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Maternal Exam 3 > Medical Surgical Disorders part 2 > Flashcards

Medical Surgical Disorders part 2 Flashcards

1
Q

Goal of managing a pregnancy in mom with asthma?

A

Prevent mom from becoming hypoxic to prevent baby from losing oxygen

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2
Q

How to monitor lung functioning in mom with asthma?

A

Peak expiratory flow
Forced expiratory volume test
Her respiratory complaints

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3
Q

Are all asthma patients treated the same?

What if they are having financial issues?

A

No because they all use different medication combinations.

Help with financial issues and encourage them to share that with provider

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4
Q

Drugs for asthma

Will they use these during labor? And after?

A

Corticosteroids for inflammation (budesonide or pulmicort)
Bronchodilators for dilation of airways (albuterol)

yes they can use these in labor and postpartum

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5
Q

If mom knows that a certain medication or exposure to smoke triggers her asthma, what should the nurse tell her?

A

Avoid her triggers

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6
Q

Since pregnancy can sort of exacerbate asthma symptoms or what not, how soon will the asthma mom be back to normal?

A

3 months post partum

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7
Q

What is Latent Tuberculosis TB?

Treatment for latent?

A

TB disease but no symptoms.

Latent Tuberculosis is treated with Isoniazid and Vit B

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8
Q

What is Active Tuberculosis TB?

Treatment for active?

A

TB disease with symptoms

Active Tuberculosis needs Isoniazid, Vit B w Ethambutol, and Rifampin

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9
Q

Can mom transfer her TB to her baby?

Can mom breastfeed?

A

Yes through respiratory. Rare for it to transfer through placenta

So mom needs to wear a mask during breastfeeding if she is being treated

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10
Q

What is Pruritus Graviadarum?

A

Generalized itching of the abdomen but no rash

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11
Q

Skin issues that cause itching in Pruritus Gravidarum?

Past medical history that can cause the itching ?

A

Skin distention and striae

Diabetes
Nulliparity
Multiple gestations
Fertility tx

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12
Q

Treatment of Pruritus Gravidarum that they can give?

What does those with Pruritus gravidarum need to limit exposure to?

A

Treat itching with …
skin lubricants
topical antipruritics
oral antihistamines

Limit exposure to outside sun

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13
Q

What is PUPPS?

A

Pruritic Urticarial Papules and Plaques in Pregnancy

This team she has itching with lesions on abdomen or thighs but spreads

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14
Q

What is PUPPS associated with or risks?

A

Gaining weight
Having multiple gestations
Elevated BP

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15
Q

PUPPS treatment

A

Antipruritic topical meds
Steroid topical
Oral antihistamines
Oral prednisone

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16
Q

Does PUPPS usually affect the baby in any negative way

A

No not usually,

If it is extreme they might induce labor for mom’s comfort and so she doesn’t itch herself into an infection from staph

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17
Q

Intrahepatic Cholestasis of Pregnancy

A

Liver disorder that has itching of palms, feet, or other body parts too with no lesions

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18
Q

When is Intrahepatic Cholestasis of Pregnancy worse at?

A

Night

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19
Q

Because Intrahepatic Cholestasis of Pregnancy involves the liver, what might we see?

What labs will you check?

What about toileting?

A

Jaundice

Elevated liver enzymes
Elevated serum bile acids

Urine is dark and light colored stools

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20
Q

Intrahepatic Cholestasis of Pregnancy treatment med?

A

Ursodeoxycholic acid that needs to be tapered off before delivery though

If it is just too severe, they can induce her around 37 weeks (just like pupps).

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21
Q

Dismissal care for Intrahepatic Cholestasis of Pregnancy?

A

The itching of palms and feet or elsewhere can happen again if she used Oral contraceptives BC or if she gets pregnant again

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22
Q

Most common neurologic disorder in PG

A

epilepsy

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23
Q

Ideally, what do we want women with epilepsy to be like before getting pregnant?

A

Seizure free for years and well controlled with meds

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24
Q

How do you treat epilepsy while mom is pregnant?

