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NURS 132 OB/Peds > OB Exam 2 > Flashcards

OB Exam 2 Flashcards

1
Q

What is the function of progesterone?

A

It decreases uterine motility and contractility.

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2
Q

What is the function of prostaglandins?

A

It promotes smooth muscle relaxation.

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3
Q

What hormones are secreted by the Hypothalamus?

A

Gonadotropin-releasing hormone (GnRH)

  • -> which causes anterior pituitary gland to release:
  • FHS = maturation of follicle
  • LH = ⬆ production of progesterone - release of mature follicle
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4
Q

During the ovarian cycle, when does the follicular phase occur?

A

Days 1-14 (controlled by FHS and LH)

–> body temp ⬆ after ovulation

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5
Q

During the ovarian cycle, when does the luteal phase start?

A

Days 15-28

–> begins when ovum leaves follicle

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6
Q

What are the 4 stages of the endometrial cycle?

A

1) Menstrual phase = shedding of endometrium due to ⬇ levels of estrogen and progesterone
2) Proliferative phase = ⬆ estrogen levels
3) Secretory phase = ⬆ progesterone levels
4) Ischemic phase = starts if fertilization does not occur

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7
Q

After ovulation, how long does the ovum remain viable?

A

24 hours

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8
Q

What are the main causes known for infertility?

A
  • Ovulatory dysfunction (20-40%)
  • Tubal and peritoneal pathology (30-40%)
  • Male factors (30-40%)
  • Uterine pathology is relatively uncommon
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9
Q

What is another cause of ovarian dysfunction?

A

Polycystic ovarian syndrome = most prevalent ovarian disorder.

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10
Q

What are 3 tubal and pelvic potential problems?

A

1) Endometriosis = uterine cells grow in other areas of the body
2) Tubal Scaring from PID (Pelvic Inflammatory Disease) = Gonorrhea, Chlamydia
3) Asherman’s syndrome = uterine adhesions resulting from trauma

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11
Q

What are gametes and what do they become when united?

A

Gametes are the combination of a sperm and ovum together forming a zygote.

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12
Q

What are the different developmental steps occurring during the pre-embryonic (or germinal) stage?

A

1) Morula is formed (12-16 cells)
2) Blastocyst (100 cells)
3) The inner cell mass develops into fetus
4) Trophoblast = develops into placenta and fetal membranes

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13
Q

How long is the pre-embryonic stage?

A

First 14 days of human development

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14
Q

When does the implantation of conceptus (zygote)?

A

Between the 6th and 10th days

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15
Q

How is the corpus luteum maintained after conception?

A

It is maintained by the hormone HCG secreted by the zygote

–> in turn, the corpus luteum will continue to secrete estrogen and progesterone.

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16
Q

What is the difference between monozygotic and dizygotic twins?

A

Dizygotic twins have 2 ova fertilized by 2 different sperms.

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17
Q

When does the embryonic stage start?

A

From third to eighth week.

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18
Q

During the embryonic stage, what happens at week 3 through 8?

A

Week 3 = Early ❤development
Week 4 = neural tube closes, beginning of internal ear and eye, upper extremities bud - lung and GI tract start development
Week 5 = rapid brain growth, ❤ is developing 4 chambers, embryo is about 0.4 cm long.
Week 6 = ❤ reaches final 4 chambers form - facial and digits development (yolk sac earliest source of nutrients)
Week 7 = eyelids and internal organs form (liver, intestines, kidneys)
Week 8 = EVERY SYSTEM IS FORMED

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19
Q

What are the main potential teratogens to avoid during pregnancy?

A 
Toxoplasmosis 
Other = Syphillis, Gonorrhea, Chlamydia, Condyloma, Trichoniasis
Rubella
Cytomegalovirus 
Herpes Genitalis
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20
Q

What symptoms can be caused by congenital toxoplasmosis on the newborn?

A
  • Mental retardation
  • microcephaly
  • Hydrocephalus
  • Anemia
  • Jaundice
  • Deafness
  • Seizures
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21
Q

What symptoms can be caused by Syphilis?

A
  • Chancre sores in different areas such as external genitals, vagina, anus and rectum.
  • -> Can be passed to the fetus = high risk of death
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22
Q

What are the consequences of Rubella on pregnancy or the fetus?

