quiz 1- module 1- part one

Question 1

What single-most important factor has led to improved perinatal mortality rates for women with pre-gestational diabetes

Answer 1

Understanding and management of strict maternal glucose control

Question 2

the primary focus of nursing care for women who have pre-gestational diabetes

Answer 2

A primary goal of nursing is to provide the woman with information on the changes to her diabetes management due to pregnancy, to help her achieve and maintain excellent blood glucose control.

Question 3

During pregnancy, where does the growing fetus get glucose from?

Answer 3

Maternal

Question 4

Where does fetus get insulin from?

Answer 4

Around the 10th week of gestation, the fetus secretes its own insulin at levels adequate to use the glucose obtained from the mother.

Question 5

insulin production in first trimester and its effects

Answer 5

first trimester and early second trimester:
inc. production of insulin d/t rising levels of estrogen and progesterone– stimulate B cell in the pancreases to inc. insulin production- promotes inc. peripheral use of glucose and dec. blood glucose; at the same time, an inc. tissue glycogen stores and dec. hepatic glucose production, which together further lower the fasting glucose levels. so for type 1 and 2 women – prone to hypoglycaemia during the first trimester.

Question 6

later second trimester and third trimester

Answer 6

pregnancy exert a diabetogenic effect on the maternal metabolic status d/t dec. tolerance to glucose, inc. insulin resistance, dec. hepatic glycogen stores, inc. hepatic production of glucose. inc. human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol and insulin’s inc. increase insulin resistance through their actions — as inulin antagonist.

Question 7

insulin resistance during sec. and third trimester/ purpose of diabetogenic effect

Answer 7

it is glucose sparing mechanism that ensures a abundant supply of glucose for the fetus; as a result, maternal insulin needs inc. from 18 to 24 weeks to about 36 weeks.

Question 8

last few weeks of pregnancy

Answer 8

ensure diabetes is not getting worse with inc. insulin.

Question 9

date of birth

Answer 9

insulin needs drop drastically to approach prepreganancy levels d/t expulsion of the placenta; dec. all insulin antagonist level

Question 10

for non breastfeeding mother

Answer 10

insulin return to pre-pregnancy level about 7-10 days

Question 11

for breastfeeding mother

Answer 11

lactation use maternal glucose; so insulin needs is low as long as she is nursing

Question 12

on completion of warning

Answer 12

breastfeeding mother’s pre-pregnancy insulin needs is re-set

Question 13

implications of falling insulin need

Answer 13

removal of placenta; drop insulin antagonist level; lactation use maternal glucose

Question 14

List pregnancy and other health complications for women with poorly controlled pre-gestational diabetes.

Answer 14

Perinatal mortality, congenital malformations, hypertension, preterm delivery, large for- gestational- age infants, caesarean birth and neonatal morbidities.
Pre-eclampsia; preterm birth, caesarean birth and maternal mortality, infection, ketoacidosis

Question 15

List fetal and neonatal risks and complications associated with diabetes. What complication places neonates at risk for birth injury?

Answer 15

major risk: sudden and unexplained stilldeath.
fetal death complicated by pre-existing diabetes.
hyperglycaemia, keto acidosis, congenital anomalies, infection and mental obesity are thought to be the reason for fetal death.
in the third trimester, fetal acidosis is cause of fetal death.
the most important cause of perinatal loss in diabetic women: congenital malformations –(30-50% of all perinatal loss)
hyperglycaemia during the first trimester, is the main cause of birth defects.
neonate at risk for birth injury: macrosomia d/t response to maternal hyperglycaemia - induce production of excessive insulin.

Question 16

What is the normal glucose range (euglycemia) for a pregnant woman?

Answer 16

Normal glucose range: 3.4-6.7 mmol/L

Question 17

Identify priorities for hygiene and personal care a nurse should teach pregnant women with diabetes.

Answer 17

A daily bath should include good perineal and foot care.
Lotions, creams or oils can be applied to dry skin.
The woman should avoid wearing tight clothing.
Always wear shoes or slippers that fit properly, preferably with socks or stockings. Feet should be inspected regularly;
toenails should be cut straight across. Needs to avoid extremes of temperature.

Question 18

Identify key messages the nurse would include when teaching about meals.

