Test 1 Flashcards
(207 cards)
1
Q
What is gravidity?
A
Number of pregnancies
2
Q
What is nulligravida?
A
Never been pregnant
3
Q
What is primigravida?
A
First time pregnant
4
Q
What is multigravida?
A
2 or more pregnancies including current
5
Q
What is parity?
A
Number of pregnancies carried past 20 weeks
6
Q
What is nullipara?
A
Never given birth to a viable child
7
Q
What is primipara?
A
1 child born past 20 weeks
8
Q
What is multipara?
A
Multiple children born past 20 weeks
9
Q
What is the definition of preterm?
A
Born between 20 weeks and 36 weeks and 6 days
10
Q
What is the definition of term?
A
Born after 37 weeks
11
Q
What is the definition of postterm?
A
Born after 40 weeks
12
Q
What is the definition of a stillbirth?
A
Birth of the fetus, but not living (needs to be after 20 weeks to be considered a stillbirth. Before 20 weeks - abortion)
13
Q
When is a fetus considered to be viable?
A
20 weeks
14
Q
What does para mean?
A
Number of times she has carried past 20 weeks gestation. Baby has to have been delivered
15
Q
What is gravida?
A
Number of pregnancies (including current)
16
Q
What does GTPAL stand for?
A
G – Gravida (first preg = gravida 1) T – Term After 37 completed weeks Any term delivery (live or stillbirth) P – Preterm (NOT PARA) Before 37 completed weeks Any preterm delivery (live or stillbirth) A – Abortion Before 20 weeks gestation (miscarriage – spontaneous or induced) L – Living Number of currently living children
17
Q
“Mary Smith presents to her nurse-midwife for her first prenatal care visit. She is currently 8 weeks pregnant. When asked about her past pregnancies, Ms. Smith states, “I have four living children. I delivered a little first at 24 weeks, twin boys at 37 weeks, and a boy at 38 weeks,” Using the G/P system, how would you document Ms. Smith’s obstetrical history? Using the GTPAL system, how would you document Ms. Smith’s obstetrical history?”
A
G4, P3
G4, T1, P2, A0, L4
18
Q
Where the heck is the fundus?
A
Top of the uterus.
19
Q
What does the measurement of the fundus coordinate with?
A
Measurement will corresponding to gest age!
20
Q
At 12 weeks, the fundus will measure ____ cm
A
12
21
Q
At 20 weeks, the fundus will measure ____ cm
A
20 (at umbilicus)
22
Q
What happens to the fundus before delivery? When will this happen?
A
- It will drop
* When it drops varies from person to person
23
Q
What is EDD?
A
estimated date of delivery
24
Q
What is Naegele’s rule?
A
How to figure out EDD
- Obtain the first day of the last menstrual period (LMP)
- Add 7 days
- Subtract 3 months (or add 9 months)
- Adjust for the year
25
What are the 3 groups of signs of pregnancy?
* Presumptive (subjective)
The client experiences these
Makes them suspect that they might be pregnant
Could be from other things besides pregnancy
* Probable (more objective)
Signs that make the examiner suspect the client is pregnant
Can be from other physiological factors
* Positive (Definitive)
Explained only by being pregnant
26
Presumptive signs are _________.
Subjective
27
T/F: Amenorrhea does not necessarily mean you are pregnant?
True
28
What is quickening? When does it happen?
* Mother feels the movement of the fetus – fluttering sensation
* 16 – 20 weeks of gestation
* Usually 16 weeks of gestation in a multigravida client
* Usually 18 weeks of gestation in a primigravida client
29
Tell me some presumptive signs of pregnancy:
* Amenorrhea (NOT NECESSARILY A POSITIVE)
* Fatigue
* Nausea and vomiting
* Urinary frequency (common in first and third trimester)
* Breast changes (tenderness)
* Uterine enlargement
* Quickening
30
What is Hegar’s sign?
Softening of lower uterus
31
What is Chadwick’s sign?
* Bluish color of cervix (from increased blood flow)
| CHAD will talk until he is BLUE in the face
32
What is Goodell’s sign?
Softening of the tip of the cervix
33
What is ballottement?
Rebound of fetus
| Tap the fetus and it taps back. Creepy AF.
