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NCM 214 A > Unit 1: The High Risk Prenatal Client > Flashcards

Unit 1: The High Risk Prenatal Client Flashcards

1
Q

How many days does higher risk extends for the puerperium period?

A

30 days

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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

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3
Q

What are the examples of pre-existing risks

A

Age
Parity
Social/ Environmental Status
Marital Status

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4
Q

What are examples of risks emerging during pregnancy?

A

Anemia
Antepartum hemorrhage
Toxemia
Transverse lie term
Suspected Cephalo-pelvic Disproportion

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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

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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

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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

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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

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9
Q

What are examples of genetic considerations?

A

Multiple pregnancies
Large Fetal size
Transmissible inherited disorder

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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
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11
Q

What are the common medical and obstetric growth disorder?

A
  • Preterm Labor
  • Polyhydramnios
  • Intrauterine Growth Restriction
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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
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13
Q

Who are at risk of Polyhydramnios?

A
  • diabetes mellitus
  • multiple gestation
  • abnormal fetal presentation
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14
Q

Who are at risk of Intrauterine Growth Restriction?

A
  • multiple gestation
  • poor nutrition
  • preeclampsia
  • drug abuse. alcohol
  • fetal infection
  • chronic hypertension
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15
Q

What are the psychosocial factors of Pregnancy?

A

Smoking-risk
Caffeine
Alcohol

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16
Q

What can be the effect of smoking towards pregnant woman?

A

low birth weight
miscarriages
increase PROM
high neonatal mortality

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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

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18
Q

What are the results of taking Alcohol during pregnancy?

A

Fetal alcohol syndrome
learning disabilities
hyperactivity

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19
Q

What are the risks factors for psychologic status?

A
  • intrapsychic disturbances and addictive lifestyle
  • unsafe cultural, ethnic or religious practices
  • situational crises
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20
Q

What are the socio demographic factors for a pregnant woman?

A

low income
lack of prenatal care
age
residence

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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
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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
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23
Q

How does age affect pregnancy?

A
  • more complication for < 15 years of age
  • problems exist for pregnancies occurring 4 years before menarche
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24
Q

What are the common complications for mature mothers?

A
  • Mortality
  • Hypertension
  • Preeclampsia
  • Extended Labor
  • Cesarean Birth
  • Placenta Previa
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25
Q

How does residence affect pregnancy?

A
  • metropolitan women tend to have more check up compared to rural woman
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26
Q

What are the common antepartum testing or biophysical assessment done in pregnant woman?

A
  • Daily Fetal Movement Count
  • Non-stress test (NST)
  • Contraction stress test (CST)
  • Ultrasonography
  • Magnetic Resonance Imaging
  • Amniocentesis
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27
Q

It is a test that counts the number of kick in order to monitor complications affecting oxygenation.

A

Daily Fetal Movement Count (DFMC)

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28
Q

What is the method of doing DFMC?

A
  • 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
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29
Q

How many movements warrant evaluation

A

less than or equal to 3

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30
Q

It is a painless test evaluating the baby’s heart condition by monitoring fetal heartbeat through rest and movement.

A

Non-stress test (NST)

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31
Q

What are the results of Non-Stress Test?

A

Reactive
Non reactive
Unsatisfactory

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32
Q

2 or more accelerations of 15 beats per minute lasting 15 seconds or more in 20 min period.

A

Reactive

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33
Q

High risk pregnancy allowed to continue if twice weekly NST are active.

A

Reactive

34
Q

No FHR acceleration or acceleration less than 15 beats per minute or lasting than 15 seconds through fetal movements

A

Nonreactive

35
Q

What is the significance of a non reactive NST?

A

Need to attempt to clarify FHR pattern, implement CST and routine external monitoring

36
Q

FHR pattern not able to interpret

A

Unsatisfactory

37
Q

What is the significance of unsatisfactory NST?

A

Repeat NST or do CST

38
Q

It measures the oxygen given via the vein, It is needed if baby heart slow down in certain pattern?

A

Contraction Stress test

39
Q

What are the needed preparation for CST?

A
  • NPO for 4 to 8 hours
  • Empty Bladder
  • If the woman smokes, Stop 2 hours
  • Woman ask consent, contraction test
40
Q

What are the results for CST?

A

Negative
Positive
Suspicious
Unsatisfactory

41
Q

3 contractions, 40 - 60 sec long within 10-min period no late decelerations

A

Negative

42
Q

Persistent/consistent late decelerations with > 50% contractions

A

Positive

43
Q

Less deceleration less than 50% contractions

A

Suspicious

44
Q

Inadequate pattern or poor tracing

A

Unsatisfactory

45
Q

What is the significance of a negative CST?

A

Fetus should tolerate labor if occurs within 1 week

46
Q

What is the significance of a positive CST?

A

Fetus at increase risk may have additional testing may try induction CS

47
Q

What is the significance of a suspicious CST?

A

Repeat CST within 24 hours or the fetal assess

48
Q

What is the significance of unsatisfactory CST?

