Unit 32 High Risk Prenatal/Postpartum Depression/Genetics Flashcards
What is Maternity “baby blues”? What are the symptoms? The treatment?
- Can be normal reaction to hormonal changes after delivery
- Occurs within 3-5 days
- Lasts 3 days to 3 weeks and usually goes away on it’s own
Symptoms include: crying, irritability, fatigue, anxiety
If persisting more than ~10 days needs to be evaluated because could progress to PP
Treatment: support, reassurance, and follow up
What is Postpartum Depression? What must they have in order to be dx? what do the symptoms range from? When does the depressive episode begin?
- Major Depressive Disorder
- Must have 5 or more symptoms for at least 2 weeks and including depressed mood or loss of interest
- Symptoms range from insomnia to suicidal ideations
- Depressive episode can begin within 4 weeks of postpartum and can last up to 1 year
What are symptoms of PP Depression?
Depressed mood Loss of interest or pleasure in daily activities Sleep changes Fatigue or loss of energy Loss of appetite Inability to concentrate or think Suicidal Ideations
Somatic symptoms like: headache, constipation, diarrhea, and severe anxiety
What are examples of genetic prenatal testing and prenatal testing?
- Chorionic Villi Sampling (CVS)
- Biophysical Profile Kickcount (looks at overall health of baby)
- Amniocentesis (do not let PT see needle)
- Non stress test/Stress test (Don’t push Pitocin)
What is important to stress to a client with heart disease being seen for her first prenatal visit?
It is important to take prenatal vitamins and iron as prescribed
What is the best non weight bearing exercise?
Swimming
Why is Heparin chosen over warfarin in pregnancy?
warfarin (Coumadin) in teratogenic
What is hyperemesis gravidarum? What does it cause? what is the fetus at risk for?
Extreme nausea and vomiting during the first 20 weeks.
- Creates maternal dehydration, weight loss, electrolyte imbalances
- Cause unknown
- Fetus at risk for macrosomia, abnormal development, IUGR, or death from lack of nutrition, hypoxia, and maternal ketoacidosis
What can dehydration lead to in pregnancy?
Premature labor
What is a natural nausea relief?
Chewing on ginger
What is the care for hyperemesis gravidarum?
- IV therapy of D5LR to restore fluid and electrolyte balance
- Common to see TPN and antiemetics
- Encourage 6 or more SMALL meals a day; clear liquids such as lemonade and teas and salty foods are sometimes tolerated better first.
- Fetal growth monitored by serial ultrasounds
What are substance abuse issues in pregnancy and how are substances screened for?
Issues from substance abuse include:
- Spontaneous abortion
- IUGR
- Preterm labor
- Placental abruption
- Stillbirth
- Fetal alcohol syndrome
Substances are screened by urine toxicology
What is the difference between a diabetic and a women who has gestational diabetes?
One has diabetes and becomes pregnant vs one that does not have diabetes, becomes pregnant and develops gestational diabetes, which after delivery of child does not.
An insulin dependent diabetic client gives birth, the nurse expects the client’s insulin requirements in the first 24 hrs to what? Why?
Drop significantly
Think: The energy needed to recuperate after delivery uses the body’s glucose.
-The placenta causes insulin resistance and is no longer there after delivery
What laboratory test bests provides information on insulin control for a gestational diabetic?
A1C/Glycosylated hemoglobin
Describe pregnancy’s effect on insulin during the first half and second half of pregnancy.
First half of pregnancy, increasing maternal hormones increase the demand for insulin
Second half of pregnancy there is insulin resistance due to human placental lactogen
What are complications that are more common with insulin dependent diabetes mellitus?
- polyhydramnios
- pregnancy induced hypertension
- stillbirths
- neonatal macrosomia, hypoglycemia, hyperbilrubinea, congenital anomalies, delayed fetal lung maturity
Following birth, the infant of a woman with preexisting diabetes mellitus is at greatest risk for the development of what?
Hypoglycemia
What is the management for GDM? what is a better choice for hypoglycemia and why? What is the urine testing for in relation to the management?
- Teach how to manage hypoglycemia, in pregnancy skim milk is better choice than OJ as the protein lasts longer with a more steady blood sugar rise
- Urine testing for glycosuria and keytones
- Monitor for infections such as UTI’s and vaginal yeast infections
- Insulin generally given in multiple injections, 4 dose approach lispro before each meal and NPH added at bedtime
Why are some oral hypoglycemic meds not given during pregnancy or are avoided altogether?
Because they are teratogenic
What are ways to evaluate the fetal well being during pregnancy? and at how many weeks?
- Maternal serum alpha fetoprotein screening done at 16-20 weeks to assess for neural tube defects
- NST done at around 28 weeks
- Ultrasound done at 18 weeks to establish gestational age repeated at 28 weeks to monitor for macrosomia and anomalies
- Biophysical profile done in third trimester to monitor fetal well wing
Who is PIH/Pre-eclampsia/Eclampsia more common in? What are they at risk for?
More common in:
- Young primigravida
- Women over 35
- Multiples
- Diabetes Mellitus
At risk for:
- CVA
- DIC ( Dissemated Intravascular Coagulation)
- Renal failure
- Hepatic failure
What does severe epigastric pain signal in pregnancy?
Hepatic rupture during hypertensive episodes (pre-ecamplsia/ecampsia) from high liver levels.
What is Gestational Hypertension/PIH?
- Occurs during pregnancy and is resolved by delivery of the fetus.
- Very slight rise in BP
- IS NOT associated with proteinuria or edema
What is the Preeclamspa triad?
Hypertension > 140/90 or increase from prepregnancy BP > 30 systolic or 15 diastolic
Edema
Proteinuria
What is mild preeclampsia which is essentially the Preeclampsia triad?
Hypertension >140/90 or increase of 30/15 from baseline
Proteinuria +1
Mild to moderate pretibial edema with weight gain of 2 - 2.5 lbs per week