34
What gastrointestinal changes happen during pregnancies?
* Progesterone relaxes muscles → reflux when the esophagus relaxes
* Nausea and/or vomiting (d/t hormones and displacement)
* Increased salivation
* Bleeding gums
* Flatulence
* Heartburn
* Gallbladder changes (gallstones can happen d/t slowed gastric emptying)
* Constipation
* Hemorrhoids
* Delayed emptying!
35
What are some probable signs of pregnancy?
* Abdominal enlargement
* Hegar’s sign
→ Softening of lower uterus
* Chadwick’s sign
→ Bluish color of cervix (from increased blood flow)
* Goodell’s sign
→ Softening of the tip of the cervix
* Ballottement
→ Rebound of fetus
* Positive pregnancy test
→ Can be false positive!
* Uterine and abdominal growth
*Braxton Hicks contractions
36
What are some positive signs of pregnancy?
* Auscultation of fetal heart rate (10-12 weeks by doppler)
* Observation and palpation of fetal movement (after 20 weeks)
* Sonographic visualization of the fetus
* Cardiac movement at 4-8 weeks
37
What hormones do preg tests detect?
Human chorionic gonadotropin (hCG) hormone
38
What is hCG hormone?
Hormone produced by the placenta
* Human chorionic gonadotropin (hCG) is a hormone produced by the placenta during pregnancy. It helps thicken a person's uterine lining to support a growing embryo and tells the body to stop menstruation.
39
What can interfere with pregnancy test results?
Medications can interfere with results
40
When is the best time to take a home pregnancy test?
First void in the morning
41
The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? Select all that apply.
1. Elevated hCG (hormone produced by placenta) levels in blood and urine
2. Brownish pigmentation on the face
3. Fetal movement detected by the examiner
4. Bluish-purple coloration of vagina and cervix
5. Occasional mild contractions
1,2,4,5
42
The weeks of pregnancy can be placed into __ trimesters.
3
| consisting of 12-14 weeks / which is 3 months each
43
What integumentary changes happen during pregnancies?
* Striae gravidarum (stretch marks)
* Skin hyperpigmentation
* Linea nigra
* Melasma (chloasma)
* Mask of pregnancy – blotchy, brownish hyperpigmentation of the skin on the forehead, nose, & cheeks. This goes away.
* Dry skin, pruritus (itching)
* Acne or pregnancy glow
* Hair changes (thickening or increased growth)
* Hair loss after birth
* Nails can thin and grow faster
* Darkening of the areola (leads the baby to feed!), vulva, and axillae
* Discomforts: Edema, gingivitis, itching, varicose veins, increased thirst
44
Define the second trimester
Weeks 14 to 26 (Months 3 to 7)
45
Define the third trimester
Weeks 27 to 40 (or delivery) (Months 7 through 9)
46
Re: CV changes during pregnancy, you see an increase in
| ______________ and ________________.
blood volume, cardiac output (heart enlarges slightly)
47
Lab values in CV: Increases or decreases?
| RBC, H/H, WBC
RBC (increases), H/H (decreases), WBC (increases – can be around 16,000)
48
What kinds of anemia are we watching for with pregnancy?
Iron deficiency anemia (Hemoglobin <11; Hematocrit <33%), and physiologic anemia
49
Greater blood volume + increased RBC = ____________
physiologic anemia
| I don't get this. Why would you have anemia if your RBCs are increased as well?
50
What VS changes happen during pregnancies?
* Heart rate increases 10 – 15 beats (starting at 32 weeks gestation)
* Risk of orthostatic hypotension d/t lower systemic vascular resistance (progesterone dilates all the vessels) EDUCATE ABOUT FALL RISKS
* Supine hypotension
* Increased risk of clotting
* High BP
51
What is supine hypotension. What can we do to help with this?
Hypotension that occurs during the second half of pregnancy d/t compression on vena cava. Occludes blood flow. Wedge one hip → it will take pressure off.
52
Why is there an increased risk of clotting in pregnancy?
d/t decreased circulation, increased clotting factors, and decreased factors that inhibit coag. Fibrolynic activity is depressed to decrease the chance of bleeding during pregnancy.