A
  • Miscarriages
  • Stillbirths
  • Fetal anomalies
  • If infected in first trimester = high risk of infant having congenital rubella syndrome (CRS –> cataracts, ❤ defects, and deafness)
  • Vaccinated women should not get pregnant for 1 month after the immunization
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23
Q

What is the consequence on the fetus if mom is infected with CMV (herpes-virus group)?

A

The fetus has a 30-40% chance of getting infected in utero.

  • -> S x S =
  • hearing loss
  • vision impairment
  • seizures
  • developmental delay
  • mental retardation
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24
Q

When does the fetal stage start?

A

Weeks 9-40
–> All systems in place = refinement during this phase

  • Teratogens less likely to damage already formed structures
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25
Q

What happens between week 9 and 12 of the fetal phase?

A
  • body proportions change
  • eyes close
  • blood formation
  • urine production
  • -> by end of 12th week fetal ❤can be heard by Doppler
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26
Q

What happens between week 13 and 16 of fetal phase?

A

“Quickening” (sometimes not felt until 20th week)

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27
Q

What happens between weeks 17 and 20 during the fetal phase?

A
  • Vernix covers fetus
  • Lanugo grows on body
  • Brown fat starts to develop
  • Eyebrows and hair appear
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28
Q

What happens between week 21 and 24 during the fetal phase?

A
  • Skin translucent
  • Lungs begin surfactant formation
  • Alveoli capillary exchange poor
  • -> if born = poor chance of survival
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29
Q

What happens between weeks 25 and 28 during the fetal phase?

A
  • SQ fat develops
  • Eyes open now
  • Fetus may assume head down position
  • -> better chance for survival
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30
Q

What happens between weeks 29 and 32 during the fetal phase?

A
  • Skin thickens
  • Nails present
  • -> good survival chance if born now
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31
Q

What happens between weeks 33 and 40 during the fetal phase?

A
  • Mainly gain of weight
  • Lungs mature
  • Vernix and lanugo disappear by term
  • Breast tissue palpable
  • Testes are descending
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32
Q

During what week and phase, is the placenta formed?

A

By the 10th week during the fetal phase.

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33
Q

What is the consequence on the infant in contact w/ HSV (Herpes Simplex Virus)?

A

If left untreated, survival rate is 50%.

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34
Q

What are the implications on an infant of an HIV + mother?

A
  • The infant will have a 25-45% risk of developing the disease
  • Mother has to abstain from breastfeeding
  • Mother will receive antiretrovirals (AZT or ZDV) during pregnancy (after the 14th week not to harm fetus during 1st trimester)
  • Short course of antiretrovirals for baby for 6 weeks
  • To avoid contamination at birth = Cesarian is preferred method of birth
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35
Q

What are the implications on the infant of a mother w/ Group B Streptococcus (GBS)?

A

The infant can get:

  • pneumonia
  • meningitis
  • overwhelming sepsis

Prenatal treatment = PCN/Ampicillin to prevent this cross-infection from occurring.

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36
Q

For OTC and prescribed drugs, what are the significance of the different categories?

A
  • Category A = no risk
  • Category B = animal studies no risk - no human studies
  • Category C = no adequate studies
  • Category D = evidence of risk - but benefits can outweigh risks
  • Category X = SEVERE fetal risk
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37
Q

What are the implications of tobacco use on pregnancy?

A

1) Fetal hypoxia
2) Low birth weight
3) ⬆ risk for miscarriage, premature birth and stillbirths
4) ⬆ risk for SIDS
5) Neuro and intellectual developmental problems later in school

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38
Q

What are the implications of alcohol use on pregnancy?

A

Can cause Fetal Alcohol Syndrome (FAS)

  • -> potential mental retardation (low IQ, microencephaly)
  • -> prenatal and postnatal growth restriction
  • -> flat midface, small chin, thin upper lip
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39
Q

What are some maternal disorders and their implications?

A

1) Diabetes (most common) = ❤ diseases, anencephaly, macrosomia
2) Heart diseases = stress the cardiovascular system
3) Phenylketonuria = microcephaly, ❤ disease
4) Sickle cell, Thalassemia

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40
Q

What are the main 4 problems in early pregnancy?

