Maternity week 2-Workbook

Question 1

what developmental tasks might be interrupted by pregnancy in adolescence

Answer 1

1. to establish a sense of self-worth or value system,
2. to emancipate from parents
3. to adjust to a new body image
4. to choose a vocation

Question 2

what are the 7 prominent complications of pregnancy for adolescents

Answer 2

1. High risks of gestational HTN,-bed rest is best
2. iron def anemia-d/t poor intake
3. premature labor,-uterus not fully grown
4. postpartum hemmorhage-as uterus not grown and gets distended by preg so it cant contract
5. lack of knowledge of infant care
6. disproportion of fetal and pelvic size,
7. inability to adapt postpartally-talk to prevent postpartum dep

other issues are hemorhoids, intimate partner violence and low birth wt…

Question 3

what is most effective for prenatal care of pregnant adolescent
one in particular is best and others?

Answer 3

• Minimizing the number of care providers may be most effective
• Early and consistent care
• Some like group care for peer interaction

Question 4

is a woman >40 likely to have serious complications during pregnancy/delivery
why
what is most common

Answer 4

not generally. with good prenatal care she should be fine

fetal chromosomal abn have inc incidence in those >40

Question 5

how might the physical health of a pregnant woman >40 be different than a younger one
what system in particular?

Answer 5

she will likely enter pregnancy with comorbidities

cardiovascular issues

Question 6

what is the developmental task of those >40 and how would this affect their pregnancy

Answer 6

• their developmental task is to expand their awareness or develop generativity-a sense of moving away from themselves nad getting involved with the world or community. This might make them ambivalent towards preg as they want to continue their reg activities

Question 7

what social, work, relationship, role issues might >40 pregnant woman face

Answer 7

• they might feel the clock is ticking and get preg immed after starting new relationship=many adjustments at once
• if she has high-paying job/career might be hard to stop work
• might be sandwich generation with multiple older and younger dependents
• may not have friends her age having babies-less peer support

Question 8

what chromosomal risk do women >40 face inc risk of

Answer 8

• inc risk of Down Syndrome from 1/1500 to 1/1000

Question 9

names of specific tests done for Down Syndrome

other tests done

Answer 9

• quad screen or integrated screen are done to see if open spinal cord or chromosomal defect could be present in fetus
• U/S for nuchal translucency
• Lab tests of alpha fetoprotein and
-test for hCG (hormone made by placenta)
-test for estriol (made by placenta and fetus
-test for inhibin A (made by ovaries and placenta done at 15-16wks)

Question 10

when is ultrasound for nuchal translucency

Answer 10

if it is translucent it suggests Down syndrome and its done weeks 10-13

Question 11

what is alpha fetoprotein

what does it mean if this and the other substances tested are high

Answer 11

alpha fetoprotein (protein made by fetus), hCG, estriol (made by fetus and placenta), inhibin A a protein made by placenta and ovaries. 
These substances will be inc in maternal serum if fetus has open spinal defect and lower than usual if a chromosomal abn is present

Question 12

what does “substance dependent” mean

Answer 12

• A person is substance dependent when they have withdrawal symptoms following discontinuation of the substance, combined with abandonment of important activities, spending inc time in actitivities r/t substance use, using substances for longer time than planned, or continued use despite worsening problems because of substance use

Question 13

how does being subsstance dependence impact the mother

Answer 13

• She may not have $ for supplements, nutrition, iron
• May have inc risk of Hep B or HIV, STIs
• Mum might have inc BP, tachycardia, vasoconstriction from the drugs
-likely she has less supports, less $ and poor nutrition

Question 14

how does being substance dependent affect the fetus

-what beyond the direct and immediate effects of the drug will harm the fetus?

Answer 14

• She may not have $ for supplements, nutrition, iron
-she might not access prenatal care
• Infant may have drug withdrawal after birth if she was still using up to labour,

Question 15

-is it easy for drugs to cross the placenta? how much?

