The High Risk Pregnancy And/or Delivery Flashcards
Medical management during ectopic pregnancy if patient is stable
Methotrexate
What is important to remember when administering methotrexate for ectopic treatment ?
Appropiate PPE (double glove)
Verify pt name , med and dosage w another nurse
Do not expel air from the syringe
How long is urine considered toxic for methotrexate ?
72 hours- so avoid getting urine on toilet sear and flush toilet twice w lid closed after voiding
Adverse effects of methotrexate
N&V
& transient abdominal pain
What should a pt refrain from when taking methotrexate ?
Drinking alcohol , taking vitamins w folic acid, using NSADIS, and avoid sunlight
For a mom with placenta previa that is stable with no fetal compromise. What can be given in order to speed up maturation of fetal lungs?
Corticosteroids
With someone who has gestational trophoblastic disease - what can be given IF hcg levels rise which indicate possible malignancy?
Methotrexate
What can be given for home management of a mom and fetus who is stable w placenta previa?
Corticosteroids for their lungs
C section prep for total or partial previa for heavy bleeding or deterioration of mother/fetus
Additional help (people)
Large bore 18g and consider second IV line
Blood on stand by or immediately available
NICU Team for baby
Conservative management if mild and fetus is <34 wks no sign of distress
Bed rest
Possible admin of tocolytic to reduce uterine activity
Corticosteroids to accelerate fetal lung maturity
Rogam for RH neg women
DIC causes
Placental abruption or prolonged retention of dead fetus
Condition characterized by endothelial damage
Severe preeclampsia and HELLP syndrome
Maternal sepsis
Amniotic fluid
Primary sources of iron
Meat, fish, chicken, liver, green leafy vegetables
Who should come into contact it’s varicella zoster virus t the hospital and what precautions are they on
Only immune stuff should come into contact with these patients
Airborne/contact
13- 20 wk gestation effect from varicella zoster virus
Limb hypoplasia
Cutaneous scars
Chorirentinits
Cataracts
Microcephalic
IUGR
5-2 days before birth effect from varicella zoster virus
Life threatening varicella infection congenital varicella syndrome
Group b strep positive test treatments
Cephazolin or penicillin 2 before birth
Clindamycin every 8 hours so at least 1 before birth
What is important to treat when a mom gets diagnosed with chorioamnionitis
Keep the fever down , babies heart rate will be high during fever so it will decrease once moms fever goes down
What is the issue with giving corticosteroids while mom has chorioamnioitis
Mom already has a count greater than 15,000 without it so if we give it then the WBC will be higher and its harder to track if infection is getting worse or not.
Why is antibiotic therapy good before or after birth when infection chorioamnioitis is identified?
Helps to prevent mom from getting endometritis
What are moms with GBS or STD at risk for
PROM
Risk for prolapse cord
What can be given to a mom with PROM who is less than 36 weeks
Corticosteroids, short term tocolytics, antibiotics to prevent infection ( 7 day course)
When a pt test negative for fetal fibronetin test
Pt has 1% chance of delivering in the next two weeks
What do we administer to moms who are coming in with signs of preterm labor
IV fluids and encourage hydration but we do have to watch out for fluid over load ( maternal resp distress - pulmonary edema)
What can delay pre term birth
Tocolytics
Since tocolytics are given to delay birth .. what does it give time to do ?
Maternal corticosteroids
Antibiotics to prevent GBS neonatal
Transfer to a tertiary facility
Mag sulfate
What does mag sulfate protect baby from when administering to mom for preterm labor?
It gives baby neuro protection
What can mag sulfate also be given for
PIH
Maternal effects off mag sulfate
CNS depressant
Flushing, dry mouth , lethargy , headache, muscle weakness , pulmonary edema* , cardiac arrest
What can mag sulfate reduce in neonate
Cerebral palsy ( neuro protection)
Nursing management for magsulfate
Monitor FHR , contractions
S/s of mag sulfate toxicity
S/s of mag sulfate toxicity
Absent DTR
Resp <12*
Severe hypotension
Decrease LOC
Pulmonary edema ( lung sounds)
Chest pain
Urine output <30 ml/hr
Mag sulfate toxicity antidote
Calcium gluconate
Indomethacin sodium
Naproxen sodium - fenoprofen
Delays pregnancy for about 48 hours
Only used in pregnancy under 32 weeks
How long should indomethacin sodium be given
No later than 48 hours
Maternal effects of indomethacin sodium
Nausea
Heart burn
GI upset
Pulmonary edema *
Blurred vision
Headache
Nausea
PP hemorrhage
Why dont we give mom indomethacin sodium after 32 weeks
It causes constriction of the ducats arteriosus
What is the nursing management for indomethacin sodium
Monitor FHR
Uterine contractions
Treat nausea , heart burn
Monitor lung sounds (pulmonary edema)
PP hemorrhage
Other side effects of indomethacin sodium
Pulmonary hypertension
Reversible decrease in renal function with oligohydramnios
Intraventricular hemorrhage
Hyperbillirubinemia , NEC
Missed or incomplete abortion treatment if they are between 18-20 wks
Prostaglandin E2 or cytotec
Classifications of placenta previa
Marginal or low lying
Partial
Total or complete
Marginal or low lying placenta previa
Marginal or low lying
Placenta implanted in lower uterus but more tha 3 cm from internal cervical os
Partial placenta previa
Lower placenta border is within 3 cm of the internal cervical os but does it completely cover the os
Total or complete placenta previa
Placenta completely covers the internal os
What is important to note about placenta previa
Vaginal bleeding is ALWAYS contraindicated
Do not check mom ( you can cause it to bleed ) so order ultrasound
Abruption placenta types
Partial
Martina
Complete
Partial abruptio placenta
You see the blood where the placenta is torn away
Marginal abruptio placentae
If it i at the bottom you will see the blood come out
Complete abruptio placentae
Comes out all behind the placenta so you dont see any blood come out
Nifedapine
Nicardapine
(Pro cardio , adulat)
Effective in delaying delivery 48-71 hours
PO
Nifadapine should not be used with
Magnesium sulfate and terbutaline
Maternal effects of nifapine
Flushing
Headache
Dizziness
Nausea
Transient hypotension
Pulmonary edema
Use w caution- renal disease and hypo tension
Nursing management with nifedapine
Monitor FHR and UCs
Monitor maternal blood pressure and heart rate
Hold dose for blood pressure <90/50 or heart rate >120
Terbutaline ritodrine
Can delay delivery for 3 days
IV or sub q
Maternal effects of terbutaline ritodrine
Cardiac or cardio pulmonary arrhythmias
Pulmonary edema*
Myocardial ischemia
Hypotension
Tachy cardia
Elevation in maternal glucose **
Hypokalemia
Fetal effects of terbutaline ritodrine
Fetal tachycardia
Hyperinsulinemia
Hyperglycemia
Myocardial and septal
Hypertrophy , myocardial and septal hypertrophy
Myocardial ischemia
Antenatal corticosteroids
Betemathasone or dexamethasone
Betamethasone
12 mg IM two dose 12-24 hours apart
Precaution with corticosteroids should be used with what
Pregnancies complicated by diabetes
Recommended admin for corticosteroids
24- 34 weeks
Risk for preterm birth within 7 days
What two postions cause shoulder dystocia
Occiput posterior (OP)
Occiuput transverse position
