pregnancy - week 3 Flashcards
conflicts of nonadherence for the patient
Conflict
Increased mortality and morbidity rates
Embarrassment
Changes in the quality of life
conquenses of nonadherence for the healthcare system
Increased cost
Increased use of health care services
Naegele’s Rule
First day of Last Menstrual period
3 months + 7 Days
OR
9 months + 7 Days
Or
40 weeks
LMP Started on the 28th March 2023 and ended on the 3rd of April 2023. What is her EDD?
2nd January 2024
what does GTPAL or GP mean?
G (gravida): the current pregnancy including past pregnancies
T (term births): the number of pregnancies ending >37 weeks’ gestation, at term
P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A (abortions): the number of pregnancies ending before 20 weeks or viability
L (living children): number of children currently living
2nd Terminology
G (gravida): the current pregnancy including past pregnancies
P (Para): ORParityis the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable). … A woman who has been pregnant once and deliveredtwinsafter 20 weeks would be noted to be a Gravid 1 Para 1.
immunizations to never give during pregency
Never give these during pregnancy
MMR
HPV
infections that endanger the baby
Toxoplasmosis
GBS
spontaneous abortiion
Spontaneous abortion is up to 20 weeks
Cause unknown and highly variable
* 1st trimester commonly due to fetal genetic abnormalities
* 2nd trimester more likely related to maternal conditions
Types: Threatened, Inevitable, Incomplete, Complete, Missed, Habitual
spontaneous abortion nursing assessment
- Vaginal bleeding- inspection of products of conception
- Cramping or contractions,
- backache
- Vital signs may change if blood loss is excessive
- pain level
- Client’s understanding –guilt
spontaneous abortion nursing management
Continued monitoring
* Vaginal bleeding, pad count
* Passage of products of conception
* Pain level
Medical Management
* Pain medication
* Preparation for procedure -Dilatation and Curettage/Evacuation
Support
* Physical and emotional; verbalization of feelings
* Grief support, referral to community support group
* Follow up
cervical insufficiency defination and therupetic managment
Premature dilatation of cervix
Cause unknown; possibly due to cervical damage
Therapeutic management
* Bed rest, pelvic rest, avoidance of heavy lifting
* Cervical cerclage
* Shirodkar’s suture
ecpotic pregnancy
Ectopic Pregnancy-Ovum implantation outside the uterus-Obstruction or slow passage of ovum
hallmark sign
missed period
gestational thropastic disease
Two types
* Hydatidiform mole
* Choriocarcinoma
Exact cause unknown
**Diagnosis **
extreme nausea
Elevated HCG levels
Ultrasound shows grape like structure
Management
Immediate evacuation of uterine contents (D&C)
Long-term follow-up-for up to 2 years
Monitoring of serial HCG levels
Education: treatment, prophylactic chemotherapy
hyperemesis gravidarum
Hyperemesis gravidarum is extreme, persistent nausea and vomiting during pregnancy.
Assessment
Onset, duration, course of N/V; diet history; risk factors, weight, associated symptoms,
perception of situation
Diagnosis
Dehydration, metabolic acidosis, and hypokalemia
Liver enzymes, CBC, BUN, electrolytes, HCG levels
Ultrasound (rule out molar pregnancy)
Urine - ketonuria
hyperemsis gravidarum mangement
Management
* Hydration-IV fluids, I&O
* Conservative - lifestyle changes, address cause of nausea if possible e.g. avoiding trigger smells
* Diet - amount, ginger, crackers, timing
* Wrist bands for nausea
* Diclectin - doxylamine + pyridoxine
Support education: reassurance, home care follow-up
placenta previa therapeuteic managment
Therapeutic management: dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labour signs and symptoms
nursing assessment and managment of placenta previa
- Vaginal bleeding (painless, bright red in 2nd or 3rd trimester, spontaneous cessation then recurrence), soft relaxed uterus-
- NO PV EXAM Except by Dr with a double set up
- Monitoring of maternal–fetal status
- Vaginal bleeding; pad count
- FHR
- Start an IV
- Maintain the pregnancy for as long as possible
- Support and education: fetal movement counts, prolonged bed rest (if necessary)
- signs and symptoms to report
Preparation for cesarean birth
placenta pervia
a problem during pregnancy when the placenta completely or partially covers the opening of the uterus
aburptio placentae
Separation of placenta leading to compromised fetal blood supply
Etiology unknown
assessment and management of aburptio placentae
- PV exam by Dr only
- Bleeding (dark red) – Present or absent
- Pain (knife-like), uterine tenderness, board like rigidity, contractions
- Fetal movement and activity (decreased)non stress test
- Laboratory and diagnostic testing: ultrasound, CBC, fibrinogen levels, PT/a PTT, type and cross-match
Extensive bleeding