Answer 15

• Illicit drugs are small molecular weight often and they can eaily cross the placenta
• Fetus has drug conc of 50% of the mom

Question 16

what complications can result fom substance use in pregnancy

what is one of the main issues with durg use during preg beyond the direct toxins

Answer 16

• Can lead to fetal abn, preterm birth, abruption placentae.
• May have dec fetal heart rate variability from poor tissue perfusion (poor perfusion)

Question 17

what are the 4 compications asso with >40 pregnancy

im not so sure which she means…

Answer 17

Gest HTN-inc risk d/t blood vessel elasticity dec. the HTN may have existed before preg

failure to progress in labour as cervical dilation doesnt happen as easily

post.p.hem-uterus might not contract as readily

, preterm birth-
or postterm birth,
cesarean

hemorrhoids, varicose veins, thrombophlebitis

Question 18

what are the risks assoc with uterine rupture

Answer 18

• prolonged labor,
• abnormal presentation,
• multiple gestation
• , unwise use of oxytocin,
• obst labor,
• and traumatic maneuvers of forceps or traction

Question 19

what are the sés of uterine rupture for mum and babe

Answer 19

• sudden, severe pain during a strong labor contraction. Rupture can be complete, going through the endometrium, myometrium, and peritoneum layers or incomplete leaving it intact
o 2 distinct swellings on abd: retracted uterus and exttrauterine fetus
• Hemorrhage from the torn uterine floods into abdcavicty and possibly vagina. Signs of hypotensive shock begin
• If rupture is incomplete, signs are less evident…localized tenderness and persistent aching pain over te area of lower uterine segment
• Fetal heart sounds, lack of contractions and the change in vital signs reveal fetal and maternal distress

Question 20

what are the nursing and medical interventions for uterin rupture

Answer 20

• Administer IV fluid, maybe IV oxytocin to contract the uterus
• Prepare woman for possible laparotomy to control bleed
• They might do tubal ligation or hysterectomy as she is advised not to conceive again

Question 21

what is uterine inversion and what two events might cause it

Answer 21

• Uterus turning inside out with either birth of the fetus or delivery of the placenta

2 events that cause inversion
• May occur if the traction is applied to the cord to remove the placenta or if pressure is applied to the uterine fundus when the uterus is not contracted. May also occur if the placenta is attaché at the fundus so that, during birth, the passage of the fetus pulls the fundus downward

Question 22

how might the pt present or what can tell nurse that pt has uterine inversion

how can uterine inversion be prevented

Answer 22

Nurse might notice
• Lg amount of Blood gushes through vagina
• Fundus is no longer palpable
• S&S if her bleeding continues: dizziness. Hypotensive, pale, diaphoresis

To prevent in future after inversion occurs she will need c-section

Question 23

how to respond to uterine inversion

what do you NOT do

Answer 23

• Don’t attempt to replace inversion-more bleeding
• Oxytocin should be d/c bc makes uterus more tense and difficult to replace. Will admin after physician replaces fundus manually to help uterus contract and remain in natural place
• IV fluid or blood
• O2 by mask and vitals
• Prepare for CPR in case too much blood loss
• Will be given general anesthesia, possibly nitroglycerin, or tocolytic drug to relax uterus
• Abx to prevent infection

Question 24

what is an amniotic fluid embolism and how does it present

Answer 24

• Occurs when amniotic fluid is forced into an open maternal uterin blood isnus after a membrane rupture of partial premature separation of the placenta
• Humoral or anaphlactoid response to amniotic fluid in the maternal circulation. May occur in labor or postpartal period

S&S:
• sits up and suddenly grasps chest bc of sharp pain and inability to breath as pulmonary artery constriction occurs. Becomes pale then typical bluish gray associated w a PE and lack o blood flow to the lungs. Within min, LOC and fetus is in danger bc placenta circulation stops

Question 25

what is amniotic fluid embolism assoc with and how can you prevent it

Answer 25

Associated with induction of labor, multiple pregnancy, and perhaps hydramnios,
Not preventable bc cant be predicted

Question 26

still to do: substances, anomalies of placenta and cord…reflection questions..maybe the highlighted words.

