Obstetrics Flashcards
How do genetics improve our ability to predict susceptibility, onset, and progression of disease and the response to treatment?
It provides genetic markers, indicating response to medication
Study of a single gene disorder
Genetics
Study of all the genes in the human genome together including including interactions with each other, influence of psychological factors and cultural factors
Genomics
Why are genetic diseases now more difficult to diagnose?
Intermingling of races
What is the nurse’s role in genetics?
Preconception counseling and testing, neonatal screening, palliative care, and specialized care
Which genetic abnormality requires immediate palliative care?
Ancephally
Which genetic test has a high false positive rate for open spinal disorders?
Alfa fetal protein
Why do people not like to do genetic testing?
Insurances can raise their rates or drop them based on the result
When is the heart formed?
3-5 weeks after conception
A major cause of reproductive loss, congenital problems and gynecologic disorders
Chromosomal abnormalities
When do chromosomal abnormalities occur?
During mitosis or meiosis
What are the sex chromosomal abnormalities?
Turner, Klinefelter’s, and XXY
What type of genetic testing is direct or molecular?
Linkage analysis
What type of genetic testing is biochemical?
Cytogenetic testing
What are the types of prenatal genetic testing?
Maternal serum screening, fetal ultrasound, amniocentesis, and chronic villus sampling
What is the chromosomal abnormality associated with Turner syndrome?
Monosomy X
What does Turner’s syndrome present as?
Female has underdeveloped ovaries, is short, has webbing of the neck, a low hairline in the back, low set ears, lymphedema of the hands and feet and may have impaired intelligence
What does Klinefelter’s syndrome present as?
Male has poorly developed secondary sex characteristics and small testes, is infertile, tall, effeminate and slow to learn
What is the XXY abnormality linked to ?
Aggression
Single gene controlling a trait, disorder or defect
Unifactorial
What are examples of unifactorial defects?
Autosomal dominant inheritance, autosomal recessive disorder, inborn errors of metabolism, X-linked dominant inheritance, and X-linked recessive inheritance
Which disease is an inborn error of metabolism?
PKU
What does PKU present as?
Light skin, hair, and eyes, delayed mental and social skills, small head, hyperactivity, intellectual disability, seizures, and rashes
A disease caused by a defective gene that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body
Cystic Fibrosis
What does CF present as?
No bowel movements in the first 24-48 hours, delayed growth, salty skin, distended abdomen, pale or clay colored stools, infertility, clubbed fingers
What are the screening tests for CF?
Immunoreactive trypsinogen, chest x-ray, CT, fecal at test, lung function test, measurement of pancreatic function, secretin stimulation test, trypsin and chymotrypsin in stool and upper GI and small bowel series
What is the diagnostic test for CF?
Sweat chloride test
Genetic disorder in which one copy of the gene is needed for expression
Autosomal dominant
Genetic disorder in which two copes of the gene is needed
Autosomal recessive
A type of genetic disorder in which females are carriers and males express the disease
X-linked dominant inheritance
Name examples of X-linked recessive inheritance
Color blindness, hemophilia, and muscular dystrophy
Parents are known to be at risk for producing a child with the disease
Occurrence risk
Parents once they have produced a child with the disease
Recurrence risk
Bleeding disorder most common in males
Hemophilia
Most common genetic malfunction that is a combination of environmental and genetic factors
Multifactorial
Name examples of multifactorial genetic abnormalities
Cleft lip and palate, congenital heart disease, neural tube defeats, and pyloric stenosis
What is the nurse’s role in genetic counseling?
Inform, educate, support
Where does conception take place?
In the fallopian tubes
How common is color blindness?
1 in 10 boys
When does the lip form?
4-7 weeks
How many chromosomes does each gamete bring to conception?
23
At what point does ancephaly occur?
