NUR332 Exam 1 Flashcards
Things to assess with a newborn?
- general assessment with VS, labs, etc
- preterm/term
- measurements/height
- meds received: erythromycin, vitamin K injection, hep injection
- significant data from mom’s chart
- APGAR score
- feedings
- bonding with parents
mons pubis
protects pelvic bone
labia majora
protects underlying tissue
labia minora
lubricate vulvar skin and secretes sebum and skin oils
clitoris
female erectile tissue
urethral meatus
urine comes out
skene’s glands
create secretions for vaginal opening
hymen
tissue that surrounds vaginal opening
perineal body
stretches for delivery
vagina
muscular tube that connects outer genitals with uterus, “birth canal”
fundus of the uterus
rounded upper portion of uterus
anterior and posterior fornix
space around the cervix that allows for pooling of semen
broad ligament
sheath that covers pelvic cavity to provide stability for the uterus and keeps it centrally placed
round ligament
keep uterus in place by pulling it down and forward
cardinal ligament
suspend uterus in the pelvis, prevents prolapse
isthmus
connects fallopian tubes with uterus
ampulla
site for fertilization
fimbriae
fingerlike projections that grab the egg and bring it into the fallopian tube
ovaries
release eggs with ovulation
false pelvis
supports the weight of an enlarged uterus and directs fetus into the pelvis
pelvic inlet
area that goes from false pelvis into true pelvis
pelvic cavity
area with canal for baby to pass through
pelvic outlet
passage under the pubic arch
progesterones
stabilize uterus for implantation, increases breast tissue
FSH
helps egg follicle mature
LH
low in estrogen production while allowing progesterone to continue producing
ovarian cycle
- follicular - day 1-14 where immature follicles mature as a result of FSH. oocyte grows in follicle, ovum discharged into fimbria of fallopian tube
- luteal phase - days 15-28 where ovum leaves the follicle, ovum remains in the ampulla if fertilized, reaches uterus 72-96 hrs after release then implants into the endometrium and secretes human chorionic gonadotropin (hCG) OR if no fertilization, corpus leteum degenerates
What days of the ovarian cycle are females the most fertile?
13-15
Menstrual Cycle
- menstrual - shedding some endometrial cells
- proliferative - endometrial cells enlarge and thicken due to increased estrogen, peaking just before ovulation, cervical mucous is more elastic/thin/clear
- secretory - progesterone causes marked swelling of epithelium, vascularity of uterus increases to provide nourishing bed for implantation
- ischemic - begins if implantation doesn’t occur, estrogen and progesterone levels decrease, corpus leteum degenerates
testes
produces sperm, secretes testosterone
epididymis
sperm resivoir
vas deferens and ejaculatory ducts
connect epididymis to prostate and allow for passage
seminal vessels and prostate glands
secrete clear fluid to hold sperm during ejaculation
mitosis
for growth and repair, process by which our bodies divide cells and replace themselves
exact copies of original cell
meiosis
process leading to development of eggs and sperm
cells only contain half the genetic material of chromosomes so that when fertilization occurs, the normal cell number is restored
gametogenesis
meiosis occurs during gametogenesis in which gametes are produced
oogenesis
produces female gamate in female, all ova present at birth
spermatogenesis
produces male gamete, takes place starting at puberty
fertilization
- ova are fertile for 12-24 hrs after ovulation
- sperm live for 48-72 hrs, may only be fertile for 24
- fertilization takes place in the ampulla of fallopian tube
- only single sperm enters ovum which leads to fertilization
- chromosomes pair up and create diploid zygote
yolk sac
how nutrition is transferred before placenta
fraternal vs identical twins
- fraternal - two ova, two sperm, two blastocysts, two amnions, two chorions
- identical twins - one ovum, one sperm, one blastocyst (inner cell mass splits in two), two amnions (maybe), one chorion, same gender
amniotic fluid
- cushions fetus and umbilical cord
- helps control temperature
- allows fetus to change positions
- analyze for fetal health and maturity
- promotes growth and development
- made of albumin, vernix, fetal urine, uric acid, lecithin, and sphingomyelin
- fetus swallows it and fluid flows out of the lungs - helps lungs mature
polyhydramnios
more fluid than expecting (>2000mL)
could be due to twins, uncontrolled DM
oligohydramnios
too little fluid (<400mL), low AFI
could be due to HTN, baby kidney problem, or other perfusion issues
umbilical cord
- body stalk that connects placenta with fetus
- contains 2 arteries and 1 vein
- surrounded by special connective tissue called Wharton’s jelly
- no sensory or motor innervation
- twisted and spiral shape due to fetal development
placental functions
- immunologic properties protect against antibody production since homograft
- excretion
- fetal respiration
- production of fetal nutrients
- production of hormones
What happens in embryonic week 4?
