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IM 6 Test 3 > Pregnancy at Risk > Flashcards

Pregnancy at Risk Flashcards

1
Q

abortion

A

pregnancy loss before the fetus is viable or capable of living outside the uterus

before 20 weeks or <500 g

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2
Q

when does spontaneous abortion occur most

A

1st trimester

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3
Q

parental age and spontaneous abortion

A

incidence increases

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4
Q

most common cause of spontaneous abortions

A

chromosomal abnormalities

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5
Q

threatened abortion

A

vaginal bleeding and pregnancy threatened

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6
Q

inevitable abortion

A

cannot be stopped

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7
Q

incomplete abortion

A

not all products are expelled - placenta is usually retained

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8
Q

complete abortion

A

all products of conception are expelled

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9
Q

missed abortion

A

when fetus dies but is retained in uterus

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10
Q

recurrent spontaneous abortion

A

defined as 3+ spontaneous abortions

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11
Q

what is required in incomplete abortions and missed abortions

A

D&C/D&E

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12
Q

clinical manifestations of spontaneous abortions X3

A

uterine cramping and vaginal bleeding

persistent backache and feelings of pelvic pressure

passing of products of conception

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13
Q

abortion mgmt

A

watch for excessive bleeding or signs of infection

D&C/D&E or induction

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14
Q

major complication for missed abortion

A

infection and DIC

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15
Q

D&C

A

dilation and cutterage

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16
Q

D&E

A

dilation and evacuation

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17
Q

missed abortion treatment under 13 weeks

A

D&C

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18
Q

missed abortion treatment over 13 weeks

A

D&E

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19
Q

abortion psych impact X4

A

frightening
sense of loss, grief, anger and disappointment
grief can last for 18 months
may feel guilt/speculate she could have saved it

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20
Q

cervical incompetence/insufficiency

A

mechanical defect that causes preemie cervical ripening

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21
Q

cervical incompetence associated with X2

A

previous cervical ripening

congenital structural defects of uterus/cervix

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22
Q

tcervical incompetence treatment

A

cervical cerclage

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23
Q

cerclage

A

purse string suture placed around the cervix between 12-16 weeks

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24
Q

what is given during a cerclage

A

antibiotics and tocolytics, RhoD immune globulin

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25
Q

cerclage post op monitoring/home care

A

monitor for bleeding, cramping, infection, fluid leakage, pelvic rest for a week

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26
Q

ectopic pregnancy

A

implantation of fertilized ovum in site other than endometrial lining of uterus (usually fallopian tube)

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27
Q

ectopic pregnancy risk factors X2

A

anything that compromises tubal patency

previous ectopic pregnancy

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28
Q

adnexal pain

A

R/LUQ ovluation pains that mimic appendicitis

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29
Q

when do ectopic pregnancy symptoms occur

A

6-8 week time period

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30
Q

ectopic pregnancy assessment X4

A

LMP
pelvic and abdominal exam
masses
adnexal tenderness

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31
Q

ruptured ectopic pregnancy s/s

A

referred shoulder pain or mid-scapular pain

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32
Q

how do you test for ectopic prgnancy

A

low hCG and transvaginal ultrasound shows no fetus

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33
Q

ectopic pregnancy treatment

A

stable: methotrexate
ruptured: surgical treatment w/ attempt to preserve tubef

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34
Q

methotrexate

A

chemo agent used to undce aboritons

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35
Q

pt education for methotrexate

A

urine is considered toxic for 72 hours - flush twice with closed lid

do not drink
no folic acid
no NSAID’s
avoid sunlight

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36
Q

gestational trophoblastic disease aka

A

hydatidiform mole

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37
Q

molar pregnancy

A

trophoblasts that attach the fertilized ovum to the uterine wall develop abnormally