53
What can high BP lead to and what are the early signs of this?
SEIZURES. Signs: Headache, swelling (all over).
54
What respiratory changes happen during pregnancies?
* Nasal and sinus congestion
* Epistaxis (nose bleeds)
- -----> Humidify
* Increased maternal oxygen consumption (20-40%, but doesn’t affect RR.)
* Chest expansion to allow for growing fetus. Upward pressure on diaphragm.
* Feeling of fullness in ears
* Encourage slow deep breaths
* Encourage good posture
* Sleep with extra pillows
55
Why does nasal and sinus congestion happen during pregnancy? And what is something we can do to help this?
d/t increased blood supply and dilated capillaries. Add humidifier.
56
How much is maternal oxygen consumption increased? Why?
20-40% --> But doesn’t affect RR
| Chest expansion to allow for growing fetus. Upward pressure on diaphragm.
57
The growing fetus causes repositioning of the lungs and work of breathing more uncomfortable (dyspnea), what can we do to help?
Encourage slow deep breaths
Encourage good posture
Sleep with extra pillows
58
Why is there an increased feeling of fullness in their ears?
Increased vascularity causes tympanic membranes in eustachian tubes to swell.
59
What gastrointestinal changes happen during pregnancies?
* Progesterone relaxes muscles → reflux when the esophagus relaxes
* Nausea and/or vomiting (d/t hormones and displacement)
* Increased salivation
* Bleeding gums
* Flatulence
* Heartburn
* Gallbladder changes (gallstones can happen d/t slowed gastric emptying)
* Constipation
* Hemorrhoids
* Delayed emptying!
60
What is ptyalism?
Increased salivation
61
Why do folks get heartburn during pregnancy?
d/t stomach displacement bc of an enlarged uterus, decreased GI motility
62
Nursing intervention for hemorrhoids?
Sitz baths, witch hazel
63
Hormones can lead to increased ____________.
Cholesterol
64
What are striae gravidarum?
Stretch marks. Separation of the underlying connective tissue on breasts, thighs, & abdomen.
65
What is the linea nigra
Line of pigmentation from the symphysis pubis to the top of the fundus
66
What is melasma (chloasma)?
A skin condition that causes patches and spots, usually on the face, which are darker than your natural skin tone. Melasma can be due to hormonal changes during pregnancy or from sun exposure. Women are much more likely than men to develop this condition.
The brown or gray-brown patches of melasma appear most often on the cheeks, forehead, nose, and chin.
In women, melasma often fades on its own after pregnancy or after an affected woman goes off birth control pills. Skin lightening creams can help lasting melasma.
67
Education to help patient with integumentary changes?
Movement, stretching, using lotion, compression hose, etc
68
What integumentary changes happen during pregnancies?
* Striae gravidarum (stretch marks)
* Skin hyperpigmentation
* Linea nigra
* Melasma (chloasma)
* Mask of pregnancy – blotchy, brownish hyperpigmentation of the skin on the forehead, nose, & cheeks. This goes away.
* Dry skin, pruritus (itching)
* Acne or pregnancy glow
* Hair changes (thickening or increased growth)
* Hair loss after birth
* Nails can thin and grow faster
* Darkening of the areola (leads the baby to feed!), vulva, and axillae
* Discomforts: Edema, gingivitis, itching, varicose veins, increased thirst
69
Low back pain, joint discomfort, difficulty walking
D/t growing fetus, more pressure, more weight on joints
70
What is diastasis recti?
Abdominal muscles separate d/t expanding uterus
| More common with multi-fetal preg
71
Nursing interventions for leg cramps in pregnancy?
* Dorsiflex foot
| * Heat/massage
72
What musculoskeletal changes happen during pregnancies?
* Low back pain, joint discomfort, difficulty walking
* Lordosis/swayback (forward curvature of the spine)
* Anterior neck flexion (anyone understand this?)
* Increased mobility of pelvic joints (pelvic joints relax)
* Leg cramps (Compressing nerves that run down legs)
* Ligament spasm, diastasis recti
73
When is urinary frequency and urgency the worst (which trimesters)? And what is this linked to?
