightening, menstual-like cramping, increased vaginal discharge, intestinal cramping
30
Q

Tx of preterm labour?

A

o Bedrest, hydration, treat UTIs,
o Betamethasone to mature lungs, Turbutalane (tocolytic) to stop contractions, antibiotics to tx infections, Magnesium sulphate (smooth muscle relaxant)

31
Q

When is “preterm” rupture of membranes?
Causes?
Risk of this?

A
  • Rupture of membrane + loss of amniotic before 37 wks
  • Caused by infection, multiple gestation, unknown. Risk of cord prolapse
  • There is significant risk for infection for the neonate and mother.
32
Q

Will labour be halted if preterm rupture of membrane occurs?

A

Labour is not usually stopped if it starts d/t large infection risk

33
Q

How is it confirmed that the fluid is actually amniotic fluid in premature rupture?

A
  • Confirmed with nitrazine paper, ferning, U/S
  • Amniotic fluid is alkaline – nitrazine paper shows up bright blue
  • Ferning: under microscope, amniotic fluid looks like ferns because has lots of salt; sample taken from
34
Q

Medical tx of premature rupture of membranes?

A

From class:
• IV access, antibiotics IV, bedrest, betamethasone

From text:
• If no contractions in 24hrs + fetus is viable stage, will induce with IV oxytocin
• If not viable: bed rest + given corticosteroids to hasten surfactant, prophylactic BSAbx
o If no signs infect, can give tocolytic agent
• Amnioinfusion

** In class emphasized that usually they won’t put off labour d/t infect risk

35
Q

Cause of gestational htn?

Possible outcome for mom?

A

• vasospasm. Underlying cause unknown, some correlation with length of time the couple have known one another, younger and older mothers

risk for seizures, coma, and death r/t cerebral edema.

36
Q

3 CARDINAL SIGNS of gest htn?

Assessments to do?

A
  • Increased blood pressures (30mmHg above patient’s baseline…not 140/90), edema, proteinuria.
  • Assess: hyperreflexia, urine dips for protein q morning, 24 hour creatinine clearance, liver function tests, clonus, daily weight.
37
Q

Signs + symptoms of gest htn?

A
  • headache, blurred vision or visual disturbance, epigastric pain and discomfort
  • RUQ pain as liver becomes inflamed
  • Can have significant renal damage

More???/?

38
Q

Tx for gest htn?

A
  • Tx with bedrest, quiet, antihypertensives (LABETELOL), anti-convulsant (MAGNESIUM SULPHATE)
  • Deliver a lot of pre-term infants in order to keep mom alive - • Obstetrician is having to make decision around how to balance delivery too early and endangering life of mom
39
Q

Difference between pre-eclampsia + eclampsia?

A
  • Pre-eclampsia: HTN, edema + proteinuria

* Eclampsia = had seizure!

40
Q

How much edema is worrisome in preg?

A

• Anything beyond hands and feet is worrisome edema! (face + sacrum, sudden weight gain)

41
Q

Why are there visual disturbances in gest htn?

A

cerebral edema + P on ocular nerve

42
Q

What does hyper-reflexivity indicate with pt with gest htn?

What does clonus show?

A

bad! indicates near seizure

Clonus indicates cerebral edema

43
Q

What is HELLP

A

HELLP = variation of gestational htn
• Hemolysis (leading to anemia), Elevated Liver enzymes (epigastric pain), Low Platelets (abn kindey bleeding/clotting)
• Preeclampsia is a precursor
• Abnormal bleeding and clotting-therefore birth is a risk.
• Life-threatening=ICU
• Cause unknown
• Cure is delivery of the infant

44
Q

• Take notes on the Nursing Process Overview on pp. 549-550

A

x

45
Q

Antiphospholipid Antibody Syndrome (APS)

“Why does my condition cause me to repeatedly miscarry?”

A

• Auto-immune disease
• Abn protein (antiphospholipid autoantibodies) initiate coagulation, leads to clotting in arteries and veins. If this occurs in placental vessels- blocks placenta growth and thrombi can loosen the placenta and interfere with o2 and nutrient exchange
o Result of this is recurrent miscarriages and hypertension of preg

46
Q

What treatment plan will the nurse teach a patient with antiphospholipid antibody syndrome to follow?

A

o Clotting risk inc with bed ret, smoking, obesity, and use of estrogen-based birth control ills
o Prophylaxis therapy to prevent miscarriages is oral low dose aspirin and subcut heparin started at beginning of pregnancy, continued for several wks after birth
o Women taught to self admin hep; teach aspirin is essential (not like other people taking it)
o Alt therapies- IV immunoglobulin infusions or administration of a corticosteroid such as prednisone can be added if heparin and aspirin are not adequate.

47
Q

What specific risk will woman with antiphospholipid symdrome have postpartally?

A

DVT in legs

48
Q

Ectopic Pregnancy-“Why has this happened to me?”

what causes this?

