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4040 maternal child > mod 2 complication > Flashcards

mod 2 complication Flashcards

1
Q

What situations should the pt reach out to a provider during pregnancy that could indicate an emergency

A

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

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2
Q

Type of miscarriage

A

inevitable, threatened, complete, incomplete, missed, septic, recurrent

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3
Q

S/S of miscarriage

A

bleeding (spotty heavy) cramping, pain

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4
Q

management of pt post miscarriage

A

bedrest, supportive care, D&C

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5
Q

S/S for ectopic pregnancy

A

pain, bleeding, abd tenderness (lower quadrant), referred shoulder pain

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6
Q

What is the treatment for ectopic pregnancy

A

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

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7
Q

what is placenta previa and what are S/S

A

the placenta covers the cervical OS
PAINLESS BLEEDING in the later half of pregnancy

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8
Q

what are complication related to placenta previa

A

premature ROM, premature birth

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9
Q

what is the management of placenta previa prior to 36 weeks

A

conservative to push the pregnancy as long as possible, they will need a c/s
NO VAGINAL EXAM BY NURSE

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10
Q

What is the S/S for abruptio placentae

A

Sudden intense, rigid abdomen, bleeding, mass noted under placenta
high risk for deaths to both

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11
Q

how do you manage abruptio placentae

A

vaginal birth is still an option with extreme monitoring and a possible stat C/S

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12
Q

what are the three placenta variations and to what layer do they penetrate

A

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

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13
Q

what is the main concern with vasa previa

A

rupture and compression of the vessels to fetus
it is diagnosed with color or pulse Doppler US
can lead to fetal death

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14
Q

what leads to suspicion of cervical insufficiency and what is the treatment of it

A

multiple miscarriage, bed rest and cerclage between 11-15 wks

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15
Q

what causes dehydration, weight loss, ion imbalance, ketosis or acetonuria

A

hyperemesis gravid arum NOT morning sickness

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16
Q

what are some collaborative care interventions done with a pt suffering from hyperemesis gravidarum

A

rule out problems like kidney liver gallbladder, pancreas
psychological assessment
give iv fluids, meds, bland foods

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17
Q

what are some disease the baby is at risk for if blood is incompatible with mothers

A

icterus gravis, kernicterus, bilirubine encephalopathy, (erythroblastosis fatalis syndrome)
preventions is rhogam at 28 weeks (Coombs test)

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18
Q

in what situation would the baby be at risk for incompatible blood

A

mom is negative and baby is positive
ABO is when mother is O and fetus is A,B,AB(assess for hyperbillirubinemeia)

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19
Q

what can anemia during pregnancy lead to

A

hemoglobinopathy like sickle cell or thalassemia, puerperal complication (boob ouch)

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20
Q

what is the treatment and Dx is the pt has a 3 hr glucose test where 2/3 are over 130mg/dL

A

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

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21
Q

what are complications associated with GDM with the fetus

A

spontanous AB, infecions, preeclampsia
diagnosed with NST, breathing, movement, tone, HR, amniotic fluid

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22
Q

how long are post partum GDM patent monitored after

A

6 weeks

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23
Q

chronic HTN criteria

A

prior to 20th wk or before pregnant

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24
Q

gestational HTN criteria

A

BP over 140/90 after 20 weeks (recorded x2 4 hr apart)

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25
Q

preeclampsia criteria

A

HTN with proteinuria or w/o after 20 wks

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26
Q

what are prognosis for HTN disorders in regard to perinatal morbidity/mortality

A

uteroplacental insuffuncency , premature birth

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27
Q

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

A

thrombocytopenia, impaired Liver, new renal insufficiency , pulmonary edema, new cerebral or visual disturbances

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28
Q

What are risk factor for Pre E

A

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

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29
Q

what is the path of pre e

A

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

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30
Q

what is a laboratory dx of a severe variant of severe pre e that involves hepatic dysfunction

A

HELLP
hemolysis(H)
elevated liver enzymes (EL)
low platelets (LP)

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31
Q

S/S of HELLP

A

flu like symptoms, epigastric pain, nausea, HA, bruising

Tx- Mg, BP meds, assess for shock and hepatic rupture

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32
Q

risk factor for HELLP

A

1st pregnancy
multiple gestatiom
age extreme
obesity
GDM, collagen dx, HTN
family hx of pre e
new paternity

