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ABSN > OB exam 1- Comps of Antepartum > Flashcards

OB exam 1- Comps of Antepartum Flashcards

1
Q

GDM pathophys

A

in 1st trimester there is a decreased need for insulin b/c hormones enhance insulin production & tissue response to insulin then late in the 1st, there is an increased need for insulin b/c hormones act like insulin antagonists

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2
Q

where does the fetus get insulin from

A

because glucose crosses the fetal membrane, the fetus produces its own insulin based on the glucose in mother’s blood

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3
Q

by the end of pregnancy, how much does insulin need increase

A

double or triple

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4
Q

maternal risks of GDM

A

-polyhydramnios d/t increased fetal urine
-preeclampsia / eclampsia
-ketoacidosis (main reason for still birth)
-dystocia (difficult birth)
-increased susceptibility to infections (UTI, yeast, ret)

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5
Q

fetal / neonatal risks w/ DM

A

-perinatal mortality
-congenital anomalies
-macrosomia
-growth restriction
-res distress
-polycythemia
-hypoglycemia after birth
-hyperbilirubinemia

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6
Q

when is a women screened for GDM

A

low risk: 24 to 28 wks
high risk: as early as possible

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7
Q

1hr glucose tolerance test

A

women comes into office and drinks a 50g glucose drink within 10-15 mins and then 1 hr later draw blood to test glucose, if >140 then further testing is needed
pt does not need to be fasting before

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8
Q

3hr glucose tolerance test

A

if 1hr is failed then women are recommended to eat a high carb diet for several days and then fast before coming into the office for a blood draw -> after the draw pt will drink a 100g glucose drink within 10-15 mins -> after finishing blood will be drawn 1hr later, 2hrs later and 3hrs later
if 2 out of the 4 levels are elevated they will get diagnosed w/ GDM

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9
Q

3hr GTT failing glucose marks

A

fasting >/95
1hr >180
2hr > 155
3hr >140

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10
Q

treatment goals for GDM

A

-diet therapy and exercise
-glucose monitoring
-insulin therapy

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11
Q

glucose goals for GDM

A

fasting <95
2hr post meals <120
to help provent macrosomia

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12
Q

nursing mgt of a GDM pt

A

-assessment of glucose
-nutrition counseling (consult RD)
-ed about the disease & mgt
-ed about how to monitor glucose & administer insulin (+overdoses risk)
-assess the fetus w/ ultrasounds every 4 wks, daily fetal movement counts and NST
-give support

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13
Q

when would we delivery a baby before 39 wks

A

complications
baby is too large
mom’s blood sugars are not staying within range

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14
Q

how often should you assess glucose during labor

A

every hour bc the stress of labor can impact glucose levels
continue to check after delivery

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15
Q

GDM mgt postpartum

A

-assess glucose and recognize maternal insulin requirements drop significantly
-encourage breastfeeding
-follow up at 6wks to check levels, if still high then dx of type 2

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16
Q

iron deficiency anemia

A

d/t inadequate iron intake, pt will feel tired and wont handle bleeding well (dx at lower then 11)
tx: iron supplement during pregnancy

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17
Q

sickle cell anemia

A

-recessive autosomal disease
-decreased O2 present d/c sickling
tx: prevent crisis by treating w/ IV fluids, 02 abx, folic acid and analgesics

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18
Q

folic acid deficiency anemia

A

-RBC fail to divide in the absence of folic acid putting the baby at high fetal risk of neural tube defects like SB
tx: women of childbearing age should take 400mcg of folic acid daily then during pregnancy take 1mg folate daily

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19
Q

what is the ideal nursing goal for substance abuse

A

prevention

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20
Q

what needs to be screened for in all pregnancies

A

HIV bc mother could have it without knowing

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21
Q

what is an important part of care for a substance abuse pt

A

-educating on the affects on herself as well as the baby
-establishing a trusting, non judgmental relationship

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22
Q

if a mother finds out she has HIV while pregnant, what is the next step

A

give mother antiretrovirals to reduce risk of transmission to baby (mother to baby is a vertical transmission)

