Reproduction: Complicated Pregnancy/Nutrition/Intrapartum Risk Factors Flashcards
What are teens at risk for if they become pregnant?
- less likely to finish school
- less likely to go to college
- more likely to be single
- Less likely to receive child support
- More likely to require public assistance
What is the baby at risk for with teen pregnancies?
- increased risk for preterm birth, low birth weight, and infant mortality
- tend to score lower on assessments of knowledge, language development, and cognition
- More likely to grow up without a father
- higher rates of abuse and neglect
What are the benefits of having a baby over the age of 35?
- parents tend to be well-educated and be financially secure
- decision to have a baby is usually deliberate
What are the medical risks associated with having a baby over 35?
- maternal death
- higher risk of miscarriage
- chronic medical conditions
- low-birth-weight infants and preterm births
- Child with Down Syndrome
What are some special concerns of an expectant couple over the age of 35?
- energy level
- dealing with the needs of children as they themselves age
- Financial concerns
- Blended families
- Facing own morality
- More medical procedures
- Social isolation
- Biological clock
- Potential loss of the child= grief combines with anxiety about conceiving again
What is the most common medical complication of pregnancy?
iron deficiency anemia
What are people who have anemia during pregnancy susceptible to?
infection and high blood pressure
How is iron-deficiency anemia during pregnancy prevented?
iron supplements
What can folic acid deficiency anemia cause in infants?
- can cause neural tube defects
- Usually detected in later pregnancy
- treated with a daily supplement of folate
How does sickle cell disease affect pregnancy?
- good prognosis if adequate nutrition, prenatal care
- mortality is rare (incidence of fetal death during and immediately following an attack decreased greatly)
- additional folic acid supplements required
- treat infection promptly
Why are women at risk for diabetes when pregnant?
During the second half of pregnancy, the fetus uses more glucose and amino acid so the body makes more
What is the influence of preexisting and gestational diabetes during pregnancy?
- alter insulin requirements
- accelerate the progress of the vascular disease
- Diabetes more difficult to control
- Possible ketoacidosis
- hypertension
What are the maternal risks that come with diabetes during pregnancy?
- team approach has reduced health problems
- hydramnios
- preeclampsia-eclampsia
- Ketoacidosis
- Difficult labor
- retinopathy
- Hyperglycemia
What are the fetal-neonatal risks for diabetes during pregnancy?
- congenital anomalies
- increased risk of death
- Large for gestational age
- respiratory distress syndrome
- hyperbilirubinemia, hypocalcemia
What are the clinical therapies for diabetes during pregnancy?
- assess at the first prenatal visit
- laboratory assessment of long-term glucose control (diet, exercise, insulin therapy)
- Evaluation of fetal status (nonstress testing/ultrasound)
What is the postpartum management for diabetes during pregnancy?
- discontinue insulin for women with GDM
- Monitor blood levels
- reassess 6 weeks postpartum
What are the most common congenital heart defects?
- tetralogy of Fallot
- atrial septal defect
- ventricular septal defect
- Patent ductus arteriosus
- Coarctation of the aorta
What is Marfan syndrome?
An autosomal dominant disorder of connective tissue which may have serious cardiovascular involvement
What is peripartum cardiomyopathy?
- Dysfunction of the left ventricle that occurs in the last month of pregnancy or 5 months postpartum
- mortality rate between 5% and 50%
What are the clinical therapies for cardiac disease during pregnancy?
- early diagnosis and ongoing treatment
- classes I-IV (severity determined by physical abilities)
- drug therapy
- Labor and childbirth
- antepartum period (dietary and activity changes)
What are the medications typically given for cardiac disease during pregnancy?
- anticoagulant heparin
2. thiazide diuretics for CHF
What are the clinical therapies for cardiac disease during pregnancy in the intrapartum period?
- reduce physical exertions and fatigue
- evaluate maternal VS frequently
- Continuous electronic fetal monitoring
What are the clinical therapies for cardiac disease during pregnancy in the postpartum period?
- strain on heart 48 hours after birth
- longer hospitalization if necessary
- appropriate health teaching for the client and family
What are some interventions for prenatal substance abuse?
- motivating client to abstain
2. support through withdrawal and recovery
What are some interventions for HIV/AIDS during pregnancy?
- transmission to fetus can be reduced
- antiretroviral medications
- most safe in pregnancy
- cesarean birth
- abstaining from breast feeding
What are some interventions for asthma during pregnancy?
- promote oxygenation
- teach client how to recognize signs of labor
- Premature birth higher in clients with asthma
- prevent maternal exacerbations
- Inhaled albuterol for exacerbation
What are some interventions for epilepsy in pregnancy?
- continue recommended medication
- supplement with folic acid
- vitamin D
What are some interventions for hypothyroidism during pregnancy?
- focus on early identification and treatment
- teach about importance of medication
- weekly nonstress test recommended after 35 weeks
What are some interventions for Rheumatoid arthritis during pregnancy?
- monitor for anemia
- encourage rest and ROM exercises
- client may be in remission
- may be advised to stop medications
What are some interventions for TB during pregnancy?
