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OB > Perfusion > Flashcards

Perfusion Flashcards

1
Q

Mild Preclampsia s/s

A

After 20 weeks gestation
Protein in urine
Edema
HTN > 140/90

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2
Q

Severe Preclampsia S/S

A

BP > 160/110

HA, visual impairments, hyperreflexia clonus +4

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3
Q

Mild Preclampsia Tx

A

Rest / w/ no activity limits
Office visits 1-2 weekly for NST
Bed rest may be problematic
No restrictions in diet unless chronic HTN then avoid salt

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4
Q

Severe Preclampsia Txf

A 
Hospitalization
Quiet room with no visitors, prevent stimulation, near nurses station
Bed rest on left side (helps kidneys lower angiotensin II)
Daily weights
NST
High protein, moderate salt diet
Monitor F&E
IV (vasopressin)
Mag sulfate to prevent seizures
Tmp a4, q2 if fever
Hourly I&O
Urine diagnosis will be 3-4+ w/ each urine
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5
Q

Patho of Gest Hypertensive disorders

A

Increased vascular resistance
Elevation of BP
Decreased blood flow to:

Brain = HA, visual, hyperreflexia
Liver = Impaired function, increased enzymes, epigastric pain
Kidneys = decreased GFR, oliguria, increased Na, BUN, uric acid, and creatinine.
Proteinuria - reduces plasma pressures; moves more fluid to extracellular spaces, increasing fluid and edema.
Placenta: vasoconstriction contributes to IUGR, abruption, fetal hypoxia, and acidosis

Hemoconcentration occurs from decrease in intravascular volume r/t the fluid shifts = elevated Hct and blood viscosity.

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6
Q

Therapeutic level of mag sulfate

A

4-7 meg/L

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7
Q

Bolus dose of mag sulfate

A

4-6g over 15-20 minutes

acts immediately
lasts only 30-60 mins
administered via IV
hot flushing sensation

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8
Q

Signs of toxicity of mag sulfate

A

oliguaria < 30 ml/hr
decreased tendon reflex - patella earliest sign
decreased respirations
decreased LOC

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9
Q

Piggy back dose of mag sulfate

A

1-3g/hr (pump)

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10
Q

Secondary effect of mag sulfate

A

relaxes smooth muscle, lowers BP, decreases contractions

Tx of pre-term labor to decrease contractions

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11
Q

Maternal complications of pre-clampsia

A 
Abruption placenta
chronic renal problems
detached retina
chronic HTN
HELLP syndrome
DIC (Disseminated intravascular coagulation)
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12
Q

Fetal complications of preclampsia

A

Prematurity
Intrauterine growth restriction
Asphyxsia

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13
Q

HELLP Syndrome

A 
(H)emolysis
(E)leveated
(L)iver enzymes
(L)ow
(P)latelets

20% of mothers with preeclampsia (same tx as preeclampsia)

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14
Q

How many pregnancies end in miscarriage

A

15-20%

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15
Q

Causes of miscarriage in 1st trimester

A

genetic abnormalities

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16
Q

Causes of miscarriage in 2nd trimester

A 
incompetent cervix
hypothyroidism
diabetes
lupus
CMV
HSV
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17
Q

How many pregnancies are ectopic

A

1 in 50 (2%)

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18
Q

Where can ectopic pregnancies be planted?

A

fallopian tubes
cervix
ovary
abdominal cavity

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19
Q

Risk factors for ectopic pregnancy

A 
Chlamydia
PID
endometriosis
infertility treatments
tubal surgery
IUDs
PP infection
fibroid tumors
smoking
douching
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20
Q

Med for ectopic pregnancy

A

methotrexate (chemotherapeutic med that destroys rapidly developing cells)

21
Q

Benefits of med in ectopic treatment

A

Quicker healing time
less scarring
more scarring increases risk of another ectopic pregnancy

22
Q

Molar pregnancy causes

A

ovular defect
stress
nutritional deficiency

23
Q

Complete mole

A

r/t choriocarcinoma

24
Q

Molar pregnancy patho

A

two sperm filled one ovum

25
Q

Placenta previa

A

PAINLESS BRIGHT RED VAGINAL BLEEDING

marginal can be detected at 20 wk scan. Possibly can grow to size of uterus

Partial - most c-section depends on how much near cervix occurs in 1-400 pregnancies