1st and 3rd trimester
| Linked to increase in preg hormones, metabolic demand
74
What do we need to teach the pregnant patient about fluid gushing from their vagina?
THIS MAY BE PRETERM LABOR
75
What urinary/renal changes happen during pregnancies?
* Urinary frequency and urgency
* (GFR) Filtration rate increases
* UTI risk (teach about symptoms that differ from just normal urinary frequencies --> do yr kegels!)
76
What hormone(s) increase during pregnancy?
```
hCG
Progesterone
Estrogen
Human placental lactogen
Prostaglandins
Prolactin
Oxytocin
Thyroid
BMR
Cortisol
Increased need for glucose/production of insulin
```
77
What hormone maintains pregnancy?
Progesterone
78
What hormone(s) decrease in pregnancy?
FSH
79
What endocrine changes happen during pregnancies?
* Placenta becomes an endocrine organ
80
Hormones maintain _____________ and prepare for ___________.
Pregnancy, delivery
81
Urine becomes _______ acidic, vag floor becomes _____ alkaline
less, more
| watch for yeast infections!
82
What endocrine issue should we always be sure to ask a pregnant person about?
DIABETES!
83
Intervention for carpal tunnel during pregnancy?
Elevate hands at night
84
What should you do when you feel s/s of syncope in pregnancy?
Lay on left-side (left lateral position)
| Giant uterus compresses vena cava when on back
85
When in pregnancy is insomnia more common?
More common in 2nd and 3rd trimester
86
What can a headache be a warning sign for in pregnancy?
Preeclampsia! Educate to call provider.
87
What neurological changes happen during pregnancies?
* Headache (r/t increased blood volume).
* Carpal tunnel (r/t elevated hormones, swelling, compressed nerves)
* Syncope
Giant uterus compressed vena cava when on back
* Fatigue (worst 1st and 3rd trimester)
* Insomnia
88
A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply.
```
A. Waddling gait
B. Low back pain
C. Increased risk of falls
D. Fractures
E. Severe muscle aches
```
She didn't put the answer in the PP
89
ADD CARDS ABOUT THE DANGER SIGNS OF PREG
Need to look up. Coming soon.
90
What are the goals of prenatal care?
* Safe outcome to pregnancy
| * Fostering positive feelings by client and family around childbearing experience
91
Ideally, when do you want to begin prenatal assessments?
Within 12 weeks
92
What happens in the first prenatal appointment?
Social supports, review of systems – determine risk factors, physical assessment, weight, vitals, pelvic exam, labs
93
What happens in the second prenatal appointment?
Monitor weight, b/p, urine, fetal development, fundal height, fetal movement (16-20 weeks), management of discomforts
94
What labs do you run when someone is pregnant? There are 8 million, this is just an FYI.
* Blood type
* Rh factor, Indirect Coombs’ test
* CBC, Hgb, Hct
* Hgb electrophoresis
* Rubella, Hep B, GBS, VDRL, HIV, G/C
* Urinalysis, One-hour glucose tolerance test, Three-hour glucose tolerance test
* Pap test
* PPD
* MSAFP
* Toxoplasmosis, infections, TORCH screening
95
Health promotion education for pregnant folks (8)?
* Avoid OTC medications, alcohol, substance use, hot tubs, saunas
* Exercise
* Consume 8-10 glasses of water/day
* Need for flu vaccine
* Smoking cessation
* Treatment of infections
* Genetic testing
* Hazardous material exposure
96
What are the weight gain recommendations during pregnancy?
* 2.2 to 4.4 lbs during 1st trimester
* 1 lb a week during 2nd and 3rd trimester
* Recommended weight gain for single pregnancy = 25 – 35 lbs
* Underweight 28-40; Overweight 15-25
97
Nutritional risk factors during pregnancy?
Teen, vegetarian, N/V, PICA, eating disorders, excessive weight gain, financial issues
98
Can you have vaccines when you are pregnant?
Yes
99
Which vaccines can you get when you are pregnant?
* Influenza vaccine - not the live virus
| * Tdap vaccine (tetanus, diphtheria, pertussis)
100
Which vaccines can you NOT get when you are pregnant and should get after delivery?
