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OB > Test 4 Medical Surgical Disorders > Flashcards

Test 4 Medical Surgical Disorders Flashcards

1
Q

What are hemodynamic changes of pregnancy?

A
  • CO increases 30-50% by mid-pregnancy

- Placental fluids back into vascular system after birth

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2
Q

CV changes during pregancy constitute a major complication for the client with ____ ____ ____.

A

preexisting heart disease

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3
Q

What is cardiac decompensation?

A

inability to maintain adequate cardiac output

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4
Q

What are the NYHA classifications r/t Functional Ability? (Mom with CV problems are rated this way)

A

Class I
Class II
Class III
Class IV

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5
Q

Which class? Asymptomatic, no limitations of activity

A

Class I

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6
Q

Which class? Symptomatic with slight limitation of activity

A

Class II

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7
Q

Which class? Symptomatic, marked limitation, normal activity leads to cardiac symptoms

A

Class III

risk for MI, may need c-sec

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8
Q

Which class? Cardiac insufficiency or angina occurs even at rest.

A 
Class IV
(poor fetal perfusion, c-sec b/c mom can't handle the stress of vaginal delivery)
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9
Q

The greatest risk for CV issues is ___-___. Why?

A

28-32

That’s when the mom’s volume peaks

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10
Q

Can the NYHA classification change for mom during pregnancy?

A

Yes, it is not absolute

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11
Q

What are the 3 major cardiac concerns during pregnancy?

A

1) cardiac decompensation
2) CHF
3) circulatory changes lead to decreased uterine perfusion

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12
Q

Decreased uterine perfusion can lead to…

A
  • spontaneous abortion
  • preterm labor and birth
  • IUGR
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13
Q

Symptoms of CHF:

A

1) Edema (progresses from pedal edema to generalized, pitting, and pulmonary edema)
2) Fatigue increasing
3) Dyspnea with ADL
4) Crackles at bases of lungs

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14
Q

What do you monitor in a pt with CV issues?

A

Vitals
Symptoms of decompensation
Symptoms of infections

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15
Q

Why do we worry about infection in a CV pt?

A

Infection increases the workload of the heart

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16
Q

What diagnostic tests are often used on a CV pt?

A

EKG
Echo
Cardiac cath
Fetal status (serial testing - baby gets checked multiple times a day)

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17
Q

When is a prophylactic antibiotic given to mom? Why?

A
  • invasive procedures
  • at birth
    (to prevent bacterial endocarditis)
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18
Q

What drug can be given to mom to increase contractility of the heart and slow heart for effective filling?

A

Lanoxin

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19
Q

What meds are commonly given to moms with CV probs?

A
  • prophylactic antibiotic
  • lanoxin
  • antiarrhythmic
  • diuretic (controversial)
  • heparin
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20
Q

FDA categories for drugs

A

A: no risk
B: harm not confirmed
C: only if benefits justifies the potential risk to fetus
D: fetal risk, but benefits may out weigh the risk
X: never give to pregnant woman

21
Q

4 reasons for anemia during pregnancy?

A
  • iron deficiency
  • folate deficiency
  • sickle cell trait
  • sickle cell disease
22
Q

An autosomal recessive genetic disorder that results in mild obstructive lung disease.

A

cystic fibrosis

23
Q

What can severe cystic fibrosis result in?

A

maternal & perinatal mortality

24
Q

What is a risk for the fetus with CF?

A

uteroplacental insufficiency –> IUGR

25
Q

What antiepileptic meds should be avoided during pregnancy? Why?

A

tegretol
depakote
(neural tube defects)

26
Q

If antiepileptic meds must be given, what should be remembered?

A
  • take lowest dose possible

- folic acid 4mg/day

27
Q

Substances frequently abused in United States are:

A

1) Tobacco
2) Alcohol
3) Marijuana
4) Cocaine
5) Crack cocaine
6) Heroin

28
Q

What are effects of substance abuse on pregnancy?

A
  • spontaneous abortion
  • IUGR
  • preterm labor/fetal demise
  • placental abruption
  • neonatal addiction
  • fetal alcohol syndrome
29
Q

Monitor addicted client for:

A
  • anemia
  • inadequate nutrition and weight gain
  • HTN
  • Preterm labor
  • Random urine toxicology screening may be ordered
30
Q

Methods of fetal monitoring:

A

fundal height
Ultrasound
NST
biophysical profile (BPP)

31
Q

What should we teach a mother with substance abuse problems?

A
  • nutrition
  • support pt’s efforts to change behavior
  • don’t stop cold turkey
  • heroin addicts may be put on methadone hcl (Dolophine)
32
Q

What is methadone hcl (Dolophine)?

A

narcotic agonist that lacks the severe symptoms of heroin withdrawal

33
Q

HIV is transmitted through contact with ____ ____ and ____ ____.

A

infected blood

body secretions

34
Q

How can HIV progress to AIDS?

A

decreased immunity and overwhelming opportunistic infection

35
Q

Does pregnancy change the course of AIDS for the mother?

A

no

36
Q

Why is the mom with HIV managed as high risk?

A

b/c she is vulnerable to infections

37
Q

How can an infant contract HIV from the mother?

A
  • contact with infectious material at birth

- breast feeding

38
Q

Can the mom with HIV/AIDS breastfeed?

A

no

39
Q

What med is given to treat AIDS during pregnancy?

A

Zidovudine (ZDV)

40
Q

When is ZDV begun?

A

after 14 wks gestation

41
Q

How is ZDV given during labor?

A

IV

42
Q

When is ZDV given to the infant?

A

at 6 weeks after delivery

43
Q

Interventions for pregnancy with AIDS: PRENATAL

A
  • prevent opportunistic infections

- avoid procedures that increase the risk of preinatal transmission (ie, amniocentesis)

44
Q

Interventions for pregnancy with AIDS: INTRAPARTUM

A
  • avoid use of scalp electrodes
  • avoid episiotomy to decrease the amount of maternal blood around the birth canal
  • pitocin not administered b/c strong UC may cause vaginal tears or require episiotomy
  • Zidovudine IV as ordered to mom during labor
  • Minimized neonates exposure to blood
45
Q

Interventions for pregnancy with AIDS: POSTPARTUM

A
  • mom in protective isolation if immunosuppressed
  • NO breastfeeding
  • monitor for infection
46
Q

What can reduce the risk of HIV transmission to neonate?

A
  • antiviral meds
  • reduction of neonatal exposure to maternal blood & body fluids
  • early identification of HIV
47
Q

What should be done BEFORE any invasive procedures of a baby with an HIV mom?

A

Bathe before any invasive procedures

Vitamin K, heel sticks, venipuncture

48
Q

Cholelithiasis & Cholecystitis: Pregnant client is 2x more likely to form gallstones because increased ____ levels. Why?

A

progesterone

because bile thickens, decreased muscle tone leads to prolonged gastric emptying time

49
Q

What treatment is given to a pregnant woman with gallstones?

A

antibiotics

meperidine or atropine to decrease spasms

OB (12 decks)

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