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Mgmt Test 2 - OB > pregnancy at risk > Flashcards

pregnancy at risk Flashcards

1
Q

1st trimester preg disorders

A

hyperemesis gravidarum

early preg bld’g disorders (spontaneous abortion, ectopic preg, gestational trophoblastic disease)

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2
Q

hyperemesis gravidarum

A

persistent uncontrollable vomitting usually occurs at the beginning of preg but can last the duration
may be related to increased estrogen/hcg; vit B deficiency; hyperthyroidism; psych fxrs
dx by 5% weight loss, ketonuria, dehydration

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3
Q

mgmt of hyperemesis

A

B6, anti-emetics

tpn, iv hydration (hospital)

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4
Q

care of hyperemesis

A

stabilize
hydrate
weight mgmt

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5
Q

spontaneous abortion classified as

A

loss prior to 20 weeks

most occur within first 12 wks

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6
Q

risk fxr for spontaneous abortion

A

maternal infection
inadeq. progesterone production
pre-existing cond. (DM, lupus)
fetal abnormalities

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7
Q

characteristics of spontaneous abortion

A

threatened - spotting, cramping (long duration, high prob)
inevitable - spotting, cramping, ROM, cerv. dilation
incomplete - bld, cramp, dilation - passage of tissue
complete - passage of product of conception, no further trt needed
missed - fetus expired, labor not begun
recurrent - 3+ preg

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8
Q

ectopic preg risk fxrs

A

ovulation inducing drugs
smoking
hx of ectopic preg

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9
Q

manifest of ectopic preg

A

abd pain
dark blood
referred shoulder pain

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10
Q

trt of ectopic preg

A

surgical removal

trt w/methotrexate

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11
Q

Gestational Trophoblastic Disease aka/is

A

Hydatidiform mole or Molar pregnancy
complete mole = no fetus
partial mole = some fetal parts
resembles cluster of grapes (proliferation of chronic villi)

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12
Q

manifest of GTD

A

uterine size greater than gestational age
dark red bld’g
n/v & cramping

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13
Q

trt for GTD

A

immed evac of mole
oxytocin to promote involution
monitor HcG levels
no preg. for 1yr

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14
Q

care for pt. w/GTD

A

prevent hemorrhage/infection
pain mgmt
emotional status/support
educate

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15
Q

late preg bld’g disorders

A

placenta previa

placenta abruptio

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16
Q

placenta previa characterized by

A 
complete or partial covering of cervix by the placenta painless bright red bld'g
3 types (low lying or marginal, partial, complete)
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17
Q

placenta previa risk fxrs

A

smoking/drug use
hx of previa
maternal age
uterine surgery

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18
Q

mgmt of placenta previa

A

delivery via c-section

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19
Q

abruptio placentae

A

premature separation of placenta from uterine wall

painful bleeding

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20
Q

manifest of abruptio placentae

A 
board like abdomen
abnormal FHR
fetal death
uterine hyperactivity
may be concealed or apparent; marginal, partial or complete
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21
Q

3 grades for abruptio placentae

A

grade 1 - 10-20% separation
grade 2 - 20-50% separation
grade 3 - >50% separation

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22
Q

risk fxr for abruptio placentae

A 
maternal htn
short cord
drug use/smoking
hx
abd. trauma
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23
Q

mgmt of abruptio placentae

A

condition of fetus
cardiovascular of mom
immed delivery w/fetal compromise/excessive bld’g

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24
Q

late preg bld’g care

A

status of fetus & mom
educate
immed delivery w/fetal compromise, excessive bld’g or maternal compromise

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25
Q

nursing dx for late preg bld’g

A

risk for injury/infection

ineffective tissue perfusion

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26
Q

perinatal infections

A

infections having devastating affect on fetus/min on mom

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27
Q

fxrs governing affects of perinatal infections

A

gestational age
trt options
specific organism
route of transmission - vertical=across placenta- horizontal=through breast-feeding