A

1) Spontaneous Abortion
2) Ectopic Pregnancy
3) Hydatidiform Mole (Molar pregnancy)
4) Hyperemesis Gravidum

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41
Q

What are the S x S of a Spontaneous Abortion?

  • Occur in 20% of all pregnancies
A
  • Cramping
  • Backache
  • Bleeding
  • Vaginal bleeding can be significant and life-threatening
  • -> emergency IV fluids and meds
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42
Q

What is the definition of an Ectopic pregnancy?

A

An implantation of a fertilized ovum in an area outside the uterine cavity - 98% of time in Fallopian tube (Ampulla area)

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43
Q

What are the S x S of an Ectopic pregnancy?

A
  • Missed menstrual period
  • Abdominal pain (one sided)
  • Vaginal spotting
  • Caution if tube ruptures –> Hypovolemic shock symptoms (shoulder or neck pain w/ minimal or no external bleeding)
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44
Q

What are the risk factors to an Ectopic pregnancy?

A
  • Hx of STDs
  • Hx of Pelvic Inflammatory Disease (PID)
  • Hx of previous Ectopic pregnancies
  • Failed tubal ligation
  • Use of an IUD
  • Multiple induced abortions
  • Maternal age > 35
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45
Q

What are some complications with a diabetic woman during pregnancy?

A

1st Trimester = insulin levels ⬆ (estrogen ⬇ progesterone ⬆)
–> Risk for Hypoglycemia

2nd + 3rd Trimesters = insulin levels ⬇ ( HPL + HgH ⬆)
–> Risk for Hyperglycemia

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46
Q

What is the definition of Hydatidiform Mole?

A

Rare condition in which tissue around a fertilized egg (normally would develop into placenta) develops into an abnormal cluster of grape-like cells.

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47
Q

What are the 2 types of Hydatidiform Mole (Aka Gestational Trophoblastic Disease)?

A

1) Complete - empty egg fertilized by normal sperm, HIGHLY associated w/ cancer :(
2) Partial - too many chromosomes

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48
Q

What are the clinical implications of a Hydatidiform Mole?

A

1) If not removed, 15% of moles will become cancerous
2) Can cause serious bleeding
3) Another 5% will develop into fast-growing cancer called choriocarcinomas

  • It is highly recommended to NOT get pregnant for at least 1 year afterwards.
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49
Q

What is Hyperemesis Gravidarum?

A

A persistent, uncontrollable vomiting that can continue throughout pregnancy but is usually more prominent during the first trimester.

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50
Q

What are the implications of Hyperemesis Gravidarum

A
  • Weight loss
  • Dehydration
  • Ketosis
  • Electrolyte imbalance (K+)
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51
Q

What are the risk factors for Hyperemesis Gravidarum?

A
  • Young age
  • First pregnancy
  • Problem w/ nausea + vomiting in previous pregnancy
  • Hx of intolerance to oral contraceptives
  • Previous gallbladder disease
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52
Q

What therapeutic management can be implemented w/ Hyperemesis Gravidarum?

A
  • Drug therapy
  • IV fluids w/ K+ (possibly TPN)
  • Offer small, frequent meals, blend but high in K+ and Mag (simple carbs)
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53
Q

In concerns to the breasts, what physiological changes can the pregnant woman experience?

A

1) Estrogen stimulates growth of ductal tissues
2) Progesterone stimulates lobule growth
3) Secreted HPL (human placental lactogen) also stimulates breast growth
4) By 12-16 weeks production of some colostrum
5) Darkened areolae, superficial veins prominent
6) Striae may develop

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54
Q

In concerns to the cardiovascular system, what physiological changes can the pregnant woman experience?

A

1) Heart sounds - splitting of the first ❤ sound and murmur common in 90%
2) BP remains stable even w/ ⬆ of blood volume
3) ⬆ cardiac output - 500 mL/min required to perfuse the placenta
4) Supine hypotensive syndrome
5) Plasma fibrinogen ⬆ = Risk for loos clot
6) Physiologic anemia of pregnancy –> Blood volume ⬆ and RBCs production can’t keep up (diluted blood) Hct is lower
7) Hgb may need iron therapy

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55
Q

What teaching tip should be shared w/ the pregnant patient in concerns to iron therapy?