* Rubella
| * Varicella
101
A client who is 7 weeks gestation is experiencing nausea and vomiting in the morning. Which of the following information should the nurse include?
A. Eat crackers or plain toast before getting out of bed
B. Awaken during the night to eat a snack
C. Skip breakfast and eat lunch after nausea has subsided
D. Eat a large evening meal
A. Eat crackers or plain toast before getting out of bed
102
Where does fertilization take place?
In the distal third of the fallopian tube
103
Implantation occurs in the _________ between _____ days following conception
uterus, 6-10 days
104
What are the 3 phases of the menstrual cycle ovarian cycle?
* Follicular
* Ovulatory
* Luteal
105
What happens during the ovulatory phase?
Estrogen levels peak
106
What happens during the luteal phase?
Corpus luteum produces high levels of progesterone and low levels of estrogen
107
What happens during the follicular phase?
LH, FSH, graafian follicle produces estrogen
108
What are the 3 phases of the endometrial cycle?
* Proliferative
* Secretory
* Menstrual
109
What is the primary hormone in the proliferative phase of the endometrial cycle?
Estrogen
110
What is the primary hormone in the secretory phase of the endometrial cycle?
Progesterone
111
What are the hormones in the menstrual phase of the endometrial cycle and what is happening to them?
Progesterone and estrogen, significantly decreasing
112
What does FSH primarily act to stimulate?
A. Development of the uterine endometrium
B. Release of the mature ovum
C. Maturation of the ovarian follicle
D. Development of the ovary
C. Maturation of the ovarian follicle
113
What procedure should you have to have a child if you have HIV/AIDS?
C-section
114
What procedures should you avoid when you are pregnant with HIV/AIDS?
Avoid procedures where maternal blood mixes with fetal blood
115
What should you educate a new parent with HIV/AIDS about what NOT to do with their newborn?
No breastfeeding
116
Meds for newborn with HIV/AIDS parent?
* Antiretroviral med, Retrovir
* Administer 14 weeks gestation, throughout pregnancy, before labor and c-section
* Administer to the infant at delivery and for 6 weeks after birth
117
What the eff is chlamydia?
* Bacterial infection
| * Most commonly reported STI in American women
118
S/S of chlamydia?
Trick questions! Asymptomatic.
119
What happens if you leave chlamydia untreated?
PID, infertility
120
Meds for chlamydia?
Azithromycin / Amoxicillin
- Take entire prescription
- Treat partners
- Retest pregnant clients (3 weeks)
- Given during pregnancy
- Erythromycin ointment for infants
121
What prevents mixing of fetal and maternal blood?
The placenta!
122
Aside from preventing the mixing of fetal and maternal blood, what else does the placenta do (2)?
* Metabolic & gas exchange
* Hormone production
- --> Progesterone, Estrogen, hCG, hPL
123
How many umbilical arteries are there? And veins?
* Two umbilical arteries
| * One umbilical vein
124
Re: The umbilical veins and arteries: __________ carry deoxygenated blood and _________ carry oxygenated blood.
Arteries, veins.
125
Name 3 teratogens.
* Drugs and chemicals
* Infections / Viruses
* Exposure
126
What is a common feeling pregnant folks experience during the first trimester?
Ambivalent feelings toward pregnancy
127
What behaviors do we often see in the second trimester?
* Concerns with body image
| * Nesting behaviors
128
How do people often feel in the third trimester?
Dislikes being pregnant, but loves the child
129
Name the Family Development Stages (4).
* Prepare (Prepare for role as child-care providers)
* Reorganize (Reorganize home, family member duties, patterns of money management)
* Reorient (Reorient family relationships)
* Adjust (Adjust)
130
What are the Tasks of Pregnancy?
* Seeking (Seeking safe passage)
* Securing (Securing acceptance)
* Learning (Learning to give of self)
* Committing (Committing self to the unknown child)
131
A woman is in the first trimester of her first pregnancy and confides to the nurse that she is not really sure if she is happy because so many things in her life will change. She is not sure she is willing to alter her current lifestyle. What action by the nurse is most appropriate?
A. Ask the woman if she would like to see a counselor.
B. Reassure the woman that ambivalence is normal now.
C. Refer the woman to an expectant-mother support group.
D. Tell the woman she needs to think of her unborn child.
She didn't answer this but ... B or C? Not D.
