Unit 1: The High Risk Prenatal Client Flashcards
1
Q
How many days does higher risk extends for the puerperium period?
A
30 days
2
Q
What are the 4 divisions of Maternal Risks
A
Pre-existing risks
Risk Emerging During Pregnancy
Risk of Labor and Delivery
Risk of Postpartum
3
Q
What are the examples of pre-existing risks
A
Age
Parity
Social/ Environmental Status
Marital Status
4
Q
What are examples of risks emerging during pregnancy?
A
Anemia
Antepartum hemorrhage
Toxemia
Transverse lie term
Suspected Cephalo-pelvic Disproportion
5
Q
What are examples of risks of Labor and Delivery?
A
PROM
Transverse lie
Prolonged obstructed labor
Intrapartum bleeding from placenta previa and post-partum hemorrhage
6
Q
What are examples of risk of post-partum?
A
Puerperal infection
Hemorrhage
Subinvolution
Post-operative complication in the case of cesarean section
Post-partal depression
7
Q
What are the different Categories of High Risk?
A
Genetic Consideration
Nutritional Status
Medical and Obstetric Disorder
Psychosocial Factors
Psychological Status
Socio Demographic Factors
Low income
Lack of Prenatal Care
Age
Residence
8
Q
Determine the category of high risk. Interfere with normal fetal or neonatal development, results in congenital anomalies or create difficulties for the mother.
A
Genetic Consideration
9
Q
What are examples of genetic considerations?
A
Multiple pregnancies
Large Fetal size
Transmissible inherited disorder
10
Q
What are the conditions that influence nutritional status?
A
- Young age
- three pregnancies in the previous 2 years
inadequate dietary intake because of chronic illness or food fads - inadequate or excessive weight gain
- hematocrit value less than 33%
- tabaco, alcohol or drug use
11
Q
What are the common medical and obstetric growth disorder?
A
- Preterm Labor
- Polyhydramnios
- Intrauterine Growth Restriction
12
Q
Who are at risk of preterm labor?
A
- age younger than 16 or older 5
- low socioeconomic status
- maternal weight below 50 kg
- poor nutrition
- previous preterm birth
- smoking
- drug addiction and alcohol
- pneumonia
- multiple gestation
- anemia
- abnormal fetal presentation
13
Q
Who are at risk of Polyhydramnios?
A
- diabetes mellitus
- multiple gestation
- abnormal fetal presentation
14
Q
Who are at risk of Intrauterine Growth Restriction?
A
- multiple gestation
- poor nutrition
- preeclampsia
- drug abuse. alcohol
- fetal infection
- chronic hypertension
15
Q
What are the psychosocial factors of Pregnancy?
A
Smoking-risk
Caffeine
Alcohol
16
Q
What can be the effect of smoking towards pregnant woman?
A
low birth weight
miscarriages
increase PROM
high neonatal mortality
17
Q
What are the effects of Caffeine towards pregnant woman?
A
High intake ( 3 or more cups of coffee each day) has been related to slight decrease in birth weight
18
Q
What are the results of taking Alcohol during pregnancy?
A
Fetal alcohol syndrome
learning disabilities
hyperactivity
19
Q
What are the risks factors for psychologic status?
A
- intrapsychic disturbances and addictive lifestyle
- unsafe cultural, ethnic or religious practices
- situational crises
20
Q
What are the socio demographic factors for a pregnant woman?
A
low income
lack of prenatal care
age
residence
21
Q
Why does low income affect pregnancy?
A
- inadequate financial resources for food and prenatal care
- poor general health
- increased risk of medical complications of pregnancy
22
Q
How does lack of prenatal care affect pregnancy?
A
- failure to diagnose and treat complications early
- lack of understanding of the need for early and continued care or cultural beliefs that do not support the need
23
Q
How does age affect pregnancy?
A
- more complication for < 15 years of age
- problems exist for pregnancies occurring 4 years before menarche
24
Q
What are the common complications for mature mothers?