- heart begins to beat
- arm and leg buds present
- somites develop - beginning vertebrae
- primary lung buds present
- eyes and ears begin to form
What happens in embryonic week 6?
- body is straighter
- trachea is developed
- nares are present
- liver produces blood cells
- heart begins circulating blood
- digits develop
- tail begins to recede
What happens in fetal week 12?
- face well developed
- eyelids are closed
- tooth buds appear
- genitals are well differentiated
- urine is produced
- spontaneous movement occurs
- fetal heart tones can be heard
What happens in embryonic week 20?
- subcutaneous brown fat appears
- vernix begins to form
- lanugo over entire body
- nipples and tails are present
- fetal movement felt by mother
What happens in embryonic week 24?
- eyes are structurally complete
- vernix caseosa covers skin
- alveoli begin to form
- both grasp and startle reflexes present
- fingerprints and footprints present
- considered viable*
What happens in embryonic week 28?
- brain develops rapidly
- nervous system begins to regulate
- eyelids open
- testes begin to descend
- lungs can provide gas exchange
What happens in embryonic week 36?
- increase in SQ fat
- lanugo begins to disappear
What happens in embryonic week 38?
- full term starts at 37 weeks
- skin smooth and polished
- verni caseosa in creases and folds
- head is bigger than chest
fibrocystic breast changes
- thickening of normal breast tissue
- due to imbalance in estrogen and progesterone
- s/s - cyclic pain, tenderness, swelling right before menses
- dx - mammography, MRI, fine needle aspiration
- tx - limit caffeine, decrease sodium, use oral contraceptives
endometriosis
- presence of endometrial tissue outside of urine cavity
- cause is unknown, maybe due to backflow of menstrual flow, inflammation of the endometrium, immune defect
- s/s - pelvic pain usually at time of menses
- confirmed by laparoscopy
- tx - surgical removal of endometrial tissue, NSAIDS, oral contraceptives
polycystic ovarian syndrome
- ovaries enlarged and contain numerous small cysts along outer edge of ovaries
- unknown cause
- s/s - irregular to absent menses, elevated testosterone and androgen levels, obesity, insulin resistance, infertility
- dx - h&p, labs, vaginal ultrasound to evaluate uterus and ovaries
- tx - oral contraceptives, glucophage and spironolactone
toxic shock syndrome
- disease of women in their reproductive years around menses or postpartum
- cause - toxin released by staph A
- sx - fever, rash on trunk that resembles a sunburn, vomiting, hypotension, inflamed mucous membranes
- dx - elevated BUN, AST, ALT, bilirubin, and low platelets
- tx - hospitalization, IVF to maintain BP, abx
bacterial vaginosis
- decrease in normal vaginal flora
- caused by overgrowth of bacteria probably due to douching or frequent sex
- s/s - increased amount of thin, watery, whitish/grey fluid with fishy smell
- dx - vaginal pH greater than 4.5
- tx - flagyl, clindamycin vaginal cream
vaginal candidiasis
- yeast infection
- caused by antibiotics, oral contraceptives, immunosuppressants, DM
- s/s - thick curdy vaginal discharge, severe itching, rash
- dx - vaginal discharge will spores under microscope
- tx - diflucan or nystatin
trichmoniasis
- STI
- s/s - yellow/green discharge, inflammation, itching, dysuria
- dx - visualization of organism on microscope slide
- tx - flagyl
chlamydia
- STD
- s/s - thin purulent discharge, dysuria, lower abd pain
- dx - lab culture
- tx - azithromycin
gonorrhea
- STD increasing risk for PID
- caused by bacteria
- s/s - purulent green/yellow discharge, dysuria, vulva swelling
- dx - lab culture
- tx - rocefin (ceftriaxone) and azithromycin
- untreated can cause gonococcal ophthalmia neonatorum
herpes genitalis
- HSV 1 and HSV2*
- s/s - simple blister-like vesical in genital area
- dx - culture of the lesion
- tx - no cure, acyclovir to keep virus dormant
syphilis
- chronic infection from contact with open would or acquired congenitally
- s/s - chancre that later turns into a wart like plaque on vulva, fever, weight loss, malaise
