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Exam 4 (Spring) > Pregnancy at Risk > Flashcards

Pregnancy at Risk Flashcards

1
Q

Pregnancies that are at risk

A 
Hyperemesis Gravidarum
Multifetal pregnancy
Ectopic pregnancy
Spontaneoius AB
Incompetent cervix
Placenta previa
Abruption
DIC
Postpartum hemorrhage
GH (PIH)
Preterm, postterm
Hydatidiform mole
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2
Q

What is the most common discomfort of pregnancy?

A

Morning sickness

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3
Q

Hyperemesis gravidarum

A

Excessive vomiting that can lead to electrolye, metabolic, and nutritional imblances

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4
Q

Hyperemesis gravidarum: Etiology

A

Exact casue unknown

Possibly homrones or psychogenic factors

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5
Q

Hyperemesis gravidarum: S&S

A 
Persistent N/V
Significant weight loss
Dehydration
Electrolyte/Acid base imbalances
Unusual stress
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6
Q

Hyperemesis gravidarum: Assesment

A
  • Frequency, amount, character of emesis
  • Hydration status (I&O, skin turgor, mucous mebranes, daily weight, etc)
  • Psychosocial assesment
  • Fetus
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7
Q

Hyperemesis gravidarum: Medical management

A
  • May need IVFs
  • Antiemetics (Reglan, Zofran)
  • Pyridoxine (B6) is also helpful
  • Diet: low fat, high protein, non-spicy with frequent small meals
  • Camomile tea, ginger ale, and some like PB on toast/crackers
  • Parenteral nutrition(worse case scenario)
  • Counseling/support
  • Prognosis is good
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8
Q

Multifetal pregnancy

A

Twins- A- monozygotic (originate from one fertilized ovum) or B- diazygotic (two sepearte ova fertilized at the same time)

  • Preterm labor
  • Growth deficiencies
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9
Q

Multifetal pregnancy: S&S

A

Uterine enlargement excess “normal”
Abdominal palpation is done using Leopold’s manuevers
Two distinct heart tones
Ultrasonography= multiple fetuses

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10
Q

Ectopic pregnancy

A

Rupture of the fallopian tube and bleeding into the abdominal cavity

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11
Q

Ectopic pregancy: S&S

A

Slight vaginal bleeding
S&S of peritoneal irritation: sharp, localized, one-sided pain or pain referred to the shoulder
Abdomen may be rigid and tender

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12
Q

Ectopic pregnancy: Medical management

A 
Rapid, surgical treatment
Blood replacement
Methotrexate administration for unruptrued ectopic pregnancy
D+C
D+E
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13
Q

Ectopic pregnancy: NIs

A 
Frequent VS
Assess lung and bowel sounds
IVFs and blood
Antibiotics
Pain meds
NPO pre-op
Foley
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14
Q

Spontaneous abortion

A

Termination of pregnancy before the age of viability (20 wks)

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15
Q

Spontaneous abortion: S&S

A

Threatened: bleeding & cramping
Inevitable: bleeding increases & cervix dilates
Complete: all products of conception expelled
Incomplete: some, not all products of conception are expelled
Missed: fetus dies and gorwth ceases, but fetus remains in utero
Septic: malodorous bleeding, fever, cramping
Habitual: sontaneously aborted in three or more consecutive pregnancies

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16
Q

Spontaneous abortion: patient teaching

A

Need rest
Iron supplementation (if blood loss occured)
Emotional component

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17
Q

Incompetent cervix

A

Passive and painless dilation of the cervix during the 2nd trimester

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18
Q

Incompetent cervix: causes

A
  • History of previous cervical lacerations
  • Excess dilation for curettage or biopsy
  • DES (diethylstilbestrol daughter)
  • Congenitally short cervix or cervical or uterine anomalies
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19
Q

Incompetent cervix: medical management

A
  • Prophylactc cerclage at 10-14 weeks of gestation
  • No intercourse, prolonged standing, and heavy lifting
  • After cerclage, monitor for contractions, symptoms, or rupture of membranes, and infection
  • Provide support
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20
Q

Cerclage

A

a surgical procedure in which the cervix is sewn closed during pregnancy

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21
Q

______ _______ during pregnancy should always be reported to the physican

A

Vaginal bleeding

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22
Q

Placenta previa

A

Type of bleeding disorder

  • Placenta implants in the lower uterine segment
  • Unknown cause
  • Painless, bright red vaginal bleeding
  • Bleeding may be intermittent or occur in gushes
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23
Q

Placenta previa: Medical Management

A
  • Cesarean birth is treatment of choice
  • Following diagnosis, in hospital under close supervison
  • Blood, typed and cross-matched, available for emergency use
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24
Q

Abruptio placentae (abruption)

A
  • Premature separation of the normally implanted placenta from the uterine wall
  • Generally occurs late in pregnancy, frequently during labor
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25
Q

Abruptio placentae: predisposing factors

A

Choronic hypertension and GH (PIH)

