Pregnancy & Preterm Labor Flashcards
It determines how well the kidneys are working
GLOMERULAR FILTRATION RATE
Organ of exchange for numerous substances
PLACENTA
Liver metabolism of drugs is much slower in the fetus because of ________
Liver immaturity
Substances that cause developmental abnormalities
TERATOGENS
Drug used to prevent iron deficiency anemia
IRON
Required dose of iron during pregnancy
27 mg/day
It increases iron absorption
VITAMIN C
It is taken to avoid birth defects (NTDs), complications, spontaneous abortion, and spina bifida
FOLIC ACID (B9)
Amount of folic acid required during pregnancy
600 mcg/day
Deficiency of folic acid can lead to:
SPONTANEOUS ABORTION
BIRTH DEFECTS
NEURAL TUBE DEFECTS
Failure of embryonic neural tube to close properly
NEURAL TUBE DEFECTS
What multiple vitamins are needed during pregnancy?
VIT. A
VIT. B-complex
VIT. B12
VIT C
CALCIUM
VIT. D
VIT. E
IRON
3 Therapeutic drugs needed during pregnancy
IRON
FOLIC ACID
MULTIVITAMINS
Also called as “morning sickness”
NAUSEA & VOMITING
—severe nausea and
vomiting that may require hospitalization for hydration and
nutrition
HYPEREMESIS GRAVIDARUM
Drugs for nausea & vomiting
DOXYLAMINE SUCCINATE
PYRIDOXINE HYRODCHLORIDE
a burning sensation in the epigastric and sternal regions that occurs with reflux of acidic stomach contents,
HEARTBURN (PYROSIS)
PYROSIS
HEARTBURN
An increase in this hormone causes decreased motility of GI tract and relaxation of lower esophageal sphincter, causing pyrosis & constipation
PROGESTERONE
Drug for heartburn (pyrosis)
SUCRALFATE
It should be considered first-line therapy if the patient
does not respond to nonpharmacologic therapy
ANTACIDS
A combination of various compounds with various salts of calcium, magnesium, and aluminum as active ingredients that act by neutralizing the acid in the stomach by inhibiting pepsin (a proteolytic enzyme)
ANTACIDS
Caused by decreased GI motility
CONSTIPATION
Drugs for constipation
METAMUCIL
DOCUSATE SODIUM
DOXYLAMINE SUCCINATE
PYRIDOXINE HYRODCHLORIDE
Nausea & Vomiting
Antacids
HEARTBURN & INDIGESTION
SUCRALFATE
HEARTBURN (PYROSIS)
METAMUCIL
DOCUSATE SODIUM
CONSTIPATION
Oil that stimulates uterine contractions
CASTOR OIL
oil that reduces absorption of fat-soluble vitamins
MINERAL OIL
Castor Oil
Mineral Oil
- Stimulate uterine contractions
- Reduce absorption of fat-soluble vitamins
Vitamin K deficiency will lead to
HEMORRHAGE; NEONATAL HEMORRHAGE
Drugs for pain
ACETAMINOPHEN
It is the most commonly non-Rx ingested drug for pain / headaches during pregnancy
ACETAMINOPHEN
Acetaminophen
PAIN
can inhibit the initiation of labor and may prolong labor through its effects on uterine contractility; therefore its use is not recommended during pregnancy.
ASPIRIN
Classified as Category C drug which changes to category D if used in 3rd trimester. If taken late in pregnancy, it can cause premature closure of ductus arteriousus
IBUPROFEN
Antidepressant Drugs
- SELECTED SEROTONIN REUPTAKE INHIBITORS (SSRIs)
- TRICYCLICS
Adverse outcomes have included low birth weight (LBW), infants born small for gestational age (SGA), preterm delivery, and increased neonatal
irritability and decreased attentiveness
ANTIDEPRESSANT DRUGS
Responsible for contractions
CALCIUM
Antidote for magnesium sulfate overdose
CALCIUM GLUCONATE
CALCIUM GLUCONATE
Antidote for magnesium sulfate overdose
CALCIUM
Responsible for contractions
Decreases intensity and frequency of uterine contractions and relaxes muscles
TERBUTALINE
TERBUTALINE
Decreases intensity and frequency of uterine contractions and relaxes muscles
Main treatment for eclampsia
MAGNESIUM SULFATE
MAGNESIUM SULFATE
for eclampsia
It speeds up fetal lung maturity
CORTICOSTEROIDS
COTRICOSTEROIDS
speeds up lung maturity
Defined as cervical changes and uterine contractions that occur between 20 and 37 weeks of pregnancy
PRETERM LABOR
any birth that occurs before the completion of 37 weeks of pregnancy, regardless of birth weight
PRETERM BIRTH
It includes monitoring the heart rate & fetal lung maturity
FETAL SURVEILLANCE
drug therapy to decrease uterine muscle contractions.