Answer 26

x

Question 27

placenta normal wt

how many cm diameter

Answer 27

• Normal weight = 500g, 15-20cm diameter, 1.5-3.0cm thick; weight ~1/6 of fetus

Question 28

what are the 6 anomalies of the placenta

Answer 28

the placenta is the baby’s p-SAC…and VBV

placenta succentariata
placenta accreta
placenta circumvallata

vasa previa

battledore placenta
valamentous insertion of the cord

Question 29

which types of placental anomalies are not assoc w abnormalities

which of these must be removed manually to prevent adverse effects

Answer 29

placenta succentariata-remove manually to prevent hem
placenta circumvallata
battledore placenta

Question 30

what type of placenta abn can you not deliver with

Answer 30

Placenta Accreta

Question 31

what is significant about pacenta accreta

Answer 31

• Unusually deep attachment of placenta to uterine myometrium
• Will not loosen + deliver
• Can’t remove d/t hem risk…may need hysterectomy or tx w methotrexate

Question 32

Placenta Succentariata what is it and what is the danger

Answer 32

• One or more accessory lobes connected to main placenta by blood vessels
• No fetal abnormality
• Small lobes may be retained after birth  severe maternal hem
• If recognized + removed manually, no adverse effects

Question 33

which of the placental abn has some extent of the fetal side covered with chorion

Answer 33

placnta circumvallata

Question 34

placenta circumvallata
how bad is it
what is it

Answer 34

• Usually chorion membrane extends from edge of placenta + goes over fetus
• Here, fetal side of placenta covered to some extent with chorion
• Umbilical cord enters placenta at usual midpoint + large vessels spread from there..but end abruptly at point where chorium folds back onto the surface
• In placenta marginata, fold of chorion reaches just to edge of placenta
• No abnormalities assoc with this

Question 35

which placental abn has an Unusually deep attachment of placenta to uterine myometrium
what might be necessary

Answer 35

Placenta Accreta
• Will not loosen + deliver
• Can’t remove d/t hem risk…may need hysterectomy or tx w methotrexate

Question 36

which of the placenta abn is most rare and not cliniclly significant
what occurs in this

Answer 36

3) Battledore Placenta
• Cord inserted marginally rather than centrally
• Rare + no clinical significance

Question 37

Valamentous Insertion of the Cord

what is the issue
what is it often assoc with
what type of anomalies might result

Answer 37

• Cord, instead of entering placenta directly, separates into small vessels that reach placenta by spreading across fold of amnion
• Most frequently found with multi gestations
• Assoc with fetal anomalies d/t possible loss of blood supply

Question 38

which placental abn has vessels laying across the cervical os that might be delivered before the baby and tear

Answer 38

vasa previa (i think “vas” like vessel and “previa” like previous. The vessels can come previous to the fetus)

• Umbilical vessels of a velamentous cord sertion cross the cervical os + deliver before fetus
• Vessels may tear w cervical dilation (just like placenta previa)
• Tear = sudden fetal blood loss (suspected if sudden painless blood loss occurs with cervical dilation)
• Careful when inserting fetal monitoring devices
• Identified by U/S
• Need C-section

Question 39

what are the 2 anomalies of the cord

Answer 39

unusual cord length

two vesse cord

Question 40

what are the vessels normally found in the cord and what do they contain

Answer 40

1 vein (the vein carries nutrient rich blood to babby, 2 arteries that carry waste back to placenta

Question 41

what is 2 vessel cord
what systems might have been affected
consideration for checking the cord

Answer 41

• Here, only 1 artery
• Assoc with congenital heart + kidney anomalies (insult affected vessel also affected other mesoderm germ layer)
• Must check cord immed after birth for all vessels before drying occurs – if see this, baby needs to be assessed carefully

Question 42

what are the problems with a umbilical cord that is too short or too long

Answer 42

• If short, can result in premature separation of the placenta or abnormal fetal lie
• If long, may twist + knot  will most likely not affect blood supply

Question 43

what is a nuchal cord and is it serious

Answer 43

• Nuchal cord – wraps around fetal neck. Not usually harmful.

