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NSG 432 - OB > T4: High Risk Perinatal Care: Gestational Cond. > Flashcards

T4: High Risk Perinatal Care: Gestational Cond. Flashcards

1
Q

gestational hypertension

A

mom is 20 weeks of gestation OR MORE and her blood pressure is elevated (140/90), NO PROTEIN IN URINE

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2
Q

chronic hypertension

A

elevated BP BEFORE 20 weeks, NO PROTEIN IN URINE

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3
Q

preeclampsia

A

BP is elevated WITH PROTEIN IN URINE

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4
Q

s/s of preeclampsia

A

o Generalized edema, rapid weight gain (>5lbs in one week), vasoconstriction of cerebral vessels
o S/S; HA, blurred vison, abdominal pain, excessive weight gain, protein in urine

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5
Q

what can happen if preeclampsia is left untreated

A

eclampsia or HELLP syndrome

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6
Q

HELLP syndrome

A
  • HEMOLYSIS (Burr cells on peripheral smear)
  • ELEVATED LIVER ENZYMES (AST, ALT)
  • LOW PLATELETS
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7
Q

what do we need to diagnose HELLP

A

LAB RESULTS/TESTS

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8
Q

What is the cure of preeclampsia?

A

delivery

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9
Q

eclampsia

A

when preeclampsia progresses, and they HAVE A SEIZURE( If mom has seizure, baby will not be well oxygenated)

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10
Q

preeclampsia or eclampsia superimposed on chronic hypertension

A

patient had chronic HTN before getting pregnant but now with pregnancy they have getting PROTEIN IN THE URINE or SEIZURES (depending on if its preeclampsia or eclampsia)

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11
Q

physical exam of preeclampsia

A

Edema, reflexes (monitor DTR for the presence of hyper reflexia or clonus because it indicated increased CNS irritability), proteinuria

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12
Q

s/s of eclampsia

A

o Headache
o Hyperreflexia
o Proteinuria
o Edema
o Clonus (indicated cerebral edema and patient can have a seizure)
o Visual changes (blurred vision)
o Epigastric pain (because liver enzymes are elevated and liver is swollen)
o Excessive weight gain (>5lbs in one week)

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13
Q

immediate care for ecclampsia

A

o Maintain patient airway and safety during seizure
- Seizure precautions
o Stabilize mother after seizure
o Magnesium sulfate
o Fetal status

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14
Q

education for eclampsia

A

EDUCATE about HA, blurred vision, and epigastric because mom can still have a seizure up to 6 weeks after delivery

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15
Q

Labetalol IV

A

an antihypertensive is needed to lower the blood pressure (slows HR and reduced BP)

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16
Q

other preeclampsia BP medications

A

Hydralazine IV
Nifedipine PO

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17
Q

Mag sulfate is used for

A

an anticonvulsant to prevent seizures, preterm labor (slows uterine ctx), & neural protection (decrease preterm brain bleeds)

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18
Q

administration of mag sulfate

A

MAG ALWAYS GOES ON A PUMP, administered as a secondary IV fluid

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19
Q

In a mom with a premature baby and preeclampsia what steroid is given

A

betamethasone

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20
Q

How is betamethasone administered?

A

2 injections (12mg IM, then 24 hours first dose it is repeated), now mother is in her steroid window

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21
Q

dosage for mag sulfate

A

o 4-6 gram loading dose
o 2-3 grams per hour maintenance infusion

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22
Q

Goal serum magnesium level

A

4-7 mEq/L

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23
Q

Antidote for magnesium sulfate toxicity

A

CALCIUM GLUCONATE

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24
Q

what do we monitor for when a patient is on mag sulfate

A

Respitatory rate!

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25
Q

intervention if RR is low with mag sulfate

A

TURN THE MAG OFF THEN ADMINSTER CALCIUM GLUCONATE

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26
Q

hyperemesis gravidarum

A

excessive vomiting during pregnancy

27
Q

clincal manifestation of hyperemesis gravidarum

A

o Excessive vomiting
o Weight loss
o Dehydration
fluid and electrolyte imbalabces

28
Q

intervention for hyperemesis gravidarum

A

zofran

29
Q

first trimester

A

1-13 weeks

30
Q

third trimester

A

27-40 weeks

31
Q

first trimester hemorrhagic disorders

A

Miscarriage or ectopic pregnancy

32
Q

third trimester hemorrhagic disorders

A

Placenta previa and abruptio placentae

33
Q

miscarriage (spontaneous abortion)

A

: pregnancy ended before 20 weeks, < 500 gm, not viable

34
Q

When do most miscarriages occur?