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28
Q

perinatal infections maternal risks

A

premature labor
PROM
UTI

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29
Q

perinatal infections fetal risks

A 
prematurity
malformations
IUGR(intrauterine growth restriction)
IUFD (intrauterine fetal death)
sepsis
30
Q

sexually transmitted infections

A

chlamydia
gonorrhea
trichomoniasis

31
Q

chlamydia maternal affects

A

PROM

chorioamnionitis

32
Q

chlamydia fetal affects

A

IUGR
vertical transmission
conjunctivitis
otitis media

33
Q

chlamydia nurs considerations

A

presumptively trt for gonorrhea

erythromycin eye oint for newborn

34
Q

gonorrhea maternal affects

A

dysuria; freq
chorioamnionitis
PTL; PROM

35
Q

gonorrhea fetal affects

A

vertical transmission
rare perm. visual damage or systemic disease
conjunctivitis

36
Q

gonorrhea nurs considerations

A

presumptively trt for chlamydia

erythromycin eye trt for newborn

37
Q

trichomoniasis maternal affects

A

increased risk for preterm labor/birth

PROM

38
Q

trichomoniasis fetal effects

A

vertical transmission at birth
asymptomatic or resp. infection
low birth weight

39
Q

trichomoniasis nursing considerations

A

mom & partner must be treated

40
Q

genitourinary infections

A

bacterial vaginosis
group b hemolytic strep (GBS)
cystitis & pyelonephritis

41
Q

bacterial vaginosis maternal affects

A

imbalance in vaginas normal flora by hormonal chg or antibiotic trt
asymptomatic or white/yellow discharge w/fishy odor
assoc w/preterm labor, PROM, UTI

42
Q

bacterial vaginosis fetal affects

A

limited- assoc w/ preterm birth

43
Q

bacterial vaginosis nurs considerations

A

prenatal screen

hx of preterm delivery

44
Q

GBS maternal affects

A

often asymptomatic (15-40% are colonized)
discharge
uti
preterm labor

45
Q

GBS fetal affects

A

most common cause of neonatal infections, morbidity and mortality
acquired by vertical transmission during birth causing sepsis, pneumonia, meningitis
early (within 48hrs) or late onset (after 1wk of life)

46
Q

GBS nurs considerations

A

maternal screen 35-37 weeks

47
Q

cystitis & pyelonephritis maternal affects

A

cystitis may cause dysuria - freq, hematuria, urgency
premature l&d
progression to pyelonephitis - fever, n/v, chills, cva tenderness

48
Q

cystitis & pyelonephritis fetal affects

A

effects related to preterm labor/birth

49
Q

cystitis & pyelonephritis nurs considerations

A

teach importance of finishing meds

if turns into pyelonephritis, hospitalization necessary for iv trt w/antibiotics

50
Q

Torch Infections

A 
toxoplasmosis
other (syphilis/Hep B)
Rubella
Cytomegalovirus
Herpes Simplex Virus
51
Q

toxoplasmosis Maternal/Preg Affects

A

consuming poorly cooked meat
exposure to cat feces
acutely infected can cause congenitally infected
90% are asymptomatic
general malaise, premature L&D, miscarriage

52
Q

toxoplasmosis Fetal Affects

A

transmitted across placenta
may be asymptomatic at birth
long term blindness, mr, impaired vision
IUGR

53
Q

toxoplasmosis Nursing Considerations

A

Maternal treatment with pyrimethamine, sulfadiazine and folinic acid (leucovorin) during 2nd & 3rd trimesters
Neonates treated w/leucovorin

54
Q

other (syphilis/Hep B) Maternal/Preg Affects

A

HEPATITIS B - Preterm labor &/or delivery, Stillbirth

SYPHILIS - Can cause spontaneous abortion, fetal death, and congenital syphills

55
Q

other (syphilis/Hep B) Fetal Affects

A

HEPATITIS B - Vertically transmitted-Infants infected at birth have 90% risk of becoming a carrier, 25% risk of
developing significant liver disease 90-95% of those infected are symptomatic
SYPHILIS- Fetal infection may involve multiple organs and can cause fetal growth restriction, non-immune hydrops, and increases risk of premature birth. May also be asympotmatic at birth; symptomatic in 1st 3 months

56
Q

other (syphilis/Hep B) Nursing Considerations

A

HEPATITIS B -Neonatal treatment isHBV vaccine (within 12hrs of birth, at 1-2 months & 6-18 months) •HBV immunoglobulin (HBIG) plus vaccine if mother is a carrier or HbsAG+ •All pregnant women are screened prenatally
SYPHILIS -Infected newborns are treated w/PCN over 10-
14 days•AAP states that no newborn be discharged without knowing mother’s serologic status for syphilis•
Provide support to parents related to their feelings about how infection was transmitted

