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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
Q

Ectopic preg

Clinical manifestations
Ruptured fallopian tube CM

A

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
Q

Ectopic preg
Diagnosed with:

A

HCG/progesterone levels

Transvaginal US

27
Q

Ectopic pregnancy management

-labs
-early vs late stage tx
-at risk for
What to do for this risk

A

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
Q

Gestational trophoblastic disease (GTD)
-aka
-what it is (what it can cause)
-how it effects embryo
-can cause what

A

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
Q

GTD partial vs complete

A

Partial: some fetal parts

Complete: no fetal parts

30
Q

GTD
Clinical manifestations

A

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
Q

GTD
Diagnosis

A

Transvaginal US

Persistently high hCG levels

32
Q

GTD care management f/u care

Care
Moniotr what and how often
If stays high do what
Discourage what

A

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
Q

Placenta previa

What is it
Classifications

A

Placenta implanted low, near or over cervix

Complete: complete cover cervix

Partial: partially covers cervix

Marginal/low-lying placenta: low but doesnt cover

34
Q

Placenta previa

RF

A

Previous c-section

Uterine scarring:
-curettage
-endometritis

Previous placenta previa
Advanced maternal age (over 35y/o)
Multiparity (multiple births)
Smoking

35
Q

Placenta previa

Clinical manifestation
How diagnosed

A

*Painless bright red vaginal bleeding (2nd, 3rd tri)

Diagnosed on US before bleeding occurs

Soft, relaxed non-tender uterus w/ normal tone

36
Q

Placenta previa

Management
Avoid

A

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
Q

Placenta previa

If delivery is imminent

A

Get type and screen

2 units of cross matched PRBCs

Having a c-section

38
Q

Placenta previa

Maternal and fetal outcomes
-major complications
How will they deliver and why

A

Hemorrhage

Will deliver c-section if:
Full term, excessive bleeding, active labor

Preterm birth: IUGR

39
Q

Placental abruption

What is it
Leading cause of what

A

Detachment of part or all of placenta from implantation site

After 20 wks

Leading cause of maternal death

40
Q

Placental abruption

RF

A

Maternal HTN
Preeclampsia
Cocaine/tobacco use

Blint external trauma/ partner violence
Hx of abruption

41
Q

Placental abruption

Clinical manifestation

A

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
Q

Placental abruption

Management
-prepare for what
-labs
-identify what
-post op monitor for

A

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
Q

Types of HTN in pregnancy

A

Chronic

Gestational

Preeclampsia

44
Q

Chronic HTN

How to classify that

Chronic HTN can acquire what

A

HTN present before pregnancy
Or
Diagnosed before 20 weeks gestations

Chronic HTN with superimposed preeclampsia
Acquire preeclampsia or eclampsia

45
Q

Chronic HTN management

Begins when
Management
High risk managed with what

A

Begins before pregnancy

Wt loss
Diet
Excerise
Smoking/alcohol cessation

High risk managed w/ antihypertensive assessment

46
Q

Gestational HTN

Onset
SBP greater than
Diastolic greater than for how long apart

Resolves by when

A

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
Q

Preeclampsia

Classified as
Can get it when

A

HTN and proteinuria 1+ or more after 20 wk gestation in previously normotensive women

Can develop for 1st time after postpartum period (RARE)

48
Q

Severe preeclampsia features (10)

A

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
Q

Eclampsia

Preceded by:

A

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
Q

HELLP syndrome

Hepatic dysfunction characterized by:

A

Hemolysis of RBCs: anemia and jaundice
Elevated Live enzymes (ALT,AST)
Low platelets

(Watch for these s/s with pt w/ preeclampsia

51
Q

Preecmapsia: RF (9)

A

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
Q

Preeclampsia assessment

A

Accurate BP

Proteinuria:
-dipstick 1+
-ideally measured w/ 24hr urine collection

Assess edema

53
Q

Interventions for preeclampsia and gestational HTN
Without severe features

A

Monitor BP

Fetal monitoring (kicks, FHR, NST, CST, US)

F/u with provider

Bedrest

54
Q

Interventions for preeclampsia and gestational HTN
With severe features

Preexlampsia management
Tx
Meds

Intrapartum management
Assess

A

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
Q

HTN indicated when

Goal BP

If untreated concerns of

Meds for it

A

Indicated when SBP exceeds 160 or DBP 110

Goal: 140-150/90-100

Untreated concern:
Cerebral hemorrhage
Placental abruption

Meds:
Hydralazine
Labetalol
Nifedipine

56
Q

Mg sulfate

High alert?
Prevent/tx what
Given how
Little effect on what
Will see what
Can drawl what

A

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
Q

Mg toxicity

S/s
Where excreted
D/c if
Reversal
Effect of mother vs fetus

A

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
Q

Eclampsia interventions (SZ)

Premonitory s/s

Can appear when like what

Immediate care

A

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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