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Module 6 > The High Risk Pregnancy And/or Delivery > Flashcards

The High Risk Pregnancy And/or Delivery Flashcards

1
Q

Medical management during ectopic pregnancy if patient is stable

A

Methotrexate

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2
Q

What is important to remember when administering methotrexate for ectopic treatment ?

A

Appropiate PPE (double glove)
Verify pt name , med and dosage w another nurse
Do not expel air from the syringe

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3
Q

How long is urine considered toxic for methotrexate ?

A

72 hours- so avoid getting urine on toilet sear and flush toilet twice w lid closed after voiding

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4
Q

Adverse effects of methotrexate

A

N&V
& transient abdominal pain

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5
Q

What should a pt refrain from when taking methotrexate ?

A

Drinking alcohol , taking vitamins w folic acid, using NSADIS, and avoid sunlight

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6
Q

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?

A

Corticosteroids

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7
Q

With someone who has gestational trophoblastic disease - what can be given IF hcg levels rise which indicate possible malignancy?

A

Methotrexate

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8
Q

What can be given for home management of a mom and fetus who is stable w placenta previa?

A

Corticosteroids for their lungs

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9
Q

C section prep for total or partial previa for heavy bleeding or deterioration of mother/fetus

A

Additional help (people)
Large bore 18g and consider second IV line
Blood on stand by or immediately available
NICU Team for baby

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10
Q

Conservative management if mild and fetus is <34 wks no sign of distress

A

Bed rest
Possible admin of tocolytic to reduce uterine activity
Corticosteroids to accelerate fetal lung maturity
Rogam for RH neg women

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11
Q

DIC causes

A

Placental abruption or prolonged retention of dead fetus
Condition characterized by endothelial damage
Severe preeclampsia and HELLP syndrome
Maternal sepsis
Amniotic fluid

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12
Q

Primary sources of iron

A

Meat, fish, chicken, liver, green leafy vegetables

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13
Q

Who should come into contact it’s varicella zoster virus t the hospital and what precautions are they on

A

Only immune stuff should come into contact with these patients

Airborne/contact

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14
Q

13- 20 wk gestation effect from varicella zoster virus

A

Limb hypoplasia
Cutaneous scars
Chorirentinits
Cataracts
Microcephalic
IUGR

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15
Q

5-2 days before birth effect from varicella zoster virus

A

Life threatening varicella infection congenital varicella syndrome

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16
Q

Group b strep positive test treatments

A

Cephazolin or penicillin 2 before birth

Clindamycin every 8 hours so at least 1 before birth

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17
Q

What is important to treat when a mom gets diagnosed with chorioamnionitis

A

Keep the fever down , babies heart rate will be high during fever so it will decrease once moms fever goes down

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18
Q

What is the issue with giving corticosteroids while mom has chorioamnioitis

A

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.

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19
Q

Why is antibiotic therapy good before or after birth when infection chorioamnioitis is identified?

A

Helps to prevent mom from getting endometritis

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20
Q

What are moms with GBS or STD at risk for

A

PROM
Risk for prolapse cord

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21
Q

What can be given to a mom with PROM who is less than 36 weeks

A

Corticosteroids, short term tocolytics, antibiotics to prevent infection ( 7 day course)

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22
Q

When a pt test negative for fetal fibronetin test

A

Pt has 1% chance of delivering in the next two weeks

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23
Q

What do we administer to moms who are coming in with signs of preterm labor

A

IV fluids and encourage hydration but we do have to watch out for fluid over load ( maternal resp distress - pulmonary edema)

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24
Q

What can delay pre term birth

A

Tocolytics

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25
Q

Since tocolytics are given to delay birth .. what does it give time to do ?

A

Maternal corticosteroids
Antibiotics to prevent GBS neonatal
Transfer to a tertiary facility
Mag sulfate

26
Q

What does mag sulfate protect baby from when administering to mom for preterm labor?

