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NURS 2275 > pregnancy - week 3 > Flashcards

pregnancy - week 3 Flashcards

1
Q

conflicts of nonadherence for the patient

A

Conflict
Increased mortality and morbidity rates
Embarrassment
Changes in the quality of life

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2
Q

conquenses of nonadherence for the healthcare system

A

Increased cost
Increased use of health care services

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3
Q

Naegele’s Rule

A

First day of Last Menstrual period
3 months + 7 Days
OR
9 months + 7 Days
Or
40 weeks

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4
Q

LMP Started on the 28th March 2023 and ended on the 3rd of April 2023. What is her EDD?

A

2nd January 2024

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5
Q

what does GTPAL or GP mean?

A

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.

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6
Q

immunizations to never give during pregency

A

Never give these during pregnancy
MMR
HPV

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7
Q

infections that endanger the baby

A

Toxoplasmosis
GBS

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8
Q

spontaneous abortiion

A

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

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9
Q

spontaneous abortion nursing assessment

A
  • 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
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10
Q

spontaneous abortion nursing management

A

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

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11
Q

cervical insufficiency defination and therupetic managment

A

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

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12
Q

ecpotic pregnancy

A

Ectopic Pregnancy-Ovum implantation outside the uterus-Obstruction or slow passage of ovum

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13
Q

hallmark sign

A

missed period

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14
Q

gestational thropastic disease

A

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

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15
Q

hyperemesis gravidarum

A

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

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16
Q

hyperemsis gravidarum mangement

A

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

17
Q

placenta previa therapeuteic managment

A

Therapeutic management: dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labour signs and symptoms

18
Q

nursing assessment and managment of placenta previa

A
  • 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
19
Q

placenta pervia

A

a problem during pregnancy when the placenta completely or partially covers the opening of the uterus

20
Q

aburptio placentae

A

Separation of placenta leading to compromised fetal blood supply
Etiology unknown

21
Q

assessment and management of aburptio placentae

A
  • 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

22
Q

preterm labour

A

Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation

23
Q

preterm labour nursing assessment

A
  • 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
24
Q

therapeutic management

A
  • 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
25
Q

pre- exsiting hypertension

A

before pregnancy or before 20 weeks

26
Q

gestational hypertesnion

A
  • 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
27
Q

pre eclampsia

A

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
28
Q

gestational hypertension nursing assessment and managment

A
  • 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
29
Q

ABO incompatibility

A

type O mothers & fetuses with type A or B blood (less severe than Rh incompatibility)

30
Q

Rh incompatibility

A

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

31
Q

blood incompatibility nursing assessment and management

A
  • 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
32
Q

gestational diabetes (pathophy)

A
  • Fetal demands
  • Placental hormones that causes Changes in insulin resistance Human Placental Lactogen
33
Q

gestational diabetes assessment

A
  • Health history; physical examination; risk factors
  • Screening at first prenatal visit; screening at 24 to 28 weeks for women considered at risk
    *
34
Q

gestational diabetes surveillance

A

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

35
Q

polyhydramnios cause and assessment

A

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

36
Q

polyhydramanios management

A

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)

37
Q

oligohydramnios

A

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

38
Q

pre rupture of membranes

A

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

39
Q

PPROM managment

A
  • 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

NURS 2275 (11 decks)

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