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Maternity > Pregnancy at Risk > Flashcards

Pregnancy at Risk Flashcards

1
Q

High-risk pregnancy

A

-Jeopardy to mother, fetus, or both
-D/t pregnancy or result of condition present before pregnancy
-Stress may increase risk for adverse birth outcomes
-Risk assessment w/ 1st antepartal visit
-Ex: DM, HTN, PCOS, autoimmune disease, obesity, HIV, zika, older or younger age, substance abuse, birth defects, previous preterm birth, multiple births, ectopic pregnancy

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2
Q

Conditions d/t pregnancy complications

A

-Bleeding during pregnancy
-Hyperemesis gravidarum
-Gestational HTN
-HELLP syndrome
-Blood incompatibility
-Amniotic fluid imbalances
-Multiple gestation
-Premature rupture membranes

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3
Q

Conditions associated w/ early bleeding during pregnancy

A

-Spontaneous abortion (miscarriage before 20 weeks gestation)
-Ectopic pregnancy (fetus develops outside of uterus –> miscarriage)
-Gestational trophoblastic disease
-Cervical insufficiency
-Uterine fibroids

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4
Q

Spontaneous abortion: cause

A

-Cause unknown
-1st trimester: d/t fetal genetic abnormalities
-2nd trimester: r/t maternal conditions

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5
Q

Spontaneous abortion: types

A

-Threatened (uterine bleeding occurs)
-Inevitable (cervix is dilated)
-Incomplete (some products of conception have been expelled, possible infection)
-Complete (all products of conception have passed)
-Missed (fetus dies but remains in uterus)
-Habitual (3+ consecutive pregnancy losses before 20 weeks)

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6
Q

Spontaneous abortion: nursing mgmt

A

-Vaginal bleeding (pad count aka 1 saturated pad per hour is significant, bright red is significant)
-Tell mother to bring clots or tissues for testing
-Pain level
-Preparation for surgery to remove contents
-Meds such as misoprostol, PGE2, mifepristone, RhD
-Stress that woman is not cause of loss
-Cramping or contractions

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7
Q

Ectopic pregnancy: cause

A

-Ovum implantation outside of uterus
-Obstruction to or slowing passage of ovum thru tube to uterus
-Most causes d/t tubal scarring secondary to PID
-Silent infections
-May cause organ rupture
-May be life-threatening

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8
Q

Ectopic pregnancy: nursing mgmt

A

-Drug therapy (methotrexate 1st and early, prostaglandins, misoprostol, actinomycin)
-Surgery if ruptures
-Classic triad is abdominal pain, amenorrhea, vaginal bleeding
-Rh immunoglobulin if woman is Rh-negative
-Hallmark sign: abdominal pain w/ spotting within 6-8 weeks after missed menses
-Lab testing via transvagina ultrasound or serum beta hCG to rule out other conditions

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9
Q

Gestational trophoblastic disease: cause and types

A

-Unknown cause
-Group of tumors that form
-Majority are benign
-Types: hydatidiform mole (snowstorm pattern on ultrasound w/ no fetus or gestational sac, benign neoplasm of chorion), choriocarcinoma

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10
Q

Gestational trophoblastic disease: nursing mgmt

A

-Immediate evacuation of uterine contents (D&C)
-Long-term follow up and monitoring of serial hCG levels
-Prophylactic chemotherapy
-Serial hCG monitoring (high levels)
-Clinical manifestations similar to spontaneous abortion at 12 weeks
-Ultrasound visualization
-Tx for 12 months, avoid pregnancy for 1 year

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11
Q

Cervical insufficiency: cause

A

-Premature dilation of cervix
-Weak, structurally defective cervix that spontaneously dilates in absence of uterine contractions in 2nd or 3rd trimester, resulting in loss of pregnancy
-Cause unknown, possibly d/t cervical damage

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12
Q

Cervical insufficiency: nursing mgmt

A

-Look for pink-tinged vaginal discharge or an increase in low pelvic pressure, backache, membrane rupture, uterine contractions
-Main dx is hx of pregnancy loss during 2nd or 3rd trimester associated w/ painless cervical dilation w/o evidence of uterine activity
-Ultrasound done between 16-24 weeks

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13
Q

Conditions associated w/ late bleeding during pregnancy

A

-Placenta previa
-Placental abruption

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14
Q

Placenta previa: cause

A

-“Afterbirth first”
-Cause unknown
-Placenta covers part or all of cervix, or opening to the uterus
-Classification important