Between the 23rd and 26th days of conception
A problem with a baby’s stomach that causes forceful vomiting, this is caused by the pylorus swelling and thickening
Pyloric Stenosis
At what age do the symptoms of pyloric stenosis present?
Between birth and 5 months
How is pyloric stenosis treated?
Surgery
How is cleft lip treated?
Plastic surgery
What abnormalities are present with congenital heart disease?
Vertebral abnormalities, anal atresia, cardiovascular abnormalities, trachioesophageal fistulas, esophageal atresia, renal and radial abnormalities, and limb defects
What is the presenting symptom of congenital heart disease?
Low oxygen saturation within the blood supply
What week does the brain develop?
24
During what weeks do the kidneys develop?
5-9 weeks
During what weeks do the ears develop?
9-30 weeks
What is the endometrium called after implantation?
Decidua
Where does the chorionic cilli tap into the maternal blood vessels?
Decdidua Basalis
A 16-cell morula embedded in the endometrium that develops into two parts, the trophoblast and embryoblast
Blastocyst
What does the trophoblast give rise to?
The placenta
What does the embryoblast give rise to?
The embryo
When does the blastocyte develop?
Within three days of conception
What three germ layers does the embryo differentiate into?
Ectoderm, mesoderm and endoderm
When does the embryo differentiate?
Week 3
What does the ectoderm develop into?
Epidermis, glands, nails and hair, central and peripheral nervous systems, lens of the eye, tooth enamel and flor of the amniotic cavity
What does the mesoderm develop into?
Bones and teeth, muscles, dermis and connective tissue, cardiovascular system, spleen, and urogenital system
What does the endoderm develop into?
Epithelium lining in the respiratory and digestive tracts, liver and pancreas, urethra, bladder, and vagina
Finger-like projections that extend into the blood-filled spaces of the endometrium to obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products
Chorionic Villi
What is the purpose of the fetal intestines?
They make meconium
When is meconium released?
When the baby is in distress
When do fetal intestines begin to develop?
Eight weeks
Where do the fetal intestines develop?
The umbilical cord
When do the fetal intestines move into the baby’s abdomen?
When its big enough, at about 10 weeks
When do the fetal intestines start working?
At 11 weeks
When does the large intestine start making and storing meconium?
16 weeks
How long does the embryo take to develop?
Day 15 until week 8
What does the chorion contain?
The major vessels of the umbilical cord
When do the fetal kidneys begin working?
Between weeks 13 and 15
What is urine output at 22 weeks?
2.2 mL/hour
What is urine output at 32 weeks?
12.2 mL/hour
What is urine output at term?
28 mL/hour
What indicates a possible renal abnormality?
Too little amniotic fluid (oligohydramnios)
What is the function of amniotic fluid?
Protection
How does the amniotic fluid protect the fetus?
Maintains temperature, maintains fluid and electrolyte imbalance, cushions the fetus, allows for movement, barrier to infections, allows fetal lung development, and facilitates smmetric growth
What is hydramnios associated with?
GI malformations
What does the amniotic fluid contain?
Albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, and lanugo hair
What part of the embryo becomes the primitive digestive system?
The yolk
What vasculature is contained within the umbilical cord?
Two arteries and one vein
Why is it very important to make sure the umbilical cord contains two arteries and one vein after birth?
To screen for congenital abnormalities
What do the arteries in the umbilical cord do for the baby?
Carry blood away from the embryo and to the chorionic villi
What does the vein in the umbilical cord for the baby?
Brings blood to the embryo
What is the life span of the placenta?
40 weeks and 6 days
When does maternal-placental-embryonic circulation develop?
Day 17
What is the function of the placental?
It acts as the fetal endocrine gland, metabolic regulator, and stores nutrients
What parts of maternal health affect the placenta?
Nutrition and hypertension
What organ secretes hCG and hCS?
The placenta
What hormone enables the gestation of the fetus?
Progesterone
What does hCG do?