- dx - blood test VDRL or RPR
- tx - pcn
HPV
- STI through vaginal, oral, or anal sex, usually the cause of cervical cancer
- sx - genital warts
- dx - biopsy lesion
- tx - cryotherapy, shave excision, acid removal
PID
- inflammatory disorder of upper female genitalia, can cause tubal damage and infertility
- caused by women with multiple sexual partners, use of IUD, untreated gonorrhea, and chlamydia
- sx - bilateral sharp cramping pain, fever, chills, purulent drainage
- dx - cultures, CBC, VDRL, RPR
- tx - abx
cystitis
- lower UTI
- caused by ecoli, enterococcus, or staph
- s/s - low grade temp, hematuria, painful urination
- dx - urine specimen, labs
- tx - abx
pyelonephritis
- proceeded by lower infection
- s/s - high temp, chills, flank pain
- dx - urine specimen, labs
- tx - IVF, IV abx, pain meds
secondary infertility
unable to conceive or sustain a pregnancy after 1 or more successful pregnancies
essential components of fertility: female
- favorable cervical mucous
- patent tubes
- ovaries that produce and release normal ova
- no obstruction between ovary and uterus
- favorable endometrium
- adequate reproductive hormones
essential components of fertility: male
- normal quantity, quality, and motility of sperm
- unobstructed genital tract
- normal genital tract secretions
- ejaculated sperm able to reach cervix
ways to improve fertility
- no douching or artificial lubricants
- retain or avoid leaking sperm for at least 20-30mins after intercourse
- sex every other day during fertile period
- decrease anxiety and stress
- adequate nutrition
infertility workup components
- women - BBT, cervical mucous changes, hormonal assessment, endometrial biopsy, transvaginal US
- men - ductal obstruction or abnormal sperm/sperm production
infertility treatments
- meds - clomiphene citrate, progesterone, gonadotropins, bromocriptine
- therapeutic insemination - donor deposited into cervix or uterus mechanically
- in vitro fertilization - egg collected from ovary, fertilized in lab, and placed in uterus after embryo development starts
- gamete intrafallopian transfer - egg removed by laparoscopy and placed with sperm, fertilization occurs in fallopian tube, then egg travels to uterus to implant
- zygote intrafallopian transfer - eggs retrieved and incubated with sperm and placed back into fallopian tubes once fertilization occurs
- adoption
karotype
pictoral view of chromosomes
phenotype
observable expression of trait
autosomal dominant inheritance
- affected individual has affected parent
- affected individuals have 50% chance of passing defect onto their children
- parent may have mild form of the disease and child may have a severe form
autosomal recessive inheritance
- affected individual has clinically normal parents, but both are carriers
- when both are carriers, both have a 25% chance of passing defect onto children
- if child of 2 carriers, 50% that the child will be a carrier
chadwick’s sign
blue-purple discoloration due to increased blood flow
breast changes during pregnancy
- glandular hyperplasia and hypertrophy
- areolae darken, superficial veins prominent
- striae may develop
- colostrum secreted
respiratory changes during pregnancy
- oxygen consumption increases
- subcostal angle and AP diameter increases
- breathing changes from abdominal to thoracic
- nasal stuffiness and epistaxis
cardiac changes during pregnancy
- blood volume increases from 40-50%
- physiologic anemia
- decrease in systemic and pulmonary vascular resistance
- increase in cardiac output
- somewhat hypercoagulable state - increased clotting factors, doesn’t return blood back to the heart as it should
GI changes during pregnancy
- n/v
- softening and bleeding of gums
- increase in saliva
- constipation
- heartburn
- gallstones
- hemorrhoids
urinary changes during pregnancy
- pressure on bladder causes frequency
- dilation of kidneys and ureters
- increased GFR and renal plasma flow
skin changes during pregnancy
- hyperpigmentation
- striae
- facial chloasma
- vascular spider nevi
- decreased hair growth
- hyperactive sweat and sebaceous glands