A

o Fertilization still occurs in the distal third of the fallopian tube but there is an obstr present such as an adhesion of the fallopian tube from a previous infection, congenital malformations, scars from tubal surgery or a uterine tumor pressuing on the proximal end of the tube, the zygote cannot travel the length of the tube
o Incidence is inc possibly bc of inc rate of pelvic inflammatory disease which can lead to tubal scarring. Incidene is also increased following in vitro fertilization and also in women who smoke.

49
Q

Where are most ectopic pregnancies implanted?

A

o Implantation ouside uterine cavity. Most common site is the fallopian tube. 80% occur in ampullar portion, 12% in isthmus, and 8% are interstitial or fimbrial
o Fertilization still occurs in the distal third of the fallopian tube but there is an obstr present + zygote cannot travel length of tube

50
Q

What are the signs and symptoms of an ectopic pregnancy?

A

♣ No unusual symp of implantation (no menstruation occurs, have usual N+V)
♣ Usually diagnosed by ultrasound or MRI.
♣ S+S of rupture: sharp, stabbing pain in one of her lower abdm quadrants at the time of the rupture, followed by scant vaginal spotting.
♣ Inc blood loss- chance of hypovolemic shock therefore, lightheadness, inc pulse, etc.
♣ If woman waits to long- abdm becomes rigid from peritoneal irriation and umbilicus may develop a bluish- tinged hue (Cullen sign)

51
Q

Why is hemorrhage a major nursing concern with ectopic pregnancy?

A

♣ At 6-12 weeks, the zygote grows large enough that if it ruptures the slender fallopian tube
♣ Tearing and destruction of blood v and bleeding result
♣ If implantation was in the interstitial portion of the tube (where the tube meets the uterus) rupture can cause severe intraperitoneal bleeding because of the alrge blood v in that part of the tube.
♣ Amount of blood present does not indicate amount lost
♣ Placenta dislodges, progesterone secretion will stop and the uterine decidua will begin to clough, causing additional vaginal bleeding.
♣ May have continuing extensive or dull vaginal and abdm movement; movement of the cervix on pelvic examination can cause excruciating pain
♣ May have pain in her shoulders from blood in the peritoneal cavity irritating phrenic nerve
♣ A tender mass is usually palpable in douglas cul-de-sac on vaginal examination

52
Q

What medication is used to treat an ectopic pregnancy?

A

o Therapetuic mgmt.: some spont end before the rupture and are reabsorbed over the next few days requiring no tx.
♣ Usually treated by PO med of methotrexate.
♣ Adv: tube is left intact with no surgical scarring that oculd cause a 2nd ectopic implantation
♣ Treated until neg hCG titer is achieved also use an US to check and make sure tube is patent and no more implantation
♣ Amount of blood evident is poor estimate of actual blood loss.

53
Q

Hydatiform Mole-
aka?
What is it?
Two types?

A
  • Aka Gestational Throphoblastic Disease
  • Abnormal proliferation and then degernation of the trophoblastic villi. The embryo fails to develop beyond a primitive start.
  • two types of molar growth can be identified by chromosome analysis. With a complete mole, all trophoblastic villi swell and become cystic. If an embryo forms, it dies early at 1-2 mm in size, with no fetal blood present in the villi.
54
Q

How is hydatiform mole assoc w cancer?

Which type has stronger association?

A
  • Abnormal trophoblast cells assoc with choriocarcinoma, a rapidly metastasized malignancy
  • Complete moles more likely lead to choriocarcinoma (not partial)
55
Q

How is the # of chromosomes changed with complete mole + partial mole?

“I thought I was pregnant, but now everyone is talking about cancer risks. Can you help me understand what is going on?”

A

• On chromosomal anaylysis although the karyotype is a normal 46XX 46XY, this chromosome was only contributed by the father or an “empty ovum” was fertilized and the chromosome materal was duplicated.

• With a partial mole of the villi form normally, the syncytiotrophoblastic layer of the villi appears sweollen and misshapen. Embryo may grow 9 wk and macerate
o has 69 chr. (69XX, 69XY) – 3 chr for every pair instead of 2 (triploid formation)

56
Q

S+S and progression of hydatiform mole..

dont’ think we need to know this

A

o Uterus tends to expand faster than usual
o Rapid development could also be multiple pregnancies or miscalculated due date
o hCG is produced y trophoblast cells that are overgrowing
o n and v is usually marked, prob bc high hCG
o gestational htn may be present before wk 20 w gestational trophoblastic disease
o US shows dense growth but no fetal growth and no heart sounds.
o At wk 16- if struc not identified it will show through vaginal bleeding. Next accompanied by clear fluid-filled vesicles. Presence of these cysts change the dx from simple miscarriage to gestational trophoblastic disease.

57
Q

Tx of hydatiform mole?

A

o Suction curettage to evacuate the abnormal trophoblast cells. Following extraction women should have a baseline pelvic exam and a serum test for the beta subunit of hCG
o If level plateaus or inc – malignant transformation (choriocarcinoma).
o After 6 months if hCG levels are still neg, theoretically free from malignancy. By 12 months can plan 2nd preg. frustrating to have to wait!
o Some are given prophylactic course of methotrexate. If malignancy should occur, can be treated effectively with methotrexate. Dactonomycin can also be added.

