Toni - Week 5 - Exam 3 Flashcards
what is Group B Streptococcus?
a bacteria that can become colonized in women - no problem for women, but can be deadly for a newborn
what percentage of woman are colonized with GBS?
25% of pregnant women
for newborns, GBS is the leading cause of ____ and _____.
sepsis and deathj
how and when is Group B Streptococcus screened?
GBS is screened via swab/culture of a woman’s rectum and vagina at 35 to 37 weeks gestation
what is done if a woman tests GBS+??
She is given IV antibiotics during labor
If a woman is GBS+ and planned for a C-S, is antibiotics given to treat the GBS??
depends, are the membranes intact or not? if intact, it’s okay; prophylactic antibiotics given during C-S
what two antibiotics are given for GBS?
- penicillin G: 5 million units initial dose, then 2.5 million units q4hr until delivery
- ampicillin: 2 g initial dose, then 1 g q4hr until delivery
what occurs if a mother is GBS+, in labor, not yet screened, and not yet given antibiotics?
there is rapid GBS screen; we will try go wait labor until baby has had an adequate dose of 4 hrs
what occurs when a baby has not been given an adequate dose for GBS antibiotics?
If baby born within 1/2/3hr - not given adequate tx - tell MD - further watching
what is cervical insufficiency?
premature dilation of cervix WITHOUT contractions - (efface/change of the cervix)
what are the risk factors of cervical insufficiency?
short cervix, cervical trauma, and possibly an abortion that manipulated the cervix (the integrity of cervix is lacking in order to stay closed)
what are the 4 ways that cervical insufficiency be managed?
bedrest, fluids, possible tocolysis (meds to stop contraction), and cerclage
cerclage: what is it?
circle stitch around cervix to reinforce CLOSED cervix **can’t tighten up, needs to be closed
cerclage: when is it placed?
surgically placed 12 - 14 weeks gestation
cerclage: what are activity restrictions?
pelvic rest (no tampons, no sex, minimal vaginal exam) possible bedrest
what is hyperemesis gravidarum?
pernicious (dangerous) vomiting first 20 weeks - beyond morning sickness
what is hyperemesis gravidarum associated with?
significant dehydration and weight loss **hard on mother and developing fetus
what are the 7 interventions for hyperemesis gravidarum?
- IV fluids with glucose, electrolytes, vitamins (NS, D5W, Banana Bag)
- Antiemetics
- Sea-bands (accupressure), ginger, herbal tea
- TPN, small frequent meals (crackers)
- Avoid laying down 2 hrs after eating
- Home: carbonated drinks, high protein drinks
- Monitor fetal growth via serial ultrasounds
what is placenta previa?
placenta implanted near or over cervix
what are the signs and symptoms of placenta previa?
painless bleeding after 20th week without uterine contractions
what are the risk factors of placenta previa?
history of C/S, ↑ maternal age/parity, smoking
what are the three different types of placenta previa?
marginal, complete, low lying
what are the management steps for placenta previa?
- ultrasound, type/Rh/cross, CBC (H+H)
- IV, external fetal monitoring, bedrest, pelvic rest, no straining for BM (stool softener, nutritiono)
- no vaginal exams, assess blood loss (dislodged placenta)
placenta previa: what types are possible for a vaginal birth?
low lying or marginal previa
placenta previa: what types are only for C/S?
marginal or complete previa
women with placenta previa are at an increased risk of what?
increased risk of infection (healing site is closer to the entrance)
increased risk of hemorrhage (don’t have same tough fibers)
what is abruptio placentae?
premature separation of placenta after 20th week
- partial or complete
- bleeding can be revealed or concealed
what are the s/sx of abruptio placentae?
painful, board-like abdomen (constant contraction), vaginal bleeding, uterine irritability, fetal distress, late decelerations
what are the risk factors of abruptio placentae?
abdomen trauma, HTN, somking, cocaine/alcohol use, car accident, domestic violence
how can abruptio placentae be managed?
- CT scan, bedrest, external fetal monitoring, IV, type/Rh/cross, CBC (H+H)
- Assess blood loss (use 18 gauge for blood transfusion) to prevent hemolysis)
T/F there is a risk of depleting clotting factors and disseminated intravascular coagulopathy with abruptio placentae
TRUE; this is clotting and bleeding at the same time
with abruptio placentae, fetal outcome depends on ___________ and _________.
the degree of separation and gestation
when does preeclampsia occur?
occurs after 20 wk.↑ incidence delayed postpartum onset - **reason we check DTR
Preeclampsia is the _____________
2nd leading cause of pregnancy related death
who is at risk for preeclampsia?
primigravida, > age 40, history of preeclampsia, obesity
Etiology for preeclampsia has ______________.
not been determined
what is the pathophysiology of preelampsia? *the disordered physiological processes associated with disease or injury.
- endothelial injury
- vasoconstriction
- CNS changes
- decreased renal perfusion
- hepatic malfunction
what are the adverse effects of preeclampsia in relation to the baby?
- intrauterine growth retardation (↓ perfusion)
- prematurity
- death
what are the adverse effects of preeclampsia in relation to the mother?
- abruption
- kidney damage
- liver infarction/rupture
- stroke
- intracranial bleed
- retinal detachment
- pulmonary edema
- death
what is eclampsia??
onset of seizures in preelamptic women
how is preeclampsia defined as far as diagnostics?
defined as the presence of
- hypertension: BP >/= 140/90 on 2 occasions at least 6 hrs apart
- proteinuria: > 300mg/L total protein in 24 hr urine
what are some other s/sx of preeclampsia?
edema (face/hands), weight gain, oliguria, ↑ renal labs, severe HA, tinnitus, visual disturbances, hyperreflexia, epigastric pain
what is HELLP syndrome?
a severe form of preeclampsia
What does HELLP stand for?