A

Repeat CST within 24 hours or the fetal assess

49
Q

What are the critical information provided by ultrasonography?

A

Fetal activity and gestation age
Normal vs abnormal fetal growth
Fetal and Placental anomaly
Fetal well being

50
Q

What are the indications for use of ultrasonography during the 1st trimester?

A
  • 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
Q

What are the indications for use of ultrasonography during the 2nd and 3rd trimester?

A
  • fetal viability, number. position, gestational age, growth pattern, and abnormalities
  • placental location and maturity
  • uterine fibroids and anomalies
  • adrenal masses
  • cervical lengthening
52
Q

What are the 2 types of ultrasound?

A

Transvaginal ultrasound and abdominal ultrasound

53
Q

Should be performed with an empty bladder for the first trimester for earlier visualization.

A

Transvaginal ultrasound

54
Q

A full bladder is needed to elevate the uterus out of pelvis for better visualization for the first half or pregnancy.

A

Abdominal ultrasound

55
Q

This test provide the perfect picture of soft tissue

A

MRE or Magnetic Resonance Imaging

56
Q

What can be visualize using MRI?

A
  • 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
Q

It is performed to obtain amniotic fluid which contains fetal cells.

A

Amniocentesis

58
Q

Maternal Complications of Amniocentesis

A

Labor
Abruptio Placenta
Amniotic Fluid Embolism
Inadvertent damage to the intestines
Hemorrhage
Infection

59
Q

Fetal Complications of Amniocentesis

A

Death
Hemorrhage
Direct Injury from the needle
Miscarriage or preterm labor
Leakage of amniotic fluid

60
Q

What are the common nursing diagnosis for various test performed during pregnancy?

A
  • Health seeking behaviors
  • Deficient knowledge related to tests performed
  • Fear related to the view of specific tests
61
Q

True anemia is present when hemoglobin concentration is:

A

< 11g/dl (hematocrit 33%) - in the 1st and 3rd trimester
< 10.5 g/dl (hematocrit is 32%) - in the 2nd trimester

62
Q

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%?

A

Pseudoanemia in pregnancy

63
Q

What are the 2 most common types of anemia during pregnancy?

A

Iron Deficiency Anemia
Folic Acid Deficiency Anemia

64
Q

It is the most common anemia of pregnancy complicating as many as 15% to 24 % of all pregnancy.

A

Iron deficiency Anemia

65
Q

What component confirms Iron deficiency anemia?

A

low serum iron level

66
Q

What are the causes of Iron deficiency anemia?

A
  • 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
Q

What are the signs and symptoms of iron deficiency anemia?

A

easy fatigability
pallor
exercise intolerance
dizziness
Pica - eating inedible

68
Q

What are the effects of Anemia to pregnancy?

A
  • Decrease resistance to infection
  • predispose to heavy bleeding during labor and puerperium
  • associate prematurity and low birth weight infants
69
Q

What are the prevention for iron deficiency anemia?

A
  • 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
Q

Seen in 1% to 5% of pregnancies. Formation of large and immature blood cells

A

Folic Acid Deficiency Anemia

71
Q

It is necessary for the formation of RBC in the mother as well as being associated with preventing neural tube defects.

A

Folic Acid

72
Q

Termed for enlarge RBC

A

Megaloblastic Anemia

73
Q

Where does Folic Acid deficiency anemia mostly occur?

A

Multiple pregnancy
With secondary hemolytic deficiency
Taking hydantoin
Poor gastric absorption

74
Q

What is the therapeutic management for Folic Acid deficiency anemia?

A

Supplement of 400 mcg folic acid daily and increase to 600 mcg during pregnancy

75
Q

What are examples of Folic Acid foods

A

Beans and legumes
Citrus
Green and leafy
pork
poultry
shellfish
wheat bran

76
Q

What are nursing diagnosis for folic acid deficiency anemia?

A
  • Risk for ineffective tissue perfusion
  • Impaired oral mucus membrane
  • Fatigue
  • Anxiety
  • Fear
  • Ineffective Coping
  • Difficult Knowledge
77
Q

It is a condition where pancreas cannot produce enough insulin and regulate blood glucose level.

A

Diabetes Mellitus

78
Q

Abnormal glucose metabolism that arise during pregnancy.

A

Gestational Diabetes

79
Q

What are the signs and symptoms of DM?

A

Polyuria (freq urination)
Polydipsia (excessive thirst)
Polyphagia (excessive eating)
Involuntary weight loss
High Blood Glucose

80
Q

What are the assessments included for DM mothers?

A

Obesity
History of large babies
History of unexplained loss
Family history of diabetes

81
Q

What population has a high risk of Diabetes?

A

Native American and Asian

82
Q

What tests are required for Diabetes Mellitus Mothers?

A

Urinalysis
Fasting Blood Sugar (FBS)
OGTT (Oral Glucose Tolerance Test)

NCM 214 A (8 decks)

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