mod 2 complication Flashcards
What situations should the pt reach out to a provider during pregnancy that could indicate an emergency
bleeding/leaking fluid from vag
sudden severe swelling of face hand fingers
severe long lasting HA
discomfort pain in lower abdomen
fever chills
vomitting or have persistent nausea
dysuria
vision problems or blurry vision
dizzy
suspect less movement than normal after 28 wks
have thought of harming yourself or baby
Type of miscarriage
inevitable, threatened, complete, incomplete, missed, septic, recurrent
S/S of miscarriage
bleeding (spotty heavy) cramping, pain
management of pt post miscarriage
bedrest, supportive care, D&C
S/S for ectopic pregnancy
pain, bleeding, abd tenderness (lower quadrant), referred shoulder pain
What is the treatment for ectopic pregnancy
meth or surgery (may or may not leave the Fallopian tube based on if pt desire to retry, must wait 3 months to try again)
recurrent ectopic pregnancy need appt if she thinks she is prego
what is placenta previa and what are S/S
the placenta covers the cervical OS
PAINLESS BLEEDING in the later half of pregnancy
what are complication related to placenta previa
premature ROM, premature birth
what is the management of placenta previa prior to 36 weeks
conservative to push the pregnancy as long as possible, they will need a c/s
NO VAGINAL EXAM BY NURSE
What is the S/S for abruptio placentae
Sudden intense, rigid abdomen, bleeding, mass noted under placenta
high risk for deaths to both
how do you manage abruptio placentae
vaginal birth is still an option with extreme monitoring and a possible stat C/S
what are the three placenta variations and to what layer do they penetrate
accreta- endometrium
increta- myometrium
percreta- uterine wall to other organ
these lead to post delivery hemorrhage and require C/S or hysterectomy if bleeding cannot be controlled
what is the main concern with vasa previa
rupture and compression of the vessels to fetus
it is diagnosed with color or pulse Doppler US
can lead to fetal death
what leads to suspicion of cervical insufficiency and what is the treatment of it
multiple miscarriage, bed rest and cerclage between 11-15 wks
what causes dehydration, weight loss, ion imbalance, ketosis or acetonuria
hyperemesis gravid arum NOT morning sickness
what are some collaborative care interventions done with a pt suffering from hyperemesis gravidarum
rule out problems like kidney liver gallbladder, pancreas
psychological assessment
give iv fluids, meds, bland foods
what are some disease the baby is at risk for if blood is incompatible with mothers
icterus gravis, kernicterus, bilirubine encephalopathy, (erythroblastosis fatalis syndrome)
preventions is rhogam at 28 weeks (Coombs test)
in what situation would the baby be at risk for incompatible blood
mom is negative and baby is positive
ABO is when mother is O and fetus is A,B,AB(assess for hyperbillirubinemeia)
what can anemia during pregnancy lead to
hemoglobinopathy like sickle cell or thalassemia, puerperal complication (boob ouch)
what is the treatment and Dx is the pt has a 3 hr glucose test where 2/3 are over 130mg/dL
she has gestational diabetes mellitus and need to start treatment with exercise and diet first, then metformin, if that doesn’t work then insulin it is MF
what are complications associated with GDM with the fetus
spontanous AB, infecions, preeclampsia
diagnosed with NST, breathing, movement, tone, HR, amniotic fluid
how long are post partum GDM patent monitored after
6 weeks
chronic HTN criteria
prior to 20th wk or before pregnant
gestational HTN criteria
BP over 140/90 after 20 weeks (recorded x2 4 hr apart)
preeclampsia criteria
HTN with proteinuria or w/o after 20 wks
what are prognosis for HTN disorders in regard to perinatal morbidity/mortality
uteroplacental insuffuncency , premature birth
Pre E is condition with HTN and proteinuria developed after 20 wks in previously normotensive mother… if proteinuria is absent what else would conclude to Pre E
thrombocytopenia, impaired Liver, new renal insufficiency , pulmonary edema, new cerebral or visual disturbances
What are risk factor for Pre E
1st baby under 19 over 40
new paternity
extreme obesity
history of pre e
african
family hx
multifetal gestation
chronic renal dx
chronic HTN
DM
RA
SLE
what is the path of pre e
main problem is poor perfusion