Preserves the function of the corpus luteum, ensuring a continued suppoly of estrogen and progesterone
What does hCS do?
Stimulates the maternal metabolism to supply needed nutrients for fetal growth, increases resistance to insulin, and facilitates glucose transport
Where does deoxygenated blood come into fetal circulation?
Placenta
What allows the most oxygenated blood to go from the right to left atrium and out the aorta to the brain?
A patent foramen ovale
How does blood travel through the umbilical vasculature of a fetus?
Poorly oxygenated blood goes from the fetal arteries into umbilical arteries to get oxygen from the placenta and then is returned to fetal circulation via the umbilical vein
At what age is a fetus viable?
20 weeks
What limits viability before 20 weeks?
CNS function and oxygenation capability of the lungs
What is a normal fetal heart rate?
110-160 beats/minute
What is the first organ system to develop in a fetus?
Cardiovascular
When do fetal blood vessels and blood cells begin to form and function?
Week 3
How are the fetal lungs bypassed during gestation?
Ductus Arteriosus
At what age are rH (-) fetuses at risk for contamination?
Six weeks
When do respiratory surfactants appear?
Between 24 weeks and birth
When does a baby have enough surgactant for survival?
32 weeks except in white males
What is essential for thermoregulation?
Brown fat and glycogen storage
At what age is glycogen able to be stored in the liver?
9 weeks
At what age does brown fat appear on the baby’s back?
26-30 weeks
What is the glycogen stores of a baby at birth?
Twice that of an adult
Where does a fetus’s urine go?
Into the amniotic fluid
How is fetal waste removed from the body?
It goes into the mother’s blood and is filtered out by the mother’s kidneys
At what age can fetal respiratory movements be seen on ultrasound?
Week 11
What does surfactant do?
It expands the air spaces in the lungs
What process squeezes out excess surfactant?
Birth
Women who is pregnant
Gravida
Women who has completed pregnancy to viability
Para
At what age is a fetus post-term?
Beyond 42 weeks
At what age is a fetus pre-term?
20-37 weeks
Women pregnant for the first time
Primigravida
Woman who has completed one pregnancy with fetus or fetuses who have reached the stage of viability
Primipara
At what age is a fetus term?
38-42 weeks
Changes from pregnancy that are felt by the woman
Presumptive signs
Name examples of presumptive signs of pregancy
Amenorrhea, breast changes, nausea and vomiting, quickening, urinary frequency, and fatigue
Changes from pregancy that are observed by the examiner
Probable signs
Name examples of probably signs of pregnancy
Chadwick’s, Goodell’s, and Hegar’s signs, positive pregnancy test, Braxton-Hicks contractions, and ballottement
Softening of the cervix
Goodell’s sign
Blueish discoloration of the cervix
Chadwick’s sign
Softening of the uterus
Hegar’s sign
Increased fluid in the suprapettallar pouch
Ballottement
Signs of pregnancy attributed only to the presence of the fetus
Positive signs
Name examples of positive signs of pregnancy
Ultrasound and fetal heart tones
At what age does fetal sensory awareness develop?
3-24 weeks
When does the fetal thyroid develop?
3-4 weeks
What does the fetus of a diabetic mother look like?
Macrosomic
When does the musculoskeletal system begin to develop?
Week 4
What immunoglobulins can pass through the placenta?
Only igG
What immunoglobulins can pass through the colostrum?
Only IgA
A women is 8 months pregnant. She tells the nurse that she knows her baby listens to her but her husband thinks she is imagining things. The most appropirate response by the nurse is:
Babies in utero do respond to their mother’s voice
What best describes the pattern of genetic trasnmission known as autosomal recessive interitance?
Disorders in which both genes of a pair must be abnormal for the disorder to be expressed
The student nurse is giving a presentation about milestone in embryonic development. Which infomation should he or she include?