Blunt external abdominal trauma

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26
Q

Abruptio placentae: S&S

A

Sudden, severe pain accompanied by uterine rigidity

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27
Q

Abruptio placentae: Nursing Assesment

A
  • Duration, amount, color, characteristic of bleeding
  • VS
  • Pain
  • Fetal HR
  • Emotional response
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28
Q

Abruptio placentae: Diagnostic tests

A
  • H+H
  • Blood type and cross match
  • US
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29
Q

Abruptio placentae: Medical Management

A

C-section delivery

Hysterectomy

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30
Q

Abruptio placentae: NIs

A
  • O2
  • IV or blood replacement (may be needed)
  • Support, attend, prepare her for possible loss
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31
Q

Disseminated Intravascular Coagulation (DIC)

A

Alterations in normal clotting mechanism

It may be seen with abruptio placentae, incomplete abortion, HTN disease, or infectious process

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32
Q

DIC: Assesment

A

All women with complications that me result in DIC should be observed closely for signs of bleedign

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33
Q

DIC: Diagnostic tests

A

H+H

Clotting factor studies

34
Q

DIC: Medical Management

A
  • IV administration of fibrinogen, blood, and other substances that will help restore normal clotting mechanisms
  • May include heparin via continuous infusion pump and O2 therapy
  • Delivery of fetus ASAP
35
Q

DIC: NIs

A

Supprt medical treatment

Report S&S promptly

36
Q

Postpartum Hemorrhage

A

Early postpartum hemorrhage- >500 mL in the 24 hours after delivery

Late- after the first 24h

37
Q

What is the most common cause of early postpartum hemorrhaege?

A
  • Uterine atony
  • Retained placenta or fragments of it
  • Lacerations of the perineum/cvx
38
Q

Postpartum Hemorrhage: Assessment

A

Uterine contraction and lochia
Bleeding- color, amount source
VS

39
Q

Postpartum Hemorrhage: Medical Management

A
  • D&C
  • Repair of lacerations
  • Fundal massage; keep bladder empty, administer oxytocics
  • Failure to control bleeding may necessitate a hysterectomy
40
Q

Postpartum Hemorrhage: NIs

A

Fundal massage
VS
Prepare for surgery if indicated
Administer oxytocin or other drugs as ordered

41
Q

Postpartum Hemorrhage: Teaching

A

Teach pt. how to perform the postpartum checks of the fundus and lochia
Call physician if bleeding is excessive

42
Q

Hydatidiform Mole

A

a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy

43
Q

Hydatidiform Mole: S&S

A
  • Bleeding (from spotting to hemorrhage)
  • Rapid uterine growth
  • Failure to detect fetal heart tone
  • Signs of hyperemesis gravidarum
  • Diagnosed early
  • Higher levels of hCG
  • Snowstorm pattern of ultrasound
44
Q

Hydatidiform Mole: Treatment

A

Vacuum aspiration
D+E
Recheck hCG for 1 year
Emotional support

45
Q

Gestational Hypertension (AKA PIH)

A
  • Characterized by increasing HTN, albuminuria, and generalized edema
  • Includes preeclampsia and eclampsia
  • Unknown cause
  • Increasd risk in multiple pregnancy, DM, or family history of GH
46
Q

What do complex hormonal and vascular changes lead to?

A 
Increased blood pressure
Decreaed placental perfusion
Decreased renal perfusion
Altered glomerular filtration rate
F&E imbalance
47
Q

Gestational Hypertension: Assesment

A 
Weight
BP (S about 30 mmHg above baseline; D about 15 mmHg above baseline)
Edema: scale of 1+-4+
Urine tested for albumin
Visual changes
RUQ pain
48
Q

Gestational Hypertension: Diagnostic tests

A 
Hematocrit
BUN
CBC
Clotting studies
Liverenzymes
Type and Screen
Urine for specific gravity and protein
Electrolyte panels
49
Q

Gestational Hypertension: Medical Management

A 
May or may not need hospitilization
Bed rest; Lateral recumbant position
Well-balanced diet with adequate protein
IV therapy for emergency situations
Sedatives and antihypertensives
Mag sulfate to prevent seizures
Deliver baby
50
Q

Gestational Hypertension: NIs

A 
Assess for H/A, edema, and blurry vision
Monitor I&O (catheter may be necessary)
Monitor fetal status
Perform kick count
Monitor daily weight
Enforce bedrest
Provide emotional support
51
Q

Gestational Hypertension: Patient teaching

A
  • Educate on danger signs of complications of pregnancy
  • Stress importance of regular medical supervision
  • Encourage high-quality protein, vitamin, and mineral intake
  • Exercise may have to be curtailed
  • Avoid weight loss programs
  • DC smoking and ETOH
  • Primary management is without drugs since normal falls in the first 2 trimesters
  • Fetal Kicks
  • Side lying postion
52
Q

What should you watch for in a pt. with PIH (GH)?