eye, cognitive, and metabolic changes of pregnancy
- decreased IOP
- thickening of cornea
- reports of decreased attention, concentration, and memory
- extra water, fat, and protein are stored
- fats are more completely absorbed
endocrine changes of pregnancy
- thyroid gland enlargens
- concentration of parathyroid hormone increases
- prolactin is responsible for lactation
- secretion of oxytocin and vasopressin
- increased aldosterone
presumptive signs of pregnancy
- amenorrhea
- n/v
- excessive fatigue
- urinary frequency
- breast changes
- quickening
probable signs of pregnancy
- changes of pelvic organs - goodwell’s sign, chadwick’s sign, hegar’s sign
- enlargement of abdomen
- braxton hick’s contractions
- abdominal striae
- uterine souffle
- changes in pigmentation of skin
- positive pregnancy tests
- palpation of fetal outline
positive signs of pregnancy
- auscultation of fetal heartbeat
- fetal movement
- visualization of fetus
Rubin’s tasks of pregnancy
- ensuring safe passage through pregnancy, labor and birth
- seeking acceptance of this child by others
- seeking commitment and acceptance of self as mother to infant
- learning to give oneself on behalf of one’s child
prenatal history
- current and past pregnancies
- gynecologic history
- current and PMH, including substance abuse
- family medical history
- religious, spiritual, occupational history
- partner history
- social history and preferences
GTPAL
- G - number of pregnancies
- T - number of deliveries 37 weeks or later
- P - number of deliveries 20-36 weeks
- A - number of pregnancies ending in spontaneous or therapeutic abortion
- L - number of current living children
major prenatal screening tests
- pap smear
- CBC
- Hgb
- rubella titer
- ABO and Rh typing
- Hep B screening
- STI screening
- sickle cell screen for women of aftican or latino descent
- CF
- HIV
- drugs - urine or blood test
- fetal chromosome anomaly
- urine screen and culture (12-16 weeks)
- group B strep
AFP quad screen
- open spina bifida - AFP high
- anencephaly - AFP high
- down syndrome - AFP low
- edward’s syndrome - AFP low
danger signs of pregnancy
- gush of fluid from vagina
- vaginal bleeding
- abdominal pain
- fever
- dizziness, blurred vision, spots before eye
- persistent vomiting
- edema
- muscular irritability or convulsions
- epigastric pain
- oliguria
- dysuria
- absence of fetal movement
how to alleviate n/v in a pregnant woman
eat dry crackers/toast before rinsing, small frequent meals, avoid greasy or spicy foods, drink carbonated beverages
how to alleviate urinary frequency in a pregnant woman
void every 2 hours during the day
how to alleviate fatigue in a pregnant woman
napping
how to alleviate breast tenderness in a pregnant woman
wear supportive bra
how to alleviate vaginal discharge in a pregnant woman
daily bathing, cotton underwear, avoid douching
how to alleviate nasal stuffiness in a pregnant woman
cool air vaporizers, normal saline spray
how to alleviate heartburn in a pregnant woman
take combination of non-sodium antacids
how to alleviate ankle edema in a pregnant woman
avoid prolonged sitting or standing, keep feet and legs elevated
how to alleviate varicose veins in a pregnant woman
regular exercise, avoid prolonged sitting or standing
how to alleviate flatulence in a pregnant woman
regular bowel habits
how to alleviate hemorrhoids in a pregnant woman
avoid constipation, gently reduce, topical ointments, warm soaks, sitz baths
how to alleviate constipation in a pregnant woman
increase fluids and roughage, daily exercise, regular bowel habits
how to alleviate backache in a pregnant woman
pelvic tilt exercises, good posture, avoid fatigue, good body mechanics when lifting
how to alleviate leg cramps in a pregnant woman
massage, warm soaks, stretching exercises, dorsiflex the foot
how to alleviate faintness in a pregnant woman
sit down and lower head and knees, avoid standing in one place too long
how to alleviate SOA in a pregnant woman
good posture when sitting, prop up in bed
(check pulse ox, does it happen with exercise or at rest?)