Question 44

who is most likely to be using substances during preg (age)

Answer 44

young weomen

Question 45

how does cocaine affect the body of mom and therefore the fetus

what risks are there

Answer 45

• Affects CNS  vasoconstriction  inc resp + cardiac rates
• Effect can be so dramatic it leads to cardiac failure
• During preg, vasoconstriction  severely compromised placental circ + premature separation of the placenta  preterm labour or fetal death

Question 46

how might a baby going through cocaine withdrawal look
beyond preterm labour, fetal death, cardiac failure what immediate risk is there to fetus

what type of long term deficits might be seen

Answer 46

• Infants suffer immediate effects of intracranial hem + abstinence syndrome of tremulousness, irritability, muscle rigidity
• Poss social + learning deficits in long term (not well documented)

Question 47

Amphetamines
what effects do they have
name of meth that is smoked

Answer 47

Amphetamines 
•	Methanphetamine = speed – neurostimulant + neurotoxin
•	Cheap, made in home labs 
•	Effects similar to cocaine
•	Ice = rock type of meth smoked

Question 48

what can amphetamine use look like in the woman

what would it ook like in the infant

Answer 48

• Women: blackened + infected teeth

* Infant: jitteriness + poor feeding at birth, growth restrictions

Question 49

effects of marijauna and hashish
why might a woman use this
is it safe for breastfeeding

Answer 49

• Both from cannabis
• Produce tachycardia + sense of well-being
• May use pot for nausea in preg
• Effects not well documented, as often part of polydrug abuse
• Mom may be asked not to breast feed as have reduced breast milk + contains the drug

Question 50

what effects is marijauna assoc w

Answer 50

• Assoc w loss of short-term memory + inc in resp infections in adults

Question 51

what is pcp

whys it bad

Answer 51

• PCP-phenylcyclidine
• Used by rave culture, used to be used as anesthetic
• Leaves maternal cells + concentrates in fetal cells, may be particularly injurious to fetus

Question 52

what result can drinking alohol during preg have for fetus
taching consideration for YA
what other drug seems to have sim effects

Answer 52

• Results in FASD (recognizable facial features, cognitive challenges, memory deficits)
• Ensure young adults know binge drinking is not safe for fetus (this seems a little obvious??)
-inhalants have sim effects

Question 53

inhalants what are they and what causes the damage

what is the negative effect

Answer 53

• Glue, cooking sprays, computer keyboard cleaner
• Often done by adolescents
• Freon in these products  resp + cardiac irregularities
• Appears to have similar effects to alcohol during preg
• Resp depression leads to dec O2 to fetus

Question 54

what matures faster in infants whosse mums were substance dependent. how does this benefit them

Answer 54

• Fetal livers and lungs often mature faster w substance dependent mom  can deal with bilirubin better + have less resp distress syndrome than average

Question 55

what negative effects does heroin have for poor baby

Answer 55

• Heroin: can result in fetal opiate dependence + severe abstinence symptoms is child after birth
o Babies small, inc fetal distress + meconium aspiration

Question 56

what are the abstinence symptoms of a baby from heroin

Answer 56

o Abstinence symptoms: NVD, abdm pain, shivering, insomnia, body aches, muscle jerks – can begin as soon as 6 hrs after last dose + continue for several days

Question 57

if heroin taken what kind of complications can the pregnancy have

Answer 57

• Cocaine: pregnancy complications incl gestation HTN, phlebitis, subacute bacterial endocarditis, heb B and HIV (if injected)

Question 58

benefits to mom on methadone vs heroin

what else might they use

Answer 58

• If possible, want mom in methadone program during preg – fetus still will have abstinence symptoms at birth…sometimes worse with methadone than heroin (but at least is being procide better nutrition, prenatal care, less exposure to hep B + HIV)
• Bupredorphine sometimes used if methadone not available or suboxone (naloxone + bupredorphine)

Question 59

what unique considerations to include for woman over 40 physical assessment

Answer 59

• physical exam—esp circulatory problems. Get urine spec to test for renal fx and diabetes. Look for breast CA. Gestational trophoblastic disease (hydatiform mole) is more common so assess funal height and fetal movement