A
  • Do not take iron w/ milk products

- Take vitamin C to help iron absorption

56
Q

What is the Vena Cava Syndrome?

A

The gravid uterus compresses on the vena cava in supine position
–> reduces blood flow returning to the ❤
As a result = Maternal hypotension

  • If baby pressing on spine –> ⬇ blood flow –> change mom’s position to side.
57
Q

What is an expected amount of blood loss at birth?

A

1) Vaginal = < 500 mL

2) C-section = < 1000 mL

58
Q

In concerns to the Respiratory system, what physiological changes can the pregnant woman experience?

A

1) ⬆ in O2 consumption by 15-20%
2) Progesterone causes relaxation of smooth muscle –> can result in dyspnea and fainting
3) Vascular congestion of nasal mucosa can cause nasal stuffiness + epistaxis

59
Q

In concerns to the GI system, what physiological changes can the pregnant woman experience?

A

1) Estrogen causes gums to bleed + excessive salivation (Ptyalism)
2) Progesterone causes relaxation of esophageal sphincter –> Heartburn + longer emptying of stomach
3) Constipation + hemorrhoids more common
4) Nausea + vomiting (1st trimester)
5) “Pica” = cravings for dirt, starch

60
Q

In concerns to the Integumentary system, what physiological changes can the pregnant woman experience?

A

1) Hyperpigmentation (Melonocyte-stimulating hormone) =
- chloasma (beauty marks on face)
- linea nigra (vertical line along belly)
2) Stretch marks
- striae gravidarum
3) Spider nevi
4) Hyperactive sweat + sebaceous glands

61
Q

In concerns to the Musculoskeletal system, what physiological changes can the pregnant woman experience?

A

1) Relaxin causes relaxation of pelvic joints –> waddling gait + change of gravity center (⬆ risk for falls)
2) “Lordosis” (lower curvature of spine) later in pregnancy
3) Calcium + phosphorous needs ⬆
4) Separation of rectus abdominis

62
Q

In concerns to the CNS system, what physiological changes can the pregnant woman experience?

A

1) Reports of ⬇ attention, concentration, and memory

2) Sleep problems

63
Q

In concerns to the Endocrine system, what physiological changes can the pregnant woman experience?

A

1) Estrogen produced by placenta stimulates:
- uterine growth
- breast ductal system
- hyperpigmentation + vascular changes in skin
2) Progesterone (MOST important hormone in pregnancy) produced by CL then placenta:
- maintains endometrial layer
- prevents miscarriage by relaxing smooth muscle
- stimulates breast lobes and lobules
- facilitates fat storage for energy
3) HPL (Human placental lactogen) promotes:
- fetal growth by ⬆ availability of glucose to the fetus
- -> ⬇ maternal insulin sensitivity and glucose use = ⬆ maternal blood sugar
- breast development for lactation

64
Q

What are some objective signs of pregnancy?

A

1) Changes in cervix:
- Chadwick’s sign = bluish discoloration of cervix, vagina and labia
- Goodell’s sign = softening of vaginal portion of cervix
2) Changes in uterus:
- ballottement = fetus rebounds (@ 24 weeks)
- Hegar’s sign = softening of isthmus of uterus
- Braxton Hick’s contractions = similar to real contractions
- Uterine soufflé

65
Q

What are some assessments or tests that can confirm a pregnancy?

A

1) Palpation of fetal outline:
- Leopold’s Maneuver = assess baby’s position
2) Blood test = assess HCG presence
3) Auscultation of fetal ❤ sounds = Doppler @ 10-12 weeks
4) Fetal movements = after 20 weeks
5) Visualization of fetus = x-ray, ultrasound @ 4-5 weeks

66
Q

What are some important antepartum assessments performed during the physical exam?

A

1) Pelvic adequacy
2) Deep Tendon Reflexes (DTRs)
3) External + internal genitalia
4) Labs = h & h or CBC, blood type + Rh, urine, VDRL and HIV
5) Fundal height w/ McDonald’s method
- -> * could be higher w/ twins = ⬆ risk of hemorrhage

67
Q

What is the recommended weight gain for a pregnant woman?