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23
Q

what should be avoided as much as possible if a person has HIV

A

invasion procedures

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24
Q

a women with high risk is screened for HIV initially after finding out she was pregnant and the screen came back negative, what should you expect to be ordered later in pregnancy

A

during the 3rd trimester, re test for HIV

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25
Q

what is our recommendation for feeding to a HIV + mother

A

formula feed baby bc breastmilk can contain HIV if only option, then breastfeed, usually seen in 3rd world countries

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26
Q

congenital heart disease

A

pt born with it and it causes decreased cardiac reserve needed for extra work of pregnancy

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27
Q

peripartum cardiomyopathy

A

left ventricular dysfunction that may occur during last month of pregnancy through 5 month PP
sx: edema, cough, chest pain, fatigue

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28
Q

Eisenmenger syndrome

A

left to right shunting leading to pulmonary HTN

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29
Q

mitral valve prolapse

A

M value prolapses into the left atrium

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30
Q

standard changes during pregnancy

A

increased cardiac output
increased heart rate
increased blood volume

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31
Q

cardiac disease assessment during pregnancy

A

-monitor cardiac functional capacity
-VS
-signs of decomp
-factors that increase stress on heart
always cough, dyspnea, edema, murmur, palpitations, rales & wt gain

32
Q

what are factors that increase stress on the heart

A

anemia, infection, lack of support, home & career demands

33
Q

rest requirements for cardio pts

A

-restricted activities
-8 to 10 hr of sleep
-rests periods
-avoid sources of infection

34
Q

if a pt has a cardiac disorder, how frequently should they visit their HCP

A

every 2 weeks during the first half of pregnancy and then every week during the 2nd half

35
Q

diet for cardiac pts

A

high iron, high protein, low sodium, adequate calories

36
Q

cardiac pt pushing parameters

A

shorter, moderate pushes with periods of relaxation between pushes
epidurals are recommended to help decrease cardiac output and oxygen demands

37
Q

how often do you check VS postpartum for a cardiac pt

A

every 4 hours

38
Q

what position do we encourage for cardiac pts

A

side lying or semi fowlers

39
Q

postpartum of a cardiac pt, what medication do you expect to see ordered

A

stool softeners to prevent bearing down

40
Q

threatened abortion

A

cervix is closed, placenta is attached and pt is experiencing bleeding and cramps

41
Q

imminent abortion

A

cervix is dilated, the placenta is separated and the patient is bleeding

42
Q

incomplete abortion

A

baby has been delivered by placenta is still inside the uterus + bleeding

43
Q

nursing care during a miscarriage

A

-assess the amount and appearance of any vaginal bleeding
-monitor the women’s vital signs and degree of discomfort
-assess need for Rh immune globulin
-assess the response and coping of the women & her family

44
Q

recurrent miscarriage

A

defined by 3 or more consecutive losses or >/2 if advanced maternal age

45
Q

follow up testing for pt with recurrent miscarriage

A

-genetic testing of both parents
-anti phospholipid antibody syndrome
-thyroid disease screen

46
Q

ectopic pregnancy

A

occurs when a fertilized egg is implant some other place other than the uterus’s endometrium

47
Q

what might a pt with an ectopic pregnancy complain of

A

sharp, one sided pain, syncope or referred pain to their should or lower abdomen (possible bleeding)

48
Q

what medication is given for an ectopic pregnancy

A

methotrexate IM that can be administered outpatient

49
Q

methotrexate medication teaching

A

avoid sun exposure, report severe pain and heavy bleeding

50
Q

ectopic pregnancy hospital based care

A

-if surgery is required then IV, preop & postop care
-assess for signs of shock
-administer analgesics

51
Q

in a healthy pregnancy, what are hCG trends

A

should double every 2-3 days and if it doesn’t it is concerned low and concerning

52
Q

gestational trophoblastic disease (molar disease)

A

proliferation of trophoblastic (outer layer of the embryonic cells)

53
Q

hydatiform mole

A

either have a complete mole (ovum containing non genetic material is fertilized by normal sperm) or partial mole (normal ovum is fertilized by two sperm or sperm that has not divided)