how to alleviate difficulty sleeping in a pregnant woman
avoid caffeine, maximum comfort in bed
how to alleviate round ligament pain in a pregnant woman
warmth to abdomen
how to alleviate carpal tunnel syndrome in a pregnant woman
avoid repetitive hand movements, may disappear after delivery, sometimes surgery is required
fetal kick counts
noted between 16-22 weeks, check about the same time each day (1hr after meals), lay in a side lying position,
contact HCP if less than 10 movements in 2 hours
exercise in pregnancy
- don’t learn a new sport during this time
- eat an additional 300 cals per day
- avoid overheating and hot/humid weather
- contraindications: ROM, increased BP, incompetent cervix, vaginal bleeding, preterm labor or hx of placenta previa after 26th week
concerns about sexual activity during pregnancy
- first trimester - fatigue, nausea, vomiting
- second trimester - fewer discomforts, vascular congestion
- third trimester - fatigue, SOA, decreased mobility
immunizations during pregnancy
- avoid attenuated live vaccines
- encouraged to take flu and tdap vaccine
- up to date with vaccines before pregnancy if possible
tobacco associated birth defects
- low birth weight
- preterm birth
- PROM
- fetal demise
- placenta previa
- abruptio placenta
alcohol associated birth defects
- FAS - growth delay, facial anomalies, mental delay
- increased risk of miscarriages
- IUFD
- lower birth weight
- NO safe level for drinking in pregnancy
caffeine associated birth defects
- no clear evidence to support birth defects, delayed growth, or preterm birth
- may have hypersensitivity of newborn
- limit caffeine intake to about 200mg/day
cocaine associated birth defects
- potential for maternal MI, cardiac arrhythmias, ruptured aorta, seizures, stroke, abruptio placenta, PROM, low birth weight, SIDS, congenital heart defects, limb defects
- cord sampling is done to detect use
- urine screening may not work because it is metabolized quickly
advanced maternal age related birth defects
- high risk
- increased rate of miscarriage, increased risk for GDM, GHTN, placenta previa, difficult labor, increased risk of CS, multiple births, down syndrome, and infertility
physiologic risks of pregnancy
- preterm birth and LBW infants
- preeclampsia, eclampsia
- iron deficiency anemia
- cephalopelvic disproportion
- effects of alcohol and drug use
- STI
risks associated with obesity in pregnancy
- spontaneous abortion
- gestational diabetes
- preeclampsia
- labor induction
- C section
- fetal anomalies
How much fluid should a pregnant woman consume?
8-10 glasses (8oz)
4-6 should be water
pica
- craving of nonnutrive substances
- can produce iron deficiency anemia - clay, soil, powdered laundry starch, soap, baking powder
ways to assess fetal well being
- ultrasound - can identify anomalies, neural tube deficits, and skeletal malformations
- nuchal translucency testing - detects down syndrome
- transvaginal ultrasound - predictor of preterm births by understanding shortened cervical length or funneling
- doppler blood flow studies - measures blood flow and maternal and fetal circulation
- nonstress test - shows fetal HR, adequate oxygenation, and intact CNS
- fetal acoustic stimulation - produces sound and vibrations to stimulate infant, should show accelerations in HR
- contraction stress test - evaluates oxygenation and carbon dioxide exchange of the placenta, shows if there is enough oxygen reserve in placenta
- amniotic fluid analysis - understands fetal lung maturity
- chorionic villus sampling
gestational DM
- patho - in first trimester, decreased need for insulin because hormones enhance production and tissue response to insulin, later in first trimester, there is an increased need for insulin because hormones act as insulin-antagonists
- maternal risks - polyhydramnios, preeclampsia, eclampsia, ketoacidosis, dystocia, increased susceptibility to infections
- fetal risks - perinatal mortality, congenital anomalies, macrosomia, IUGR, RDS, polycythemia, hypoglycemia after delivery, hyperbilirubinemia
- screening - oral glucose tolerance test
- treatment goals - fasting <95 and 2 hrs PP <120
anemia treatment
- iron deficiency - treat with supplemental iron
- sickle cell - prevent crisis by treating with IV fluids, abx, folic acid, and analgesics
- folic acid - take supplement before pregnancy and during pregnancy
signs of substance abuse
unusual complaints, hx of abuse, depression, STI, prior drug use, poor nutritional status, track marks, mood swings, hallucinations, frequent accidents or falls, cirrhosis, hep