A
- Mortality
- Hypertension
- Preeclampsia
- Extended Labor
- Cesarean Birth
- Placenta Previa
25
How does residence affect pregnancy?
- metropolitan women tend to have more check up compared to rural woman
26
What are the common antepartum testing or biophysical assessment done in pregnant woman?
- Daily Fetal Movement Count
- Non-stress test (NST)
- Contraction stress test (CST)
- Ultrasonography
- Magnetic Resonance Imaging
- Amniocentesis
27
It is a test that counts the number of kick in order to monitor complications affecting oxygenation.
Daily Fetal Movement Count (DFMC)
28
What is the method of doing DFMC?
- lie in the left recumbent after meal
- record until 10 movements count
- record time (usually an hour)
- if no movements or less, walk, count again
- if not felt report
29
How many movements warrant evaluation
less than or equal to 3
30
It is a painless test evaluating the baby's heart condition by monitoring fetal heartbeat through rest and movement.
Non-stress test (NST)
31
What are the results of Non-Stress Test?
Reactive
Non reactive
Unsatisfactory
32
2 or more accelerations of 15 beats per minute lasting 15 seconds or more in 20 min period.
Reactive
33
High risk pregnancy allowed to continue if twice weekly NST are active.
Reactive
34
No FHR acceleration or acceleration less than 15 beats per minute or lasting than 15 seconds through fetal movements
Nonreactive
35
What is the significance of a non reactive NST?
Need to attempt to clarify FHR pattern, implement CST and routine external monitoring
36
FHR pattern not able to interpret
Unsatisfactory
37
What is the significance of unsatisfactory NST?
Repeat NST or do CST
38
It measures the oxygen given via the vein, It is needed if baby heart slow down in certain pattern?
Contraction Stress test
39
What are the needed preparation for CST?
- NPO for 4 to 8 hours
- Empty Bladder
- If the woman smokes, Stop 2 hours
- Woman ask consent, contraction test
40
What are the results for CST?
Negative
Positive
Suspicious
Unsatisfactory
41
3 contractions, 40 - 60 sec long within 10-min period no late decelerations
Negative
42
Persistent/consistent late decelerations with > 50% contractions
Positive
43
Less deceleration less than 50% contractions
Suspicious
44
Inadequate pattern or poor tracing
Unsatisfactory
45
What is the significance of a negative CST?
Fetus should tolerate labor if occurs within 1 week
46
What is the significance of a positive CST?
Fetus at increase risk may have additional testing may try induction CS
47
What is the significance of a suspicious CST?
Repeat CST within 24 hours or the fetal assess
48
What is the significance of unsatisfactory CST?
Repeat CST within 24 hours or the fetal assess
49
What are the critical information provided by ultrasonography?
Fetal activity and gestation age
Normal vs abnormal fetal growth
Fetal and Placental anomaly
Fetal well being
50
What are the indications for use of ultrasonography during the 1st trimester?
- number, size, location of gestational sac
- presence or absence off fetal cardiac and body movement
- presence or absence of uterine abnormalities
- Date of pregnancy
51
What are the indications for use of ultrasonography during the 2nd and 3rd trimester?
- fetal viability, number. position, gestational age, growth pattern, and abnormalities
- placental location and maturity
- uterine fibroids and anomalies
- adrenal masses
- cervical lengthening
52
What are the 2 types of ultrasound?
Transvaginal ultrasound and abdominal ultrasound
53
Should be performed with an empty bladder for the first trimester for earlier visualization.
Transvaginal ultrasound
54
A full bladder is needed to elevate the uterus out of pelvis for better visualization for the first half or pregnancy.
Abdominal ultrasound
55
This test provide the perfect picture of soft tissue
MRE or Magnetic Resonance Imaging
56
What can be visualize using MRI?
- fetal structure and overall growth
- placenta
- quantity of amniotic fluid
- maternal structures
- biochemical status of tissue and organ
- soft tissue, metabolic or functional anomalies
57
It is performed to obtain amniotic fluid which contains fetal cells.