decreased renal profusion->low oncotic pressure causes edema->vasoconstriction of cerebral vessels lead to rupture cap that impact eyes and DTR
what is a laboratory dx of a severe variant of severe pre e that involves hepatic dysfunction
HELLP
hemolysis(H)
elevated liver enzymes (EL)
low platelets (LP)
S/S of HELLP
flu like symptoms, epigastric pain, nausea, HA, bruising
Tx- Mg, BP meds, assess for shock and hepatic rupture
risk factor for HELLP
1st pregnancy
multiple gestatiom
age extreme
obesity
GDM, collagen dx, HTN
family hx of pre e
new paternity
how do we control seizures and HTN
for SBP >160 and DBP >110 then labetalol or hydralazine
seizure- mag sulfate
therapeutic range for Mg sulfate
4.8-8.4
what level do you notice mental status change while on mg sulfate
10-12
how is Mg sulfate given
IV piggyback and NEVER IM
what is the assessment for mg sulfate
DTR, mental q hour, respiration qhour, HR qhour, UOP qhour, listen to lung qshift , bedrest, NPO or Clear liquid
warning signs of mg sulfate toxicity
absent DTR, UOP <30mL/hr
what is the antidote for mg sulfate
calcium glutinate 20mL 10% IV push VERY SLOW NO FASTER THAN 2mL/min
how long between bolus of hydralazine
20 min
treatment of hypotension post HTN medication
lateral position, hypovolemia assessment, monitor FHR, monitor pulmonary edema
what can happen if GBS is crossed to the baby
PROM, preterm labor, chorioamniotitis, uti, sepsis
What is TORCH
toxicoplasmosis, other infection, rubella (miscarriage), Cytamegalovirus (HSV family), HSV
what precaution is taken with a. mother with an active TB infection
no breastfeeding
what meds stop or slow down labor (tocolytics)
Indomethacin
Nifedipine (flushing, HA, dizzy)
Mag sulfate
Terbutaline (tachy, palpitation, pulomary edema)
what are interventiosn for a shoulder dystocia baby
mcroberts (knees to chest)
pressure on supraapubic
what is a baby at risk for after devleoping bruising and hematoma
jaundice
macrosomimc baby
baby greater than 4000g
CPD- cephalopelvic disporportion is assoicated with what
uterine rupture
what are risk of delivery with obese pt
GDM, Pre E, Thrombosis, vaccum use, laceration, macrosomia, shoulder dystocia
EVC (external cephalic version)
turning a breach or transverse presentation
works better if baby is not engaged
IF PT IS Rh - GIVE RHOGAM DUE TO BLEEDING RISK
What causes PROM
infection, incompetent cervix, fetal condition, social and enviormental factors
What is included in the nursing assessment for PROM
Rupture
gestation
favorable cervix
nitrozine
pooling
ferning
What are risk factors for PPROM
before 37 weeks
hydraminos
bleeding
fetal abnoramlities
STI
Smoking
Nutrional problems
Risk for mom and baby for PPROM
mom- infetion C/S
baby- sepstis, hypoxia, deformities
Risk factors for preterm labor
young old
smoker
GDM, HTN
multiples
low prepreg weight
Nursing assessment for preterm baby
risk factors
Ctx
Backache
cramping
D/C
leaking of fluid
cervical change (consisitent, growing stronger)
education (dehydration)
Primary prevention for preterm labor
prophylatic progestrone sup (if hx)
tocolytic drug
hyfration
bedrest
Antibx
steriods (betamethazone, dexamethasone for fetal lung development)
fFn
fetal fibronectin test- test to see if they are going to be preterm for next 7-10 days
Chroioamnionitis S/S
maternal fever
tachy for both mom or fetus
uterine tenderness (extreme)
odor of amniotic fluid (c dif)
how is labor induced
crevical ripening (cytotec or cervidil)
balloon
stripping membrane
amniotomy (breakin water)
what are risk for post term babes
decreased amniotic fluids, old pacenta, meconium aspiration, macrosomia
what can cause mecomium leakage
decels, stress, OR
Nursing actions for pitocin induction
consent
start low dose
V/S q30
monitor fetal/maternal response
monitor labor progress
watch ctx pattern
what are some qualitification for a VBAC
low transverse incision, adequte pelvis, OR and surgical team ready
What is a bishops score for
score to assess if they are a candidate for TOLAC
<6 not a caniddate
>8 good chace to go
What are some intrapartum emergencies
placental abnormatilitse
shoulder dystocia
prolapse cord
uterine rupture/inversion
anaphlactoid syndrome (embolism)
trauma
what are risk factors for prolapsed cord
malpresentation, unengaged presentation, hyaminos, small fetus, multiple gestation
CAUSE BRADYCARDIA IN FETUS !!!