132
Re: Glucose Tolerance Test (GTT): Who gets screened? When? Can the E/D before the test?
* ERRRRYONE!
* 28 weeks preggo
* Yep
133
During a 1 hour GTT, how much glucose to they ingest? How long do then then wait to get the BG checked?
* 50 g glucose orally
| * Wait 1 hour
134
What is a positing GTT reading?
→ 130 mg/dL or greater = positive (70-110 is ideal)
135
What happens if you get a positive 1-hour GTT?
Will set up another appt and do the 3 hour test
136
Tell me about the 3-hour GTT?
* Patient will fast beforehand, no caffeine or smoking for 12 hours before
* Give 100 g oral glucose, check after 1, 2, and 3 hours
* BG should be lowering the further out we go
137
How do we initially treat gestational diabetes?
Diet and exercise alone
138
If diet and exercise alone do not fix the diabetes issue, what do we do next?
If that does not work, move to insulin
139
What is the only anti-diabetic drug not counter-indicated for preggos?
Glyburide (glibenclamide)
140
When we are educating about diet and exercise, we should tell pregnant folks to limit carbs to ______% of intake of calories.
50%
| Who actually does this?
141
½ of women diagnosed with gestational diabetes will go on to develop ____________.
Type 2 diabetes
142
What is hyperemesis gravidarium?
Excessive nausea and vomiting (not your normal “morning sickness”)
143
What is a big concern with hyperemesis gravidarium?
Concern for F/E imbalances and nutritional imbalances
144
What VS might we see with hyperemesis gravidarium?
* Increased pulse
* Lowered BP
* Poor skin turgor
* Dry MM
145
What nursing care is important with hyperemesis gravidarium?
* Monitor I & O
* Check turgor
* Check MM
* Monitor VS and weight
* Help with fluid status (LRS is commonly used)
* Vitamins and supplements (sometimes via IV)
146
What is some patient education we can provide for someone dealing with hyperemesis gravidarium?
* Start with clear liquids, and then to bland diet to see if tolerated. Then move to a soft diet.
* Frequent small meals
147
What are TORCH infections?
Infections that can cross the placenta and have teratogenic effects on the fetus
148
What does TORCH stand for?
* Toxoplasmosis --> Consuming raw or undercook meat; cat box
* Other infections (hepatitis, syphilis, mumps, varicella)
* Rubella Virus (ask if they have been immunized, but can’t get vx during preg; will have to wait 3 months after being vaccinated to get preg)
* Cytomegalovirus
* Herpes virus (Herpes Simplex Virus (HSV) → common)
149
Name two other teratogenic factors.
* Medications
| * Environmental factors.
150
What is GBS?
Group B Streptococcus
151
Is GBS found in normal vag flora?
Yes! Often with normal vaginal flora in nonpregnant clients / some pregnant clients
152
Re: GBS being in normal vag flora: So what's the damn problem then?
Doesn’t cause a problem for a pregnant person, but can cause complications if transmitted to neonate
153
How do we treat GBS?
* Antibiotics prophylactically – Penicillin G or Ampicillin IV (during labor → not earlier because it will just come back)
* Will give q 4 hours during labor; d/c once baby is born
154
A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates an understanding of the teaching?
A. Obtain an immunization against rubella early in pregnancy.
B. Seek prophylactic treatment if cytomegalovirus is detected during pregnancy.
C. A client should avoid crowded places during pregnancy.
D. A client should avoid consuming undercooked meat while pregnant.
D. A client should avoid consuming undercooked meat while pregnant.
155
When we check the blood type of a pregnant person, what will make use concerned for Rh issues (positive or negative)?
We want to see if they are NEGATIVE. Positive is fine.
156
So we have a Rh-negative mother and Rh-positive baby. What is the concern?
* Rh-positive cells of baby can gain entry into parent with delivery or some type of procedure/trauma. Usually happens with delivery.
* Antibodies form against the antigens
157
What do we give if the pregnant person is Rh-negative? When do we give it?
RhoGAM (Rh immunoglobulin) given at 28 weeks
158
Is the only time we give RhoGAM at 28 weeks?