management of cardiac abnormalities in antepartum phase
- monitor cardiac functional capacity, VS, and signs of cardiac decompensation at each antepartal visit (cough, dyspnea, edema, murmur, palpitations, rales, weight gain)
- assess for factors that increase stress on the heart
- restrict activity, complete 8-10 hrs of sleep, have frequent rest periods, avoid infection
- frequent visits to HCP
- diet - high iron, high protein, low sodium, adequate cals
management of cardiac abnormalities in intrapartum phase
- assess VS and lung sounds
- encourage side lying and semi fowlers
- continuous support and EFM
- give oxygen, diuretics, sedatives, analgesics, prophylactic abx, and digi as needed
- pushing will be shorter and moderate pushes with periods of rest between
- epidurals are recommended to decrease cardiac demand
management of cardiac abnormalities during postpartum period
- assess VS and signs of decompensation
- encourage side lying or semi fowlers
- activity is gradually increased
- encourage appropriate diet and stool softeners
- know s/s of problems with d/c
nursing care of spontaneous abortion
- assess amount and appearance of vaginal bleeding
- monitor VS and degree of discomfort
- assess need for Rh immunoglobulin
- assess responses and coping
recurrent miscarriage
- defined by 3+ consecutive losses
- care is dependent on hx and present situation
- follow up testing - both parents genetic testing, antiphospholipid antibody syndrome, thyroid disease
nursing care of ectopic pregnancy
- methotrexate IM may be administered outpatient (avoid sun, report severe pain and heavy bleeding)
- hospital based care - surgery may be required, assess for signs of shock, administer analgesics
gestational trophoblastic disease
- proliferation of trophoblastic cells
- hydatiform mole - molar pregnancy
- complete mole - ovum containing no genetic material is fertilized by normal sperm
- partial mole - normal ovum is fertilized by sperm that has not divided
hydatiform mole
- characteristics - dark brown vaginal bleeding, anemia, grapelike vesicles, uterine enlargement, absence of FHT, elevated levels of hCG for dates, low serum levels of MSAFP
- s/s - hyperemesis, preeclampsia
- treatment - D&C, possible hysterectomy (risk of choriocarcinoma)
hyperemesis gravidarum
- excessive vomiting during pregnancy that impacts hydration and nutrition
- patho - nutritional deficits
- dx - problematic vomiting in 1st trimester, dehydration, ketonuria, and weight loss
- NC - assess, maintain fluid volume, may need tpn, encourage balanced diet as tolerated, provide relaxed and quiet environment, free of noxious stimuli, antiemetics, counsel/support, referral as indicated
Rh alloimmunization
- Rh- mother and Rh+ fetus which causes maternal antibodies to be produced and hemolysis of RBC, rapid production of erythroblasts, hyperbilirubinemia
- if treatment is not initiated - anemia results in destruction of fetal RBC and can cause fetal edema, CHF, jaundice, kernicterus, erythroblastosis fetalis (severe hemolytic syndrome)
- management - antibody screening, admin of Rh immunoglobulin, prophylactic at 38 weeks if antibody screen is negative and procedures/trauma
- monitor fetus with nonstress tests, serial ultrasounds, amniotic fluid analysis, doppler
- if severe anemia or fetal hydrops, fetus is given intrauterine transfusion and preterm delivery
- within 72 hrs of birth - given Rh immunoglobulin, if coombs positive - monitor for hemolytic disease of infant
- Kleihauer-Betke test - determines how much Rh positive blood is present in maternal circulation and to calculate amount of Rhogam needed
impact of HTN and pregnancy
- the earlier the HTN develops, the greater risk of developing preeclampsia later in pregnancy
- gestational HTN has an increased risk of chronic HTN and increased incidence of obesity related to increased risk of preeclampsia
- increased risk for placental abruption, preterm delivery and intrauterine growth restriction
gestational HTN
- SBP >140 or DBP >90
- occurs after 20 weeks, no proteinuria
- if still elevated 6 weeks after delivery, it is chronic
preeclampsia
- increased BP after 20 weeks gestation categorized as mild or severe
- RF - chronic HTN, chronic renal disease, DM, Rh incompatibility, primigravidity, family hx, maternal age <20 and >40, multiple gestation, in vitro fertilization, and new paternity