nursing intervention for prolapsed cord
nurse takes sterile hand to stick it in there and decompress cord until it is out
What is EBL for vaginal and c/s that considered hemorrhage
vag- >500mL
c/s- >1000mL
What is uterine atony and what does it lead to
boggy fundus and it leads to hemorrhage
what are some risk factors for uterine atony
overdistension of uterus
multiparity
intrapartum factors
clinical signs for uterine atony
boggy fundus
cant find fundus
only firm when it is massaged
fundus is above expected level
excessive clots
how do you treat post partum hemrrhage
massage
empty bladder
pitocin
methergine
cytotec (s/e- shivering diarrhea, pyrexia)
hembate
iv fluids (isotonic)
What is methergine is used for
sustained contraction of uterus
not giving to HTN pt
given IM best but also PO
what does cytotec (misoprotol) do
contract uterus
S/E- HA, N/V/D, fever, chills
given rectally or buccal or PO
What puts mom at risk for post party infection
long labor
trauma
hand washing
too many cervical examines
Risk factors for transient tachypnea of newborn
C/S, asphyxia, macrosomia, multiple gestation, maternal sedation, prolonged labor, male gender, GDM, postterm/preterm
S/S for transient tachypnea of newborn
grunting, retractions, nasal flaring, mild cyanosis, Chest xray show hyper inflation, presence of fluid,
management of transient tachypnea of newborn
o2 therapy, continuous gavage feeding, IV fluid, observe for infection, antibiotics
Asphyxia
meconium aspiration- intrautrine trauma results in possible aspiration, birth trauma
MAS- meconium aspiration syndrome causes what
hypoxia, obstruction of airway/pneumonia, airtrapping
assessment and management of MAS
yellow stained nails and skin and signs of mild respiratory distress
tx- deep suctions with ET tube, intubation , resuscitation
what are examples of acquired problems for newborn
birth trauma, maternal SU,
S/S for neonatal infection
apnea, bradycardia, poor perfusion, hypotensive, seizure, grunting, retraction, acidosis, feeding intolerance, vomiting’s, jaundice, petechiae
key sign of sepsis
mottling
substance use related disorders for newborn
alcohol- fetal alcohol syndrome- craniofacial features, low ears, thin upper lip, developmental delay
tobacco- preterm, SGA
methadone- w/draw
heroin- w/draw, LBW, SGA, high pitched cry, seizure
Met- SGA, preterm, lethargy, behavioral problems
COKE- preterm, SGA, microcephaly, w/draw
Neonatal abstinence syndrome assessment tool and tx
Finnegan score/flacc score
swaddle
small frequent feed
suction
post term baby assessment findings
MAS, hypoxia, polycythemia, hyperbilirubinemia, hypoglycemia, poor sub q stores, dry scly skin, poor feeding, lack of vernix, profuse hair and long fingernails
at risk for SGA when …
maternal SUD, MGD, pre e, chromic conditions, uteroplacental insufficiency, multiple, TORCH, cord problems
manifestations for SGA infant
growth deficiency, hypoglycemia, polycythemia, unstable temp, perinatal asphyxia, hypoglycemia, acrocyanosis, hypotonia, decreased SQ gat
management of SGA infant
o2 support, early feeding, glucose management, developmental screening, thermal reg
LGA risks
birth injury, asphyxia, hypoglycemia, polycythemia