A

Lowest effective dose of SINGLE anticonvulsants

  • Keppra or Lamictal
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25
Q

Why do a lot of women end up having seizures in pregnancy despite being prescribed a single anticonvulsant though?

A

She gets the idea that her drugs can harm her baby and so she stops taking them.

It is better to take the drugs rather than causing trauma to mom and baby with a seizure!

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26
Q

How do exacerbations of epilepsy in pregnancyhappen?

A

N/V and throwing up meds
No sleep
Noncompliance.. which is the main reason

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27
Q

What does lab need to do for epileptic pregnant moms?

A

Monitor the drug level since we want a low therapeutic level

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28
Q

Biggest threat to baby during an epileptic seizure?

A

Hypoxia

Trauma

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29
Q

What medicine is used to treat a seizure during labor?

Can mom breastfeed in general?

A

Ativan

yes she can

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30
Q

When giving a baby a bath, what should epileptic mom consider?
Stairs?

A

Need another adult so if she goes into seizure, so baby doesn’t drown
She needs to avoid carrying baby up stairs too bc she can fall and drop the baby
- using a stroller is always best for anytime you have to transport baby instead of carrying

31
Q

Bell Palsy

Effects of bell palsy?

A

Acute idiopathic facial paralysis

One sided ear pain, lack of eye coordination, hearing , and taste just lacking

32
Q

Bell palsy cause?

A

Facial paralysis cause is unknown but it COULD be from viral herpes exposure or recent other viral infection like flu, covid, etc.

33
Q

Why is Bell palsy more common in pregnant woman than non-pregnant woman?

A

Due to increased risk for BP and preeclampsia

34
Q

Bell palsy treatment

A

Steroids within 3-5 days like prednisone

- do a bolus dose and taper off

35
Q

How long does Bell palsy take to recover from?

A

Approximately 1/2 may not have full recovery but those who do, will be recovered by one year

36
Q

What do people mistake bell pasly for?

A

Stroke ! but you know it is palsy if its just the face affected

37
Q

Cholelithiasis

Why can it occur in pregnancy more often?

A

Gall stones

occur in pregnant woman because of the hormone change and pressure of the uterus blocking the gallbladder from draining

38
Q

Symptoms of Cholelithiasis

What increases the risk of the gall stones

A

Biliary pain, epigastric pain to back w fatty foods

Obesity and multiparity (more pregnancies hx)

39
Q

Cholecystitis

What causes this?

A

Inflammation of the gallbladder

A stone now is obstructing the cystic duct

40
Q

Cholecystitis symptoms that are different than Cholelithiasis?

A

Cholecystitis will have same symptoms but pain will hurt more and biggest thing is they will now have a fever

41
Q

Food management of Cholecystitis or surgery?

remember trimesters

A

They’ll try to do diet first and hopefully wait until she has delivered to do any surgery (for 2nd and 3rd trimester moms) BUT sometimes the surgery has to be done

42
Q

Most common cause for surgery in PG that isn’t due to OB reasons

A

Appendicitis

43
Q

Appendicitis symptoms

diagnostic testing done for appendicitis?

A

Can be hard to diagnose bc the appendix can be pushed up in PG so pain won’t be in RLQ. RUQ
- n/v with elevated wbc

Ultrasound due to less radiation than CT. they can do MRI but more expensive
Test for UTI with urine test
Chest x ray to r/o pneumonia

44
Q

Appendicitis surgical treatment?

Meds for treatment?

A

appendectomy to remove the appendix

Clindomycin or Gentamicin if and when they rupture

45
Q

Appendicitis maternal and fetal mortality rate

A

4% mom

30% baby

46
Q

Best indicator of Maternal status in pre-operating room and the recovery period is what?

A

FHR - if baby is doing good then mom is doing good

47
Q

Which trimester has increase sab if they do surgery?

preterm?

A

1st sab

3rd preterm

48
Q

Which trimester has less complications w surgery ?

A

2nd trimester

49
Q

What to address before surgery in any pregnant mom?

A

Address her fear and anxiety

- anesthesia will do their part too

50
Q

Meds to neutralize gastric acidity before procedure?

A

Antacid

51
Q

What was the biggest risk for regional anesthesia and how is it prevented?