26
Q

Risk factors of placenta previa

A 
advanced maternal age
abortion
multipara
smoking
asian descent
previous previa
previous c-sections

1-160 after 2
1-60 after 3 because increased scar tissue
1-30 after 4
1-10 > 4

27
Q

Placeta abruption

A

signs include rigid board like abdomen web not being able to indent uterus at all
no oxygen / bleeding
complete needs STAT section
Partial may be possible vaginal birth

28
Q

Placenta abruption s/s

A

“Dark” vaginal bleeding
Constant abdominal pain
Uterine tenderness
Firm uterus

29
Q

Placenta abruption risk factors

A

HTN, cocaine, too much fluid, trauma, alcohol, multipara, can lead to DIC.

30
Q

Occult Umbilical Cord Prolapse

A

hidden cord

31
Q

Over Umbilical Cord Prolapse

A

seen / felt cord

32
Q

Umbilical Cord Prolapse NI

A 
CHANGE MATERNAL POSITION - KNEE/CHEST or trendelenberg with butt in air
assess SROM or PROM
monitor FHR
Don't ambulate
Vaginal exam
Elevate presenting part
Call for help
O2
Notify HCP
Prepare for stat c-section
Explain to pt what is happening
33
Q

Predisposing factors for Cord Prolapse

A

malpresentation
growth restriction
hydraminos
breech / transverse presentation

34
Q

Cord Prolapse stats

A

1-300

35
Q

Meconium aspiration stats

A

20%

36
Q

Meconium aspiration risk factors

A 
post-term pregnancies
forcep delivery
breech
maternal HTN
CGA
Oligohydramnios
prolapsed cord
IUGR
DM
37
Q

Uterine Rupture

A

A tear in uterus usually at previous c-section
initial signs may be sudden fetal bradycardia and acute / continuous ab pain
only 10-30 mins before significant damage to fetus occurs

38
Q

Meconium Aspiration Interventions

A

O2 support afterwards
antibiotics
surfactant
assess prolonged tachypnea, grunting, cyanosis

39
Q

Uterine Rupture Risk Factors

A

trauma, cocaine use, multipara, malpresentation, invasive molar pregnancy, fibroid removal, placenta accreta, excessive uterine stimulation

40
Q

Postpartum Hemorrhage

A

Blood loss >500 following vaginal
Blood loss >1000 following c-section
Most common cause is uterine atony

41
Q

Postpartum Hemorrhage Tx

A 
assess cause to stop bleeding
two large bore IVs for transfusion
fundal massage; pad count
Adminster uterotonic
Fluid administration
Monitor for s/s of shock
42
Q

Postpartum Hemorrhage Risk factors

A 
Big baby
Tissue damage
Trauma
Thrombosis (lack of clotting)
infection
retained placental fragments
43
Q

Meds for postpartum hemmorhage

A

oxytocin, miso-rostov, dinoprostone, methylergonovine, prostoglandin

44
Q

Early signs of shock

A 
Normal blood pressure
increased HR
Normal temp. Cool / moist
Anxiety
Increased rate / depth of respirations
45
Q

Late Signs of shock

A 
low BP
Increased HR, weak
Pale / cold
Coma
Increased / shallow resps
46
Q

Shock types

A 
HYPOVOLEMIC - inadequate intravascular volume
septic
cardiogenic
distributive
toxic drug induced
47
Q

Lab / Diagnostic tests for shock

A 
Blood glucose
Electrolytes
CBC with differential
Blood culture
C-reactive protein
Arterial blood gas
Toxicology panel
Lumbar puncture
Urinalysis
Urine culture
Radiographs
48
Q

Nursing management of shock

A 
ABCs
Vascular access
Restore fluid volume (LR or NSS [isotonic])
Blood transfusion
Foley catheter to measure output
49
Q

Vasoactive meds for shock

A

Dobutamine - improves cardiac contractility
Epinephirine - vasoconstrictor
Dopamine - affects heart / vasculature

OB (9 decks)

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