Amniocentesis
58
Maternal Complications of Amniocentesis
Labor
Abruptio Placenta
Amniotic Fluid Embolism
Inadvertent damage to the intestines
Hemorrhage
Infection
59
Fetal Complications of Amniocentesis
Death
Hemorrhage
Direct Injury from the needle
Miscarriage or preterm labor
Leakage of amniotic fluid
60
What are the common nursing diagnosis for various test performed during pregnancy?
- Health seeking behaviors
- Deficient knowledge related to tests performed
- Fear related to the view of specific tests
61
True anemia is present when hemoglobin concentration is:
< 11g/dl (hematocrit 33%) - in the 1st and 3rd trimester
< 10.5 g/dl (hematocrit is 32%) - in the 2nd trimester
62
It is characterized as a drop in hematocrit during pregnancy and plasma volume increases by 50% when the red blood cell continue to increase by 30%?
Pseudoanemia in pregnancy
63
What are the 2 most common types of anemia during pregnancy?
Iron Deficiency Anemia
Folic Acid Deficiency Anemia
64
It is the most common anemia of pregnancy complicating as many as 15% to 24 % of all pregnancy.
Iron deficiency Anemia
65
What component confirms Iron deficiency anemia?
low serum iron level
66
What are the causes of Iron deficiency anemia?
- diet low in iron
- heavy menstrual period
- weight reducing programs
- getting pregnant in less than 2 years before the current pregnancy
- low socioeconomic levels who have not had iron-rich diets.
67
What are the signs and symptoms of iron deficiency anemia?
easy fatigability
pallor
exercise intolerance
dizziness
Pica - eating inedible
68
What are the effects of Anemia to pregnancy?
- Decrease resistance to infection
- predispose to heavy bleeding during labor and puerperium
- associate prematurity and low birth weight infants
69
What are the prevention for iron deficiency anemia?
- take prenatal vitamins containing iron supplement of 27 mg element iron as prophylactic therapy
- eat diet high in iron, legumes, leafy vegetables and fruit
- woman who develop iron deficiency anemia will be prescribed with therapeutic levels of medication (120 - 200 mg elemental iron/day usually ferrous sulfate or ferrous glyceridase
- intake orange juice for easy absorption
- increase roughage for constipation or gastric irritations
- if difficult to absorb take intramuscularly or intravenously
70
Seen in 1% to 5% of pregnancies. Formation of large and immature blood cells
Folic Acid Deficiency Anemia
71
It is necessary for the formation of RBC in the mother as well as being associated with preventing neural tube defects.
Folic Acid
72
Termed for enlarge RBC
Megaloblastic Anemia
73
Where does Folic Acid deficiency anemia mostly occur?
Multiple pregnancy
With secondary hemolytic deficiency
Taking hydantoin
Poor gastric absorption
74
What is the therapeutic management for Folic Acid deficiency anemia?
Supplement of 400 mcg folic acid daily and increase to 600 mcg during pregnancy
75
What are examples of Folic Acid foods
Beans and legumes
Citrus
Green and leafy
pork
poultry
shellfish
wheat bran
76
What are nursing diagnosis for folic acid deficiency anemia?
- Risk for ineffective tissue perfusion
- Impaired oral mucus membrane
- Fatigue
- Anxiety
- Fear
- Ineffective Coping
- Difficult Knowledge
77
It is a condition where pancreas cannot produce enough insulin and regulate blood glucose level.
Diabetes Mellitus
78
Abnormal glucose metabolism that arise during pregnancy.
Gestational Diabetes
79
What are the signs and symptoms of DM?
Polyuria (freq urination)
Polydipsia (excessive thirst)
Polyphagia (excessive eating)
Involuntary weight loss
High Blood Glucose
80
What are the assessments included for DM mothers?
Obesity
History of large babies
History of unexplained loss
Family history of diabetes
81
What population has a high risk of Diabetes?
Native American and Asian
82
What tests are required for Diabetes Mellitus Mothers?
Urinalysis
Fasting Blood Sugar (FBS)
OGTT (Oral Glucose Tolerance Test)
