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Mother Baby > WEEK 3-ATI > Flashcards

WEEK 3-ATI Flashcards

pph

1
Q

corpus luteum

A

A structure that develops in an ovary where ovulation took place that secretes estrogen and progesterone until the placenta takes over.

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2
Q

how long is the cervix

A

slightly over 2 cm

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3
Q

internal cervical os

A

opening of the cervix at the uterus

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4
Q

external cervical os

A

Also known as endocervical canal, it is the passage that connects the vagina to the uterus.

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5
Q

what state is pregnancy in

A

prothrombotic state:

A blood condition that increases the risk of clots to form in blood vessels.

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6
Q

why does a prothrombotic state occur

A

pregnant clients have an increase in some coagulation factors, reduced fibrinolysis, and increased platelet reactivity.

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7
Q

fibrinolysis

A

A process that prevents clots from forming or breaks down clots that formed.

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8
Q

spontaneous abortion

A

Spontaneous pregnancy loss that occurs prior to 20 weeks gestation.

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9
Q

what are the 6 types of spontaneous abortions

A

threatened
inevitable
incomplete
complete
septic
missed

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10
Q

threatened abortion

A

The products of conception are threatened with expulsion through uterine cramping and bleeding. The embryo continues to be viable, and the cervix remains closed.

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11
Q

inevitable abortion

A

The products of conception have not passed through the client’s dilated cervix; abortion is unavoidable.

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12
Q

incomplete abortion

A

A partial passing of the products of conception from the cervical os.

some contents remain in the uterus

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13
Q

complete abortion

A

all products of conception have been completely expelled

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14
Q

septic abortion

A

Occurs when products of conception are retained and become infected.

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15
Q

missed abortion

A

Passage of some products of conception. The cervix is closed, but there is no fetal cardiac activity.

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16
Q

can spontaneous abortions happen prior to a client knowing they were pregnant?

A

yes

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17
Q

A nurse is caring for a client who has had a spontaneous abortion. Which of the following is a possible cause of spontaneous abortions?

A

chromosomal instability

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18
Q

cause of spontaneous abortions

A

varies and is not always known

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19
Q

what causes about 50% of spontaneous abortions

A

fetal chromosomal anomalies

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20
Q

spontaneous abortion and age relation

A

chance of having one DECREASES as the gestational age INCREASES

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21
Q

modifiable risk factors for a spontaneous abortion

A

hypertension
large amounts of caffeine
alcohol use
malnutrition
physical trauma

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22
Q

level of alcohol shown to cause spontaneous abortions

A

250 mL
although no level is considered safe of course

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23
Q

risk factors

A

for spontaneous abortion that cannot be modified are thrombophilia and antiphospholipid syndrome (APS)

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24
Q

thrombophilia

A

Blood disorder that causes blood clots.

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25
Q

antiphospholipid syndrome (APS)

A

A condition in which the immune system creates antibodies that attack tissues in the body.

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26
Q

rates with spontaneous abortions rise?

A

with maternal age

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27
Q

clinical presentation of spontaneous abortions

A

uterine cramping or light vaginal bleeding
not always
can also mean ectopic preg
vaginal bleeding may or may not be with passage of tissue too

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28
Q

septic spontaneous abortion clinical presentation

A

fever
purulent
foul-smelling vaginal discharge
tachycardia

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29
Q

most common medication for spontaneous abortion

A

misoprostol
800 mcg vaginally once PRN 3 hr up to 7 days after first dose

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30
Q

molar pregnancy

A

Unexpected chromosomes can cause a molar pregnancy, also known as a hydatidiform mole. Molar pregnancy is a premalignant condition and occurs after improper fertilization

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31
Q

most common type of molar pregnancy

A

gestational trophoblastic disease

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32
Q

gestational trophoblastic disease

A

Lesions or tumors, which include placental site nodule, exaggerated placental site, and molar pregnancy, that demonstrate unexpected growth of trophoblast of the placenta; usually non neoplastic, but can become cancerous; highly curable if treated early.

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33
Q

molar pregnancies are benign but can develop into a malignancy called?