At 20 weeks, the vernix caseosa and lanugo appear
A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:
Discuss options with the couple, including amniocentesis to determine whether the fetus is affected
A couple has been counseled for genetic abnormalities. They ask you, “What is karyotyping?” Your best response is:
Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes
With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that:
The risk factor remains the same no matter how many affected children are already in the family
With regard to abnormalities of chromosomes, nurses should be aware that:
Abnormalities of number are the leading cause of pregnancy loss
A key finding from the Human Genome Project is:
Approximately 20,000 to 25,000 genes make up the genome
Most of the genetic tests now offered in clinical practice are tests for:
Single-gene disorders
A woman’s cousin gave birth to an infant with a congenital heart abnormality. The woman asks the nurse when such abnormalities occur during development. Which response by the nurse is most accurate?
3-5 weeks
A maternity nurse should be aware of which fact about amniotic fluid?
It serves as a source of oral fluid and as a repository for waste from the fetus
A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates:
Lung maturity
The nurse should teach a pregnant woman that which substances are teratogens?
Cigarette smoke, Isotretinoin, and Rubella
How is the due date of a baby determined?
Date of last menstrual period, fundal height, and ultra sound
What is a positive pregnancy test based on?
Recognition of hCG or a Beta subunit of hCG
What are urine pregnancy tests based on?
ELISA testing
When is nipple discharge during pregnancy normal?
12-14 weeks
What happens to a mother’s blood pressure during pregnancy?
It should remain stable
What happens to a mother’s heart rate during pregnancy?
It increases 10-15 beats/minute
What happens to a mother’s blood volume during pregnancy?
It increases 1500 mL
What happens to a mother’s hemoglobin and hematocrit during pregnancy?
They decrease
What happens to a mother’s cardiac output during pregnancy?
It increases 30-50% so blood can reach the fetus’s tissues
How should a pregnant woman lay?
On her left side
What happens to a mother’s clotting factors during pregnancy?
They increase
What happens to a mother’s pulmonary function during pregnancy?
It increases
What kind of respiratory balance is a pregnant woman generally in?
Respiratory alkalosis
How can a pregnant woman maintain her renal health?
Drink water
As a baby gets bigger, what renal problem is the mother at risk for?
Renal caliculi
Mask of pregnancy
Chloasma
What causes the chloasma?
Increased estrogen levels
Broken blood vessel that go away after pregnancy
Angioma
What integumentary system changes occur during pregnancy?
Chloasma, linea nigra, striae gravidarum, angiomas, palmar erythema
What changes occur to the musculoskeletal system during pregnancy?
Softening of ligaments, widening of pelvis, increased fat storage, splitting of abdominal muscles, and lordosis
What changes occur to the neurologic system during pregnancy?
Pregnancy brain, heightened sensitivity, and nesting
What changes occur to the endocrine system during pregnancy?
Diabetes, hypothyroidism and rarely hyperthyroidism
If exhibited by a pregnant woman, what represents a positive sign of pregnancy?
Fetal heartbeat
Which H&H result represents the lowest acceptable values for a woman in the third trimester of pregnancy?
33% and 11g/dL
When assessing the fetal heart rate of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/minute. Initially the nurse should:
Assess the woman’s radial pulse
OTC pregnancy tests usually rely on which technology to test for hCG?
ELISA
A nurse teaches a pregnancy woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:
Fetal movement
During a client’s physical exam, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this as:
Hegar sign
Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
Increased pulse
A woman who has completed on pregnancy with a fetus reaching the stage of viability is called:
Primipara
Which presumptive signs or positive sign of pregnancy is not matched with another possible cause?
Goodell sign and cervical polyps
In order to reassure and educate pregnant clients about change in their blood pressure, maternity nurses should be aware that:
Compression of the iliac veins and interior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy
What is the nurse’s most important role for a pregnant client?
Education
What is Nagele rule?
Add 7 days to last missed period and count forward nine months
When does the father start to realize and accept the pregnancy?
