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N330 > Nursing Management Of Pregnancy At Risk: Preg Related Comp > Flashcards

Nursing Management Of Pregnancy At Risk: Preg Related Comp Flashcards

1
Q

Hyperemesis gravidarum
Causes

A

Excessive N/V prolonged past 16 weeks

Causes:
Wt loss
Dehydration
Electrolyte imbalance
Nutritional deficits
Ketonuria

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2
Q

Hyperemesis gravidarum

Risk factors 6

A

Maternal age less than 30

Personal or family hx

Multifetal gestation (twins, triplets)

Hyperthyroid disorder

Diabetes

Molar pregnancy (high hCg levels)

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3
Q

Hyperemesis gravidarum

Assessment

A

Vomiting for prolonged period
S/s of dehydration
Wt loss
Increased HR, decreased BP
Poor skin turgor, dry membranes

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4
Q

Hyperemesis gravidarum

Labs

A

U/a:
-elevated specific gravity
-ketouria

Renal:
Low Na/K,Chloride

Can cause metabolic alkalosis

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5
Q

Hyperemesis gravidarum

Management

A

Intially IV LR

Meds for N/V:
-diclegis (pyriidoxine & doxylamine)
-promethazine
-ondansetron
-metoclopramide

ADT (advance diet as tolerated)

If cant keep food down: may need TPN or enteral tube

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6
Q

Hyperemesis gravidarum

Recommended diet

A

Clear liquid

Bland foods once vomiting has stopped:
BRAT: bananas, rice, apple sauce, toast)

Freq, small meals

Eat what sounds good and can tolerate

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7
Q

Cervical insufficiency

What it is

Can result in

A

Passive/painless premature cervical dilation (2 & 3rd trimester)

Can result in loss/preterm delivery

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8
Q

Cervical insufficiency

How to see this
Risks

A

Speculum
Digital exam
Transvaginal US

Risks:
Hx of cervical trauma/sx
Hx of early pregnancy loss
Short cervix

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9
Q

Cervical insufficiency
Tx

A

Bed rest
Pelvic rest
Avoidance of heavy lifting
Progesterone supp
Cerclage placement up to 28wks

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10
Q

Cervical cerclage

What is it
Best results and when to remove
Reasons to remove cervlage
Education
Bedrest? Intecourse?

A

Suture round the cervix to constrict the internal cervical

Best results placed 12-14 weeks
Removed around 37 weeks

Remove if: ROM or PTL(preterm labor)

Education on:
Labor,infection,ROM

Bedrest for couple days to week
Intercourse is recommended to avoid

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11
Q

Early pregnancy bleeding
Misscarriage
-what is it

A

Pregnancy loss result of natural causes before:
-fetal viability (20wks or 500Grams)

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12
Q

Threatened abortion

Assessment

A

Hasnt happened yet

Slight spotting
Mild cramping
No tissue passed
Cervix closed

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13
Q

Threatened misscarriage

Nursing considerations

A

US
HCG levels
CBC
Rest for 24-48 hrs
No intercourse for 2wks

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14
Q

Inevitable (its happening)

Assessment

A

Mod bleeding
Mild/mod cramping
No tissue passed
Cervical dilation

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15
Q

Inevitable miscarriage

Nursing consideration

A

Monitor:
-s/s of hemorrhage
-infection

May need D&C: scrape out remains

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16
Q

Incomplete misscarriage
(Not all tissue has passed)

Assessment

A

Heavy bleeding
Severe cramping
Tissue passed
Cervical dilation

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17
Q

Incomplete miscarriage

Nursing considerations

A

Cytotec, oxytocin (contractions to help tissues pass)
Blood products (hypovolemic)
Fluids

May need D&C

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18
Q

Complete miscarriage

Assessment

A

Minimal bleeding
Mild cramps
Tissue pass
Cervix closed after tissue passed

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19
Q

Complete miscarriage

Nursing considerations

A

No tx if no s/s of:

-hemorrhagic shock
-infection

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20
Q

Missed miscarriage

Assessment

A

No s/s
Or
Mild bleeding/cramping

Prolonged retention of tissue
Cervix closed

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21
Q

Missed miscarriage

Nursing considerations

A

D&C evacuation within 4-6wks

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22
Q

Early preg bleeding

Assessment
Labs

A

Preg hx
VS
Pain assessment
Quantity and nature of bleeding

Labs:
-HCG
-CBC (H/H, WBC)
-clotting factors (ptt, pt, INR, PLT, D-Dimer, Fibrenogen