Answer 18

The dietary goals are to have weight gain consistent with a normal pregnancy, prevent ketoacidosis and achieve euglycemia through consistency in carbohydrate intake.
A large bedtime snack of at least 25 g of carbohydrate with some protein is recommended in order to help prevent hypoglycemia and starvation ketosis(when hepatic glycogen stores are exhausted, the liver produces ketones to provide an energy substrate for peripheral tissues.) during the night.
Four food groups: vegetables and fruits; grain products; milk and alternatives; meat and alternatives
Low in energy density and high in volume
divide daily food intake between 3 meals and 2-4 snacks
limit take fat
daily vitamins and iron; folic acid 4 mg/day for the first rimester and then dec. 0.4 mg/day
avoid alcohol and limit caffeine to 300mg/day

Question 19

Identify key messages the nurse would include when teaching a woman with pre- gestational diabetes about exercise.

Answer 19

Exercise need not be vigorous to be beneficial: 15-30 mins of walking four to six times a week

Other exercises that may be recommended include non- weight bearing activities such as arm ergometry or use of a recumbent bicycle

Best tine for exercise is after meals, when the blood glucose level is rising

Question 20

Identify key messages the nurse would include when teaching about blood glucose monitoring. What blood glucose levels should be reported to the healthcare provider immediately?

Answer 20

Blood glucose levels are routinely measured at various times throughout the day, such as before breakfast, lunch and dinner; 2 hours after meals; at bedtime; and in the middle of the night

When there is any readjustment in insulin dosage or diet, more frequent measurement of blood glucose is warranted.

If N/V or diarrhea occurs of if any illness is present, the women will have to monitor her BG more closely

Report hypoglycemia – less than 3.2 and hyperglycemia greater than 11

Question 21

Nurses providing postpartum care (after delivery) to women with pre-gestational diabetes monitor blood glucose levels. What trend will they see and what can they anticipate the antihyperglycemic management will be?

Answer 21

In the immediate postpartum period, insulin requirements decrease substantially d/t the major source of insulin resistance, the placenta has been removed.

Woman with type 1 diabetes may require only require one half the prenatal insulin dose on the first postpartum day

Usually insulin do not give until BG is. Greater than 11.

Many women with type 2 diabetes do not require insulin at all for the first 1-2 days after giving birth; some women require no insulin in the postpartum period and are able to maintain euglycemia through diet alone

Women who give birth by Caesarean may require an IV infusion of glucose and insulin until they resume a regular diet.

Question 22

Discuss the importance of breastfeeding for infants born to mothers with diabetes.

Answer 22

In addition to the advantage of maternal satisfaction, breastfeeding has an antidiabetogenic effect for the children of women with diabetes and for the women themselves.

Infants who are exclusively breastfed are less likely to develop diabetes; exposure to artificial milk products before 8 days of age is an import risk factor for the disease.

Question 23

Discuss particular concerns a nurse should assess for when caring for a woman with diabetes who chooses to breastfeed.

Answer 23

The mother may have early breastfeeding difficulties. Poor metabolic control may delay lactogenesis and contribute to dec. milk production

Insulin requirement in breastfeeding women may be one half of pre-pregnancy levels because of the carbohydrate used in human milk production. Because glucose levels are lower than normal, breastfeeding women are at increased risk for hypoglycemia, esp. in the early postpartum period and after breastfeeding sessions, particularly after late- night nursing.

Breastfeeding mothers with diabetes may be at inc. risk for mastitis and yeast infection of the breast.

Question 24

Why are women who develop gestational diabetes less likely to deliver infants with congenital anomalies than women with pre-gestational diabetes?

Answer 24

Because gestational diabetes usually develops after the week 20th of pregnancy – after the critical period of organogenesis(first trimester) has passed.

Question 25

Why do some women develop gestational diabetes?

Answer 25

Most pregnant women are capable of increasing insulin production to compensate for the insulin resistance (result from the insulin antagonistic effect of the placental hormones, cortisol and insulinzse.) and maintain euglycemia.

When the pancreas is unable to produce sufficient insulin or the insulin not used effectively, GDM can result.

Question 26

Which women are considered at higher risk for developing gestational diabetes and should be screened earlier?

Answer 26

Risk factors: (women with multiple risk factors should be screen in the first trimester to identify hyperglycemia early)
• Age>=35
• Previous GDM
• Prediabetes
• Indigenous, lain American, south Asian, Asian, African
• BMI >=30
• Polycystic ovarian syndrome
• Acanthosis nigricans
• Corticosteroid use
• History of macrocosmic infant
• Current fetal macrosomia or polyhydramnios

Question 27

Within Canada, how are women screened for gestational diabetes?

