Midterm - Mod 3 Flashcards
What’s included in the Biophysical exam?
1) Fetal heart rate and reactivity
2) Fetal breathing movements
3) Body movements
4) Tone (closure of hand)
5) Volume of Amniotic fluid (AFI)
(score 8-10 = No fetal asphyxia - repeat testing weekly)
Amniotic fluid index (AFI) is a quantitative estimate of amniotic fluid and an indicator of fetal well-being. How is the Amniotic fluid volume tested?
US measures amniotic fluid pockets in all four quadrants surrounding the mothers umbilicus and produces AFI.
What is a transvaginal ultrasound ?
Usually done in 3rd trimester
- used to determine length of cervix to detect risk of preterm birth
(requires empty bladder unlike other US)
What is a doppler test
Used to determine adequacy of blood flow through fetal vessels, placenta and the umbilical cord
- For women in whom it is likely to be impaired (such as women with pregnancy-induced hypertension or diabetes mellitus)
What is a amniocentesis?
What do nurses monitor post-amniocentesis?
- Insertion of a thin needle through abdominal and uterine walls to obtain a sample of amniotic fluid
- signs of bleeding, monitor site for echymosis, drainage (TACO)
what is a Litmus (Nitrazine) test?
What does it mean if the strip turns blue?
- Nitrazine test involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye
- The strips change color depending on the pH of the fluid.
- The strips will turn blue if the pH is greater than 6.0. A blue strip means it’s more likely the membranes have ruptured
What is a ferning test?
- determine whether amniotic fluid or urine came out if pt comes in stating they had leakage
- If your water is broken, the fluid mixed together with estrogen will create a “fern-like” pattern under a microscope due to salt crystallization
Danger Signs in Pregnancy
- Sudden gush of fluid from the vagina
- Vaginal bleeding
- Abdominal pain
- Persistent vomiting
- Epigastric pain
- Edema of face and hands
- Severe, persistent headache
- Blurred vision or dizziness
- Chills with fever over 38.0°C (100.4°F)
- Painful urination or reduced urine output
What is Hyperemesis gravidarum?
Treatment?
Nursing care?
- pregnancy complication characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Feeling faint may also occur. more severe than morning sickness.
- Treatments: Diclectin, Zofran, IV hydration, parental nutrition
- Nursing Care
o Avoid triggers/odors
o Record accurate daily intake and outputs
o Stress reduction
Preterm Premature Rupture of Membranes (PPROM) - Spontaneous rupture of membranes before 37 weeks of gestation and before labor begins. How is it diagnosed and nursing care?
- Diagnosis confirmed by Nitrazine paper test
- Nursing Care:
o Assess temperature, fetal tachycardia, lower abdominal tenderness
o Patient teaching about infection and preterm labor- report to health care facility asap
- report temperature higher than 38 degrees
- Avoid anything that may stimulate uterine contractions (sex, nipple stimulation)
- Report signs of infection and go to emerge
- Less than 10 kicks in 2 hours go to emergency
Diagnosis of preterm labor is based on?
How is it determined?
- cervical effacement and dilation of more than 2 cm
- shortened cervix on ultrasound at 20 weeks may determine
- A fibronectin test: a protein produced by the fetal membranes and leaks into vaginal secretions if uterine activity, infection, or cervical effacement occurs.
(presence of fibronectin in vaginal secretions between 22 and 24 weeks)
How do you stop preterm labor to get patient closest to term as possible?
Initial and inevitable measures
Initial measure:
- Identifying and treating infection
- Activity restriction
- Hydration
inevitable:
- Steroids increase fetal lung maturity - Betamethasone – 2 IM injections 24 hours apart
- Tocolytic therapy - Magnesium sulfate via IV infusion
- Thyroid-releasing hormone also enhances lung maturity in fetuses younger than 28 weeks.
*what are signs of a Threatened abortion? cervix is?Determination and recommendations if living?
- Cramping and backache with light spotting; cervix is closed – no active contractions at this point
- Ultrasound used to determine if fetus is living; bedrest, no sex
*what are signs of an inevitable abortion? cervix is?Determination and recommendations if living?
- Increase bleeding and cramping; cervix dilates
- US to determine if living - Bedrest and monitored; natural evacuation of uterus; save peri-pads
*what are signs of an Incomplete abortion? cervix is?Actions?
- Bleeding, cramping, dilation of the cervix, passage of tissue
- Uterus may be emptied of remaining tissue by D&E (dilation or evacuation) or vacuum; save peri-pads; monitor for clots
*what is a complete abortion? cervix ___? Bleeding ____?
- Passage of all products of conception (fetus is past the umbilical cord; all of the placenta, membranes) all pass through cervix, it closes and bleeding stops
o Patient is monitored and emotional support provided
- what is a missed abortion?
what can occur?
