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Mother Baby > WEEK 4 > Flashcards

WEEK 4 Flashcards

endocrine disorders hypertension disorders

1
Q

pregestational diabetes mellitus (PDM)

A

chronic condition that will require management for a lifetime and is divided into two categories: type 1 diabetes mellitus (DM) and type 2 DM.

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2
Q

type 1 DM

A

autoimmune disorder that causes decreased or absent insulin production from the beta cells in the pancreas.

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3
Q

type 2 DM

A

may not have sufficient insulin production from the pancreas but do have insulin resistance at the cell wall, creating higher levels of circulating plasma glucose

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4
Q

vasodilation

A

Expansion of maternal blood vessels to accommodate the expected increase in maternal blood volume.

causes a decrease in baseline blood pressure

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5
Q

why does vasodilation occur

A

hormonal influences of estrogen, progesterone, relax begin to surge

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6
Q

why does the maternal blood volume increase

A

the renin-angiotensin-aldosterone system (RAAS) begins water and salt retention, expanding the maternal blood volume

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7
Q

what increases with pregnancy

A

SV
HR
CO

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8
Q

healthy BMI for pregnancy

A

less than 30

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9
Q

elevated BMI

A

can lead to hypertension

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10
Q

nonmodifiable risks for hypertension

A

chronic HTN to genetics
race
diagnosis before pregnancy
lower income (SDOH)
AMA (because body’s become less elastic)
primigravida

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11
Q

modifiable risk factors

A

BMI over 30
lack of excercise
lack of good diet

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12
Q

clinical presentation of hypertension

A

140/90 mmHg after 20 weeks of gestation

Clients presenting with no proteinuria and blood pressure readings of 140/90 mm Hg or higher on two occasions at least 4 hr apart will be diagnosed with gestational hypertension.

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13
Q

blood pressure reading

A

cuff should be an appropriate size
length 1.5 times the circumference
covers at least 80% of the arm
upright position for at least 10 min
abstained from caffeine at least 30 min prior to reading

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14
Q

Clients who have gestational hypertension have higher rates of

A

thrombocytopenia and liver dysfunction

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15
Q

thrombocytopenia

A

Platelet count less than 100,000/mm3.

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16
Q

HTN: weekly urine dipsticks to assess for what

A

proteinuria
liver enzymes
serum creatinine
CBC to assess platelets

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17
Q

manifestations of worsening HTN

A

visual changes or unresolved headache, lab testing should be repeated

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18
Q

what should have NST have

A

reactive: accelerations

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19
Q

why do we need to check liver functions of pregnant clients

A

watch clotting factor because it can lead to risk of hemorrhage

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20
Q

nonpharmacological interventions for HTN

A

adequate intake of fish oil, vitamin D, vitamin C, vitamin E, folic acid, and sodium reduction reduces the risk of a pregnancy-related hypertensive disorder

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21
Q

folic acid

A

prevents neural tube defects in fetal development

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22
Q

overloaded vascular system

A

HTN, lower sodium

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23
Q

pharma therapy for HTN

A

12-20 weeks take aspirin to help with blood flow

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24
Q

methyldopa

A

antihypertensive medication FINISH LATER

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25
Q

Labetalol

A

beta blocker (know that because of the -olol ending)
FINISH LATER

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26
Q

nifedipine

A

antihypertensive, calcium channel blocker FINISH LATER

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27
Q

Hydralazine

A

antihypertensive, vasodilator FINISH LATER

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28
Q

acute, severe HTN

A

hydralazine
greater than or equal to 160/110 mmHg

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29
Q

complications of HTN in pregnancy

A

preterm birth and maternal mortality
organ damage, proteinuria

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30
Q

chronic HTN need what

A

preconception counseling
could be on teratogenic medication

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31
Q

prevention

A

take BP and educate how to do it
refrain from smoking, drinking alcohol, eating high sugar/sodium foods
focus on walking, nutrition, gaining appropriate weight during their pregnancy

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32
Q

Clients who have a hypertensive disorder have a higher incidence

A

preterm birth
C section
placental abruption
preeclampsia

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33
Q

grief and loss with chronic hypertension or gestational hypertension

A

may affect the timing of birth, type of birth, postpartum recovery, and maternal–newborn bonding

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34
Q

preeclampsia

A

A hypertensive disorder diagnosed after 20 weeks of gestation or during the postpartum period involving organ injury. May express with or without severe features. Manifestations of preeclampsia include severe headache, visual changes, upper right abdominal pain, proteinuria, thrombocytopenia, unexpected kidney function, unexpected liver function, and pulmonary edema.