A

gestational trophoblastic neoplasia (GTN)

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34
Q

gestational trophoblastic neoplasia (GTN)

A

A malignancy that includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. All GTN have the ability to metastasize and may be fatal without treatment.

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35
Q

how are molar pregnancies classified

A

complete
partial
invasive

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36
Q

complete molar pregnancy

A

the sperm fertilizes an egg, but there is no genetic material in the egg, so no embryo (fetal tissue) is formed.

most commonly has all paternal chromosomes because the sperm fertilizes an empty egg that lacks maternal chromosomes

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37
Q

partial molar pregnancy

A

embryo in which two sperm fertilize one egg
more dad genes than mom (BAD)
excessive amount of placental or trophoblastic growth and extra set of chromosomes

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38
Q

invasive molar pregnancy

A

tumor that grows where the placenta attaches to the uterus
enlarged and attach through the myometrium and possibly into vascular spaces

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39
Q

myometrium

A

middle layer of uterine wall

M for middle

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40
Q

A nurse is caring for a client who has a molar pregnancy that contains no genetic material and no fetal tissue. Which of the following types of molar pregnancies does the client have?

A

complete molar pregnancy

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41
Q

complete mole vs partial mole

A

complete: 46 xx (all dad)

partial: 69xx (all dad)

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42
Q

A nurse is caring for a client who has an invasive mole. Which of the following areas do invasive moles grow into?

A

myometrium
vascular sites
extrauterine spaces

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43
Q

An invasive mole has enlarged

A

hydropic villi that were retained in the uterus after a partial or complete molar pregnanc

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44
Q

hydropic villi

A

Small projections that connect the placenta to the uterus.

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45
Q

risk factors for a molar pregnancy

A

extremes of maternal ages (under 15 and over 35)
history of spontaneous abortion or infertility
history of molar preg

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46
Q

vaginal bleeding in molar pregnancies

A

prune juice

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46
Q

complications of molar pregnancy

A

hyperemesis gravidarum, vaginal bleeding, and pelvic discomfort.

missed period, positive pregnancy test

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47
Q

what can be seen also in a molar pregnancy

A

preeclampsia

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48
Q

A nurse is caring for a client who has a molar pregnancy. Which of the following are manifestations of a molar pregnancy?

A

missed period
pelvic pain
vaginal bleeding

49
Q

treatments for molar pregnancies

A

For most molar pregnancies, either a uterine evacuation or hysterectomy to surgically remove the mole is recommended.

50
Q

A nurse is caring for a client who is in their second trimester of pregnancy and has a suspected molar pregnancy. Which of the following conditions may develop related to the molar pregnancy in the second trimester?

A

preeclampsia

51
Q

oxytocin

A

control postpartum bleeding (and induction of labor as well)

52
Q

risk factors for GTN

A

manifestations of trophoblastic proliferation (uterine size larger than expected for the gestational age, hCG levels greater than 100,000 mIU/mL, and lutein cysts greater than 6 cm) and age greater than 40 years old.

53
Q

how long to modify hCG after molar pregnancy

A

3 months

54
Q

caring for client with molar pregnancy

A

hCG assessed
BP for preeclampsia
hypovolemia due to vaginal bleeding

55
Q

hyperemesis gravidarum

A

Nausea and vomiting in pregnancy that is severe and persistent.

56
Q

hCG level that indicates molar pregnancy

A

greater than 100,000 mIU/mL

57
Q

cervical insufficiency

A

occurs when painless cervical dilation leads to a second-trimester pregnancy loss

58
Q

ultrasound finding for cervical insufficiency

A

less than 25 mm cervical length

58
Q

risk factors for cervical insufficiency

A

history of mid-trimester pregnancy loss
preterm birth
uterine surgery that req cervical diliatation
induced abortion
cervical trauma
cervical laceration

59
Q

clinical presentation of cervical insufficiency

A

pelvic pressure
Braxton-Hicks
cramping
backache
changes in vaginal discharge

60
Q

cerclage

A

A medical procedure in which a stitch is placed around the cervix to prevent dilation.

61
Q

ectopic pregnancy

A

embryo implants elsewhere other than the uterus

62
Q

locations of ectopic pregnancy

A

abdomen
interstitial
fallopian tube
ovary
cervix
hysterotomy scar

63
Q

hysterotomy

A

An incision made into the uterus during a medical procedure.