Answer 27

The sequential test – with a 50g glucose challenge test (GCT), performed between 24- and 28-weeks’ gestation, followed by a 75-g OGTT using glucose cut-off values as defined in fig.14.5 A.

the alternative approach: One-step test – includes a 75g OGTT that is given to a woman between 24- and 28-weeks’ gestation who has been fasting. The plasma glucose is measured within 1-2 hours

Question 28

What can the nurse do to support these women and families that is different from the support they would offer to a woman who is already knowledgeable about diabetes and its management?

Answer 28

providing detailed and comprehensive explanations to ensure understanding of, participation in, and agreement with the necessary intervention.

Potential complications should be discussed and the need for testing and maintenance of euglycemia throughout the remainder of the pregnancy reinforced.

It may be reassuring for the woman and her family to know that GDM typically disappears when the pregnancy is over.

Question 29

Why are women managed on insulin instead of oral antihyperglycemics?

Answer 29

The use of oral hypoglycemic agents, commonly used in the tx of nonpregnant pt, is being studied to determine safety for use during pregnancy and the long-term effects of in utero exposure.

insulin is the golden standard for pregnant women

Question 30

Cocaine

Answer 30

central nervous system stimulant;
if the user is pregnant, there is an inc. incidence of :
miscarriage,
preterm labour,
small- for gestational age babies, abruption of placenta,
stillbirth.
Animalities

It produces cardiovascular stress – tachycardia and hypertension can lead to heart attack or stroke, 
liver disease, 
seizures,  
perforation of the nasal septum,
hepatitis B and AIDS

Question 31

Methamphetamine

Answer 31

Active metabolite of methamphetamine is amphetamine, a central nervous system stimulant known as both “speed” and “meth”.

Causes a person to experience an elevated mood stat and pleasure as well as inc. energy and creates addictions within a short period

lead to irregular heartbeat and hypertension and overtime can create cognitive and mental as well as dental problems.

Fewer maternal and neonatal complx have been attributed to this class of substances than to cocaine, the rates of preterm births and intrauterine growth restriction with smaller head circumference are higher.

Question 32

Marijuana

Answer 32

It readily crosses the placenta and causes inc. carbon monoxide levels in the mother’s blood, which reduces the O2 supply to the fetus.

It has adverse effect outcomes on the fetus and infant.

Question 33

Opiates

Answer 33

S/S: euphoria, relaxation, relief from pain “nodding out”(apathy, detachment from reality, impaired judgement and drowsiness), constricted pupils, nausea, constipation, slurred speech and rep depression.

Woman who use opiates during pregnancy have a 6 times higher risk for problems outcomes

Neonatal abstinence syndrome is a serious concern for infants born to mothers who chronically use opioids. Withdrawal symptoms can include fetal hyperactivity and if severe, preterm labour or fetal death.

Question 34

Alcohol

Answer 34

Prenatal exposure to alcohol at high risk levels can have multiple, permanent cognitive and physical effects on the fetus; fetal alcohol spectrum disorder (FASD); inc. risk for miscarriage, stillbirth, preterm birth, and sudden infant death syndrome.

FASD – includes FAS is the most serious complication. Children with FAS have facial abnormalities – side-set and narrow eyes, growth problems and nervous system abnormalities. Low birth weight, intellectual disability, behavioural issues and learning and physical problems.

Women may experience nutritional deficiencies, pancreatitis, alcoholic hepatitis, deficient milk ejection and cirrhosis.

Question 35

Prescription Medication Use

Answer 35

Misuse can produce psychological and physical dependency in the same manner as illicit drugs.

Depression and anxiety are most common mental health problems in women. The meds treat them have some effect on the fetus and must be monitored very carefully in pregnancy women

Question 36

Other Illicit Drugs

Answer 36

It leads to flashbacks, chronic psychosis and violent behaviour.

Hallucinogens taken during pregnancy may have negative neurobehavioral effects on the new born.

Question 37

Identify barriers to treatment and prenatal care many women who use illicit substances face.

Answer 37

Guilt, stigma and shame as well as the fear of losing custody of a child; lack of knowledge of substances’ effects; long waiting lists and lack of women only recover spaces present further barriers to tx

Question 38

Many illicit substances are of small molecular size and readily pass through the placenta and affect the growing fetus. With this understanding in mind, how can nurses help women reduce their use of illicit substances?

Answer 38

a multidisciplinary team

Stabilization and treatment for women who use substances should be individualized for each woman, depending on the type of drug used and the frequency and amount of use.

built trust and communication

the causal, experimental, or recreational drug user is often able to achieve and maintain abstinence from substances when she receives education, support and continued monitoring throughout her pregnancy

Question 39

How do concepts such as shame, stigma and guilt create barriers within the nurse-patient relationship and negatively impact outcomes for mothers and newborns?