57
Q

Rubella Maternal/Preg Affects

A

transmitted across placenta

infection during 1st trimester can cause spontaneous abort

58
Q

Rubella Fetal Affects

A

more severe disease if acquired in 1st trimester

cns/heart defects, stillbirth, jaundice, cataracts

59
Q

Rubella Nursing Considerations

A

isolate exposed neonate

vaccine contraindicated during preg., vaccine after delivery, do not become preg within 1st 4 weeks

60
Q

Cytomegalovirus Maternal/Preg Affects

A

transmitted across placenta at birth or thru breast-milk

only 1-5% develop symptoms (malaise)

61
Q

Cytomegalovirus Fetal Affects

A

no trt for infants
90% unaffected
mr 5-15% w/hearing loss, microcephaly

62
Q

Cytomegalovirus Nursing Considerations

A

good hygiene
isolate infected infants
no effective drug therapy

63
Q

Herpes Simplex Virus Maternal/Preg Affects

A

Type I: Non genital type, although can infect genital area
Type II: Genital type; more often associated with
neonatal disease. Causes painful vesicle lesions on maternal external genitals, buttocks, cervix

64
Q

Herpes Simplex Virus Fetal Affects

A

Greatest risk is from maternal primary infection at birth; 85-90% acquired at time of vaginal birth•Acquired post-natally through oral lesions, breastfeeding,
and from other infected infants• Mortality of 50-60% if neonatal exposure is w/active primary infection• W/congenital transmission: SGA, low birth weight, diffuse
brain damage, microcephaly and intracranial calcification

65
Q

Herpes Simplex Virus Nursing Considerations

A

Neonates treated w/acyclovir x2-3weeks; topical ophthalmic drug in addition to IV therapy•
Prevention: if positive lesions or culture at time of
delivery –cesarean section•Avoid routine use of scalp electrodes during labor•Strict hand washing for mothers with active infections•Contact isolation w/infected infants•
Educate parents on precautions to use after discharge

66
Q

HIV transmission

A

intravenous drug use #1 route of transmission

perinatal transmission through trans-placental during delivery or breastfeeding

67
Q

HIV maternal/preg affects

A

preterm l&d

s/e from arv & haart drugs

68
Q

HIV fetal affects

A

perinatal transmission
IUGR
asymptomatic at birth (antibodies 1-18 mos)

69
Q

HIV nursing considerations

A

Antepartum•Use of ARV/HAART usually after week 14•
Prevention of opportunistic infection
Intrapartum•ACTG 076 Protocol: (mother) AZT 2mg/kg IV over 1 hour, then 1mg/kg IV continuous infusion until cutting of cord. •Avoid procedures that increase the risk of perinatal transmission, such as amniocentesis, and fetal scalp sampling by minimizing fetus/neonate’s exposure to maternal blood and body fluids.•Trend toward scheduling cesarean birth prior to the onset of labor decreases transmission to 2% (depending on viral load). Women should be counseled and supported in their decision
Postpartum•Monitor mother for signs of infection; restrict breast-feeding•Instruct mother on how to avoid the spread of HIV•Provide supportive care.•Mother will continue her anti-retroviral meds as prescribed.•Administer PO AZT or ZVD to neonate as prescribed.•AZT 2mg/kg P.O. q 6hrs x 6 weeks 8-12 hours after birth•Current guidelines suggest testing newborn within 48 hours of birth, at 1-2 months and 3-6 months of age. •Diagnosis is confirmed with two positive tests on two separate blood draws
Psychosocial support•Disclosure of a woman’s HIV status to family/significant other can put her at risk for domestic violence, rejection•Requires assistance in identifying coping strategies and managing day to day life

70
Q

nursing considerations for perinatal infections

A

focus is on screen/prevention
culture at initial appt & 3rd trimester
educate regarding effect of infect on pregnancy

71
Q

nursing dx for perinatal infections

A

ineffective coping, health maint.

risk for infection, injury/fetal

Mgmt Test 2 - OB (14 decks)

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