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35
Q

pathophysiology of preeclampsia

A

it is thought to involve unexpected placental implantation and inadequate blood flow to the placenta. thought to be shown that the placenta not being implanted the right way can impact this FINISH LATER

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36
Q

preeclampsia into two categories

A

preeclampsia without severe features and preeclampsia with severe features

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37
Q

placenta and preeclampsia

A

FINISH LATER

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38
Q

risk factors for preeclampsia

A

AMA
Use of assisted reproductive technology
Autoimmune disorders
Chronic hypertension
Chronic kidney disease
Diabetes
Fetal growth restriction
Gestational diabetes
Gestational trophoblastic disease
Multiple gestations
Nulliparity
Primigravida
BMI greater than 30
Obstructive sleep apnea

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39
Q

clinical presentation of preeclampsia without severe features

A
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40
Q

clinical presentation of preeclampsia with severe features

A
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41
Q

lab testing without severe features

A

greater than 140/90 mmHg
two occurrences at least 4 hours apart with ONLY proteinuria

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42
Q

lab testing with severe features

A

160/110 at two occurrences at least 4 hours apart with proteinuria and AT LEAST ONE symptom

Symptoms: persistent headache, pulmonary edema, right upper quadrant pain, or visual changes in conjunction

Additional: 24 hr urine sample; over 300 mg is considered positive for proteinuria; also CBC to test platelets (to test for thrombocytopenia)

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43
Q

preeclampsia fetal testing

A

increased BPP
testing a few times a week

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44
Q

how is a BPP done

A

ultrasound testing with even 2s

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45
Q

risk for what with preeclampsia

A

seizure due to high blood pressure

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46
Q

magnesium

A

2-4 g bolus to help with eclamptic seizure with a client who has preeclampsia with severe features
mom will be super relaxed, BUT still get a responses

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47
Q

magnesium

A
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48
Q

if you gave too much magnesium

A

leads to respiratory depression
decreased RR, no refluxes
administer calcium gluconate

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49
Q

how to check a persons reflex

A

deep tendon: hammer, hit with hands, stethoscope to elicit a response

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50
Q

does mag treat BP

A

NO, it is treating seizures. it will lower as a SYMPTOM but not the therapeutic use

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51
Q

antenatal steriods

A

betamethasone

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52
Q

difference with preeclampsia vs eclampsia

A

eclampsia causes seizures
had a seizure and preeclamptic, you are eclamptic

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53
Q

interventions for seizures

A

lay on side
move objects
no fingers in mouth
time the seizure
try to monitor the baby if possible

54
Q

why do we time seizures

A

eclamptic seizures you don’t breathe so need to see how long you and baby were not breathing

55
Q

during eclamptic seizure

A

suction of bedside
lay on side
supplemental O2 on mom

56
Q

after eclamptic seizure

A

continuous monitoring for mom and baby
probable delivery-but not always
generally have C section

57
Q

HELLP syndrome

A

H: hemolysis
EL: elevated liver enzymes
LP: low platelets

risk for hemorrhage (precautions: no shaving, assist them)

58
Q

what would happen with elevated liver enzymes

A

jaundice (

59
Q

liver panel labs

A

bile and CBC? finish later

60
Q

HELLP

A

begins with inadequate placental trophoblast invasion and poor uterine spiral artery remodeling, resulting in endothelium dysfunction.