- Fetus dies in utero but is not expelled; sepsis can occur
o Uterus is evacuated by D&E
A Recurrent abortion is ___
What actions are taken with a Recurrent abortion?
Two or more consecutive spontaneous abortions
o Reinforcement of the cervix by surgical suture or cerclage
Nursing care for spontaneous abortion
- Monitor and document the amount and character of bleeding; Save clots and tissue for pathologist; # and % of pad soaked
- Assess vital signs – any time of blood loss = risk of hypotension; low BP, high pulse
Patient teaching for spontaneous abortion
o Report increased bleeding
o Take temperature q8h for 3 days; report signs of infection- foul odor or brownish color of vaginal drainage
o Take iron supplements as prescribed
o Resume sexual activity as recommended by the prescriber
o Pregnancy can occur before the first menstrual period returns after the abortion
o Emotional care- little footprints with AHS
What is Placenta Previa? Signs? Risks? Monitor?
The placenta develops over the lower part of the uterus rather than the upper part
- Painless vaginal bleeding that is usually bright red
o Marginal- plancenta reaches within 2-3cm of cervical opening
o Partial- placental partly covers the cervical opening
o Total- placenta completely covers the cervical opening
- Risk of hemorrhage increase as the cervix begins to efface and dilate
- Monitor FHR and character of contractions, report blood loss
What is Abruptio placenta/ placenta abruption? S&S? Predisposing factors?
Premature separation of a placenta that is normally implanted
- S&S: Dark red bleeding accompanied by abdominal or low back pain
o Uterus is tender, firm and cramp-like contractions are felt
- Causes: Hypertension, cocaine use, cigarette smoking, poor nutrition, abdominal trauma, previous history, folate deficiency
For women who are battered/abused, what are some signs to watch out for?
- Late or erratic prenatal care; missing appointments, could be controlled by someone else
- Bruises in various stages of healing; unexplained
what is mild preeclampsia? Characterized by?
mild preeclampsia plan of care ?
- a pregnancy complication characterized by:
- BP 140-160,/90-110
- protein in the urine that wasnt there before
- occurring after week 20 of pregnancy
- cannot exercise, activity restriction is important for pre-eclampsia/ Monitor BP
- fetal health surveillance
- diet
what is severe preeclampsia characterized by? Nursing care?
Proteinuria - Protein in urine - Sustained Systolic BP >160 - Sustained Diastolic BP >110 - Epigastric pain - Excessive weight gain in the 2nd or 3rd trimester (4lbs/week) Eclampsia - Seizure activity or coma in woman diagnosed with pre-eclampsia - Liver and coagulation abnormalities are present Severe pre-eclampsia -Hospital care: - Magnesium sulphate - Control of BP - Labetalol
Diabetes mellitus causes a Major risk for congenital anomalies to occur from maternal hyperglycemia during the
embryonic period of development. What are the effects on mom and fetus in pregnancy?
Mom: Spontaneous abortion Gestational hypertension Preterm labor and premature rupture of membranes Infections Complications of large fetal size Fetal and neonatal: Congenital abnormalities Macrosomia, intrauterine growth restriction Perinatal death RDS/Delayed lung maturation Neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia and jaundice, polycythemia
what is gestational diabetes?
In true GDM, glucose usually returns to normal by when?
o Glucose intolerance with onset during pregnancy
o In true GDM, glucose usually returns to normal by 6 weeks postpartum.
GDM - If woman cannot increase insulin production, she will have periods of ?
and will also expoerience…?
o She will have periods of hyperglycemia because fetus is continuously drawing glucose from mother
o She will also experience hypoglycemia between meals and during the night because fetus is continuously drawing glucose from the mother
•During the second and third trimesters Fetus is at risk for organ damage from hyperglycemia because fetal tissue has increased tissue resistance to maternal insulin action.
Effect on pregnancy on glucose metabolism - Hormones (estrogen and progesterone), insulinase (an enzyme), and increased
prolactin levels have two effects. What are they?
- Increased resistance of cells to insulin
- Increased speed of insulin breakdown
Most women respond to these changes by secreting extra insulin
What are treatments for GDM
> Diet – Avoid single large meals with high amounts of simple carbohydrates (ensure frequent small meals, 3 meals 3snacks)
Monitoring blood glucose levels and HgbA1C à – must keep blood glucose levels as close to normal as possible and taught the S&S of hypoglycemia and hyperglycemia
Glycosylated hemoglobin (HgbA1C) is performed every 3 months to provide an indication of long-term glucose control; lower levels indicate successful glucose management
Ketone monitoring – Urine ketones may be checked to identify the need for more carbohydrates
Insulin and oral hypogycemics – Oral hypoglycemic drugs can successfully treat GDM
o Exercise
o Fetal assessment
Acronym TORCH is used to describe infections that can be devastating to the fetus or newborn. What does it stand for
Toxoplasmosis Other Rubella Cytomegalovirus Herpes