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23
Q

Early preg bleeding

Care
F/u care
Call for

A

Care: Rhogam if women Rh-

F/u care:
-rest
-refrain from: tub bath, intercourse for 2 wks

CALL for:
heavy bright red bleeding
foul smelling discharge
Fever

-take abx

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24
Q

Ectopic pregnancy

What is it
Risk factors

A

Implantation of fertilized ovum outside of uterus

RF:
-STIs
-IUD
-hx of tubal/uterine sx

25
Ectopic preg Clinical manifestations Ruptured fallopian tube CM
Unilateral lower quadrant pain (stabbing) Delayed menses (1-2wks) Abnormal bleeding (spotting) Palpable unilateral mass Low HCG levels Rupture of fallopian tube: Rigid and tender abdominal (rutpure) Referred shoulder pain if abd bleeding (rupture) S/s hemorrhage
26
Ectopic preg Diagnosed with:
HCG/progesterone levels Transvaginal US
27
Ectopic pregnancy management -labs -early vs late stage tx -at risk for What to do for this risk
CBC, Blood type/Rh Early: methotrexate (stops cellular division) Late: salpinostomy or salpingectomy (if too large you can cut them out of the fallopian tubes At risk for hemmorrhage and shock if ruptures: Moniotr h/h Iv fluids Blood replacement Rhogam for Rh- Removal of fallopian tubes with rupture
28
Gestational trophoblastic disease (GTD) -aka -what it is (what it can cause) -how it effects embryo -can cause what
Molar pregnancy Degenerative anomaly of trophoblastic villi cause: Proliferative growth, become swollen, fluidfilled, appearance of grape like clusters Embryo fails to develop Can cause cancer
29
GTD partial vs complete
Partial: some fetal parts Complete: no fetal parts
30
GTD Clinical manifestations
Dark brown vaginal bleeding (prune juice) Rapid growing uterus (fundal height will be wrong) Excessive N/V due to high hCG (doesnt drop off like it should)
31
GTD Diagnosis
Transvaginal US Persistently high hCG levels
32
GTD care management f/u care Care Moniotr what and how often If stays high do what Discourage what
Suction curettage (suction remains) RH-recieve rhogam Grief support Monitor hCG: -weekly for 3 wks -monthly for 6-12 months If continue to elevate may require : -hysterectomy -chemotherapy due to choriocarcinoma Pregnancy is discouraged for one year
33
Placenta previa What is it Classifications
Placenta implanted low, near or over cervix Complete: complete cover cervix Partial: partially covers cervix Marginal/low-lying placenta: low but doesnt cover
34
Placenta previa RF
Previous c-section Uterine scarring: -curettage -endometritis Previous placenta previa Advanced maternal age (over 35y/o) Multiparity (multiple births) Smoking
35
Placenta previa Clinical manifestation How diagnosed
*Painless bright red vaginal bleeding (2nd, 3rd tri) Diagnosed on US before bleeding occurs Soft, relaxed non-tender uterus w/ normal tone
36
Placenta previa Management Avoid
Observation if less than 36/37 wk US to locate placenta Monitor fetal status Limited activity Pelvic rest Bleeding monitor H/H Avoid vaginal exams
37
Placenta previa If delivery is imminent
Get type and screen 2 units of cross matched PRBCs Having a c-section
38
Placenta previa Maternal and fetal outcomes -major complications How will they deliver and why
Hemorrhage Will deliver c-section if: Full term, excessive bleeding, active labor Preterm birth: IUGR
39
Placental abruption What is it Leading cause of what
Detachment of part or all of placenta from implantation site After 20 wks Leading cause of maternal death
40
Placental abruption RF
Maternal HTN Preeclampsia Cocaine/tobacco use Blint external trauma/ partner violence Hx of abruption
41
Placental abruption Clinical manifestation
Sudden intense localized uterine pain (abd) Uterine rigidity and tenderness Dark red vaginal bleeding (not if concealed) Rapid s/s of maternal shock and fetal distress
42
Placental abruption Management -prepare for what -labs -identify what -post op monitor for