64
Q

IUD and ectopic pregnancies

A

increased by 53% chance
unknown as to why

65
Q

risk factors for ectopic pregnancy

A

AMA
endometriosis
infertility
PID
cigarette smoking
clients pregnant while on oral contraceptives and IUD in place

66
Q

Which of the following clients has the highest risk of ectopic pregnancy?

A

client who got pregnant with IUD in place

67
Q

syncope

A

fainting

68
Q

clinical presentation of ectopic pregnancy

A

vaginal bleeding
abdominal pain
are the most common

other include…
syncope
vomiting
diarrhea
lower urinary tract infections
urinary freq
painful urination

69
Q

A nurse is caring for a client who is suspected of having an ectopic pregnancy. Which of the following manifestations should the nurse anticipate with this client?

A

abd pain
vaginal bleeding
urinary freq

70
Q

three options for ectopic preg treatment

A

expectant management
medical management
surgical management

71
Q

expectant management for ectopic pregnancy

A

monitoring the client while waiting for the ectopic pregnancy to resolve on its own

only appropriate for asymptomatic clients who have an ectopic preg in an unknown location and who have an hCG serum level that is low (less than 200 mIU/mL) and declining

72
Q

medical management for ectopic pregnancy

A

methotrexate for stable clients with confirmed ectopic pregnancy and who are not allergic

for stable vital signs

73
Q

surgical management for ectopic pregnancy

A

salpingectomy and salpingostomy

unstable, suspected tubal rupture, allergic to methotrexate, failed methotrexate treatment

74
Q

salpingectomy

A

Surgical removal of the fallopian tube.

75
Q

salpingostomy

A

Incision into the fallopian tube without removing the tube.

76
Q

modifiable risk factors for ectopic pregnancies

A

smoking and vaginal douching

77
Q

monitor what vital signs for ectopic pregnancy

A

HR for tachycardia
BP for hypotension due to hypovolemia

78
Q

manifestations of tubal rupture

A

sharp ABD pain
severe, sharp pelvic pain
syncope
rectal pressure
hypotension
vaginal bleeding

79
Q

what to avoid on methotrexate

A

folic acid supplements
foods that contain folic acid
NSAIDs
narcotics
alcohol
gas-producing foods (can mimic ruptured ectopic preg)
avoid sunlight to prevent dermatitis

80
Q

what can methotrexate cause

A

fetal death
don’t get pregnant on this medication and for at least one ovulatory cycle after completion

81
Q

placenta previa

A

placenta does not migrate up by the third trimester and is located near or covering the cervix

82
Q

where does placenta usually attach to

A

upper, posterior uterine wall

83
Q

anterior vs posterior placenta

A

anterior: placenta placement in the front of the uterus
posterior: placenta placement in the back of the uterus

posterior placenta previas are more likely to persist than anterior.

84
Q

three types of placenta previas

A

marginal
partial
complete

85
Q

marginal placenta previa

A

Placenta lies near the cervix but does not cover the opening.

86
Q

partial placenta previa

A

The placenta covers a portion of the cervix.

87
Q

complete placenta previa

A

Placenta completely covers the cervical opening.

88
Q

what do C sections increase the risk of

A

placenta previas

89
Q

Persistence of a previa as gestational age increases indicates

A

that it will not likely resolve.

90
Q

risk factors for placenta previa

A

major ones are…

previous placenta previa
previous cesarean sections
multiple gestation

other ones are…

Other risk factors include previous uterine surgery, such as a myomectomy, increasing number of pregnancies, increasing maternal age greater than 35, fertility treatment (due to hormones or implantation), previous pregnancy termination, maternal smoking or cocaine use, male fetuses, endometriosis, and prior uterine artery embolization.

91
Q

myomectomy

A

Surgical removal of fibroids.

92
Q

when is the previa most commonly found

A

ultrasound exam at 18-20 weeks of gestation

93
Q

A nurse is caring for a client who has placenta previa. Which of the following assessment findings should the nurse anticipate with this condition?