At birth
What type of care should the nurse emphasize during pregnancy?
Preventative and optimal self care
Why are herbal drugs not safe for use during pregnancy?
Because they have not been studied
What type of lab tests should be routinely performed on pregnant women?
CBC with diff and thyroid function
When is fetal viability confirmed with an ultra sound?
8th week
When should a pregnant woman stop traveling?
37-39 weeks
What immunizations does a pregnant woman need?
Tdap, flu shots, rubella, and varicella
During the first trimester, the pregnant woman would be most motivated to learn about:
Measures to reduce nausea and fatigue so she can feel better
An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse’s BEST response would be:
“This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner’s first pregnancy?
Consistently changes the subject when the topic of the fetus/newborn is raised
What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy?
Rubella titer 1:6
A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with:
Open neural tube defects such as spina bifida.
An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that:
Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:
Turn the woman on her side.
A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:
Extends her leg and dorsiflexes her foot during the cramp.
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:
“You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:
Alteration in the pattern of fetal movement.
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her:
“Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:
She must be having a low-risk pregnancy.
Which statements about multifetal pregnancy are most appropriate?
The expectant mother often develops anemia because the fetuses have a greater demand for iron; The mother should be counseled to increase her nutritional intake and gain more weight; Backache and varicose veins are often more pronounced.
What is the biggest complication from amniocentesis?
Infection
When is chorionic villus sampling done instead of amniocentesis?
When there is a need for earlier diagnosis and rapid results
When can CVS be performed?
10-13 weeks
How does CVS give information about the fetus?
The tissue biopsied reflects the genetic makeup of the fetus
What are the dangers of CVS?
Infection and miscarriage
Direct access to fetal circulation through the umbilical cord
Percutaneous umbilical blood sampling
Which test shows Rh compatibility?
Coombs’ test
What is the goal of electronic fetal monitoring?
To determine if the intrauterine environment is supportive to the fetus
What non-invasive methods are used to stimulate the fetus?
Vibroacoustic stimulation, orange juice
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test?
“This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
For which test is a full bladder a requirement?
Ultrasound
What is an indicator for performing a contraction stress test?
Maternal diabetes mellitus and postmaturity
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
Transvaginal ultrasound
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
Is considered negative if no late decelerations are observed with the contractions.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
Doppler blood flow analysis
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to:
Administer RhoD immunoglobulin.
The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result?
Indirect Coombs test
The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test?
Jewelry must be removed before the test; Remain still throughout the test.
A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient?
Vibroacoustic stimulation may be used during the test; Drinking orange juice before the test is appropriate; Two sensors are placed on the abdomen to measure contractions and fetal heart tones.
What is the most common endocrine disorder associated with pregnancy?
Diabetes mellitus
What is the key to an optimal outcome for a woman with preexisting diabetes mellitus?
Strict maternal glucose control
What are the risks for a pregnant woman who has preexisting diabetes mellitus?
Macrosomia, hydramnios, ketoacidosis, hyperglycemia, hypoglycemia, congenital malformations and sudden still birth
For a pregnant woman, what is worse, hyperglycemia or hypoglycemia?
Hypoglycemia
What is a normal a1c level?
> 6
Why are women with pre gestational diabetes mellitus often induced early?
To prevent the baby from becoming too big
How is gestational diabetes screened for?
Urine dip sticks at every office visit and a postprandial study at 27 weeks
What is the pharmacological therapy for a woman with gestational diabetes?
Insulin and oral hypoglycemics only if they can’t take insulin
Which oral hypoglycemics are relatively safe for use during pregnancy?
Glyburide and metformin
What is the leading cause of hyperthyroidism during pregnancy?
Graves’ disease
Why does phenylkentonuria cause fetal mental retardation?
Toxic accumulations of phenylalanine in the blood interferes with brain development and function
Why do maternal cardiovascular disorders lead to preterm labor and birth?
