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

Question 1

what causes anaemia in pregnancy

Answer 1

maternal blood volume expansion

Question 2

what are the risks a diabetic pregnant women faces

Answer 2

pregnancy can alter insulin requirements

Question 3

what are the increased maternal risks for a diabetic pregnant women

Answer 3

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

Question 4

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

Answer 4

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

Question 5

what education would a nurse give to a pregnant diabetic women

Answer 5

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

Question 6

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

Answer 6

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

Question 7

what is the definition of gestational diabetes

Answer 7

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

Question 8

what is the management of gestational diabetes

Answer 8

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

Question 9

What is the definition of ectopic pregnancy

Answer 9

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

Question 10

what is the nursing assessment of ectopic pregnancy

Answer 10

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

Question 11

What are the nursing diagnosis for ectopic pregnancy?

Answer 11

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.

Question 12

what is the medical management

Answer 12

bloods, transvaginal U/S,

IM Methotrexate

Question 13

what is the surgical management

Answer 13

bloods,
transvaginal U/S
laparotomy, laparoscomy

Question 14

define gestational diabetes

Answer 14

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

Question 15

define preeclampsia

Answer 15

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

Question 16

Nursing diagnosis for pre eclampsia

Answer 16

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

Question 17

Define Eclampsia

Answer 17

seizure activity that usually occurs within 24 hrs post delivery

Question 18

what is the nursing for eclampsia

Answer 18

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

Question 19

what is hyperemesis gravidarum?

Answer 19

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

Question 20

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

Answer 20

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

Question 21

what is the nursing assessment for Hyperemesis gravidarum?

Answer 21

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

Question 22

what is the nursing management of hyperemesis gravidarum?

Answer 22

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

Question 23

what is antepartum haemorrhage

Answer 23

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

Question 24

what are the signs of antepartum haemorrhage

Answer 24

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)

Question 25

What are the nursing assessments of antepartum haemorrhage

Answer 25

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)

Question 26

what is the emergency management for antepartum haemorrhage?

Answer 26

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

Question 27

Define spontaneous miscarriage

Answer 27

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

Question 28

Nursing assessment of spontaneous miscarriage

Answer 28

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

Question 29

nursing care for spontaneous miscarriage

Answer 29

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

Question 30

what is the assessment structure for a paediatric history

Answer 30

``` 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 ```

Question 31

what are the components of a physical assessment?

Answer 31

Airway breathing circulation disability

Question 32

how do you calculate the weight of a child under 9

Answer 32

age plus 4 x 2

Question 33

how do you calcualte the weight of a child over 9

Answer 33

3x age

Question 34

what is the purpose of a focused assessment

Answer 34

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

Question 35

what is assessed in a focused assessment for a newborn

Answer 35

``` 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 ```

Question 36

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

Answer 36

150mls/kg/24 hrs

Question 37

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

Answer 37

120mls/kg/24hrs