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38
Q

molar pregnancy is more common in

A

asian woman and older women

more likely to have multiple

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39
Q

what happens if fetus is present in a molar pregnancy

A

fatal chromosomal defect

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40
Q

clinical manifestations of molar pregnancy X

A 
higher levels of hCG than expected
snowstorm pattern
enlarged uterus for gestational age
vaginal bleeding
preeclampsia before 24 weeks
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41
Q

snowstorm pattern

A

vesicles and absence of a fetal sac or fetal heartbeat on ultrasound

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42
Q

what do high hCG levels do to the woman

A

excessive nausea and vomiting

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43
Q

choriocarcinoma

A

common SE of molar pregnancy

mets to the lung liver stomach and brain and vagina

easily treated

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44
Q

molar pregnancy dx X2

A

measurement of hCG and ultrasound

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45
Q

molar pregnancy mgmt X2

A

evacuaiton of trophoblastic tissue
treat for other issues
labs for coag studies

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46
Q

uterine stimulation and molar pregnancies

A

avoid any and all stimulation including oxytocin

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47
Q

F/U care for molar pregnancy

A

hCG monthly for 6 months

avoid pregnancy

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48
Q

what happens if hCG levels rise after molar pregnancy evacuation

A

malignancy tx w methotrexate

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49
Q

when can you get pregnant after a molar pregnancy

A

when levels are at 0

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50
Q

placenta previa

A

implantation of the placenta in lower uterus

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51
Q

marginal or low-lying placenta previa

A

implanted in lower uterus but more than 3 cm from internal cervical os

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52
Q

delivery w/ marginal placenta previa

A

potentially vaginal

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53
Q

partial placenta previa

A

lower border of placenta is within 3 cm of internal cervical os but does not completely cover it

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54
Q

partial placenta previa delivery

A

c section

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55
Q

total or complete placenta previa

A

placenta completely covers the internal os

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56
Q

total placenta previa delivery

A

c section

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57
Q

placenta previa s/s X3

A

sudden onset of painless vaginal bleeding

uterus soft relaxed and non-tender
occurs at the end of 2nd trimester or during the 3rd

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58
Q

how is placenta previa assessed

A

VAGINAL EXAM IS CONTRAINDICATED

ultrasound is used to determine placement

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59
Q

placenta previa tx if mom is stable and no fetal compromise

A

delay birth to increase maturity and birth weight

admin corticosteroids

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60
Q

why are fetuses given corticosteroids

A

speed fetal lung maturity

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61
Q

when can placenta previa be managed at home X8

A

no active bleeding

strict BRWBRP

home is close to hospital

EMS is available

woman can verbalize risk understanding

develop a procedure to follow if heavy bleeding occurs

daily kick counts

assessing uterine activity

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62
Q

placenta previa tx if mom or baby arent stable

A

in patient care for weeks to months until delivery

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63
Q

abruptio placentae

A

separation of normally implanted placenta before fetus is born causes bleeding and hematoma formation to mom

64
Q

abruptio placentae RF X7

A 
illegal drug use
maternal HTN
multigravida
short cord
abdominal trauma
PROM
previous hx
65
Q

how long do women need to be monitored after abdominal trauma

A

up to 24 hours

66
Q

abruptio placentae s/s X8

A 
bleeding
uterine tenderness/pain
uterine irritability
abd/low back pain
high IUPC tone
board like abdomen
port wine colored amniotic fluid
non reassuring FHR patterns
67
Q

s/s of hypovolemic shock X5

A 
tachycardia
hypotension
pale color
cold skin
trendelenburg****
68
Q

abruptio placentae conservative mgmt

A

only if mild condition with fetus <34 weeks old

bed rest
tocolytic admin
corticosteroids
RhoD

69
Q

abruptio placentae mgmt for fetal compromise or maternal deteriorartion

A

immediate delivery

blood should be available
X2 18 g IV

70
Q

dissmeinated intravascular coagulation

A

life threatening defect in coag that may occur in several pregnancy complications

71
Q

diseases that cause DIC

A

severe preeclampsia
HELLP syndrome
dead fetus syndrome

72
Q

DIC dx X3

A

activated PTT
d-dimer
fibrin degredation product levels

73
Q

DIC tx

A 
correct underlying issue
blood replacement
O2 at 10 L/min
VS
quantify blood loss by weight
74
Q

hyperemesis gravidarum

A

persistent uncontrollable vomiting that begins in first weeks of pregnancy and may continue throughout pregnancy