A

Sudden weight gain
Edema
High BP

53
Q

Gestational Hypertension: Preeclampsia

A

GH

Protein in the urine

54
Q

Gestational Hypertension: Eclampsia

A

HTN
Protein in urine
Seizures
Liver and coagulation abnormalities

55
Q

HELLP Syndrome: What does it stand for?

A
  • H= hemolysis of erythrocytes
  • EL= elevated liver enzymes
  • LP= low platelets
56
Q

HELLP Syndrome

A

Variant of GH

  • Represents an extension of the patholgy of preeclampsia and eclampsia
  • Hemolysis occurs when RBCs are damaged when passing through small vessels
  • Obstructoin of blood through livers causes elevated liver enzymes (look for RUQ pain)
  • Low platelets from platelets adhering to site of blood vessel damage
57
Q

What is the mag sulfate normal dose?

A

1.5-2.5 mEq/L

58
Q

S&S of mag sulfate toxicity

A

Sudden drop in BP
Resp <25-30 mL/hr
-Decreased/absent DTRs

59
Q

Assessments when giving mag sulfate

A 
VS & FHR Q 15 mins
DTR prior to administration
1st to go is loss of patellar refelx
Mental status frequently 
Have resucitatoin equipment ready
60
Q

What is the antidote to mag sulfate?

A

Calcium gluconate/chloride

61
Q

What to look for with mag sulfate?

A

Patellar reflex goes first if mg toxic
Respiratory paralysis next
Cardiac conduction after that

62
Q

If giving mag sulfate, you should MONITOR?

A

DTR (start at 3.5)
RR
Urine output
Serum concentrations

63
Q

Complications of pregnacy related to the CV system

A
  • Pregnancy increases demands on the CV system (the normal, healthy heart is able to adapt to increased demands)
  • Women who have preexisting cardiac disease face increased risk when cardiac function is challenged by pregnancy
64
Q

Complications of pregnacy related to the CV system: Etiology

A

Most common problems result from:
Rheumatic heart disease
Congenital heart defects
Mitral valve prolapse

65
Q

Complications of pregnacy related to the CV system: Patho

A
  • Increased blood volume, HR, and cardiac output overstress the cardiac muscle, valves, and vessels
  • S&S of the underlying pathologic condition are exacerbated, resulting in cardiac decompesation, CHF, and other medical problems
66
Q

Complications of pregnacy related to the CV system: S&S

A 
Edema
Cyanosis
Tachycardia
Palpitations
Dysrhythmias and CP
Dyspnea and fatigue
Physical exertion may increase the symptoms
Decreased cardiac output
Pulmonary edema
67
Q

Complications of pregnacy related to the CV system: Assesment

A

VS
Evaluate unusual fatigue with activity
Monitor for edema, weight gain, murmurs, cough, dyspnea, and abnormal lung sounds

68
Q

Complications of pregnacy related to the CV system: Diagnostic tests

A

CXR
ECG, Echo
Blood gas analysis

69
Q

Complications of pregnacy related to the CV system: NIs

A

Teach- diet, meds, pacing activity, and rest
Iron intake to prevent anemia
Sodium may be restricted
Stool softeners may be admistered
Cardiotonics, diuretics, prophylactic antibiotics, sedatives, and analgesics may be required
Semi-fowlers or side lying with HOB elevated during labor
Conservation of energy during delivery

70
Q

Pre-term

A

0-37 wks of pregnancy

71
Q

Term

A

38-41 wks of pregnancy

72
Q

Postterm

A

42+ wks of pregnancy

73
Q

Ideally, when are tests performed on the newborn?

A

Between 2-8 hours of age

74
Q

Preterm infant: etiology/patho

A

Exact cause unknown
Some cases may be r/t maternal or placental problems
Infant is devlopmentally mature (not producing enough surfactant; circulation may not have adapted from fetal to neonatal as it should)
Problems with heat conservation
F&E/Acid base imblances observes
Problems with absorption of nutrients are common

75
Q

In what way can a preterm infant be neurogically immature?

A

Gag, suck, and swallow reflexes may be weak or even absent

76
Q

Preterm infant: assesment

A

All systems must be assessed

77
Q

What is the greatest potential problem with a preterm infant?

A

Respiratory distress syndrome

  • grunting on expiration
  • Nasal flaring
  • Circumoral cyanosis
  • Substernal retractoins
  • Tachypnea
78
Q

An accurate assessment of what is a good indicator of the problems the preterm infant is likely to experience?

A

Gestational age

79
Q

What is the main nursing goal with a preterm infant?

A

Maintain and stabilize preterm infants until they are mature

80
Q

Preterm infant: NIs

A 
Respiratory regulation
Thermal regulation
F&E regulation
Sensory stimulation
Promote bond with parents
81
Q

Complications of a postterm infant

A 
Placental insufficency (aging placenta is not fully functioning)
Increase risk for perinatal mortality resulting from intrauterine hypoxia during labor and birth
Risk for asphyxia, respiratory distress, hypoglycemia

Exam 4 (Spring) (12 decks)

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