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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
preeclampsia criteria
HTN with proteinuria or w/o after 20 wks
26
what are prognosis for HTN disorders in regard to perinatal morbidity/mortality
uteroplacental insuffuncency , premature birth
27
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
28
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
29
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
30
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)
31
S/S of HELLP
flu like symptoms, epigastric pain, nausea, HA, bruising Tx- Mg, BP meds, assess for shock and hepatic rupture
32
risk factor for HELLP
1st pregnancy multiple gestatiom age extreme obesity GDM, collagen dx, HTN family hx of pre e new paternity
33
how do we control seizures and HTN
for SBP >160 and DBP >110 then labetalol or hydralazine seizure- mag sulfate
34
therapeutic range for Mg sulfate
4.8-8.4
35
what level do you notice mental status change while on mg sulfate
10-12
36
how is Mg sulfate given
IV piggyback and NEVER IM
37
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
38
warning signs of mg sulfate toxicity
absent DTR, UOP <30mL/hr
39
what is the antidote for mg sulfate
calcium glutinate 20mL 10% IV push VERY SLOW NO FASTER THAN 2mL/min
40
how long between bolus of hydralazine
20 min
41
treatment of hypotension post HTN medication
lateral position, hypovolemia assessment, monitor FHR, monitor pulmonary edema
42
what can happen if GBS is crossed to the baby
PROM, preterm labor, chorioamniotitis, uti, sepsis
43
What is TORCH
toxicoplasmosis, other infection, rubella (miscarriage), Cytamegalovirus (HSV family), HSV
44
what precaution is taken with a. mother with an active TB infection
no breastfeeding
45
what meds stop or slow down labor (tocolytics)
Indomethacin Nifedipine (flushing, HA, dizzy) Mag sulfate Terbutaline (tachy, palpitation, pulomary edema)
46
what are interventiosn for a shoulder dystocia baby
mcroberts (knees to chest) pressure on supraapubic
47
what is a baby at risk for after devleoping bruising and hematoma
jaundice
48
macrosomimc baby
baby greater than 4000g
49
CPD- cephalopelvic disporportion is assoicated with what
uterine rupture
50
what are risk of delivery with obese pt
GDM, Pre E, Thrombosis, vaccum use, laceration, macrosomia, shoulder dystocia
51
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
52
What causes PROM
infection, incompetent cervix, fetal condition, social and enviormental factors
53
What is included in the nursing assessment for PROM
Rupture gestation favorable cervix nitrozine pooling ferning
54
What are risk factors for PPROM
before 37 weeks hydraminos bleeding fetal abnoramlities STI Smoking Nutrional problems
55
Risk for mom and baby for PPROM
mom- infetion C/S baby- sepstis, hypoxia, deformities
56
Risk factors for preterm labor
young old smoker GDM, HTN multiples low prepreg weight
57
Nursing assessment for preterm baby
risk factors Ctx Backache cramping D/C leaking of fluid cervical change (consisitent, growing stronger) education (dehydration)
58
Primary prevention for preterm labor
prophylatic progestrone sup (if hx) tocolytic drug hyfration bedrest Antibx steriods (betamethazone, dexamethasone for fetal lung development)
59
fFn
fetal fibronectin test- test to see if they are going to be preterm for next 7-10 days
60
Chroioamnionitis S/S
maternal fever tachy for both mom or fetus uterine tenderness (extreme) odor of amniotic fluid (c dif)
61
how is labor induced
crevical ripening (cytotec or cervidil) balloon stripping membrane amniotomy (breakin water)
62
what are risk for post term babes
decreased amniotic fluids, old pacenta, meconium aspiration, macrosomia
63
what can cause mecomium leakage
decels, stress, OR
64
Nursing actions for pitocin induction
consent start low dose V/S q30 monitor fetal/maternal response monitor labor progress watch ctx pattern
65
what are some qualitification for a VBAC
low transverse incision, adequte pelvis, OR and surgical team ready
66
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
67
What are some intrapartum emergencies
placental abnormatilitse shoulder dystocia prolapse cord uterine rupture/inversion anaphlactoid syndrome (embolism) trauma
68
what are risk factors for prolapsed cord
malpresentation, unengaged presentation, hyaminos, small fetus, multiple gestation CAUSE BRADYCARDIA IN FETUS !!!
69
nursing intervention for prolapsed cord
nurse takes sterile hand to stick it in there and decompress cord until it is out
70
What is EBL for vaginal and c/s that considered hemorrhage
vag- >500mL c/s- >1000mL
71
What is uterine atony and what does it lead to
boggy fundus and it leads to hemorrhage
72
what are some risk factors for uterine atony
overdistension of uterus multiparity intrapartum factors
73
clinical signs for uterine atony
boggy fundus cant find fundus only firm when it is massaged fundus is above expected level excessive clots
74
how do you treat post partum hemrrhage
massage empty bladder pitocin methergine cytotec (s/e- shivering diarrhea, pyrexia) hembate iv fluids (isotonic)
75
What is methergine is used for
sustained contraction of uterus not giving to HTN pt given IM best but also PO
76
what does cytotec (misoprotol) do
contract uterus S/E- HA, N/V/D, fever, chills given rectally or buccal or PO
77
What puts mom at risk for post party infection
long labor trauma hand washing too many cervical examines
78
Risk factors for transient tachypnea of newborn
C/S, asphyxia, macrosomia, multiple gestation, maternal sedation, prolonged labor, male gender, GDM, postterm/preterm
79
S/S for transient tachypnea of newborn
grunting, retractions, nasal flaring, mild cyanosis, Chest xray show hyper inflation, presence of fluid,
80
management of transient tachypnea of newborn
o2 therapy, continuous gavage feeding, IV fluid, observe for infection, antibiotics
81
Asphyxia
meconium aspiration- intrautrine trauma results in possible aspiration, birth trauma
82
MAS- meconium aspiration syndrome causes what
hypoxia, obstruction of airway/pneumonia, airtrapping
83
assessment and management of MAS
yellow stained nails and skin and signs of mild respiratory distress tx- deep suctions with ET tube, intubation , resuscitation
84
what are examples of acquired problems for newborn
birth trauma, maternal SU,
85
S/S for neonatal infection
apnea, bradycardia, poor perfusion, hypotensive, seizure, grunting, retraction, acidosis, feeding intolerance, vomiting's, jaundice, petechiae
86
key sign of sepsis
mottling
87
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
88
Neonatal abstinence syndrome assessment tool and tx
Finnegan score/flacc score swaddle small frequent feed suction
89
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
90
at risk for SGA when ...
maternal SUD, MGD, pre e, chromic conditions, uteroplacental insufficiency, multiple, TORCH, cord problems
91
manifestations for SGA infant
growth deficiency, hypoglycemia, polycythemia, unstable temp, perinatal asphyxia, hypoglycemia, acrocyanosis, hypotonia, decreased SQ gat
92
management of SGA infant
o2 support, early feeding, glucose management, developmental screening, thermal reg
93
LGA risks
birth injury, asphyxia, hypoglycemia, polycythemia
94
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4040 maternal child (6 decks)

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