- Hemolysis: ↓ H+H ↑ bilirubin
- Elevated Liver enzymes: ↑ AST + ALT
- Low Platelet count: < 100,000 mm3 (brusing, bleeding)
what is the complications of HELLP?
disseminated intravascular coagulopathy, and same complications of preeclampsia
what is the mortality rates of HELLP?
24% maternal
30% fetal
what are interventions for preeclampsia? nursing care
- bedrest lateral position (placenta perfusion), calm environment, padded side rails
- high protein diet
- foley - strict I + O
what are interventions for preeclampsia? labs/assessment
- monitor proteinuria, CBC, liver/kidney function, clotting
- Assessment: BP, daily weight, headache, edema, DTRs, clonus, visual disturbances, epigastric pain
what is management for preeclampsia?
- betamethasone (promotes fetal lung maturity)
- antihypertensive drugs
- magnesium sulfate IV (doesn’t control HTN)
- delivery
how and why is magnesium sulfate given?
Administered IV to prevent seizures (not to ↓ BP)
what are common side effects of magnesium sulfate?
warmth, flushing, muscle weakness; “heavy” feeling
what is the therapeutic level of magnesium sulfate?
monitor serum magnesium levels; therapeutic: 4 - 8 mg/dL
we should monitor for magnesium toxicity. what s/sx should we be looking for?
- oliguria
- depressed/absent DTRs
- respirations < 12
what is the anecdote for magnesium sulfate?
calcium gluconate
what are the adverse effects of magnesium sulfate?
↑ risk of postpartum hemorrhage (relaxes smooth muscle)
newborn CNS depression
what does maternal insulin resistance during pregnancy produce?
- ↑ blood glucose for fetal growth
- ↑ insulin demand on maternal pancreas
- maternal hyperglycemia if insulin inadequate
at birth, what occurs in relation to insulin?
abrupt change in hormones immediately increases maternal insulin sensitivity
- insulin dependent diabetic women will experience dramatic drop in need for exogenous insulin (24-48hr)
what is the rupture of amniotic membranes?
premature rupture of membranes (PROM)
what is it called when the rupture of membranes occurs before 37 weeks?
premature premature rupture of membranes (PPROM)
Risk of ________ increases with the length of rupture
infection
how is PROM diagnosed?
diagnosed via
- visualizing pool of fluid via sterile speculum exam (+ pooling)
- fernlike pattern of dried fluid under microscope (+ ferning)
- nitrazine paper turns blue - assuming not bleeding
- PAMG test (amni-sure) via swab
what are we monitoring during PROM
- fetal well being
- maternal VS (temp q 2hr)
- WBC, CRP
what are interventions taken for PROM?
administer antibiotics as ordered
pelvic rest, no vaginal exams
when would we like to see a woman go into labor after PROM?
within 12hr; at 18hr, we will start antibiotics
what is gestational diabetes mellitus (GDM)?
glucose intolerance onset during pregnancy
does GDM subside?
yes, usually subsides after delivery
when will the woman be evaluated for intolerance postpartum?
evaluated 6 weeks postpartum for continued glucose intolerance
how many women will develop DM type 2 if they had GDM?
1/3 will develop DM type 2 in their lifetime
what do we assess for GDM?
- 1 hour GTT 24-28 weeks
- If > 140; will have 3hr GTT (GDM diagnosed if one or more these values elevated)
- Hemoglobin A1C test: measures long term glucose control past 120 days
< 7% indicates good control
what can we do to manage diabetes during pregnancy?
very tight blood sugar control (fasting < 92mg/dL)
teach nutrition and weight management
encourage regular mild exercise
instruct in blood glucose and urine ketone testing
what meds can be given to manage diabetes in pregnancy?
insulin (dosages ↑ as pregnancy progresses)
oral antidiabetic agents may be prescribed
diabetic management: how are we monitoring the fetus?
maternal serum alpha fetoprotein, kick counts, non-stress test, biophysical profile, ultrasound, and amniocentesis
diabetic management: when is a mom a candidate for induction?
38 weeks
What is recommended for HIV+ women?
oral anti-HIV meds reccomended during pregnancy and labor
what will further reduce neonatal transmission rate and what are the rates?
IV zidovudine (AZT)
< 7 % transmission vaginal
< 1% transmission C/S
how can we protect the fetus from maternal secretions during labor?>
- leave amniotic membranes intact
- avoid inserting FSE, or IUPC (breaks skin)
- avoid forceps/vacuum extraction (trauma)
what does ATOD mean?
use of alcohol, tobacco, and other drugs; including non-medical use of prescription meds
why are we considered about ATOD?
because all pass readily through placenta to the fetus
what is the highest ATOD use in SLO county?
- alcohol
- tobacco
- opiates
what is our role as nurses in regards to ATOD?
- offer empathy/establish trust
- assess substance use (self report, urine toxicology screen)
- teach negative effects, importance of nutrition, and s/sx of preterm labor and placental abruption
- support efforts to change
- refer to counseling/support
what are the 4 Ps to asking about substance use?
- did your PARENTS have a problem with drugs + alcohol?
- does your PARTNER have a problem with D + A?
- have you ever in your PAST drank alcohol/smoke tobacco?
- in the month before you learned you were pregnant, did you drink alcohol or smoke?