- when isoniazid used pregnancy
- supplemental pyridoxine
- extra rest, limited contact with others if active
- TB inactive: breastfeed/care for the infant
- TB active: NO direct contact with the infant until noninfectious
What are some interventions for vaginal bleeding during pregnancy?
- monitor BP/pulse frequently
- observe for indicators of shock
- count and weigh pads 12 weeks or beyond
- assess fetal heart tones
- prepare woman for IV therapy
- prepare for examination
What are some interventions for spontaneous abortion (miscarriage)?
- focus on emotional support
- prevent complications
- discourage the use of hot tubs
What are some interventions for an ectopic pregnancy?
- early Identification
- emotional support
- Preventing complications
- Pain management
- Access hcG levels
- prepare client for surgery
- provide reassurance (future pregnancy)
What are some interventions for gestational trophoblastic disease?
- teaching about screening
- assess for all symptoms
- follow quantitative hCG levels
What are some interventions for hyperemesis gravidarum?
- assess hydration and nutritional status
- administer IV fluids
- Total parenteral nutrition (TPN) may be administered
- Keep client away from food odors
What are some interventions for Alloimmunization?
- administer Rhogram at 28 weeks
- if mother Rh- and father Rh+ immediately following a spontaneous miscarriage
- Assess lab results for positive Coombs test
- If positive= no Rhogram
What are some interventions for ABO incompatibility?
- assess blood type
2. Document for infant follow-up
What are some interventions for the Herpes simplex virus?
1 Prepare mother for cesarean birth if active lesions present when labor starts
What are some interventions for Group B streptococcal infection
- detection and early intervention
2. resolve before deliver
What are some interventions for a UTI with pregnancy?
- signs to report for quick intervention
2. Oral sulfonamides in last weeks of pregnancy
What are some interventions for vulvovaginal candidiasis during pregnancy?
- teaching signs and symptoms
- preventative measures
- Rapid recognition for quick treatment
What are some interventions for syphilis during pregnancy
- Screen for it during prenatal care
2. Treat and eliminate it before delivery
What are some factors that influence prenatal nutrition?
- Socioeconomic influences
- cultural, ethnic, religious influences
- psychosocial influences
- eating disorders
- vegetarianism
- pregnant vegetarian
What are some things that pregnant vegetarians must include in their diet?
- must eat combinations
- careful planning to obtain complete proteins
- Four servings of B12 fortified Foods
- Decreased mineral intake, iron, zinc, and calcium
What is Pica?
Craving for and persistent eating of nonnutritive, nonedible substances (iron deficiency anemia is a common concern with this)
How much Folic Acid must be taken for a woman who is pregnant?
400 mcg daily
What kind of artificial sweetener is safe?
Splenda or Truvia
How many pounds should an underweight woman gain during pregnancy?
28-40 lbs
how many pounds should a normal weight woman gain during pregnancy?
25-35 lbs
How many pounds should an overweight woman gain during pregnancy?
15-35 lbs
How many pounds should an obese woman gain during pregnancy?
11-20 lbs
How much weight should a woman typically gain during the first trimester?
0.9-1.8 kg
How much weight should a woman gain during the second and third trimesters?
0.3-0.5 kg/wk during the second and third trimesters
What should be monitored during abruptio placentae?
- uterine resting tone
- girth
- VS
- Urine output
What should be assessed with placenta previa?
Assess blood loss, pain, and avoid vaginal exam
What should be assessed with premature rupture of membranes?
- duration of rupture, appearance of fluid
- signs of infection
- Potential cord compression if witnessed
What should be monitored if magnesium is administered during preterm labor?
- BP q 10-15 minutes
- serum magnesium levels
- urine output
What are some interventions for hypotonic labor patterns?
- assess contractions, maternal VS, FHR
- promote maternal-fetal well-being
- Monitor for maternal exhaustion
- Assess for fetal meconium
What are some interventions for Fetal malposition?
- Assist with position changes
2. prepare for surgery if cesarean required
What are some interventions for fetal macrosomia?
- identify women at risk
- assess for labor dysfunction, lack of fetal descent
- monitor for hemorrhage postpartum
Assess newborn for cephalohematoma
What are some interventions for a prolapsed umbilical cord?
- assess FHR, observe for prolapse
- if loop found, apply pressure to presenting part
- administer oxygen
- Trendelenburg or knee-chest position
What are some interventions for an amniotic fluid embolism
- administer O2 under positive pressure
- IV access quickly established
- CPR if respiratory/cardiac arrest
What are some interventions for Cephalopelvic disproportion (CPD)?
- assess adequacy of maternal pelvis
2. Suspect CPD when labor is prolonged (dilation, effacement slow; engagement of presenting part delayed)
What are some interventions for placenta accreta?
- assess for bleeding, monitor VS
2. prepare woman for possible hysterectomy
What are some interventions for a retained placenta?
- Assess for excessive bleeding/uterine contraction
2. monitor maternal VS
What are some interventions for Lacerations?
- monitor for bright-red blood during labor
- Promote perineal massage
- If lacerations occur, manage pain, apply ice