Answer 39

Delay treatment/help, seeking prenatal care until labour begins

Question 40

How does informed consent create trust between the healthcare provider and client? Balance the imperative to gain informed consent regarding drug testing with the desire to know what substances women may be taking. How might a nurse navigate these competing needs to provide safe care? What ethical concepts inform nursing practice in this regard?

Answer 40

confidentiality
privacy
building trust
autonomy

when drug testing ordered clinically or requested by the provincial child protection agency, informed consent from the woman is mandatory.

the testing is ordered in the new-born, parental or guardian informed consent is also required.

Question 41

Substance use for women of childbearing age is a growing concern in Canada. What are your thoughts on why this is so? What determinants of health positively influence a woman’s likelihood of reducing or abstaining from substance use during pregnancy? Consider the fact that many women who use illicit substances have a significant history of violence, trauma, and mental illness. How does this knowledge direct you to respond in your role as a nurse?

Answer 41

economics
education
safe housing
social support

trauma informed care

women focus framework –p396, box 15-5

Question 42

Is breastfeeding safe for the substance using woman?

Answer 42

it must be individualised. Although all substances appear in breast milk, some in greater amount than others, breastfeeding has many benefits.

Breastfeeding should be delayed until the potential risk and benefits have been reviewed.

Women should be encouraged to remain substance free if they are breastfeeding.

Question 43

Additional Maternal Health Problems

Answer 43

three major causes of maternal morbidity are:
hemorrhage,
infection and
hypertensive disorders

However, within Canada, the primary causes of maternal morbidity differ slightly, and are influenced by mental health and social factors, and to barriers to accessing prenatal care

Question 44

What factors lead to this increase and how can nurses respond when caring for women they suspect are experiencing IPV?

Answer 44

1. the bio-psychosocial stress of pregnancy may strain he relationship beyond the couple’s ability to cope, and frustration is followed by violence
2. the partner may be jealous of the fetus, resenting the intrusion into the couple’s relationship and the woman’s displacement of attention
3. the partner may be angry at the unborn child or the woman
4. the beating maybe the partner’s conscious or subconscious attempt end the pregnancy

it is important to give her information that can enable her to make her own decisions and have control over her decisions.

Question 45

Identify causes of morbidity and mortality for the mother and infant related to complications from significant hypertension.

Answer 45

Women age greater than age 40 with their first pregnancy - highest rate of pregnancy related HTN

Rates of pre-eclampsia higher for women who mother had pre-eclampsia.

Complications from HTN: maternal death, acute renal failure, pulmonary edema, HELLP syndrome (hemolysis, inc. liver enzymes and low platelets) and cerebral edema with seizures.

Maternal Death Primarily from hepatic rupture, placental abruption and eclampsia.

Question 46

Define HDP parameters

Answer 46

It is determined by an assessed BP measure of systolic BP of 140 mm HG or greater or diastolic BP of 90 mm Hg or greater.

Severe hypertension is defined as sBP of 160mm Hg or greater or a dBP of 110 mm Hg

Question 47

Define pre-existing hypertension and gestational hypertension using the tables and readings on pp. 312-313. Differentiate

Answer 47

Pre – existing HTN – predates the pregnancy or appears before 20 weeks

a. With comorbid conditions: pre-gestational type 1 or 2 diabetes or kidney disease require tighter BP control outside of pregnancy because of their association with heightened cardiovascular risk.

b. With evidence of pre-eclampsia (onset after 20 weeks’ gestation) also as know superimposed pre-eclampsia. One or more symptoms must be present:
• Resistant HTN (defined as need for three antiHTN meds) or
• New or worsening proteinuria or
• One or more adverse conditions or
• One or more severe complications.

Question 48

gestational hypertension

Answer 48

HTN that appears for the first time at or beyond 20 weeks’ gestation

a. With comorbid conditions: pre-gestational type 1 or 2 diabetes or kidney disease require tighter BP control outside of pregnancy because of their association with heightened cardiovascular risk.

b. With evidence of pre-eclampsia (after 20 weeks’ gestation) defined as gestational HTN with one or more of the following symptoms:
• New or worsening proteinuria or
• One or more adverse conditions or
• One or more severe complications

Question 49

Define pre-eclampsia. Identify the three physiological manifestations of pre-eclampsia. Briefly define and differentiate non-severe pre-eclampsia, severe pre-eclampsia, eclampsia, and HELLP syndrome.

