week 3 & 4 Flashcards
a nurse is caring for a client who is at 32 weeks gestation and has placenta a previa. the nurse notes that the client is actively bleeding. which of the following medications should the nurse expect the provider to prescribe?
- Betamethasone
- Indomethacin
- Nifeidipine
- Methylergonovine
- Betamethasone
a nurse is caring for a cliet who is suspected of having hyperemesis gravidarum and is reviewing the client’s lab reports. which of the following findings is a manifestation?
1. hgb 12.2
2. urine ketones present
3. alanine aminotransferase 20
4. blood glucose 114
- urine ketones present
antidotes for magnesium sulfate
calcium gluconate
calcium chloride
pyridoxine
vitamin B6 supplement prescribed to clients with hyperemesis gravidarum
spontaneous abortion
pregnancy ends as a result of natural causes BEFORE 20 WEEKS of gestation
4 types = threatened, inevitable, incomplete, and missed
threatened spontaneous abortion symptoms
mild cramps
slight spotting
no tissue passed
closed cervix
inevitable spontaneous abortion symptoms
mild/moderate cramps
moderate bleeding
no tissue passed
DILATED CERVIX
Incomplete spontaneous abortion symptoms
SEVERE cramps
HEAVY bleeding
YES - tissue passed
DILATED w tissue present
complete spontaneous abortion symptoms
mild cramps
minimal bleeding
tissue passed
CLOSED CERVIX
dilation & currettage (D&C)
vs
dilation & evacuation (D&E)
D&C = dilate & scrape uterine walls
D&E = dilate & excavate AFTER 16 WEEKS
prostaglandins & oxytocin
induce uterine contractions & expulse products
interventions with bleeding during pregnancy
count pads
NO VAGINAL EXAMS
bed rest
education about spontaneous abortions
small amount of discharge is normal for 1-2 weeks
no bath tubs, or sex for 2 weeks
ectopic pregancies usually occur in
fallopian tubes
s/s of ectopic pregnancy
referred shoulder pain
unilateral quadrant pain in lower abdomen
dark red/brown spotting after normal menses
hemorrhage /shock
methotrexate
chemo drug that inhibits cell division and embryo enlargement
**ectopic pregnancies
avoid folic acid vitamins
lab test w ectopic pregnancies
indicate lower than normal HcG levels
salpingostomy
vs
laproscopic salpingectomy
salp = salvages fallopian tube
lap = removal of fallopian tube
*ectopic pregnancies
gestational trophoblastic disease
- Hydatidiform Mole*
fluid filled grapelike clusters formed from the placenta associated w cancer (choriocarcinoma)
2 types = complete mole & partial mole
patient MUST follow up
complete hydatidiform mole
all genetic material is derived from father
ovum w/o genetics, fetus, placenta, fluid
higher risk for cancer
partial hydatidiform mole
genetic material from both parents
ovum fertilized w abnormal embro/fetal parts
s/s of hydatidiform mole
hyperemesis gravidarum
PRUNE JUICE blood
uterus LARGER than gestational age
preeclampsia
anemia
labs of a hydatidiform mole will indicate
abnormally high HcG
placenta previa
implantation of placenta in lower uterus or cervix instead of fundus
*bleeding risk
**diagnosed by ultrasound
s/s of placenta previa
PAINLESS vaginal bleeding (2/3 tri)
fundal height > gestational age
fetus not in position
uterus is soft and nontender
decreased urine output
nursing interventions for placenta previa
no vaginal exams
bed rest
WEIGH PERI PADS
treated with betamethasone (helps w fetal lung maturity)
abruptio placentae
separations of placenta before fetus is born AFTER 20 WEEKS
**emergency – prepare for delivery
**increased bleeding, DIC, mortality
s/s of abruptio placentae
INTENSE uterine pain
DARK red vaginal bleeding
fetal distress
contractions w hypertonicity
risk factors for abruptio placentae
maternal HTN
cocaine & smoking
trauma to abdomen
multi-fetal pregnancies
cervical insufficiency & s/s