75
Q

hyperemesis mgmt

A

usually treated at home

in patient includes IV F/E replacement and TPN as a last step

76
Q

nursing interventions for hyperemesis

A 
dehydration teaching
daily weight
small portions with low fat
soups/liquids between meals
use ginger
sit upright after meals
77
Q

gestational HTN

A

begins after 20th week
140/90 on 2 different occasions at least 4 hours apart
no proteinuria***
BP returns to baseline by 6 weeks

78
Q

preeclampsia

A

GH with >1+ proteinuria

79
Q

severe preeclampsia

A

BP 160/110 with proteinuria of 3+ and oliguria

80
Q

s/s of severe preeclampsia

A 
cerebral/visual disturbances
extensive peripheral edema
impaired liver function
hyperreflexia
thrombocytopenia
epigastric and RUQ pain
81
Q

ankle clonus in severe preeclampsia

A

seizure imminent

82
Q

HELLP syndrome

A

hemolysis, elevated liver enzymes, low platelets

83
Q

HELLP syndrome s/s

A

pain in RUQ, low right chest or mid epigastric area

84
Q

Eclampsia

A

preeclampsia + seizure 48-72 hours postpartum

85
Q

mgmt of preeclampsia

A

do not restrict salt in diet - stay on pregnancy diet

only cure is delivery of baby and placenta

86
Q

severe preeclampsia mgmt

A

bed rest and fetal monitoring

87
Q

antiHTn meds

A

labatelol
hydralazine
nifedipine

88
Q

magnesium sulfate

A

CNS depressant irritability and relaxes smooth muscle to prevent seizures

89
Q

s/s of magnesium toxicity

A 
Respiratory depression
chest pain
mental confusion
depressed DTR
flushing, sweating, lethargy
hypotension
90
Q

magnesium sulfate antidote

A

calcium gluconate

91
Q

interventions for mag sulfate

A

assess the woman for respiratory <12
assess for DTR
assess for urine output <30 mL/hr

92
Q

chronic HTN

A

if HTn precedes pregnancy or is ID before 20 weeks or postpartum week 12

93
Q

maternal/fetal blood incompatibility

A

mom attacks baby RBC leading to hyperbilirubinemia and anemia

94
Q

how much does a standard RhoD dose cover

A

15 mL fetal RBC or 30 mL whole blood

95
Q

alloimmunized pts and RhoD

A

not given since mom is already sensitized

96
Q

ABO incompatability

A

common with rare significant hemolysis

97
Q

gestational diabetes dx

A

1 hour glucose test

<140 - testing stops
>140 - oral glucose tolerance test

98
Q

3 hour oral glucose test

A

godl standard

fasting from midnight on

99
Q

insulin requirements during pregnancy

A

1st - decreased need
2nd - increased need, glucose use increases
3rd - increased need d/t placental maturation and human placental lactogen

100
Q

breastfeeding and insulin

A

decreases the amount of insulin needed

101
Q

fetal effects form maternal hyperglycemia X9

A 
fetal death/abortion
LGA
IGUR if T1 w/ vascular changes
RDS
hyperbilirubinemia
hypoglycemia
preemie
cardiomyopathy
congenital defects
102
Q

maternal complications from diabetes X6

A 
infections
preeclampsia
hydramnios
ketoacidosis
hypoglycemia
hyperglycemia
103
Q

class I or II cardiac disease

A

limit physical activity

avoid excessive weight gain

104
Q

class III or IV cardiac disease

A

primary goal is to prevent cardiac decompensation and development of CHF

105
Q

pregnancy after bariatric surgery

A

postpone pregnancy for 12-24 months
assess for vitamin and nutritional deficiency
monitor for signs of intestinal obstruction

106
Q

sources of iron rich foods X6

A

meat, fish, chicken, liver, green leafy veggies

107
Q

anemia maternal effects X6

A 
physiologic anemia
pyelonephritis
bone infection
heart disease
preeclampsia
preterm
108
Q

sickle cell and fetus

A

fetus usually fairs well if no sickle cell crisis occurs

109
Q

most serious complication of SLE

A

congenital haert block

110
Q

antiphospholipid syndrome med

A

lovenox throughout pregnancy

111
Q

hashimoto’s thyroiditis and pregnancy

A

increased risk of miscarriage and preemie birth/preeclampsia

112
Q

major concern for epilepsy in pregnancy

A

teratogenic effects of anticonvusant

113
Q

bells palsy and pregnancy

A

3x more common in pregnancy and usually occurs third trimester

114
Q

HIV and pregnancy

A

vaginal delivery contraindicated - c section before ROM

115
Q

what is given to infants of HIV mothers immediately after delivert

A

ART prophylaxis (zidovudine)