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33
Q

how do we control seizures and HTN

A

for SBP >160 and DBP >110 then labetalol or hydralazine

seizure- mag sulfate

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34
Q

therapeutic range for Mg sulfate

A

4.8-8.4

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35
Q

what level do you notice mental status change while on mg sulfate

A

10-12

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36
Q

how is Mg sulfate given

A

IV piggyback and NEVER IM

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37
Q

what is the assessment for mg sulfate

A

DTR, mental q hour, respiration qhour, HR qhour, UOP qhour, listen to lung qshift , bedrest, NPO or Clear liquid

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38
Q

warning signs of mg sulfate toxicity

A

absent DTR, UOP <30mL/hr

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39
Q

what is the antidote for mg sulfate

A

calcium glutinate 20mL 10% IV push VERY SLOW NO FASTER THAN 2mL/min

40
Q

how long between bolus of hydralazine

A

20 min

41
Q

treatment of hypotension post HTN medication

A

lateral position, hypovolemia assessment, monitor FHR, monitor pulmonary edema

42
Q

what can happen if GBS is crossed to the baby

A

PROM, preterm labor, chorioamniotitis, uti, sepsis

43
Q

What is TORCH

A

toxicoplasmosis, other infection, rubella (miscarriage), Cytamegalovirus (HSV family), HSV

44
Q

what precaution is taken with a. mother with an active TB infection

A

no breastfeeding

45
Q

what meds stop or slow down labor (tocolytics)

A

Indomethacin
Nifedipine (flushing, HA, dizzy)
Mag sulfate
Terbutaline (tachy, palpitation, pulomary edema)

46
Q

what are interventiosn for a shoulder dystocia baby

A

mcroberts (knees to chest)
pressure on supraapubic

47
Q

what is a baby at risk for after devleoping bruising and hematoma

A

jaundice

48
Q

macrosomimc baby

A

baby greater than 4000g

49
Q

CPD- cephalopelvic disporportion is assoicated with what

A

uterine rupture

50
Q

what are risk of delivery with obese pt

A

GDM, Pre E, Thrombosis, vaccum use, laceration, macrosomia, shoulder dystocia

51
Q

EVC (external cephalic version)

A

turning a breach or transverse presentation
works better if baby is not engaged
IF PT IS Rh - GIVE RHOGAM DUE TO BLEEDING RISK

52
Q

What causes PROM

A

infection, incompetent cervix, fetal condition, social and enviormental factors

53
Q

What is included in the nursing assessment for PROM

A

Rupture
gestation
favorable cervix
nitrozine
pooling
ferning

54
Q

What are risk factors for PPROM

A

before 37 weeks

hydraminos
bleeding
fetal abnoramlities
STI
Smoking
Nutrional problems

55
Q

Risk for mom and baby for PPROM

A

mom- infetion C/S
baby- sepstis, hypoxia, deformities

56
Q

Risk factors for preterm labor

A

young old
smoker
GDM, HTN
multiples
low prepreg weight

57
Q

Nursing assessment for preterm baby

A

risk factors
Ctx
Backache
cramping
D/C
leaking of fluid
cervical change (consisitent, growing stronger)
education (dehydration)

58
Q

Primary prevention for preterm labor

A

prophylatic progestrone sup (if hx)
tocolytic drug
hyfration
bedrest
Antibx
steriods (betamethazone, dexamethasone for fetal lung development)

59
Q

fFn

A

fetal fibronectin test- test to see if they are going to be preterm for next 7-10 days

60
Q

Chroioamnionitis S/S

A

maternal fever
tachy for both mom or fetus
uterine tenderness (extreme)
odor of amniotic fluid (c dif)

61
Q

how is labor induced

A

crevical ripening (cytotec or cervidil)
balloon
stripping membrane
amniotomy (breakin water)

62
Q

what are risk for post term babes

A

decreased amniotic fluids, old pacenta, meconium aspiration, macrosomia

63
Q

what can cause mecomium leakage

A

decels, stress, OR

64
Q

Nursing actions for pitocin induction

A

consent
start low dose
V/S q30
monitor fetal/maternal response
monitor labor progress
watch ctx pattern