61
Q

lab work for DM

A

A1C and blood glucose (before meals)

62
Q

why can stress increase glucose levels

A

hormone fluctuation

63
Q

the placenta can pass glucose but not what

A

insulin
so the baby become hypoglycemic

64
Q

symptoms of hypoglycemia

A

respitary depression
jittery

65
Q

LGA can increase what

A

shoulder getting stuck
so you would have a birth injury

66
Q

gestational diabetes

A

increased insulin resistance
usually diagnosed within the second and third trimester

67
Q

fast acting insulins

A

ends in -log

68
Q

hyperemesis gravidarum

A

Nausea and vomiting in pregnancy that is severe and persistent.

dehydration, electrolyte imbalance, and weight loss

69
Q

what is Helicobacter pylori

A

bacteria in gut

70
Q

hypothyroidism

A

subclinical hypothyroidism and overt hypothyroidism

when serum levels of thyroid-stimulating hormone are elevated AND the serume levels of thyroxine decrease

71
Q

what does a hypothyriodism patient look like

A

hair loss
weight loss
all vitals would go down

72
Q

what does Grave’s patient look like

A

bulging eye
weight loss

73
Q

stage one HTN

A

130-139/80-89

74
Q

stage 2 HTN

A

140 or higher/90 or higher

75
Q

HTN crisis

A

180 or higher/120 or higher

76
Q

as maternal blood pressure increases…

A

placental blood flood decreases and limits O2 to the baby for growth, leading to fetal hypoxia

77
Q

Chronic conditions and comorbidities that reduce uterine blood flow through the placenta, such as

A

diabetes, have demonstrated an increase in HTN during pregnancy

78
Q

epidemiology of HTN disorders during pregnancy

A

2nd leading cause of global maternal mortality
increasing due to certain demographics like AMA
1/7 pregnancies diagnosed with a hypertensive disorder
6.8% of maternal deaths in the US are a result of a hypertensive disorder

79
Q

A pregnant client who initially presents with blood pressure readings in a normal range and then presents with a blood pressure of

A

140/90 mm Hg or higher after 20 weeks of gestation will be diagnosed with a hypertensive disorder of pregnancy.

80
Q

diagnosis of gestational hypertension

A

no proteinuria
BP readings of 140/90mmHg or higher on two occasions at least 4 hrs apart

81
Q

A client who has chronic hypertension will undergo

A

a complete history and physical examination during the first prenatal visit to identify risk factors and disease management challenges.

82
Q

Clients who have gestational hypertension have higher rates of

A

thrombocytopenia
liver dysfunction

83
Q

why consistent fetal testing with hypertensive disorders

A

HTN leads to vasoconstriction and reduced blood flow through the placenta, therefore fetal growth needs to be monitored.
can lead to non-reassuring fetal status, fetal growth restriction, placental abruption

84
Q

Current recommendations include an ultrasound every

A

3-4 weeks with amniotic fluid levels checked when having a HTN disorder

85
Q

​​​​​​​Clients who have gestational hypertension at or after 37 weeks of gestation should

A

give birth to prevent disease progression and poor neonatal outcomes.

86
Q

Clients who have chronic hypertension are encouraged to

A

seek preconception counseling

87
Q

Manifestations such as severe headaches not relieved by

A

acetaminophen, visual changes, right upper quadrant pain, dyspnea, and oliguria should be immediately reported to the provider.

88
Q

oliguria

A

Less than 20 mL per hr of urine output.

89
Q

pathophysiology of why preeclampsia occurs

A

not well understood
however, it is thought to involve unexpected placental implantation and inadequate blood flow to the placenta.

90
Q

The maternal response to preeclampsia

A

The inflammatory events lead to vasoconstriction, vasospasms, and a decrease in clotting factors
Endothelial cell dysfunction and decreased maternal perfusion can lead to the diagnosis of preeclampsia based on the client’s manifestations, laboratory values, and diagnostic testing.

91
Q

however, current studies indicate preeclampsia begins with

A

unexpected placental implantation and subsequent release of antiangiogenic markers.