A

painless vaginal bleeding

94
Q

clinical presentation of placenta previa

A

painless vaginal bleeding in the SECOND HALF of pregnancy

95
Q

Medication Management for placenta previa

A

antenatal corticosteroids (Betamethasone)

96
Q

A nurse is caring for a client who has placenta previa. Which of the following conditions can occur in a client who has placenta previa?

A

ptsd
anxiety
hemorrhage
difficulty sleeping

97
Q

why should clients with placenta previa not get digital vaginal exam

A

prevent palpation of the placenta, which can lead to hemorrhage.

98
Q

vitals to watch during placenta previa

A

mom’s BP for hypovolemia
fetal HR that might show signs of hypoxia or anemia

99
Q

indications for urgent C section with placenta previa

A

active labor
non-reassuring fetal heart tracing
severe or persistent bleeding
significant bleeding after 34 weeks gestation

100
Q

placental abruption

A

occurs when the placenta prematurely separates from the uterine wall at or after 20 weeks gestation

101
Q

cause of placental abruption

A

rupture of maternal vessels from the placenta

rupture of maternal vessels away from the placenta causes bleeding between the lining of the uterus and the maternal side of the placenta. As the blood accumulates, it pushes the placenta away from the uterine wall.

102
Q

acute vs chronic placental abruption

A

acute: medical emergency, high-pressure hemorrhage cause by arteries in the placenta

chronic: low pressure hemorrhage, here is an unexpected development of the spiral arteries in the placenta, which leads to decidual necrosis and placental inflammation.

103
Q

factors that increase risk for placental abruption

A

history of an abruption, cocaine use, cigarette smoking, maternal age greater than 35 years, and hypertension.

104
Q

Risk factors that can be caused by the pregnancy for placental abruption

A

multiple gestation pregnancy, polyhydramnios, preeclampsia, sudden uterine decompression from delivery of a twin or rupture of membranes with polyhydramnios, submucosal myomas, and a short umbilical cord

105
Q

A nurse is caring for a client who has a placental abruption. Which of the following are risk factors for placental abruption?

A

cocaine use
preeclampsia
polyhydramnios
cigarette smoking
short umbilical cord

106
Q

clinical presentation of placental abruption

A

sudden onset vaginal bleeding
mild to moderate abd pain
uterine contractions

107
Q

A nurse is caring for a client who has placental abruption. Which of the following findings should the nurse understand is a manifestation of hypovolemia?

A

tachycardia

108
Q

condition where the uterus is stretched due to blood that has collected in the uterus due to placental abruption?

A

Couvelaire uterus

109
Q

clotting disorders during pregnancy that one may be at risk for

A

DVT and PE

110
Q

two types of clotting disorders

A

inherited and aquired

111
Q

inherited thrombophilia

A

genetic condition that increases the risk for thromboembolic disease in pregnant clients

increased during pregnancy because of the hypercoagulable state caused by pregnancy-associated physiologic changes.

112
Q

acquired thrombophilia

A

most commonly seen is antiphospholipid syndrome (APS).

113
Q

antiphospholipid syndrome (APS)

A

causes arterial or venous thrombosis and may cause poor pregnancy outcomes due to antiphospholipid antibodies in the client’s blood

clinical autoimmune disorder that can cause recurrent early pregnancy loss

114
Q

gestational thrombocytopenia (GT)

A

acquired condition that can occur in pregnant clients and causes low platelets

aka incidental thrombocytopenia and responsible for almost all thrombocytopenia noted in uncomplicated pregnancies.

115
Q

thrombocytopenia

A

Low level of platelets in the blood.

diagnosed at less than 150,000/microL

116
Q

A nurse is teaching a group of students about thrombophilia. Which of the following should the nurse include in the teaching?

A

Factor V Leiden is the most common type.

117
Q

cause for inherited thrombophilia

A

gene mutations

118
Q

risk factors for thrombocytopenia include

A

pregnancy
preeclampsia/HELLP syndrome
DIC
thrombotic thrombocytopenia purpura
SLE

119
Q

APS manifestations

A

venous and arterial thrombosis in any organ system

120
Q
A

Mother Baby (6 decks)

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