A

1) Normal weight = Total 25-35 lbs
2) If underweight = Total 28-40 lbs
3) If overweight = Total 15-25 lbs
4) Twins = Total 35-45 lbs

68
Q

What is the formula of weight gain during pregnancy?

A

3 1/2 lbs first trimester, then 0.9 lb. per week

69
Q

What are some factors that can influence good nutrition during pregnancy?

A
  • Age = young and AMA
  • Nutrition knowledge
  • Culture
  • Vegetarianism
  • “Pica”
  • N/V
70
Q

What are the nutritional requirements during pregnancy?

A

1) Calories = additional 350 (2nd tri) 450 (3rd tri) kcal/day
2) Proteins = 71 g/day
3) Iron = 27 mg/day
4) Vitamins:
- Prenatal
- Folic acid = 600 mcg or minimum of 400 mcg/day
- Calcium = 1000-1300 mg/day

71
Q

What are some danger signs of pregnancy that would require to notify the MD right away?

A

1) Vaginal bleeding
2) Continuous headache
3) Rupture of membranes ——————-
4) Swelling of fingers, face + eyes ———– > Pre-eclampsia
5) Visual disturbances ———————-
6) Persistent or severe abdominal pain
7) Chills or fever
8) Painful urination
9) Persistent vomiting
10) Change in frequency or strength of fetal movements

72
Q

What are the signs of Preterm labor

A
  • Painful menstrual-like cramps
  • Dull back ache
  • Suprapubic pain or pressure
  • Pelvic pressure or heaviness
  • Change in appearance or amount of vaginal discharge
  • Diarrhea
  • Uterine contractions felt every 10 min for 1 hour
  • Leaking of fluid from vagina
73
Q

What are some psychosocial concerns during the 1st trimester of pregnancy?

A
  • Uncertainty
  • Ambivalence (conflicting emotions)
  • Focus on self
74
Q

What are some psychosocial concerns during the 2nd trimester of pregnancy?

A
  • Focus on fetus
  • Narcissism an introversion
  • Body image changes
  • Changes in sexuality
  • Focused on their pregnancy
75
Q

What are some psychosocial concerns during the 3rd trimester of pregnancy?

A
  • Vulnerability
  • Increasing dependence
  • Preparation for birth
  • “Nesting”
  • Role playing, fantasy (of becoming a mom), and looking for a fit are experienced during the last trimester.
76
Q

When the future dad experiences symptoms of the pregnancy, it is called…?

A

“Couvade” = ex: dad can gain weight w/ wife

77
Q

What are the most “at risk” pregnancies?

A
  • Single mother
  • Adolescent mothers
  • Alcohol or drug dependent mothers
  • Physical abuse victims
  • Older women
78
Q

What are some statistics about adolescence pregnancy?

A
  • 82% of pregnancies are unintended
  • 43% will have a second child w/in 2 years of their first
  • Babies of teen mothers are more likely to die in the first year of life
  • 1 out of every 11 teen girls become pregnant before age 20
79
Q

What are the risk factors for teen pregnancies?

A

1) Poor prenatal care = ⬆ risk for pre-eclampsia, LBW, preterms, cephalopelvic disproportions, iron deficiency (anemia)
2) Poor nutrition
3) ⬆ incidence of STDs + substance abuse
4) Interruption of psychological developmental tasks
5) Incompletion of academic scholarship
6) ⬆ risk of poverty

80
Q

What nursing interventions can be implemented w/ teen moms?

A
  • EDUCATION about pregnancy and motherhood
  • Screening for drugs + STDs
  • Assess nutritional status
  • Family adaptation
81
Q

What are the disadvantages of AMA pregnancy?

>35 y

A
  • ⬆ risk for complications
  • Chromosomal abnormalities
  • HTN
  • Uterine fibroids ( Postpartum hemorrhage)
82
Q

What are the advantages of AMA pregnancy?

A
  • More mature
  • Better financial resources
  • Priorities in place
83
Q

What are the 2 different types of Ultrasound Antepartum testing?

A

1) Ultrasonography:
- Transvaginal = confirmation/establishment of gestational age (best between 6 and 10 weeks)
- Transabdominal = @ 2nd and 3rd trimesters (full bladder to view)

2) Doppler Ultrasound Blood Flow Assessment
- -> Tracks blood through blood vessel

84
Q

What other Antepartum testing can be performed?