54
Q

if you have a complete mole, what are you at increased risk for

A

a chorionic carcinoma

55
Q

what does a molar pregnancy cause

A

abnormal placenta development that lead to fluid filled grape like clusters

56
Q

hydatiform mole

A

-dark brown vaginal bleeding & possible anemia
-hydropic “grape like” vesicles
-uterine enlargement
-absence of FHT
-elevated levels for hCG for dates
-very low serum levels of MSAFP

57
Q

hydatiform mole sx

A

-hyperemesis gravidarum
-preeclampsia

58
Q

hydatiform mole tx

A

-D&C
-possible hysterectomy d/t choriocarinoma in 20% of women
-follow up b/c increased risk for PE (watch for tachy & restlessness)

59
Q

hyperemesis gravidarum

A

excessive vomiting during pregnancy that impact hydration and nutrition, cause unknown but syndrome is connected to nutritional deficits

60
Q

hyperemesis gravidarum dx

A

problematic vomiting in 1st trimest, dehydration, ketouria, and wt loss of 5% of pre pregnancy wt

61
Q

what supplement do pts w/ hyperemesis gravidarum need

A

thiamin (B1) to reduce risk of wernicke’s encephalopathy

62
Q

hyperemesis gravidarum nursing interventions

A

-assess
-maintain fluids + ~TPN
-encourage balanced diet as tolerated
-provided relaxed low stim environment
-antiemetics

63
Q

how does Rh alloimmunization occur

A

when you have an Rh negative mother and an Rh+ fetus and the mother is exposed to the babies blood
exposure can cause mother to to create antibodies against her baby

64
Q

what happens if a mother create antibodies against the baby’s fetal blood

A

there will be a breakdown of fetal blood cells causing a rapid production of erythroblasts by the fetus that can then lead to hyperbilirubinemia
first baby is usually ok but it can hurt future offsprings

65
Q

what happens if treatment for alloimmunization is not giving

A

-anemia resulting from the destruction of fetal RBCs which can cause fetal edema/hydrops fetalis
-CHF
-icterus gravis (jaundice)
-kernicterus leading to neurological damage
-erythroblastosis fetalis

66
Q

hydrops fetalis

A

swelling around the fetal tissue and organs
lethal in 50% of cases

67
Q

antepartum mgt for Rh determination

A

antibody screening (indirect combs test) @ first prenatal visit and 28 wks gestation to determine compatibility of mother and fetal blood

68
Q

what is the next step if indirect combs comes back as incompatible but the mother has no antibodies produced

A

administer 300 mcg of Rhogam
prophylactic at 28wks if screen was negative

69
Q

what other times is rhogam prophylactic

A

-after spontaneous or induced abortion (bc we do not know baby’s blood type)
-ectopic pregnancy
-after invasive procedures during pregnancy
-after maternal trauma

70
Q

what is the next step if indirect combs comes back as incompatible and the mother has antibodies produced (aka mother is sensitized)

A

monitor the baby and complete NST, serial ultrasounds, amniotic fluid analysis (to see if we can delivery the baby early) and a doppler study (looking for signs of severe anemia or fetal hydrops)

71
Q

if severe anemia or fetal hydrops is detected while monitoring of a sensitized women, what do you do

A

you may need to give the fetus an intrauterine blood transfusion or have a preterm delivery

72
Q

what is a direct combs test

A

if mom has a negative blood type and baby is born with a positive blood type then you can test the cord blood and blood antibodies
if negative then the mothers and baby’s blood has not mixed

73
Q

if the baby has a negative antibody screen, what is our care within the first 72 hrs of life

A

give rhogam bc one dose can prevent sensitization up to 30ml of Rh positive blood

74
Q

if the baby has a positive antibody screen (direct combs), what is our care within the first 72 hrs of life

A

do not give rhogam and monitor infant for hemolytic disease

75
Q

kleihauer Betke test

A

determines how much Rh positive blood is present in maternal circulation and determines the amount of rhogam needed

76
Q

ABO incompatibility

A

occurs when mom is type O and infant is either type A, B, or AB causing the mom to create antibodies which can lead to hemolysis of fetal red blood cells & hyperbilirubinemia (jaundice)
severe anemia does not generally occur

ABSN (90 decks)

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