A

It gives baby neuro protection

27
Q

What can mag sulfate also be given for

A

PIH

28
Q

Maternal effects off mag sulfate

A

CNS depressant

Flushing, dry mouth , lethargy , headache, muscle weakness , pulmonary edema* , cardiac arrest

29
Q

What can mag sulfate reduce in neonate

A

Cerebral palsy ( neuro protection)

30
Q

Nursing management for magsulfate

A

Monitor FHR , contractions
S/s of mag sulfate toxicity

31
Q

S/s of mag sulfate toxicity

A

Absent DTR
Resp <12*
Severe hypotension
Decrease LOC
Pulmonary edema ( lung sounds)
Chest pain
Urine output <30 ml/hr

32
Q

Mag sulfate toxicity antidote

A

Calcium gluconate

33
Q

Indomethacin sodium
Naproxen sodium - fenoprofen

A

Delays pregnancy for about 48 hours
Only used in pregnancy under 32 weeks

34
Q

How long should indomethacin sodium be given

A

No later than 48 hours

35
Q

Maternal effects of indomethacin sodium

A

Nausea
Heart burn
GI upset
Pulmonary edema *
Blurred vision
Headache
Nausea
PP hemorrhage

36
Q

Why dont we give mom indomethacin sodium after 32 weeks

A

It causes constriction of the ducats arteriosus

37
Q

What is the nursing management for indomethacin sodium

A

Monitor FHR
Uterine contractions
Treat nausea , heart burn
Monitor lung sounds (pulmonary edema)
PP hemorrhage

38
Q

Other side effects of indomethacin sodium

A

Pulmonary hypertension
Reversible decrease in renal function with oligohydramnios
Intraventricular hemorrhage
Hyperbillirubinemia , NEC

39
Q

Missed or incomplete abortion treatment if they are between 18-20 wks

A

Prostaglandin E2 or cytotec

40
Q

Classifications of placenta previa

A

Marginal or low lying
Partial
Total or complete

41
Q

Marginal or low lying placenta previa

A

Marginal or low lying
Placenta implanted in lower uterus but more tha 3 cm from internal cervical os

42
Q

Partial placenta previa

A

Lower placenta border is within 3 cm of the internal cervical os but does it completely cover the os

43
Q

Total or complete placenta previa

A

Placenta completely covers the internal os

44
Q

What is important to note about placenta previa

A

Vaginal bleeding is ALWAYS contraindicated
Do not check mom ( you can cause it to bleed ) so order ultrasound

45
Q

Abruption placenta types

A

Partial
Martina
Complete

46
Q

Partial abruptio placenta

A

You see the blood where the placenta is torn away

47
Q

Marginal abruptio placentae

A

If it i at the bottom you will see the blood come out

48
Q

Complete abruptio placentae

A

Comes out all behind the placenta so you dont see any blood come out

49
Q

Nifedapine
Nicardapine
(Pro cardio , adulat)

A

Effective in delaying delivery 48-71 hours
PO

50
Q

Nifadapine should not be used with

A

Magnesium sulfate and terbutaline

51
Q

Maternal effects of nifapine

A

Flushing
Headache
Dizziness
Nausea
Transient hypotension
Pulmonary edema

Use w caution- renal disease and hypo tension

52
Q

Nursing management with nifedapine

A

Monitor FHR and UCs
Monitor maternal blood pressure and heart rate
Hold dose for blood pressure <90/50 or heart rate >120

53
Q

Terbutaline ritodrine

A

Can delay delivery for 3 days
IV or sub q

54
Q

Maternal effects of terbutaline ritodrine

A

Cardiac or cardio pulmonary arrhythmias
Pulmonary edema*
Myocardial ischemia
Hypotension
Tachy cardia
Elevation in maternal glucose **
Hypokalemia

55
Q

Fetal effects of terbutaline ritodrine

A

Fetal tachycardia
Hyperinsulinemia
Hyperglycemia
Myocardial and septal
Hypertrophy , myocardial and septal hypertrophy
Myocardial ischemia

56
Q

Antenatal corticosteroids

A

Betemathasone or dexamethasone

57
Q

Betamethasone

A

12 mg IM two dose 12-24 hours apart

58
Q

Precaution with corticosteroids should be used with what

A

Pregnancies complicated by diabetes

59
Q

Recommended admin for corticosteroids

A

24- 34 weeks

Risk for preterm birth within 7 days

60
Q

What two postions cause shoulder dystocia

A

Occiput posterior (OP)
Occiuput transverse position

Module 6 (21 decks)

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