TOCOLYTIC THERAPY/DRUGS
It stops preterm labor, only if dilation is 3 cm below
TOCOLYTIC DRUGS
TOCOLYTIC DRUGS
It stops preterm labor, only if dilation is 3 cm below
Examples of Tocolytic Drugs
- Beta2-adrenergic receptor agonists (Terbutaline)
- Calcium antagonists
- Magnesium sulfate
- Calcium channel blockers
- Nifedipine
- Indomethacin prostaglandin inhibitors
Goals of Tocolytic drugs
- Interrupt/inhibit uterine contractions to allow more time for fetal maturation in uterus
- To delay delivery so antenatal corticosteroids can be delivered to facilitate lung maturation
- To allow safe transport of px to appropriate facility if needed
act by stimulating β2-receptors on
uterine smooth muscle
BETA-SYMPATHOMIMETIC DRUGS
Example of beta-sympathomimetic drug
TERBUTALINE
A calcium antagonist and central
nervous system (CNS) depressant, relaxes the smooth muscle of the uterus through calcium displacement and can be given as an “off label” use for PTL
MAGNESIUM SULFATE
Contraindications of using tocolytic drugs:
- If woman is hemorrhaging- bleeding will increase
- Fetal distress is noted
Examples of corticosteroids therapy in Preterm Labor
BETAMETHASONE
DEXAMETHASONE
Most common serious complication of pregnancy
GESTATIONAL HYPERTENSION
Gestational hypertension with proteinuria
PREECLAMPSIA
A severe sequela of preeclampsia
HELLP syndrome:
HEMOLYSIS
ELEVATED Liver enzymes
Low Platelet count
New-onset of grand mal seizures in px with preeclampsia
ECLAMPSIA
Symptoms of Preeclampsia
-Hypertension
-Proteinuria
-Abdominal pain
-Pitting edema
-Blurred vision
Symptoms of Eclampsia
Preeclampsia + muscle twitching, seizures, coma
The only cure (treatment) for preeclampsia
Delivery of infant and placenta
Maternal seizzure
ECLAMPSIA
Treatment for Eclampsia
Delivery is postponed for 1-3 hrs if fetal status allows
Drug treatment of Preeclampsia
METHYL-HYDRA-LAB-PRAZO-NI-CLO
METHYLDOPA
HYDRALAZINE
LABETALOL
PRAZOSIN
NIFEDIPINE
CLONIDINE
passage of blood and blood products through the circulatory system to organs or tissues to deliver oxygen
and nutrients to cells, such as to the uterus and fetus.
PERFUSION
- A client in her first trimester of pregnancy calls the nurse to ask for suggestions on decreasing
nausea in the morning when she awakens. Which nonpharmacologic measures would the nurse be
aware of to decrease nausea and vomiting? (Select all that apply.)
a. Eating dry toast before rising
b. Eating small frequent meals
c. Eating a high-protein bedtime snack
d. Eating high-fat foods
a. Eating dry toast before rising
- When nonpharmacological treatment fails for
constipation, which drug would be a first-line
treatment for constipation during pregnancy?
a. Docusate sodium
b. Magnesium citrate
c. Castor oil
d. Mineral oil
a. Docusate sodium
- The nurse is teaching a pregnant client how to decrease the gastrointestinal distress she
experiences with prenatal vitamins. Which instruction would the nurse provide?
a. Take her vitamins between meals
b. Eat when she takes her vitamins
c. Drink orange juice when she takes her vitamins
d. Drink milk when she takes her vitamins
b. Eat when she takes her vitamins
- The nurse, working with a preconceptional couple at an infertility clinic, advises the woman
to take which supplement for at least 3 months before becoming pregnant?
a. Iron
b. Ginger
c. Folic acid
d. Vitamin B6
c. Folic acid
- A patient with severe preeclampsia is on magnesium sulfate. Which initial action by the nurse would be most appropriate for a magnesium sulfate level of 7 mEq/L?
a. Continue to monitor the patient because this level is therapeutic.
b. Contact the health care provider and report the level.
c. Prepare to administer 1 g of calcium gluconate.
d. Turn the patient on her left side and administer 10 liters of oxygen by nasal cannula.
a. Continue to monitor the patient because this level is therapeutic.