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15
Q

Placenta previa: nursing mgmt

A

-Look for vaginal bleeding (painless, bright red in 2nd or 3d trimester, spontaneous cessation then recurrence)
-1st episode of bleeding occurs at 27-32 weeks gestation
-“Wait and see”
-Monitor maternal-fetal status
-Vaginal bleeding; pad count
-Avoidance of vaginal exams
-FHR
-Palpate uterus
-Fetal mvmt counts
-Avoid vaginal exams bc may disrupt placenta and cause hemorrhage
-Effects of prolonged bed rest
-Preparation for possible C-section but should be avoided

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16
Q

Placental abruption: cause

A

-Separation of placenta from uterine wall before birth, leading to compromised blood supply to the fetus after 20 weeks of gestation
-High mortality rate
-Etiology unknown
-19.5

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17
Q

Placental abruption: nursing mgmt

A

-Restoration of blood loss; positive outcome
-2 large-bore IV lines w/ normal saline or LR
-C-section is fetal distress is present
-Prevention of DIC 19.2
-Look for knife-life pain, uterine tenderness, contractions, dark red bleeding, decreased fetal activity, fetal HR
-Dx test: CBC, fibrinogen levels, PT, type and cross-match, nonstress test, biophysical profile
-L lateral position, strict bed rest, O2 therapy, fundal height, fetal monitoring
-Support for possible loss of fetus

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18
Q

Placenta previa s/s

A

-Onset: insidious
-Bleeding: always visible, slight then more profuse, bright red
-Pain: none
-Uterine tone: soft
-FHR: normal range
-Fetal presentation: breech, engagement is absent

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19
Q

Placental abruption s/s

A

-Onset: sudden
-Bleeding: concealed or visible, dark
-Pain: constant
-Uterine tone: firm
-FHR: fetal distress
-Fetal presentation: no relationships

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20
Q

Hyperemesis gravidarum: cause

A

-Severe form of N/V
-s/s usually resolve by week 20
-Weight loss > 5% of prepregnancy BW
-Dehydration, metabolic acidosis, alkalosis, and hypokalemia

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21
Q

Hyperemesis gravidarum: nursing mgmt

A

-Conservative diet and lifestyle changes
-Hospitalization w/ parenteral therapy
-Report episodes of severe N/V that extends beyond 1st trimester
-Look at liver enzymes, CBC, BUN, electrolytes, USG, ultrasound
-NPO, IV fluids, hygiene, oral care, I&O
-Antiemetics rectally or IV
-If no improvement after several days of BR, TPN is instituted
-Eat small, frequent meals, avoid fatty foods, high-protein drinks, increase exposure to fresh air, drink herbal teas, eat when hungry, daily rest periods, dry crackers, toast, or soda settle stomach

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22
Q

HTN disorders of pregnancy

A

-Gestational HTN (140/90 BP after 20 weeks gestation w/o proteinuria
-Preeclampsia/eclampsia: most common, w/ proteinuria after 20 weeks and HELLP syndrome
-Chronic HTN: HTN before pregnancy or before 20 weeks w/ 140/90 BP
-Chronic HTN w/ superimposed preeclampsia: after 20 weeks

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23
Q

Preeclampsia w/o severe features

A

-140/90 BP after 20 weeks
-No seizures
-No hyperreflexia
-No other s/s

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24
Q

Preeclampsia w/ severe features

A

-160/110
-No seizures
-Yes hyperreflexia (grade 4: brisk, clonus present)
-Headache, oliguria, blurred vision, edema, thrombocytopenia, cerebral disturbances, epigastric pain, HELLP, renal insufficiency

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25
Q

Eclampsia

A

-160/110 BP
-Yes seizures
-Yes hyperreflexia
-Severe headache, edema, epigastric pain, cerebral hemorrhage, renal failure, HELLP

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26
Q

Mild preeclampsia mgmt

A

-Hospitalization
-Bed rest, daily BP monitoring, fetal mvmt counts
-IV Mg sulfate during labor

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27
Q

Preeclampsia w/ severe features mgmt

A

-Hospitalization
-Oxytocin and Mg sulfate
-High protein diet with glasses of water daily
-Preparation for birth
-Increases risk of placental abruption, preterm birth, intrauterine growth restriction, fetal distress during childbirth
-Antihypertensives

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28
Q

Eclampsia mgmt

A

-Seizure mgmt
-Mg sulfate (continue 24 hours after birth)
-Antihypertensive agents
-Birth once seizures are controlled