Answer 49

Pre-eclampsia (hypertension and new or worsening proteinuria; edema)

develops after the second trimester of pregnancy

It is defined by new-onset proteinuria and other end organ dysfunction and may result in maternal complications or intrauterine fetal morbidity and mortality d/t uteroplacental insufficiency and placental abruption.

its a multisystem, vasospastic disease process of reduced organ perfusion characterized continuum fro made to severe

Question 50

adverse conditions and severe complx of pre-eclampsia

Answer 50

table 14-2; p313

Question 51

proteinuria

Answer 51

0- neg
\+1==0.3 g/l
\+2==1.0 g/l
\+3==3. g/l
\+4==more than 10 g/l

Question 52

symptoms that indicates severe pre-eclampsia

Answer 52

presence one or more severe complx:
seizure,
blindness
stroke
severe liver dysfunction
pulmonary oedema
myocardial dysfunction

Question 53

Non-severe pre-eclampsia- see table 14-3; p314

Answer 53

sBP below 160 and dBP below 110 and proteinuria with presence of one or more adverse conditions

greater than 140/90

Question 54

Servere pre-eclampsia-see table 14-3; p314

Answer 54

greater than 160/110 and presence of new proteinuria and present of one or more severe complications.

Question 55

Eclampsia

Answer 55

Characterized by seizures from profound cerebral effect of pre-eclampsia

maternal and perinatal morbidity and mortality rates are higher when eclampsia is seen easy in gestation (before 28 weeks)

greater than 40 years

multigravida

chronic HTN or renal disease

fetus is at risk of placental abruption, preterm birthIUGR
acute hypoxia

seizure can occur before, during, and after brith

1/3 of seizure occur after brith, almost always within first 48 hours after brith

Question 56

HELLP syndrome

Answer 56

it is a laboratory diagnosis for a variant of severe pre-eclampsia that is characterized by:
hemolysis,
elevated liver enzymes,
low platelets.

It occur during the later stages of pregnancy or sometimes after childbirth

To establish a diagnosis of HELLP , the platelet count must be less 100 and liver enzyme level (AST and ALT) must be elevated.

Question 57

Review Table 14-3; p314. List the “maternal effects” from this table. These are the routine assessments completed by nursing and medical staff to detect worsening pre-eclampsia. If a pregnant woman in your nursing care presented with increased blood pressure, what assessment questions would you ask her about how she is feeling? What urine test would you ask for?

Answer 57

Maternal effects:
BP, mean arterial pressure;

Proteinuria:
(quantitative 24 hr analysis, qualitative dipstick; reflexes; urine output; headache; visual problems; right upper quadrant or epigastric pain; serum creatinine; thrombocytopenia; AST, ALT, LDH or bilirubin elevation)

Fetal effects:
fetal HR; placental perfusion; premature placental aging

Vision problems? SOB? Headache? N/V?
Qualitative dipstick – measure protein in urine

Question 58

Review the pathophysiology of pre-eclampsia on p. 315. Explain how vasospasm is the main pathogenic factor in this condition, and not simply an increase in BP.

Answer 58

Poor perfusion as a result of vasospasm. Arteriolar vasospasm diminishes the diameter of blood vessels, which impede blood flow to all organs and inc BP.

Question 59

normal adaptations of pregnancy

Answer 59

inc blood plasma vol
vasodilation
dec. systemic vascular resistance
elevated CO
dec. colloid osmotic pressure

Question 60

Note three unique nursing assessments completed routinely for women with hypertensive disorders of pregnancy. Outline key reminders for correct techniques and what would alert a nurse to a woman’s worsening condition.

Answer 60

1. BP assessment;
2. deep tendon reflexes;
3. uteroplacental perfusion

BP should be measured with the woman in a sitting position with arm at the level of the heart

Use the proper size cuff – should cover 1.5 times the circumference of the arm

Use Korotkoff phase V for the diastolic reading

If BP is consistently higher in one arm, the arm with the higher values should be used
Women must be instructed in proper BP measurement if they are performing home BP monitoring

The evaluation of DTRs is especially important if the woman is being treated with magnesium sulphate. Dec. or absent DTRs may be an indication of magnesium toxicity.

Uterine tenderness along with increasing tone may be the earliest finding of an abruption. Idiopathic preterm contractions also may be an early sign.

Question 61

Note the nursing care recommendations related to activity restrictions and diet

Answer 61

Diets high in protein and low in salt are not recommended to prevent pre-eclampsia.