Prepare for immediate delivery (c-section probably) Labs: -H/H Coagulation factors -cross and type match Identification of hemorrhagic shock and tx Post op: signs of -infection -shock -DIC
43
Types of HTN in pregnancy
Chronic Gestational Preeclampsia
44
Chronic HTN How to classify that Chronic HTN can acquire what
HTN present before pregnancy Or Diagnosed before 20 weeks gestations Chronic HTN with superimposed preeclampsia Acquire preeclampsia or eclampsia
45
Chronic HTN management Begins when Management High risk managed with what
Begins before pregnancy Wt loss Diet Excerise Smoking/alcohol cessation High risk managed w/ antihypertensive assessment
46
Gestational HTN Onset SBP greater than Diastolic greater than for how long apart Resolves by when
Onset of HTN (>140/90) without proteinuria after 20 wks gestation SBP greater than 140 and diastolic >90 at least twice 4 hrs apart in women who previously had normal BP Resolves by 12 wks postpartum
47
Preeclampsia Classified as Can get it when
HTN and proteinuria 1+ or more after 20 wk gestation in previously normotensive women Can develop for 1st time after postpartum period (RARE)
48
Severe preeclampsia features (10)
BP >160/110 Proteinuria 3+ Oliguria Elevated creatinine >1.1 HA/blurry vision/ vision issues Hyperreflexia with ankle clonus (count beats) Extensive perioheral edema Hepatic dysfunction (increased liver enzymes) Epigastric and RUQ pain Thrombocytopenia
49
Eclampsia Preceded by:
Onset of seizure activity or coma in women with severe preecclampsia who has no hx of seizures Usually preceded by: HA Visual disturbances Hyperreflexia
50
HELLP syndrome Hepatic dysfunction characterized by:
Hemolysis of RBCs: anemia and jaundice Elevated Live enzymes (ALT,AST) Low platelets (Watch for these s/s with pt w/ preeclampsia
51
Preecmapsia: RF (9)
1st pregnancy >40 y/o Personal or family Gx Chronic HTN Obesity Multifetal gestations (twins, triplets) Hx of diabetes or renal disease RA, lupus Paternal hx of producing preeclamptic pregnancy
52
Preeclampsia assessment
Accurate BP Proteinuria: -dipstick 1+ -ideally measured w/ 24hr urine collection Assess edema
53
Interventions for preeclampsia and gestational HTN Without severe features
Monitor BP Fetal monitoring (kicks, FHR, NST, CST, US) F/u with provider Bedrest
54
Interventions for preeclampsia and gestational HTN With severe features Preexlampsia management Tx Meds Intrapartum management Assess
Preeclampsia management: -hospitalized care: dark,low stimulation, quiet -sz precautions -mg sulfate IV (decrease risk of sz) -antihypertensive meds -corticosteroids to enhance fetal lung maturity Intrapartum care: Assess: LOC, VS, UO, daily weight FHR and uterine contraction monitoring Signs of placental abruption (abd pain, dark red blood)
55
HTN indicated when Goal BP If untreated concerns of Meds for it
Indicated when SBP exceeds 160 or DBP 110 Goal: 140-150/90-100 Untreated concern: Cerebral hemorrhage Placental abruption Meds: Hydralazine Labetalol Nifedipine
56
Mg sulfate High alert? Prevent/tx what Given how Little effect on what Will see what Can drawl what
High alert med CNS depressant: prevent and tx seizures IVPB or concurrent with IVF (LR) Has little effect on maternal BP Will see: decreased reflexes and s/s Can drawl mg level to see if at therapeutic range
57
Mg toxicity S/s Where excreted D/c if Reversal Effect of mother vs fetus
RR <12/min Absence of patellar DTR Decreased LOC Cardiac dysrhythmia U/o <30ml/hr Mg excreted in urine so need strict I/O D/c with signs of toxicity Calcium gluconate available Effects mother: Hot, flushed, like flu (low energy) Fetus: Floppy when born (low energy)
58
Eclampsia interventions (SZ) Premonitory s/s Can appear when like what Immediate care
Premonitory: HA. Blurred vision, hyperreflexia, AMS, epigastric pain Can appear suddenly; tonic-clonic Immediate care: Ensure pt airway Note time of onset, duration Call for help, remain w/ pt Check FHR and uterine activity

N330 (17 decks)

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