65
Q

what are some qualitification for a VBAC

A

low transverse incision, adequte pelvis, OR and surgical team ready

66
Q

What is a bishops score for

A

score to assess if they are a candidate for TOLAC

<6 not a caniddate
>8 good chace to go

67
Q

What are some intrapartum emergencies

A

placental abnormatilitse
shoulder dystocia
prolapse cord
uterine rupture/inversion
anaphlactoid syndrome (embolism)
trauma

68
Q

what are risk factors for prolapsed cord

A

malpresentation, unengaged presentation, hyaminos, small fetus, multiple gestation

CAUSE BRADYCARDIA IN FETUS !!!

69
Q

nursing intervention for prolapsed cord

A

nurse takes sterile hand to stick it in there and decompress cord until it is out

70
Q

What is EBL for vaginal and c/s that considered hemorrhage

A

vag- >500mL
c/s- >1000mL

71
Q

What is uterine atony and what does it lead to

A

boggy fundus and it leads to hemorrhage

72
Q

what are some risk factors for uterine atony

A

overdistension of uterus
multiparity
intrapartum factors

73
Q

clinical signs for uterine atony

A

boggy fundus
cant find fundus
only firm when it is massaged
fundus is above expected level
excessive clots

74
Q

how do you treat post partum hemrrhage

A

massage
empty bladder
pitocin
methergine
cytotec (s/e- shivering diarrhea, pyrexia)
hembate
iv fluids (isotonic)

75
Q

What is methergine is used for

A

sustained contraction of uterus
not giving to HTN pt
given IM best but also PO

76
Q

what does cytotec (misoprotol) do

A

contract uterus
S/E- HA, N/V/D, fever, chills
given rectally or buccal or PO

77
Q

What puts mom at risk for post party infection

A

long labor
trauma
hand washing
too many cervical examines

78
Q

Risk factors for transient tachypnea of newborn

A

C/S, asphyxia, macrosomia, multiple gestation, maternal sedation, prolonged labor, male gender, GDM, postterm/preterm

79
Q

S/S for transient tachypnea of newborn

A

grunting, retractions, nasal flaring, mild cyanosis, Chest xray show hyper inflation, presence of fluid,

80
Q

management of transient tachypnea of newborn

A

o2 therapy, continuous gavage feeding, IV fluid, observe for infection, antibiotics

81
Q

Asphyxia

A

meconium aspiration- intrautrine trauma results in possible aspiration, birth trauma

82
Q

MAS- meconium aspiration syndrome causes what

A

hypoxia, obstruction of airway/pneumonia, airtrapping

83
Q

assessment and management of MAS

A

yellow stained nails and skin and signs of mild respiratory distress

tx- deep suctions with ET tube, intubation , resuscitation

84
Q

what are examples of acquired problems for newborn

A

birth trauma, maternal SU,

85
Q

S/S for neonatal infection

A

apnea, bradycardia, poor perfusion, hypotensive, seizure, grunting, retraction, acidosis, feeding intolerance, vomiting’s, jaundice, petechiae

86
Q

key sign of sepsis

A

mottling

87
Q

substance use related disorders for newborn

A

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

88
Q

Neonatal abstinence syndrome assessment tool and tx

A

Finnegan score/flacc score
swaddle
small frequent feed
suction

89
Q

post term baby assessment findings

A

MAS, hypoxia, polycythemia, hyperbilirubinemia, hypoglycemia, poor sub q stores, dry scly skin, poor feeding, lack of vernix, profuse hair and long fingernails

90
Q

at risk for SGA when …

A

maternal SUD, MGD, pre e, chromic conditions, uteroplacental insufficiency, multiple, TORCH, cord problems

91
Q

manifestations for SGA infant

A

growth deficiency, hypoglycemia, polycythemia, unstable temp, perinatal asphyxia, hypoglycemia, acrocyanosis, hypotonia, decreased SQ gat

92
Q

management of SGA infant

A

o2 support, early feeding, glucose management, developmental screening, thermal reg

93
Q

LGA risks

A

birth injury, asphyxia, hypoglycemia, polycythemia

94
Q
A
95
Q
A

4040 maternal child (6 decks)

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