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29
Q

Gestational HTN mgmt

A

-BP, nutritional intake, weight, edema, urine for protein
-Home mgmt
-Hospitalization for severe preeclampsia
-Quiet environment, sedatives, seizure precautions, antihypertensives DTR testing, assessing for Mg toxicity, labor

30
Q

HELLP syndrome

A

-Hemolysis, elevated liver enzymes, low PLT
-Nursing assessment: similar to that for severe preeclampsia
-Nursing mgmt: same as for severe preeclampsia

31
Q

Blood incompatibility: ABO

A

-Type O mothers
-Type A or B fetuses
-Less severe than Rh incompatibility

32
Q

Blood incompatibility: Rh

A

-Exposure of Rh-negative mother to Rh-positive fetal blood
-Sensitization
-Antibody production
-Risk increases w/ each subsequent pregnancy and fetus w/ Rh-positive blood
-Nursing assessment: maternal blood type and Rh status
-Nursing mgmt: RhoGAM at 28 weeks

33
Q

Hydramnios

A

-AKA polyhydramnios
-Amniotic fluid > 2,000 mL
-Removal of fluid, indomethacin (decreases fluid by decreasing fetal urinary output)
-Amniocentesis, prostaglandin synthesis inhibitor
-Abdominal pain from being severely stretched

34
Q

Oligohydramnios

A

-Amniotic fluid < 500 mL
-Risk factors, fluid leaking from vagina
-Usually in last trimester
-Fetus at risk of mortality
-Intervention only if fetal well-being is compromised –> amnioinfusion

35
Q

Multiple gestation

A

-Nursing assessment: uterus larger than expected for EDB; ultrasound confirmation
-Nursing mgmt: labor mgmt w/ perinatal team on standby; postpartum assessment for possible hemorrhage, serial ultrasounds, close monitoring during labor, operative delivery (common)

36
Q

Premature rupture of membrane: types

A

-PROM: women beyond 37 weeks gestation
-PPROM: women < 37 weeks gestation
-Occurs spontaneously

37
Q

PROM: tx

A

-Dependent on gestational age
-No unsterile digital cervical exams until woman is in active labor
-Expectant mgmt if fetal lungs immature
-If fetal lungs immature –> adequate hydration, reduced physical activity, pelvic, rest, observing for infection
-Corticosteroids can be given to enhance fetal lung maturity
-Abx

38
Q

PROM: nursing assessment

A

-Risk for infection
-s/s of labor
-Electronic FHR monitoring
-Dx w/ speculum vaginal exam (pooling of fluid in vagina, leakage of fluid from cervix, ferning of dried fluid, alkalinity of fluid determined by nitrazine paper aka pH indicator to confirm dx)

39
Q

PROM: nursing mgmt

A

-Infection prevention
-ID of uterine contractions
-Education and support
-Discharge home (PPROM) if no labor within 48 hours
-Ultrasound q3-4w to assess amniotic fluid levels
-Possible corticosteroids
-Daily kick counts

40
Q

Conditions causing at-risk pregnancies

A

-DM
-Cardiac and respiratory disorders
-Anemia
-Autoimmune disorders
-Specific infections

41
Q

DM: types

A

-Type 1: absolute insulin deficiency d/t autoimmune beta cell destruction
-Type 2: insulin resistance/deficiency d/t progressive loss of beta cell insulin secretion
-Impaired fasting glucose and impaired glucose tolerance
-Gestational DM: onset during pregnancy
-Classification during pregnancy: pregestational DM and gestational DM

42
Q

DM: patho and pregnancy

A

-Fetal demands
-Role of placental hormones
-Changes in insulin resistance (peaks in last trimester)
-Effects on mother (hydramnios, gestational HTN, ketoacidosis, preterm labor, UTIs)
-Effects on fetus (congenital anomalies, macrosomia, birth trauma, fetal asphyxia, cord prolapse, IUGR)

43
Q

DM: nursing mgmt

A

-Preconception counseling
-Blood glucose level control (HbA1c < 7%)
-Nutrition is most important
-2 insulin doses given daily, metformin is an alternative
-Hypoglycemic agents (standard of care may be moving towards using these but currently are 2nd-line therapy after insulin)
-Avoid weight loss and dieting, ensure food intake is adequate, eat 3 meals a day + 3 snacks, protein and fat in each meal

