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NUR259 > session 2 The nurse's role in gestational health and care of potential problems > Flashcards

session 2 The nurse's role in gestational health and care of potential problems Flashcards

1
Q

what causes anaemia in pregnancy

A

maternal blood volume expansion

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2
Q

what are the risks a diabetic pregnant women faces

A

pregnancy can alter insulin requirements

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3
Q

what are the increased maternal risks for a diabetic pregnant women

A

hydramosis - increased amniotic fluid
ketoacidosis - imbalanced electrolytes
pre eclampsia/ eclampsia
c section - if large birth weight of baby is expected

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4
Q

what are the increased fetal/ neonate risks for a diabetic pregnant women

A

Macrosomia - large baby for gestational age
truamatic birth - risk of shoulder dystocia
hypocalcaemia at birth - when the cord is cut the maternal blood the baby’s been used to is gone so the glucose drops.
resp distress syndrome - increased insulin impacts the enzyme that helps produce teh surfactant
hyperbilirubinaemia - jaundice
some congenital abnormalities

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5
Q

what education would a nurse give to a pregnant diabetic women

A

What to expect
nutrition
self monitoring of glucose levels
may require blood glucose levels checked throughout the pregnancy

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6
Q

what other management is required during the pregnancy of a diabetic women

A

Assessment of the fetus
- close monitoring of size and growth, may need to induce labour earlier if baby is large for gestational age
cesarean birth may be indicated if fetal distress, hypertension or weight of fetus is to exceed 4500g

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7
Q

what is the definition of gestational diabetes

A

glucose intolerance that has an onset or is first diagnosed during pregnancy

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8
Q

what is the management of gestational diabetes

A 
mostly an educational role 
what to expect
nutrition
self monitoring
what to do in the case of an diabetic emergency
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9
Q

What is the definition of ectopic pregnancy

A

ovum lodges in the fallopian tube, embryo grows out of the space and a rupture occurs causing bleeding into the cavity and one sided pain

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10
Q

what is the nursing assessment of ectopic pregnancy

A
  1. PV blood loss
  2. Vital signs - clinical hypovolaemic shock
  3. assess emotional state and coping mechanisms

*if it looks like an ectopic pregnancy the nurse would initiate paperwork for transfer to theatre

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11
Q

What are the nursing diagnosis for ectopic pregnancy?

A
  1. Pain - acute related to abdominal bleeding secondary to tubal rupture
  2. Fluid volume dificient - related to hypovolaemia secondary to blood loss from tubal rupture
  3. Grieving- related to unexpected pregnancy loss
  4. Shock - not every woman that comes into ED with an ectopic pregnancy knows that they are pregnant.
  5. Privacy to grieve - nurse in a single room if possible and nurse holistically being mindful of culture and spiritual needs with extra care and consideration for all family members.
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12
Q

what is the medical management

A

bloods, transvaginal U/S,

IM Methotrexate

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13
Q

what is the surgical management

A

bloods,
transvaginal U/S
laparotomy, laparoscomy

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14
Q

define gestational diabetes

A

new onset of diabetes after 20 weeks gestation with no other signs of preeclampsia, that resolves within 3 months postpartum

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15
Q

define preeclampsia

A

increased in BP after 20 weeks gestation accompained by proteinuria and a previously normal BP that usually occurs in the last 10 weeks of gestation
can occur during labour
cure is to give birth and remove placenta and fetus

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16
Q

Nursing diagnosis for pre eclampsia

A

Blood pressure and Urine analysis done immediately - dipstick test
Vital signs
Measure urine output
haemological testing - may have thrombocytopenia (low platelet count causing bleeding issues)
Blood pressure (BP goes above 170systolic requires hospitalisation for monitoring)
Epigastric - pain in right upper quadrant
Neurological - headaches and blurred vision
can lead to convulsions and eclampsia
report to midwife or registra - must be reviewed
administer corticosteroids as ordered to help lung maturation of fetus, in the events of a premature labour

17
Q

Define Eclampsia

A

seizure activity that usually occurs within 24 hrs post delivery

18
Q

what is the nursing for eclampsia

A
  1. DRABCD
  2. oxygen
  3. IV access
    4 IV diazapam, midazolam
    5.magnesium sulphate infusion
  4. control of hypertension after control of seizures has been achieved
  5. Delivery of baby if possible
  6. Midwife will assess the for fetal distress
  7. when woman is stable- ready to move her for emergency cesaeran section
19
Q

what is hyperemesis gravidarum?