116
Q

toxoplasmosis comes from

A

cat poop and uncooked meats

117
Q

labor dystocia

A

dysfunctional labor or labor that doesnt progress as expected

118
Q

macrosomic infant

A

weight more than 8 lbs 13 oz or 4000 g - head might be too big

119
Q

shoulder dystocia

A

OB emergency where shoulder becomes impacted above the maternal symphysis pubis

120
Q

mcroberts maneuver

A

used in shoulder dystocia

121
Q

precipitous labor complications and definition

A

birth occurs within 3 hours of labor

associated with genitcal tract damage, infantile trauma, promotion of fetal oxygenation

122
Q

intrauterine infection aka

A

chorioamnionitis

123
Q

baby and chorioamnionitis

A

baby is more likely to die

124
Q

mom and chorioamnionitis

A

uterine rupture and infection

125
Q

chorioamnionitis interventions X5

A

temp q 2 after ROM or hourly with fever
keep under pads dry and limit vaginal exams
inform staff if s/s of infection seen
abx therapy initiated before/after birth when infection ID
assess maternal VS hoursly if fever present

126
Q

conditions associated with PPROm X5

A 
infection
weak amniotic sac
previous preterm birth
fetal abnormalities
incompetent or short cervix
127
Q

therapeutic mgmt for PROM if fetus is <36 weeks

A

short term tocolytics

corticosteroids

128
Q

mgmt for PROm if gestation is near term

A

if labor does not spontaneously begin - induction of labor begins

129
Q

mgmt for PROM if gestation is preemie

A

pro vs con weighing

130
Q

what is considered a short cervix

A

<25 mm

131
Q

fFN tests

A

negative = <1% chance of delivering in 2 weeks

positive = 12-17% chance delivering within 2 weeks

132
Q

tocolytics and preemie birth

A

dont decrease the rate of preemie births - delay them instead for medical mgmt

133
Q

mag sulfate action

A

depresses myometrium contractility - CNS depressant

134
Q

MgSO4 maternal effects

A

pulmonary edema

135
Q

MgSO4 fetal effects

A

may reduce risk of cerebral palsy in neonate

136
Q

MgSO4 mgmt

A

respirations <12**

137
Q

prostaglnadin synthesis inhibitors action

A

effective in delaying delivery 48+ hours and used in pregnancies <32 weeks

138
Q

prostaglandin synthesis inhibitors should not be used more than

A

48 hours

139
Q

Prostaglandin synthesis inhibitor maternal effects

A

pulmonary edema

140
Q

prostaglandin synthesis inhibiotr fetal effects

A

constriction of ductus arteriosus

141
Q

indomethacin class

A

prostaglandin synthesis inhibitor

142
Q

naproxen class

A

prostaglandin synthesis inhibitor

143
Q

fenoprofen class

A

prostaglandin synthesis inhibitor

144
Q

nifedapine should not be used with X2

A

mag sulfate or terbutaline

145
Q

nifedapine MOA

A

blocks Ca available for muscle contraction

146
Q

nifedapine maternal effects

A

pulmonary edema

caution in renal and hypotension

147
Q

nifedapine fetal effects

A

N/A

148
Q

nifedapine nursing mgmt

A

hold dose for BP <90/50 or HR >120

149
Q

terbutaline action

A

suppresses uterine activity for up to 3 days

150
Q

terbutaline maternal effects

A

pulmonary edema, maternal glucose elevation

151
Q

terbutaline mgmt

A

auscultate lungs for pulmonary edema

monitor blood glucose

152
Q

placenta accreta

A

invasion of trophoblast is beyond normal boundary

153
Q

placenta increta

A

invasion of trophoblast extends into uterine myometrium

154
Q

placenta percreta

A

invasion of trophoblast extends into uterine muscle and can adhere to other pelvic organs

155
Q

how fast can a mom bleed to death in uncontrolled bleeding

A

8-10 minutes

IM 6 Test 3 (4 decks)

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