- high BP leads to decreased placental perfusion, cell damage causes vasoconstriction, activation of coag cascade, and intravascular fluid redistribution which causes decreased organ perfusion
- labs - CBC, liver enzymes, type and screen, 24 hour urine collection and creatinine clearance, protein dipsticks
s/s of preeclampsia
- maternal - epigastric pain, bleeding, n/v, low platelets, DIC, proteinuria, facial edema, pulmonary edema, ascites, PE, HELLP, renal failure
- fetal - vascular stillbirth, abruption, IUGR, abnormal UA doppler, oligohydramnios
- severe maternal - visual disturbances, intrauterine fetal growth restriction, irritability/hyperreflexia, retinal edema, retinal arteriolar narrowing
- mild - SBP >140 or DBP >90 on 2 occasions at least 4 hours apart with previously normal BP, proteinuria, protein/creatinine ratio >0.3, 1+ dipstick, may see edema or weight gain
- severe - SBP>160 OR DBP>110 on 2 occasions at least 4 hours apart while the patient is on bedrest, proteinuria, low platelets, pulmonary edema, new cerebral or vision changes, elevated liver enzymes, severe persistent epigastric pain
management of mild preeclampsia
- home management - educate about symptoms of worsening, daily assessments, moderate to high protein diet
- hospital care - fetal movement record, biophysical profile, doppler velocimetry, serial ultrasounds, DTR, clonus, grade edema
care for severe preeclampsia
- complete bedrest and decreased environmental stimuli
- anticonvulsant therapy, fluid and electrolyte replacement, steroids, antihypertensives
acute control of severe HTN (and contraindications to meds)
- IV labetalol - contraindicated for asthma
- IV hydralazine - contraindicated for tachycardia
- IV nifedipine - contraindicated for tachycardia
how to prevent convulsions
- monitor for headache, n/v, hot/flushed, sedation, and muscle weakness
- mag sulfate - requires careful monitoring for mag toxicity
signs of mag toxicity
decreased or absent reflexes, decreased RR, change in LOC, therapeutic mag level is 4-7, and have IV calcium gluconate available as antidote
care for eclampsia patient
- obstetric emergency
- note time, body involvement, and duration
- avoid aspiration and prevent injury
- mag bolus 6gm
- note fetal status and signs of labor, signs of placental abruption, consider induction of labor if delivery is delayed
- postpartum management - monitor vaginal bleeding and signs of shock, regularly assess BP and HR, mag sulfate given for at least 24 hours post delivery
HELLP syndrome
- hemolysis, elevated LFT, low platelets associated with severe preeclampsia
- RBC are fragmented as they pass through damaged vessels, platelets go to site of damage, causes low platelet count, elevated LFT due to obstructed blood flow, liver distention causes epigastric pain
- s/s - n/v, flulike, epigastric pain
- treat - delivery fetus regarding gestational age
chronic HTN
- SBP >140 or DBP>90 before pregnancy or before 20th week gestation, persists 6 weeks after childbirth
- monitor for superimposed preeclampsia
- evaluate growth of fetus every 4 weeks by ultrasound
- treat - bedrest, L side lying, diet, nifedipine/labetalol, 24 hours urine studies for baseline, regular NST and BPP
chronic HTN with superimposed preeclampsia
- s/s - sudden increase in previously controlled BP or more antiHTN drugs are needed, new proteinuria, upper body edema, rise in serum uric acid
- treat - treat HTN and preeclampsia
role of nutrients in pregnancy
- fats - energy
- carbs - energy
- protein - fetal growth, energy metabolism
- calcium and phos - mineralization of bones and teeth
- iodine - used iodized table salt if infant is deficient
- sodium - metabolism, regulation of fluid balance
- zinc - protein metabolism, fetal growth, lactation
- mag - cellular metabolism, bone mineralization
- iron - carries oxygen in blood
- vitamin A - growth of epithelial cells, synthesis of glycogen, development of healthy eyes
- vitamin D - absorb and utilize calcium and phos for skeletal development
- vitamin E - antioxidation, health of cell membranes
- vitamin K - synthesis of prothrombin needed for clotting
- vitamin C - development of connective tissue, development of vascular system
- B vitamins - cell respiration and glucose oxidation, energy metabolism
changes in nutrients required for pregnancy
- cals - increase 300
- carbs - 6-11 servings of grains per day
- protein - increase of 14g per day
- calcium - 1000mg/day
- zinc - 11mg/day
- mag - 350mg per day
- folic acid - 400mcg per day