A

before 8 weeks gestation

35
Q

threatened abortion

A

mom will present with slight spotting (bleeding), mild uterine contractions (cramping), and NO CERVICAL DILATION

36
Q

Inevitable abortion

A

they do not know why, but there is moderate to heavy bleeding and the CERVIX IS DILATED/OPEN so mom WILL abort (lose the baby)

37
Q

incomplete abortion

A

bleeding is moderate to heavy; the cervix is DILATED and the baby could be delivered but the placenta is retained

38
Q

complete abortion

A

BOTH placenta and fetus are completely expelled, may have slight bleeding and the cervix after the placenta and fetus are expelled, the cervix will start to close

39
Q

missed abortion

A

bleeding, then stops, and mom can go on to have a normal pregnancy, CERVIX is closed

40
Q

bicornuate uterus

A

women that have one uterus but has a septum in between (can be pregnant on one side but not the other)

41
Q

recurrent abortion

A

when mom gets to a certain week at each pregnancy, she aborts the baby

42
Q

Cervix insufficiency

A
  • Painless cervical dilation
  • Cervical shortening
43
Q

cerclage

A

suture around the cervix and close it, the suture stays in until 36 weeks

44
Q

when is the recommended time for a cerclage placement

A

16 weeks or before

45
Q

ectopic pregnancy

A

fertilized ovum (egg) implants outside the uterine cavity (can get stuck in fallopian tube)

46
Q

Management of ectopic pregnancy

A

Stable (not ruptured): Methotrexate (baby will be aborted)
Unstable (ruptured): Surgery

47
Q

hydatidiform mole

A

ONLY the placenta is developed without a fetus
- No embryo, fetus, or amniotic sac

48
Q

management for hydatidiform mole

A

o Methotrexate will be used to expel placenta
o Avoid pregnancy for 1 year

49
Q

s/s of hydatidiform mole

A

Vaginal blessing (prune juice color)
Increase in hCG
Rapid uterine growth
Failure to detect fetal heart activity
A distinct snowstorm pattern on ultrasound with no evidence of developing fetus

50
Q

diagnosis for hydatidiform mole

A

o Elevated hCG levels, no heartbeat and no growth, snow storm pattern on US

51
Q

placenta previa

A

occurs when placenta is before the baby (Usually, placenta is at the top of the fundus, but here it is in the lower uterine segment)

52
Q

marginal placenta previa

A

implanted in lower uterus but its lower border is >3cm from internal cervical os

53
Q

complete placenta previa

A

placenta completely covers internal cervical os

54
Q

partial (low lying) placenta previa

A

lower border of placenta is within 3dm of internal cervical os but does not fully cover it

55
Q

clinical manifestations for placenta prevus

A

BRIGHT RED BLOOD AND PAINLESS in the third trimester

56
Q

when a patient comes in with suspected placenta previa, what is done

A

o NEVER DO A VAGINAL EXAM, DO AN ULTRASOUND (level 2)
- Want to know exactly where placenta is placed

57
Q

Maternal and fetal outcomes for placenta previa

A

MUST DO A C-SECTION
-bed rest for as long as possible

58
Q

abruptio placentae

A

premature separation of placenta from lining of the uterus after 20 weeks’ gestation OBSTECTRICAL EMERGENCY MUST DO A C-SECTION

59
Q

goal of abruptio placentae

A

deliver baby as soon as possible

60
Q

Types of abruptio placenta

A

o Grade I Mild separation: 10-20%
o Grade II Moderate separation: 20-50%
o Grade III Severe separation: > 50%

61
Q

clinical manifestations of abruptio placenta

A

o DARK RED BLEEDING AND PAINFUL
o Bleeding can be seen vaginally or concealed (abdomen feels board-like)

62
Q

maternal/fetal outcome for abruptio placenta

A

o No O2 or blood supply to baby, must do a C SECTION

63
Q

Cholelithiasis and Cholecystitis

A

o Causes generalized itching, induction may be suggested so that a surgeon can take over to take out the gallbladder

NSG 432 - OB (14 decks)

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