Adequate fluid intake helps maintain optimum fluid volume and aids in renal perfusion and bowel function

There is no sodium restriction, however, consider limiting excessively salty foods

Eat foods with roughage (whole grains, raw fruits and vegie)

Drink 6-8 250 ml glasses water daily

Avoid alcohol and limit caffeine intake

Question 62

What is magnesium sulphate used for? Identify the adverse effects women receiving magnesium sulphate commonly experience.

Answer 62

It is the med of choice in the prevention and tx of convulsions caused by pre-eclampsia or eclampsia.

Adverse effect:
lethargy, feeling of heat or warmth, headache or nausea.

Question 63

Identify signs of magnesium toxicity that a nurse must assess for when administering this high-alert medication. See Nursing Alert boxes on p. 321.

Answer 63

Early sign of toxicity includes vomiting, resp distress, hypotension, flushing, muscle weakness, dec. reflexes and slurred speech.

Alert:
Monitor BP, pulse and RR - every 5 mins while the loading dose is being administered iv.

Also, uterine activity and O2 should be monitored

Monitor maternal vital signs during maintenance infusion hourly

Electronic fetal monitoring and uterine activity should be monitored

Loss of patellar reflexes, respiratory and muscular depression, oliguria and a decreased LOC are signs of magnesium toxicity.

High serum levels of magnesium can cause relaxation of smooth muscle such as the uterus.

Question 64

Hydralazine- arteriolar vasodilator

Answer 64

Adverse effects:
Maternal – headache, flushing, palpitation, tachycardia, dec. in uteroplacental blood flow, inc. HR; inc. O2 consumption, N/V

Fetal – tachycardia, late deceleration and bradycardia if maternal diastolic p > 90

Question 65

Labetalol hydrochloride - b blocker—vasodilation

Answer 65

Adverse effects:
Maternal - Minimal: flushing, tremulousness, minimal change in pulse rate

Fetal – minimal, if any

Question 66

Methyldopa - maintenance therapy if need 250-500 mg every 8 hours - b2 receptor agonist - vasodilation in muscle of bronchi

Answer 66

Adverse effect:
Maternal – sleepiness, postural hypotension, constipation, med- induced fever in 1% of women and positive Coombs’ test result in 20%

Fetal – after 4-month maternal therapy, positive Coombs’ test result in infant

Question 67

Nifedipine- ca blocker - reduce systemic vascular resistance by relaxation of arterial smooth muscle

Answer 67

Adverse effect:
Maternal – headache, flushing, possible potentiation of effects on CNS if administered concurrently with magnesium sulphate may interfere with labour

Fetal – minimal

Question 68

What are three signs that usually precede eclampsia? What is an immediate goal of care during a convulsion?

Answer 68

severe headache, visual disturbance, and nausea
Tonic-Clonic convulsion signs:
1. Stage of invasion – 2-3 seconds: eyes are fixed; twitching of facial muscles occurs

2. Stage of contraction – 15-20 secs: eye protrude and are blood shot; all body muscles are in tonic contraction
3. Stage of convulsion – muscles relax and contract alternately (clonic); respirations are halted and then begin again with long, deep, stertorous inhalation; coma ensues.

The immediate goal of care during a convulsion is to ensure a patient airway

Question 69

What are the postpartum assessments a nurse performs on a woman who has had a HDP? What are some unique medication alerts the nurse needs to be aware of for the postpartum woman who has had a HDP? p323

Answer 69

Assess vital signs, intake and output, DTR (deep tendon reflexes), LOC, uterine tone and lochia flow throughout the postpartum period.

Oxytocin or prostaglandin products are used to control bleeding

Ergot products – ergonovine and methylergonovine are contraindicated because they inc. BP. The woman should be advised to report symptoms such as headaches and blurred vision.

Magnesium sulphate potentiates the action of narcotics, CNS depressants and ca blockers, thus must be administered with caution.

Woman may need to be restarted on antihypertensive med if hd BP > 100 at discharge.

Question 70

A woman with HDP may have a complicated birth and deliver a high-risk infant. What are some nursing considerations for supporting a family with a complex delivery and the stress and worry of delivering an infant needing intensive care?

Answer 70

Interactions and involvement in the care of the newborn

day to day fluctuations in the infant’s status can be emotionally draining

the woman and her family need opportunities to discuss their emotional response to complications.

If the outcome for mother or baby is unfavourable, the family should be assisted in coping with their loss and grief.