What else do you need to do before anesthesia administers the block?

What does nurse need to monitor?

A

Hypotension but prevented with fluid bolus and we have to do this before ANY time pregnant mom has regional anesthesia (not just when she is needing pain med for labor)

Empty her bladder with catheter

FHR bc it also helps give clue on mom’s status too

52
Q

What positioning will mom need to be in during surgery of any kind?

A

Tilted with hip wedge or table at 15 degree angle or so to help circulation of placenta and prevent complications of vena cava syndrome

53
Q

Post op care for surgeries?

A

turn cough deep breath
spirometry
SCD - clots
Ambulate asap - clots

54
Q

Leading cause of fetal and maternal death

A

Motor vehicle accidents so wear seatbelts

55
Q

Forms of trauma that can hurt mom and fetus

A

Falls, partner violence, burns, homicide, suicide, penetrating wounds

56
Q

What can happen if mom has too much trauma?

A

Uterine rupture, placenta abruption, preterm labor, PROM, miscarriage or stillbirth

57
Q

Most common form of violence against women

what are the odds

how many women are assessed for abuse during intake screenings

A

Intimate partner relationship so bf/husband

odds are 35.6%

all women will be screened for that in hospital in pg

58
Q

Characteristic of Potential male abusers

A 
Using intimidation
Emotional abuse
Isolating woman
Denying and blaming
Using kids
Male privilege
Economic abuse
Coercion and threats
59
Q

What are ways abused women ask for help in a not so obvious way?

A

Calling in for appointments frequently

- like if her stomach hurts all the time or something

60
Q

A mom with a bruise has to take a minute to come up with a reason why or her reason doesn’t make sense. She has bruises that are multiple different colors. What do you suspect?

A

abuse bc bruises that are different colors means she got them at different times

61
Q

Mom broke her leg 3 days ago and is just now coming in. What do you suspect and why

A

Abuse bc of the lag of coming into the hospital or getting help

62
Q

If mom has randomly missed an appointment, what should you do

A

investigate why she missed (or melzher would like you to lol )

63
Q

Mom comes in with a bf who won’t leave her alone and neither of them really makes eye contact. What should you do

A

Report your suspicions

64
Q

Should you ever let a family interpret for you and the patient

A

no - this means they can make the story or narrative whatever they want

65
Q

ABCDES of caring for mom who may be abused

A

A- alone or she is not alone
B - belief that violence against women is wrong and you should tell her that
C- confidentiality due to retaliation but restraining disorders can be obtained 24 hr/day
D - for document
S - safety call 911 if she is imminent danger

66
Q

What to educate woman on if you think she is being abused?

A

Tell her it is her choice but that what is being done is wrong. And if she ever plans to flee, tell her to be prepared for it. Have everything packed and ready to go Bc it is the moment leading up to her leaving him that will get her killed.

67
Q

Why do we recommend counseling for anyone who is abused including women

A

to break the cycle of abuse

68
Q

Why is it important to remind mom she can be successful on her own if she has an abusive partner?

A

Bc she may not view herself as capable without him but this is incorrect. She can stay at a shelter for 30-90 days to get on her feet

69
Q

When dealing with a pregnant mom who may be harmed w abuse, who do we assess first and treat?

A

the mom. without mom, baby won’t make it. So this is for the both of them

70
Q

What happens if mom is Tachycardic and hypotensive ?

How will mom compensate for the blood loss in regards to the fetus?

A

By now the hemorrhage has occurred
This is bc greater volumes of blood being lost happens before the shock.

Her body will shunt blood from uterus/fetus so if mom is stable, you do still need to take care of baby. check the strip for any sign of demise

71
Q

How long should pregnant trauma patients be monitored for ?

A

minimum of 4 hours with EFM
but the history determines how long she is monitored for

dont want to risk placental separation and fetus

72
Q

After a trauma and when you are ready to dismiss PG mom, what do you instruct her to do

A

Return IMMEDIATELY if she has bleeding, leaking fluid ,, decreased fetus movements, or severe abdominal pains

73
Q

Where do major trauma go at our hospitals

A

level 3 OB

Maternal Exam 3 (8 decks)

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