A

1) Alpha-Fetrotein Screening (AFP) = chromosomal defects
- -> done between 16-18 weeks

2) Chorionic Villus Sampling (CVS) = fetal cells for genetic, metabolic and DNA abnormalities
- -> done during 1st trimester
* CVS to screen, not diagnose (cannot detect neural tube defects)

3) Amniocentesis = can detect genetic, metabolic, DNA abnormalities and neural tube defects!
- -> done between 14-21 weeks

85
Q

What are the potential risks/side effects w/ performance of Amniocentesis?

A
  • Transient vaginal spotting
  • Cramping
  • Amniotic fluid leakage
  • Chorioamnionitis
  • Rupture of membranes
86
Q

What is the average of the Fetal Movement Assessment?

A

10 movements w/in 12 hours or

3 movements w/in 60 min

87
Q

What is Lecithin Sphingomyelin (L/S) ratio?

A

To measure the lung maturation by amniocentesis
–> will indicate risks for RDS
< 2.0 = ⬆ risk for RDS
< 1.5 = Very ⬆ risk for RDS

88
Q

What physical abnormalities will the Quad test detect and when will it be performed?

A

1) Spina Bifida (25-80% accurate)
2) Anencephaly (95%)
3) Trisomy (@ 21 and 18 chromosome)
4) Abdominal + ❤ defects
- -> Performed between 15 and 20 weeks

89
Q

What 4 substances can the Quad test measure?

A

1) AFP ( ⬆ in open defects)
2) HCG
3) Estriol
4) Inhibin A

90
Q

Why and when is the Non-stress Test performed (NST)?

A
  • Accelerations of ❤ beats = intact CNS
  • Accelerations need to be 15 beats/min above baseline and lasting 15 seconds
    1) Reactive (or reassuring) = 2 or more accelerations w/in 20 min
    2) Nonreactive (or nonreassuring) = insufficient accelerations over 40 min :(
  • -> performed after 28 weeks
91
Q

What does the Contraction Stress Test measure?

A

1) Uteroplacental function
2) ID intrauterine hypoxia
3) Fetal ❤ rate responses to contractions

As a result:

  • Negative test = no late or significant decelerations
  • Positive test = late decelerations following 50% or more contractions
92
Q

What are the 2 possible outcomes w/ the NST and CST?

A

1) Negative CST w/ reactive NST :-)

2) Positive CST w/ nonreactive NST :-((

93
Q

What is the Amniotic Fluid Index?

A

Measures the amniotic fluid volume

  • AFI of 5 or less requires further evaluation
94
Q

How is the Amniotic Fluid volume determined by?

A
  • Fetal urine output

- Fetal swallowing

95
Q

What does the Biophysical Profile measure (BPP)?

A

1) Fetal ❤ rate acceleration
2) Fetal breathing
3) Fetal movements
4) Fetal tone
5) Amniotic fluid volume

–> by ultrasound

96
Q

What are the 3 most common medical problems in pregnancy?

A

1) Diabetes Mellitus
2) Bleeding disorders
3) Hypertensive disorders

97
Q

What is type 3 diabetes?

A

Gestational Diabetes = carbohydrate intolerance r/t ⬆ estrogen, progesterone, and HPL

98
Q

What is a fasting blood sugar that would suggest Diabetes?

A

> 126 or non-fasting > 200

99
Q

What are some clinical implications due to Diabetes during pregnancy?

A
  • ⬆ risk for gestational HTN
  • DKA (Diabetic ketoacidosis) mostly type 1
  • Polyhydramnios = fetal hyperglycemia and consequent fetal diuresis
  • ⬆ risk for difficult birth C/S due to macrosomia
100
Q

What are the potential neonatal effects w/ Diabetes before birth?

A
  • ⬆ risk for spontaneous abortion
  • Congenital malformations
  • Preterm labor/birth
101
Q

What are the potential neonatal effects w/ Diabetes after birth?

A
  • Hypoglycemia
  • Hypocalcemia
  • Hyperbilirubinemia
  • Polycythemia
  • RDS
  • Birth trauma
102
Q

What are the risk factors for GDM?