* IV start, Restoration of blood loss; possibility of DIC,
* Tissue perfusion: left lateral position, strict bed rest, oxygen therapy, vital signs, fundal height, continuous fetal monitoring
* Support and education: empathy, understanding, explanations, possible loss of fetus, reduction of recurrence
* Emergency C-section
preterm labour
Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation
preterm labour nursing assessment
- Subtle signs e.g. backache
- Contraction pattern (4 contractions in 20 minutes or 8 contractions in 1 hour)
- Show, SROM
- Laboratory and diagnostic testing: fetal fibronectin
- cervical length shortens via transvaginal ultrasound, salivary estriol, home uterine activity monitoring
therapeutic management
- Bed Rest, head low position
- Education, reassurance, Psychological support
- NICU visit and Neo consult
- Tocolytic drugs - magnesium sulfate, terbutaline, indomethacin, nifedipine
- Corticosteroids – given to mom for fetal lung maturation, betamethasone 12mgs X 2 doses at an interval of 24 hours
- Antibiotic prophylaxis for women with SROM
pre- exsiting hypertension
before pregnancy or before 20 weeks
gestational hypertesnion
- Hypertension without proteinuria after 20 weeks;
- systolic blood pressure ≥160 mmHgand/ordiastolic blood pressure ≥110 mmHg are present for at least four hours-Vasospasm, hypoperfusion, endothelial injury
pre eclampsia
Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum
- generally when proteinuria(the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys.) is present
- Bed rest, daily BP monitoring and fetal movement counts, antihypertensives
- Hospitalization; IV magnesium sulfate
gestational hypertension nursing assessment and managment
- Nutritional and fluid intake/output, weight, edema;
- urine for protein;
- BP, DTR testing, magnesium toxicity,
- laboratory for LFT, magnesium levels
- fetal monitoring; uterine contraction monitoring for labour
- Quiet environment, sedatives, anti hypertensives, magnesium sulfate
- IV with restricted fluids- 80ml per hour
- seizure precautions and management
- Preparation for birth – C-Section
ABO incompatibility
type O mothers & fetuses with type A or B blood (less severe than Rh incompatibility)
Rh incompatibility
exposure of Rh-negative mother to Rh-positive fetal blood; sensitization; antibody production; risk increases with each subsequent pregnancy and fetus with Rh-positive blood
blood incompatibility nursing assessment and management
- Nursing assessment: maternal blood type and Rh status
- Nursing management: RhoGAM at 28 weeks, and again after birth in case the baby is Rh Positive
- Investigations done are the Rosette and the Kleihauer Betke
gestational diabetes (pathophy)
- Fetal demands
- Placental hormones that causes Changes in insulin resistance Human Placental Lactogen
gestational diabetes assessment
- Health history; physical examination; risk factors
- Screening at first prenatal visit; screening at 24 to 28 weeks for women considered at risk
*
gestational diabetes surveillance
Maternal surveillance:
urine for ketones, nitrates, and leukocyte evaluation of renal function/trimester; eye exam in 1st trimester;
Fetal surveillance:
ultrasound; alpha-fetoprotein levels; biophysical profile; nonstress testing; amniocentesis
Blood Sugar returns to normal postpartum
polyhydramnios cause and assessment
Amniotic fluid less than 2000mL
Cause Esophageal atresia, fetal anomalies, diabetes
assessment - risk factors, fundal height, abdominal discomfort, difficulty palpating fetal parts or obtaining FHR
polyhydramanios management
Polyhydramnios is the excessive accumulation of amniotic fluid
Nursing management
* Educate mom of risks
* ongoing fundal height assessment, ultrasounds
* assisting with therapeutic amniocentesis
* Vigilant for cord prolapse at time of ROM
* Look for congenital defects in baby’
Therapeutic management: close monitoring; removal of fluid, indomethacin decreases fluid by decreasing fetal urinary output)
oligohydramnios
amniotic fluid less than 500mL
Causes
Fetal defects in the kidneys, placental problems (post dates), PROM, maternal complications like diabetes, hypertension, dehydration
**Assessment: **
fluid leaking from vagina, ultrasound
**Therapeutic management: **
Serial monitoring with ultrasound
Amnio infusion
Continuous fetal surveillance
Expedite birth
pre rupture of membranes
PPROM - before 37 weeks’ gestation, PROM- after 37 weeks
No digital cervical exams until woman is in active labour
**Nursing assessment: **
Risk factors, signs and symptoms of labour, FHR monitoring, amniotic fluid characteristics, Nitrazine test, ultrasound
PPROM managment
- Treatment with Antibiotics
- Expectant management if fetal lungs immature
- Monitor uterine contractions, FHR, Vital Signs
- Bed rest, hospitalise
- Infection prevention, education and support
- Plan for discharge or induction