44
Q

DM: education

A

-Daily fetal kick counts
-Glucose monitoring at home
-Lots of water intake
-Well-fitted footwear
-Breast-feeding infant
-Eat breakfast within 30 min of injection
-Plan meals at fixed time
-Avoid simple sugars (cake, candy, cookies)
-s/s of hypoglycemia: sweating, tremors, cold and clammy skin, blurred vision, hunger, disorientation, irritability, headache
-Hypoglycemia tx: drink milk and eat 2 crackers or 2 glucose tablets, carry glucose boosters such as hard candies
-s/s of hyperglycemia: dry mouth, excessive thirst, rapid breathing, fatigue, hot skin, headache, frequent urination, drowsiness
-Hyperglycemia tx: notify HCP, may need hospitalization
-Early delivery for poorly controlled DM or large fetus w/ complications

45
Q

DM: assessment

A

-Screening at 1st prenatal visit
-Additional screening 24-28 weeks for women considered at risk
-Maternal surveillance: urine for protein and ketones, kidney fxn eval, eye exam, HbA1c
-Fetal surveillance: ultrasound, alpha-fetoprotein levels; biophysical profile; nonstress testing; amniocentesis

46
Q

Congenital and acquired heart disease: cause

A

-Hemodynamic changes overstressing woman’s cardiovascular system
-Structural defects present at birth but may not be discovered at that time
-Uterine blood flow increases by at least 1 L /min
-RHR increases by 20 above normal values

47
Q

Congenital and acquired heart conditions types

A

-Congenital: TOF, ASD, VSD, patent ductus arteriosus
-Acquired: mitral valve prolapse, mitral valve stenosis, aortic stenosis, peripartum cardiomyopathy, MI

48
Q

Congenital and acquired heart disease: nursing mgmt

A

-Prenatal counseling
-Increased frequency of prenatal visits (q2w until last month then weekly)
-Any surgeries should be done before pregnancy
-No warfarin (teratogen)
-Conserve energy, rest in side-lying position (enhances placental perfusion), high fiber diet, limit sodium

49
Q

Congenital and acquired heart disease: nursing assessment

A

-VS, heart sounds, weight, fetal activity, lifestyle
-s/s of cardiac decompensation

50
Q

Congenital heart conditions affecting pregnancy

A

-TOF (4 structural anomalies)
-Atrial septal defect (ASD)
-Ventricular septal defect (VSD)
-Patent ductus arteriosus

51
Q

Acquired heart conditions affecting pregnancy

A

-Mitral valve prolapse
-Mitral valve stenosis
-Aortic stenosis
-Peripartum cardiomyopathy
-Myocardial infection

52
Q

Fxnal classification system

A

-Class 1: as/s, no limitation of physical activity
-Class 2: s/s, dyspnea or chest pain w/ increased activity
-Class 3: s/s, fatigue or palpitation w/ normal activity
-Class 4: s/s at rest or w/ any physical activity

53
Q

Chronic HTN: cause

A

HTN before pregnancy or before 20th week of gestation or persistence > 12 weeks postpartum

54
Q

Chronic HTN: nursing mgmt

A

-Preconception counseling, lifestyle changes, antihypertensive agents for severe HTN (aspirin, labetalol)
-DASH diet (sodium <2.4 g/day), frequent antepartum visits, monitoring for placental abruption, preeclampsia, daily rest period; home BP monitoring; close monitoring during labor and birth and postpartum follow-up

55
Q

Asthma: cause

A

Effect of normal physiologic changes of pregnancy on respiratory system

56
Q

Asthma: nursing mgmt

A

-Asthma triggers
-Lung auscultation
-O2 sat monitoring during labor (monitor for hypoxia)
-Remove carpeting
-Allergen-proof encasing
-Remove dust collectors
-Avoid pets
-Keep humidity < 50%
-Use HEPA filter system
-Avoid use of wood stove heaters
-Stay indoors
-Wear covering over nose and mouth when outside in cold weather
-Avoid exposure to sick persons

57
Q

TB: nursing mgmt

A

-Meds: combo of isoniazid, rifampin, ethambutol
-Avoid streptomycin
-Assess for risk factors and s/s
-If exposed, reddened induration will appear within 72 hours
-If untreated for TB at time of birth, shouldn’t breastfeed until at least 2 weeks after starting meds
-No coughing, sneezing, or talking directly into newborn’s face
-Compliance w/ drug therapy
-Health promotion education
-Transmission prevention