A
  • Obesity
  • Chronic HTN
  • Family hx of DM
  • Previous birth of large infants = > 4000 g
  • Previous birth w/ congenital anomaly
  • Previous unexplained fetal demise
  • GDM in previous pregnancy
103
Q

What is the definition of Abruptio Placentae?

A

Premature separation of a normally implanted placenta.

104
Q

What are the 3 different types of Abruptio Placentae?

A

1) Marginal = placenta separates a edges
2) Central = placenta separates centrally and blood is trapped
3) Complete = total separation of placenta from uterine wall

105
Q

What are the risk factors for the occurrence of Abruptio Placentae?

A
  • Cocaine or amphetamines = vasoconstriction in endometrial arteries
  • Maternal HTN
  • Cigarette smoking
  • Short umbilical cord
  • Abdominal trauma
  • Previous Hx
106
Q

What are the S x S of Abruptio Placentae?

A
  • Bleeding (potential signs of Hypovolemic shock
  • Uterine tenderness + severe abdominal pain
  • Excess uterine activity (no rest btw contractions)
  • Fetal distress
  • Back pain
107
Q

How can Abruptio Placentae be treated?

A
  • Assess cardiovascular status of mother and fetus
  • If condition is mild = Bed rest + tocolytic meds (to suppress labor)
  • If condition is severe = Intensive monitoring –> potential delivery, IV, blood products
108
Q

What is the definition of Placenta Previa?

A

Implantation of the placenta in the lower part of the uterus.

109
Q

What are the 3 types of Placenta Previa?

A

1) Low = placenta implanted in lower uterus but at least 3 cm away from internal cervical os
2) Partial = lower border of placenta is w/in 3 cm of internal cervical os but does not completely cover it
3) Total = placenta completely covers internal cervical os

110
Q

What the risk factors for the occurrence of Placenta Previa?

A
  • AMA
  • Previous Hx of C/S and Placenta Previa
  • Cigarette smoking
  • Cocaine use
111
Q

What are the S x S of Placenta Previa?

A
  • Sudden onset of painless uterine bleeding (in last 1/2 of pregnancy)
112
Q

What are the therapeutic interventions w/ Placenta Previa?

A

1) Conservative care
- Bed rest
- IV access
- Fetal monitoring
- Watching for signs of bleeding or preterm labor
2) Aggressive care:
- Delivery of infant if mom sows S x S of Hypovolemia and/or signs of fetal compromise

113
Q

What is the definition of gestational hypertension?

A

A multi-organ disease process that develops as a consequence of pregnancy and regresses in the postpartum period.

114
Q

What are the classifications of hypertensive disorders of pregnancy?

A

1) Pre-eclampsia (HTN + proteinuria):
- Mild
- Severe
2) Eclampsia
3) HELLP
4) Gestational HTN = ⬆ BP but NO proteinuria (25% of GHTN becomes pre-eclampsia)
5) Chronic HTN

115
Q

What is the definition of Pre-eclampsia?

A

A condition in the last half of pregnancy in which a woman who previously had normal BP, experiences ⬆ BP, proteinuria, and generalized edema.

116
Q

What is the incidence rate of Pre-eclampsia?

A

It occurs in 8% of all pregnancies.

  • One of the 3 causes of perinatal morbidity and mortality
117
Q

What are the S x S of Pre-eclampsia?

A
  • Hypertension = sustained BP 140/90 or ⬆ of 30 mmHg systolic or 15 mmHg diastolic
  • Generalized edema
  • Proteinuria = 300 mg or more (24 hr sample)
118
Q

What are the clinical implications of Pre-eclampsia on the kidneys?

A
  • Glomerular damage = proteins leak through
  • Loss of proteins causes fluid shift to interstitial space
  • -> Edema (rapid weight gain, ⬇ urinary output = < 30 mL is concerning)
119
Q

What are the clinical implications of Pre-eclampsia on the liver?

A
  • ⬆ liver enzymes caused by impaired liver function

- Epigastric pain (hepatic edema)

120
Q

What are the clinical implications of Pre-eclampsia on the CNS?

A
  • Headaches
  • Visual disturbances
  • -> due to arterial vasospasm (cerebral hemorrhage)
  • Hyperactive DTRs
  • Seizures
121
Q

What are the clinical implications of Pre-eclampsia on the pulmonary system?