58
Q

Cervical Insufficiency (premature cervical dilation)

  • may not need to know this all…just asked about cervial cerclage (next Q)
A
  • Cervix that dilates prematurely and cannot retain fetus.
  • Painless and 1st sympt is show (pink-stained vaginal disch) or inc pelvic pressure which is then rupture of membranes and dichar of amniotic fluid
  • Uterine contractions begin and fetus is born.
  • Commonly occurs wk 20 and fetus is too immature
  • Associated w inc maternal age, congential structural defects and trauma to the cervix which could have occurred with cone biopsy or repeated D&Cs.
  • Often dx after preg is lost
59
Q

“What is a cervical cerclage, and why do I need to have it?”

A
  • Cervical cerclage surgery must be performed following this loss, to prevent from happening again
  • As soon as US confirms fetus of second preg is healthy at 12-14 wk purse string sutures are placed in the cervix by the vaginal route under regional anesthesia. Procedure is called a McDonald or Shirodkar procedure. Sutures strengthen the cervix and prevent it from dilating
  • Mcdonald- nylon sutures are placed horizontally and vertically across cervix
  • Shirodkar - sterile tape is threaded in a purse-string mane ruder submucosal layer of the cervix and sutured in place to achieve a closed cervix. Can be done by transabdominal route
  • Women need bed rest in trendelenburg position for a few days to dec pressure on new sutures
  • Sutures removed week 37-38. With transabdominal approach, sutures may be left in place and c-section is performed.
60
Q

Multiple pregnancy- “I’ve heard that having twins means I am ‘high-risk’. Everyone is so excited for me but should I be worried about anything more than if I was having just one baby?”

A
  • More susceptible to gest htn, hydramnios, placenta previa, preterm labor, + anemia
  • More prone to postpartum bleeding b/c additional uterine stretching
  • Can have twisting of umbilical cords, one fetus receiving disproportionate nutrients, etc
  • May have more fatigue, need several small meals (as apetite dec w P on stomach)
  • At greater risk in general
  • U/S may show multiple amniotic sacs but later only one = vanishing twin syndrome
61
Q

What is the normal amount of amniotic fluid for a woman to have? With hydramnios?

A
  • Normal amniotic fluid vol at term = 500-1000mL
  • Here have >2,000mL or amniotic fluid index >24cm
  • Additional uterine space allows fetus to turn malposition
  • Risk of premature rupture d/t P possible infect, prolapsed cord, + preterm birth
62
Q

What are some causes of hydramnios?

A

FOrmally: Amnio fluid formed by combo of cells of amniotic membrane + fetal urine –> Swallowed by fetus, absorbed across intestinal membrane into fetal bloodstream + transferred across the placenta.
• Hydramnios suggests possible fetal inability to swallow, absorb, or excessive urine production
o Inability to swallow occurs in fetus anencephalic, tracheoesophageal fistula with stenosis, or intestinal obstruct
o Mom w diabetes = hyperglycemia in mom can do same in fetus polyuria

63
Q

What important nursing care does a woman with hydramnios receive?

A
  • May be home or hospital
  • Bed rest to inc uteroplacental circ + reduce P on cervix to prevent preterm labour
  • Avoid constipation (fiber, stool softener) – P could cause rupture
  • Tell v important to notify if signs of labour
  • Assess VS + signs of edema
  • Amniocentesis possibly to reduce fluid amounts – but has to be done daily
  • Tocolysis to halt early labour
  • Almost always preterm labour + early birth – can poke needle to control slow release of fluid to prevent cord prolapse, etc
64
Q

What are the potential causes of oligohydramnios?

A

=Less than average amniotic fluid
• Usually d/t bladder or renal disorder in fetus not voiding
• Or d/t severe growth restriction of fetus not voiding as much

65
Q

What should a nurse assess for in a neonate who had oligohydramnios?

A
  • Fetus cramped weak muscles, lungs not fully developed (hypoplastic), distorted facial features
  • Suspected when growth rate not on target, confirmed by U/S
66
Q

What is a normal preg length? What is considered post-term?

When is infant considered post-mature?

A
  • Normal term = 38-42 wks; anything longer = postterm

* Infant is postmature or dysmature if evidence of placental insufficiency + this interfered w growth

67
Q

Why is important to take an accurate menstrual history from women when calculating their due date?

A
  • Some women have long menstrual cycles (40-45 days), ovulate on day 26 or 31 instead of 14 will make it appear as though child is 12-17 days late, when in fact are not
68
Q

What dangers to the fetus result from a post-term pregnancy?

A
  • <2wks overdue at greater risk: meconium aspiration as fetal GI contents reach rectum, macrosomia can create birth problem
  • Usual effect of postterm is lack of growth b/c placenta only functions for 40-42 weeks, then calcium deposits…fetus now may not get adequate O2, nutrients, fluid
  • If oligohydramnios occurs d/t less fetal urine, can have cariable decelerations in the FHR from cord compression

N332 (8 decks)

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