**premature dilation of cervix BEFORE 36-37 wks
pelvic urge to push
pink vaginal discharge
rupture of membranes
contractions
interventions for cervical insufficiency
increase hydration
avoid intercourse
prophylactic cerclage =surgical closure of cervix @ 12-14wks removed at 37/38wks
hyperemesis gravidarum
excessive nausea / vomiting PAST 16 WEEKS
urinalysis for hyperemesis gravidarum will show
ketones/ acetones (ahh-kalosis)
increased urine specific gravity (dehydration)
meds for hyperemesis gravidarum
metoclopromide (anti-emetic)
IV LR
corticosteroid
pyridoxine (vit b6)
a Hgb less than 11mg is an indication of
anemia in 1st & 3rd pregnancy trimester
a hgb les than 10.5mg is an indication of
anemia in 2nd trimester
s/s of hypoglycemia
blurred vision
weakness
irritability
headache
hunger
s/s of hyperglycemia
poly’s
nausea
fruity breath
abdominal pain
glucose tolerance tests occur when
24 to 28 weeks
starts w 1 hour test
**abnormal if greater than 140
follows w 3 hr test
gestational hypertension
occurs AFTER 20 WEEKS gestation w bp of 140/90 on 2 occasions 4 hours apart
NO PROTEINS PRESENT
*normalized after 12 wks post-partum IF NOT = normal chronic HTN
preeclampsia
HTN of 140/90 WITH proteinuria greater than or equal to 1– AFTER 20 WKS GESTATION
s/s of preeclampsia
blurred vision
transient headaches
possible edema
severe preeclampsia
bp greater than 160/110 w/ proteinuria greater than or equal to 3+
s/s of severe preeclampsia
RUQ pain
hyperreflexia
epigastric pain
visual disturbances
blood creatinine > 1.1
preeclampsia is treated w
beta methasone
magnesim sulfate (anti-convulsant)
eclampsia
preeclampsia with ONSET OF SEIZURE / COMA
- emergency
HELLP Syndrome
HTN w severe preeclampsia & hepatic dysfunction
H = hemolysis = anemia & jaundice
EL = elevated liver enzymes
LP = low platelets < 100k
magnesium sulfate toxicity
absence of patellar deep tendon reflex
decreased urine, resp, & LOC
cardiac dysrhythmias
magnesium sulfate in pregnancy is used to
prevent seizures
slow contractions
IV site w magnesium bolus is normal to experience
flushing
heat & burning
sedation
diaphoresis
HTN meds for pregnancy
methyldopa
hydralazine
nifedipine
labetalol
*NO ACE or ARB’s
Internal fetal monitoring methods & downsides
fetal scalp electrodes - fetal heart
intrauterine pressure catheter -acurate
*BOTH = require ruptured membranes and dilated cervix
periodic vs episodic
periodic = assoc w uterine contractions
episodic = not associ w uterine contractions
nitrazine paper is used for
asessing amniotic fluid
blue = amnio fluid is alkaline
yellow = acidic urine
cervical changes that define labor
effacement & dilation
5 P’s in childbirth
P = passenger (fetus & placenta)
P = passageway
P = power (contractions)
p = position (mom)
P = psychological response
toco measures
uterine activity and contraction patterns
passenger P consists of
- Fetal Presentation – what part is entering pelvis (head, breech, shoulder)
- Fetal Lie - relationship of spine to mom = transverse (sideways) or parallel*
- Fetal Attitude - relationship of fetus parts – flexion* or extension
- fetal position
Fetal Position is descirbed by
- naming the side the baby is facing–right (R) or left (L)
- presenting part of fetus =
- occiput /head (O)
- sacrum (S)
- mentum (M)
- scapula (Sc)
FIRST stage of labor
onset of labor to full dilation w/
- latent phase = 0 to 3cm
- active phase = 4 to 7cm
- transitional phase = 8 to 10 cm – expressing need for bowel movement
second stage of labor
fully dilated cervix to birth of baby
**assess for lacerations – 4 degrees each indicative of # of areas injured
third stage of labor
from the birth of fetus to the birth of the placenta
fourth stage of labor
delivery of placenta to the first 2 hours after birth