* RhoGAM (300 mcg of Rh immune globulin) is given again within 72 hours after birth if mother is Rh-negative with an Rh-positive baby (check newborn blood type after birth) → Can give IM or IV.
159
What does RhoGAM do?
RhoGAM stops the mother's immune system from making antibodies against the baby's Rh-positive blood.
160
Do we give RhoGAM with every pregnancy?
YES, given with every pregnancy. Also with any procedure or trauma → any time worried about the baby’s blood mixing.
161
Nursing considerations with RhoGAM(2)?
* Observe at least 20 minutes after administering
| * Can interfere with immune response to live vaccines, so if you need to give vx after delivery, hold off for 3 months.
162
What does Coombs testing detect?
Detecting the Rh-positive antibodies in the blood
163
What are the 2 types of Coombs tests?
* Indirect coombs test
- -> Detects Rh-positive antibodies in the mother's blood
* Direct coombs test
- -> Measure the presence of maternal antibodies in the newborn's blood
164
What kind of meds can cause a false positive with a Coombs test?
Some BP meds
165
What is placenta previa?
Abnormal implantation of the placenta
| - Low lying (partially covers the opening of the uterus ) or previa (completely covers the opening of the uterus)
166
Why does placenta previa occur?
I just happens – no reason, there nothing you can do to help this not happen
167
Where *should* the placenta implant?
Should implant up near the fundus
168
What is pelvic rest? Why is it suggested for people diagnosed with placenta previa?
* No vaginal exams, nothing inserted vaginally
* Can cause tears in the vascularisation and cause bleeding
* Patient education → no sex
* Can escalate to a hemorrhage
169
Is the bleeding noted with previa bright red or dark? Is this painful?
* Painless, bright red bleeding (No discomfort! Bright red! This is v. different from abruption!)
170
What do the letters in PREVIA stand for?
* P – Painless, bright red bleeding
* R – Relaxed soft uterus non-tender
* E – Episodes of bleeding (mild-profuse) (End of 2nd and 3rd Trimester)
* V – Visible bleeding
* I – Intercourse → post bleeding
* A – Abnormal fetal position
171
What is abruptio placentae?
Premature separation of the placenta from the uterus
172
What are some risk factors for abruptio placentae(5)?
* Hypertension → watch for s/s if has HTN
* Substance abuse – cocaine use
* Smoking
* Trauma
* If happens in one pregnancy, may happen in others
173
What is the mneumonic that goes with abruptio placentae? What does it stand for?
D – Dark red bleeding
E – Extended fundal height (due to concealed hemorrhage)
T – Tender uterus
A – Abdominal pain / contractions → body is reacting to the detachment
C – Concealed bleeding
H – Hard, rigid abdomen
174
What is a scary complication abruptio placentae?
DIC - Disseminated intravascular coagulation
175
S/S of DIC?
* Watch for oozing from IV sites, petechiae, especially under the blood pressure cuff, spontaneous bleeding from the gums and nose, signs of bruising, and hematuria
* Once you are seeing VS changes with this, it is far along d/t higher fluid volume.
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What is an ectopic pregnancy?
Fertilized egg implants in tissue outside of the uterus
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What is Cullen’s sign? What can cause this?
Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Can be caused by ruptured ectopic pregnancy.
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What is hydatidiform mole?
A molar pregnancy — also known as hydatidiform mole — is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta.
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What is the patho behind hypertensive disease in pregnancy?
* Vasospasms in epithelial lining
- -> Causes leakage of fluid in epithelium
- -> Can see changes all throughout the body
* Poor tissue perfusion
* Endothelial cell damage
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Risk factors with hypertensive disease in pregnancy?
* AMA → Advanced Maternal Age
- -> We will watch very closely
- -> Also with under 19 years of age
* More than one fetus
* Obesity
* If already have HTN
* Diabetes
* RA or lupus
* Family history
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What are some criteria of gestational HTN?
* BP was normal before 20 weeks of preg
* 140/90 mm Hg or greater (2 different occasions; at least 4 hours apart)
* No proteinuria
* B/P back at baseline by 12 weeks postpartum
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What are some criteria of mild preeclampsia?