Because when the heart is in distress it sends a message to get the cause (fetus) out
Why is intrauterine growth restriction more common in women with cardiovascular disorders?
Decreased maternal cardiac output leads to decreased tissue perfusion in the fetus
Why are heart murmurs identified during pregnancy?
The increased blood volume increases the heart’s work load, making murmurs louder
How long should heart transplant patients wait to have get pregnant?
One year after the transplant
What do women with cardiac disorders need to be monitored for postpartum?
Cardiac decompensation
Why do women with cardiac disorders decompensate after giving birth?
Most of the body’s ATP and O2 stores are used up
What foods contain folic acid?
Leafy greens and milk
Patients with asthma are at an increased risk for what complication?
Postpartum hemorrhage
Why are patients with cystic fibrosis not recommended to get pregnant?
Pregnancy is often complicated by chronic hypoxia and frequent pulmonary infections
Allergic reaction to baby
Pruritic uticarial papules and plaques
Why do patients with MG need forceps or vacuum delivery?
They don’t have the strength to push the baby out
What are the barriers to substance abuse treatment for pregnant women?
Fear losing custody and prosecution
In which patients is breastfeeding contraindicated?
Those using amphetamines, alcohol, cocaine, heroin, or marijuana
Why do substance abusers have a particularly hard time during the intra an postpartum periods?
They have a very low pain tolerance
During a prenatal visit, the nurse is explaining dietary management to a woman with pre gestational diabetes. The nurse evaluates that teaching has been effective when the woman states:
Diet and insulin needs change during pregnancy
The nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function?
Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics
Maternal and neonatal risks associated with gestational diabetes mellitus are:
Maternal preeclampsia and fetal macrosomia.
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:
Degree of glycemic control during pregnancy.
Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.
A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that:
Dietary management involves distributing nutrient requirements over three meals and two or three snacks.
During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:
Cardiac decompensation.
Thalassemia is a relatively common anemia in which:
An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs).
From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks:
Between 24 to 36 weeks of gestation.
A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often:
Decreasing energy levels.
Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes?
Herion
During pregnancy, alcohol withdrawal may be treated using:
Benzodiazepines
A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms?
Muscle aches, weight changes, and fever
A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. The nurse expects which health care provider orders to be included in the plan of care?
Serum lab levels of medications; Abdominal ultrasounds; Prenatal vitamins with vitamin D.
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for:
Miscarriage; gestational hypertension; placental abruption; stillbirth
How common is preeclampsia?
It complicates 5-10% of pregnancies
What is the most common medical complication reported during pregnancy?
Hypertension
Onset of hypertension without proteinuria after the 20th week of pregnancy
Gestational hypertension
Hypertension develops after the 20th week of pregnancy in a previously normotensive woman
Preeclampsia
Seizure activity or coma in a woman diagnosed with preeclampsia
Eclampsia
What causes preeclampsia?
Disruptions in placental perfusion and endothelial cell dysfunction
How does preeclampsia cause renal damage?
Proteinuria
What are the hallmarks of preeclampsia?
Headache, blurred vision, and proteinuria
Varient of severe preeclampsia that involves hemolysis, elevated liver enzymes, and low platelets
HELLP Syndrome
What are the elevated risks associated with the HELLP Syndrome?
Pulmonary edema, renal failure, liver hemorrhage, disseminated intravascular coagulation, placental abruption, acute respiratory distress syndrome, sepsis, stroke, and death
How is the HELLP syndrome diagnosed?
Platelet count, liver enzymes, and elevated bilirubin
What happens with coagulation in patients with HELLP syndrome?
They have a low platelet count but PT, PTT, and bleeding times remain normal
Hyperreflexia occurs in which hypertensive disorders?
Severe preeclampsia and eclampsia
What type of edema is concerning in a woman with preeclampsia?
Hand and face edema
How are mild gestational hypertension and mild preeclampsia treated?
Activity restriction