A
  • Leaking of pulmonary capillaries

- -> leading to pulmonary damage + dyspnea

122
Q

What are the clinical implications of Pre-eclampsia on the placenta?

A
  • ⬇ placental circulation + blood flow –> infant can have IUGR or fetal demise
  • Maternal risks ⬆ for Abruptio Placentae and Disseminated Intravascular Coagulation (DIC)
123
Q

What are the risk factors for the occurrence of Pre-eclampsia?

A
  • Primigravida
  • Age extremes
  • Hx of Pre-eclampsia
  • Multiple gestations
  • ⬆ BMI
124
Q

The only cure for Pre-eclampsia is delivery of the baby.

T/F?

A

True

  • Steroids can help the lung development
125
Q

What is super-imposed Pre-eclampsia?

A
  • Chronic HTN w/ development of new onset proteinuria after 20 weeks gestation
  • Sudden ⬆ in proteinuria if already present
  • Sudden ⬆ (worsening) in HTN
  • Development of HELLP syndrome w/ pre-existing HTN
126
Q

What is considered severe Pre-eclampsia?

A
  • BP is 160/110 or higher
  • Proteinuria is more than 500 mg/day (3+ or >)
  • Oliguria occurs = 500 mL or < in 24 hr
  • All other S x S
127
Q

What are the medical recommendations for a pregnant woman suffering from severe Pre-eclampsia?

A
  • Antihypertensive medications (Apresoline, Labetalol, Nifedipine)
  • Anticonvulsant medications (MgSO4)
  • Careful intrapartum monitoring
  • Postpartum assessment for at least 48 hr
  • Steroids
128
Q

What are the clinical manifestations of Eclampsia?

A
  • Generalized or grand mal seizures (last 1- 1 1/2 min)
  • Maternal mortality is as high as 20%
  • Respirations usually cease during seizures but resume afterwards
129
Q

What are the nursing interventions for a patient w/ severe Pre-eclampsia that may progress to Eclampsia?

A
  • Monitor for S x S of impending seizures (BP may drop, Temp may elevate dramatically
  • Provide a quiet environment
  • Ready the room for incidence of seizures (O2, padding around side rails, bed in low position…)
130
Q

What are the proper interventions while a seizure occurs?

A
  • Remain w/ patient and press emergency button
  • Turn woman on side to prevent aspiration and ⬆ placental functioning
  • Note time and sequence of seizure
  • Insert airway following seizure and suction mouth and nose (O2 if necessary)
  • Notify physician
  • Administer meds as directed (Phenobarbital, MgSO2)
131
Q

What are the proper nursing interventions following a seizure?

A
  • Continue w/ MgSO4 or Phenobarbital
  • Frequent assessment of pulmonary edema
  • Urine output assessment (30 mL/hr minimum)
  • DTRs monitor (fetal ❤ + vaginal bleeding)
  • Assess for possibility of delivery
132
Q

What are the S x S of MgSO2 toxicity?

A

CNS depression =

1) RR < 12/min
2) Absence of DTRs
3) Altered LOC
4) Hypotension
5) Serum MgSO4 level above 4-8 mg/dL

133
Q

What are the nursing interventions when MgSO4 toxicity occurs?

A
  • D/C MgSO4
  • Contact physician right away
  • Administer Calcium Gluconate = Antidote
134
Q

What is HELLP syndrome?

A

Hemolysis Elevated Liver enzymes Low Platelets

–> Life-threatening variation of Pre-eclampsia

135
Q

What are the clinical manifestations of HELLP

A

Liver S x S =

  • Right upper quadrant pain
  • Nausea + vomiting
  • Liver tenderness + swelling
  • Malaise

Lab data =

  • ⬇ Hct
  • ⬆ liver enzymes (bilirubin, AST, ALT)
  • Thrombocytopenia (plt count < 100,000/mm)
  • Abnormal clotting studies (PT, INR)
  • Risk for morbidity and mortality
136
Q

What are the clinical interventions in the occurrence of HELLP?

A
  • MgSO4
  • Antihypertensive meds
  • Induction of labor
  • NO LIVER PALPATION
  • IV fluids + platelets as needed
  • Note: patient may or may not have DTRs (2+ is normal)

NURS 132 OB/Peds (4 decks)

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