Same criteria as gestational hypertension but now with proteinuria greater than/ = 1+
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The client may report these S/S, but they are not required for diagnosis of mild preeclampsia?
* Transient headache
* Irritability
* Edema → Not always, but can happen
- --> Can be swelling throughout the body
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BP is ______ mm/Hg or greater with severe preeclampsia.
160/110 mm Hg or greater
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What are some neuro-related manifestations with severe preeclampsia?
* Cerebral or visual disturbances (headache and blurred vision)
* Usually frontal headaches
* Hyperreflexia with possible ankle clonus (toes to nose → foot will shake). If clonus it there, it’s 4+
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What are some kidney-related clinical manifestations with severe preeclampsia?
* Proteinuria greater than 3+ → more kidney damage
* Elevated serum creatinine greater than 1.1 mg/dL
* Oliguria → will often place foley to mark urine output
* Cerebral or visual disturbances (headache and blurred vision)
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What are some CV-related clinical manifestations with severe preeclampsia?
* Extensive peripheral edema
* Look for dependent edema, especially if laying down
* Can also have facial edema → airway issue!
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What are some hepatic-related clinical manifestations with severe preeclampsia?
* Check ALT and AST
* HELLP syndrome → very elevated levels
* Epigastric and right upper quadrant pain
- ----> These can mean you are heading toward seizure
* Nausea and Vomiting
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With eclampsia, at the onset of seizure activity or coma what are some nursing considerations?
* Have O2 on 10 L
* Note the time
* IV access → Mag
* Look at fetal monitor → how is fetus reacting to this?
- Big drops in HR?
- Will decel to comp, not like how we comp by increasing
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What is the normal fetal HR?
110-160 (ATI)
Info below is just "informational" ◡̈
* Assess baseline over a 10 min period
* Normal range 110-160
* Above 160 for 10 min is tachycardia
* Below 110 for 10 min is bradycardia
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What are some warning signs of possible convulsions?
* Headache
* Severe epigastric pain
* Hyperreflexia
* Hemoconcentrations
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What is HELLP syndrome?
A serious complication of high blood pressure during pregnancy.
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What does the H stand for in HELLP?
H: Hemolysis
- --> Break down of RBC
- --> Anemia
- --> Jaundice
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What does the EL stand for in HELLP?
Elevated Liver enzymes
- --> Elevated ALT or AST → more than double
- --> Epigastric pain
- --> Nausea and vomiting
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What does the LP stand for in HELLP?
Low Platelets
- --> Thrombocytopenia
- --> Abnormal bleeding and clotting time
- --> Bleeding gums
- --> Petechiae
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What is the worst case scenario in HELLP?
DIC
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What are we balancing re: medications for HTN in pregnancy?
Stroke vs placental profusion
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Hypertensives used in pregnancy?
* Labetalol
* Nifedipine
* Methyladopa
* Hydrolazine
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Anticonvulsant used in pregnancy?
Magnesium Sulfate
200
Normal Mg levels?
1.5 - 2 mEq/L
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Therapeutic MG levels?
4-7 mEq/L
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Toxix Mg levels?
8+ mEq/L
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What are some signs of Mg toxicity?
* Absence of patellar DTR
* Urine output of <30 ml/hr
* Respirations <12 minutes
* Decreased LOC
* Cardiac dysthymias
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What should you do if you suspect Mg toxicity?
* TURN OFF IV
* Contact provider
* Prepare to admin antidote
* Prepare to prevent respiratory or cardiac arrest
* Get ready for labs
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Mg antidote?
Calcium gluconate
| Give 10% over 1-2 minutes
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What should we monitor when administering Mg Sulfate (10)?
* BP
* Respirations
* Pulse
* I&O (use foley for u output accuracy)
* DTRs
* LOC
* Presence of neuro effects (HA, visual disturbances)
* Epigastric pain
* Uterine contractions
* Fetal HR and activity
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What are some risk factors for gestational hypertensive disorders (10)?
* Age: Under 19 or over 40
* First pregnancy
* Multi-fetal pregnancy
* Chronic renal disease
* Chronic hypertension
* Family history of preeclampsia
* Extreme obesity
* DM
* RA
* SLE