Therapeutic level of Magnesium Sulfate
4-7 mg/dl
- Which assessment finding is most concerning when examining a client in preterm labor who is receiving magnesium sulfate?
a. Feelings of lethargy
b. Feelings of warmth
c. Loss of patellar reflexes
d. Positive clonus +2 bilaterally
c. Loss of patellar reflexes
Continuous infusion of Magnesium Sulfate should not exceed ____ or maximum ____g/24 hrs
5-7 days or 40 g
- The client has been receiving magnesium sulfate
intravenously for 24 hours to treat severe preeclampsia. On assessment, the nurse finds a temperature of 37.3°C (99°F), pulse of 88, respirations at 14, blood pressure of 138/76, 2+
patellar reflexes, and negative ankle clonus.
Which intervention would be most appropriate for the nurse to take?
a. Obtain a stat magnesium sulfate level.
b. Discontinue magnesium sulfate.
c. Contact the health care provider.
d. Continue to monitor the patient.
d. Continue to monitor the patient.
- The nurse working in labor and delivery is reviewing messages to be returned to clients. Which statement made by the client alerts the
nurse to call that client first?
a. “I’m 32 weeks pregnant and taking calcium carbonate for my heartburn. Is there anything else I can take?”
b. “I’m 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?”
c. “I’m 8 weeks pregnant and taking folic acid. Will it hurt me or the baby if I stop?”
d. “I checked my blood glucose with a friend’s machine and it was 120 mg. I’m not diabetic. Is that normal?”
b. “I’m 38 weeks pregnant and taking ibuprofen for my backache. Should I take aspirin too?”
- A client is planning to become pregnant. Which actions should the nurse counsel the client to initiate before she stops taking her oral
contraceptive? (Select all that apply.)
a. Stop smoking immediately.
b. Take omega-6 fatty acids every day.
c. Take a multivitamin every day.
d. Stop taking over-the-counter acetaminophen.
e. See her health care provider.
a. Stop smoking immediately.
c. Take a multivitamin every day.
e. See her health care provider.
Uterine contractions produce progressive cervical effacement & dilation
1ST STAGE OF LABOR
Nonpharmacologic measures for Pain
- ambulation
- touch & massage
- aromatherapy
- heat & cold applications
Systemic drugs used during labor
- Sedative-hypnotics
- Narcotic agonists-antagonist
It promotes relaxation but not pain relief. Administered to minimize maternal anxiety & fear.
SEDATIVES
Examples of Sedatives
- Secobarbital (PO)
- Pentobarbital (IV)
- Hydroxyzine (IM)
Interfere with pain impulses at subcortical level of the brain
NARCOTIC AGONIST
Example of Narcotic Agonist
- Meperidine (most common)
- Fentanyl
- Morphine Sulfate
Represents loss of painful sensation w/ or w/o loss of consciousness
ANESTHESIA
2 Types of Pain in Childbirth
- VISCERAL
- SOMATIC
Pain due to pressure of the presenting part & by stretching of perineum & vagina
SOMATIC PAIN
Pain relief without loss of consciousness
REGIONAL ANESTHESIA
Types of regional anesthesia
-Pudendal block
-Epidural
-Combined epidural
-Spinal block
Anesthetic injected to epidural space
EPIDURAL BLOCKS
Anesthesia for cesarean birth
SUBARACHNOID BLOCK
Allows woman to sense contractions w/o feeling pain
EPIDURAL & INTRATHECAL OPIOIDS
Anesthesia that relives pain thru loss of consciousness. Rarely given for vaginal birth
GENERAL ANESTHESIA
Drugs that enhance uterine muscle contractility
- UTEROTROPIC DRUGS
- OXYTOCIN
- ERGOT ALKALOIDS
- (SOME) PROSTAGLANDINS
Drugs that stimulates smooth muscles of uterus
UTEROTROPIC DRUGS
It stimulates smooth muscle contraction in px already in labor
IV OXYTOCIN
Large group of alkaloids derived from fungi and are NOT used during labor because they can cause sustained uterine contractions
ERGOT ALKALOIDS
Ergot toxicity
ERGOTISM
the period from delivery until 6 weeks
PUERPERIUM