A 
Severe vomiting that results in 
ketosis
electrolyte imbalance
thryrotoxicosis
vitamin deficiency
weight loss
20
Q

what electrolylte imbalance may you suspect for a patient with hyperemesis gravidarum?

A

hypochloraemic alkalosis- give chloride saline solution
hypokalaemia -give oral potassium (always check potassium level of the person before administering to prevent putting the patient in cardiac arrest from incorrect dosage)
hyponatraemia (will show signs of orthostatic hypotesion and tachycardia - may have decreased LOC) - give IV isontonic or hypertonic saline as ordered in severe cases

21
Q

what is the nursing assessment for Hyperemesis gravidarum?

A
  1. weights
  2. vital signs - BP (low), HR (high)
  3. BGL
  4. FBC
  5. urine output - ketones
  6. blood gas = to check for electrolyte imbalance
22
Q

what is the nursing management of hyperemesis gravidarum?

A
  1. IV hydration to correct electrolyte imbalance
  2. Medications as ordered - stemitol, maxalon, dancetron
  3. vitamins - Vit B6, thyamine, folic acids
  4. Assess for depression - provide emotional support
  5. Dietician review
23
Q

what is antepartum haemorrhage

A

bleeding from the genital tract after the 20th week of pregnancy.

24
Q

what are the signs of antepartum haemorrhage

A
  1. spotting
  2. minor haemorrhage -50mls loss that settles
  3. major haemorrhage - 50-1000 mls loss with no signs of clinical shock
  4. massive haemorrhage - greater than 1000mls - signs of shock (MET CALL and code blue)
25
Q

What are the nursing assessments of antepartum haemorrhage

A
  1. Ask whe the bleeding began
  2. Gain a history of previous births
  3. Vital signs
  4. . PV blood loss - amount
  5. presence of pain - ? contractions,ectopic, miscarriage
  6. monitor urine output, U/A (urine analysis)
  7. Uterine tone (soft non tender uterus = lower genital tract cause of bleeding, increased tense rigid uterus = suggest placental abruption)
26
Q

what is the emergency management for antepartum haemorrhage?

A
  1. insert 2x large bore 16 guage cannulas
  2. Monitor O2 sats and apply oxygen as required
  3. Collection of venous blood samples( full blood picture, group and cross-match, coag studies, U & E’s, LFT,
  4. commencement of fluid therapy - IV therapy/ blood products/ volume expanders
  5. Analgesia and corticosteroids given if pregnancy is between 24-34 weeks to help mature the fetus lungs
  6. insert IDC
  7. Prepare for theatre and delivery - severe bleeding requires immediate caesarean birth regardless of the position of the placenta
  8. emotional support for patient and family
27
Q

Define spontaneous miscarriage

A

Preclinical misscarriage - a demise that occurs before 6 weeks gestation(presents as a heavier than normal period)
Miscarriage - a pregnancy loss in the first 20 weeks gestation

28
Q

Nursing assessment of spontaneous miscarriage

A

Clinical Hx
vaginal bleeding - amt and when it began
Pain- pelvic, shoulder tip and rebound tenderness - contraction pains
coping strategies- grief for the loss
nurse in a single room if possible and be kind and extra caring to the patient and family in their grief

29
Q

nursing care for spontaneous miscarriage

A

depending on stage of pregnancy -uterine evacuation in theatre
reassurance to patient and family
pain administration
fluid for fluid loss( most will be NBM for theatre prep)
prepare theatre paperwork
Be kind to the patient and family as it is a sad time

30
Q

what is the assessment structure for a paediatric history

A 
prenatal and birth hx
development hx
social hx and family
immunisation hx
medications
allergies
med and surg hx
infectious status
general appearance
vital signs
weight, height, head circumferance and BSL
31
Q

what are the components of a physical assessment?

A

Airway
breathing
circulation
disability

32
Q

how do you calculate the weight of a child under 9

A

age plus 4 x 2

33
Q

how do you calcualte the weight of a child over 9

A

3x age

34
Q

what is the purpose of a focused assessment

A

an assessment of the body system that relates directly to the complaint

35
Q

what is assessed in a focused assessment for a newborn

A 
Head
eyes, ears nose
mouth throat
neck
chest lungs
cardiovascular IPA (palpate brachial pulse in arm)
abdomen
musculoskeletal
gait
GU
neurological
skin
mongolian birth spot
36
Q

what are the normal feed requirements for under 6 mths of age

A

150mls/kg/24 hrs

37
Q

what are the normal feed requirements for over 6mths of age

A

120mls/kg/24hrs

NUR259 (12 decks)

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