58
Q

Fe-deficiency anemia: nursing mgmt

A

-Usually d/t inadequate dietary intake
-Assess for fatigue, weakness, malaise, anorexia, susceptibility of infection (frequent colds), pale mucous membranes, tachycardia, pallor, pica
-Abnormal lab results: low Hgb (< 11), low Hct, low Fe, microcytic and hypochromic cells, low ferritin
-Prenatal vitamins, Fe supplements taken w/ orange juice or empty stomach
-Dried fruits, whole grains, green leafy veggies, lean meats, peanut butter are high in Fe
-High fiber foods

59
Q

Thalassemia

A

-Alpha (minor): little effect on pregnancy except for mild persistent anemia
-Beta (major): usually no pregnancy d/t lifelong, severe hemolysis, anemia, premature death
-Autosomal recessive: low Hgb and microcytic, hypochromic anemia

60
Q

Sickle cell anemia: cause

A

-Defect in Hgb molecule (Hgb S)
-Exposure to trauma such as infection, cold air exposure, hypoxia, dehydration

61
Q

Sickle cell anemia: nursing mgmt

A

-Blood transfusions for severe anemia, analgesics for pain, abx for infection
-Evidence of crisis
-Labor: rest, pain mgmt, O2 and IV fluids, close FHR monitoring
-Postpartum: anti-embolism stockings, family planning options
-Drink lots of fluids
-Avoid infections

62
Q

Type of autoimmune diseases

A

-Localized: targets specific organs (ex: hashimoto thyroiditis, graves disease)
-Systemic: targets multiple organs (ex: lupus erythematosus targets lungs, heart, joints, kidneys, brain, RBCs)

63
Q

Infections

A

-Cytomegalovirus (herpes)
-Rubella
-Herpes simplex
-Hepatitis B
-Varicella zoster
-Parvovirus B19
-Group B streptococcus
-Toxoplasmosis
-HIV

64
Q

Stages of HIV infection

A

1) acute infection: flu-like s/s 2-4 weeks after exposure
2) as/s infection or clinical latency: viral replication continues within lymphatics but slows down
3) persistent generalized lymphadenopathy: possibly remaining in this stage for years; AIDS develops in most within 7-10 years, opportunistic infections occur
4) AIDS: severe immune deficiency, high viral load and low CD4 counts

65
Q

Women who are HIV-positive: medical mgmt

A

-Threats to self, fetus, and newborn
-Oral antiretroviral drugs BID from 14 weeks - birth
-IV meds during labor
-Oral syrup for newborn in 1st 6 weeks of life
-Decision for birthing method (C-section, no episiotomy, fetal scalp electrodes, fetal scalp sampling)

66
Q

Women who are HIV-positive: nursing mgmt

A

-Avoidance of breast-feeding
-Drugs for unborn infant
-Well-balanced diet
-Measures to reduce exposure to infections
-Avoid amniocentesis
-Family planning methods
-Western blot to confirm dx

67
Q

Vulnerable populations

A

-Adolescents
-Pregnant women over age 35
-Obese pregnant women
-Women who are positive for HIV
-Women who abuse substances

68
Q

Pregnant adolescent: nursing assessment

A

-Vision of self in future
-Realistic role models
-Level of child development education
-Financial and resource mgmt
-Anger and conflict resolution skills
-Knowledge of health and nutrition for self and child
-Challenges of parenting role
-Community resources

69
Q

Pregnant adolescent: nursing mgmt

A

-Support
-Future planning (return to school; career or job counseling)
-Frequent eval of physical and emotional well-being
-Stress mgmt; self-care
-Education

70
Q

Woman over age 35: nursing assessment

A

-Preconception counseling; lifestyle changes; beginning pregnancy in optimal state of health
-Lab and dx testing for baseline; amniocentesis; quadruple blood test screen
-Promotion of healthy pregnancy
-Early and regular prenatal care
-Dietary teaching
-Continued surveillance

71
Q

Pregnant woman w/ substance abuse

A

-Impact: fetal vulnerability, teratogenic effect, addiction consequences
-Common substances: alc (FAS, FAD), caffeine, nicotine, cocaine, marijuana, opiates and narcotics (neonatal abstinence syndrome), sedatives, methamphetamines

72
Q

FAS facial characteristics

A

-Low nasal bridge
-Short palpebral fissures
-Short nose
-Flat midface
-Epicanthal folds
-Minor ear abnormalities
-Thin upper lip
-Receding jaw

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