92
Q

risk factors for preeclampsia include

A

Age greater than 35 years
Use of assisted reproductive technology
Autoimmune disorders
Chronic hypertension
Chronic kidney disease
Diabetes
Fetal growth restriction
Gestational diabetes
Gestational trophoblastic disease
Multiple gestations
Nulliparity
Primigravida
BMI greater than 30
Obstructive sleep apnea

93
Q

Primigravida clients are at risk for

A

preeclampsia

94
Q

Manifestations of Preeclampsia With Severe Features

A

BP >/= 160/110 on two occasions at least 4 hrs apart
persistent headaches
visual changes
RIGHT upper quadrant pain
pulmonary edema
sudden weight gain
nausea and vomiting
fetal growth restriction

95
Q

Clients who are at 20 or more weeks of gestation and have blood pressure readings greater than or equal to 140/90 mm Hg on two occasions at least 4 hr apart with no other manifestations of disease will be diagnosed with

A

preeclampsia without severe features

96
Q

lab results for preeclampsia without severe features

A

no proteinuria
may indicate:
thrombocytopenia
impaired liver function
pulmonary edema
renal insufficiency
headache unresolved with medication

97
Q

long term health effects of preeclampsia

A

Cerebrovascular events, congestive heart failure, hypertension, myocardial infarction, and peripheral arterial disease are common diagnoses in clients with a history of preeclampsia

98
Q

Timing of Birth

A

A client between 34 to 36 6/7 weeks of gestation presenting with preeclampsia with severe features is a candidate for birth

99
Q

eclampsia is the severe manifestation of

A

preeclampsia
severe features with accompanying seizure activity in the absence of causes

100
Q

Eclamptic seizures can lead to

A

severe maternal hypoxia, fetal hypoxia, aspiration pneumonia, trauma, maternal death, and neonatal death.

101
Q

Nurses need to understand that clients with sudden-onset eclampsia may present without

A

any manifestations of preeclampsia with or without severe features, or worsening disease

102
Q

The pathophysiology of eclampsia lies in the

A

progression of worsening disease of preeclampsia with severe features caused by unexpected placental implantation.

103
Q

Eclampsia Risk Factors

A

Age over 35 years
Assisted reproductive technologies
Autoimmune disorders
Cardiovascular disease
Chronic hypertension
Chronic kidney disease
Diabetes
Genetics
Gestational diabetes
Gestational trophoblastic disease
Multiple gestation
Neurological disease
Nulliparity
BMI greater than 30
Obstructive sleep apnea
Poor nutrition

104
Q

clinical presentation of eclampsia

A

persistent frontal or occipital headache, blurred vision, and sensitivity to light

105
Q

If the client requires intubation for eclampsia, the nurse should frequently assess

A

blood pressure because the procedure causes a hypertensive response that may lead to an intracranial hemorrhage.

106
Q

common complications of eclampsia include

A

pulmonary edema and respiratory failure

107
Q

Maternal and Fetal Complications of Eclampsia

A

Aspiration pneumonia
Cerebral edema
Cerebral hypoperfusion
Fetal hypoxia
Impaired cerebral autoregulation
Maternal death
Neonatal death
Maternal emotional trauma  

108
Q

Clients diagnosed with posterior reversible encephalopathy syndrome (PRES) in conjunction with eclampsia are at

A

high risk for liver and renal failure

109
Q

care during an eclamptic seizure

A

The client will be positioned on their left side to improve blood flow from the inferior vena cava.
Airway management, suction, administration of oxygen, prevention of aspiration, frequent vital signs, oxygen saturation, continuous fetal monitoring, and assessment of the seizure are paramount to ensure maternal-fetal safety.
infuse magneisum sulfate and antihypertensives via mulitple IV lines
If the client experiences a persistent seizure, anticonvulsant therapy may be required.

110
Q

common complications of eclampsia maternal

A

Respiratory failure, pulmonary edema, renal failure, liver failure, posterior reversible encephalopathy (PRES), and the development of cardiovascular disease later in life

111
Q

. An increase in uterine contractions and baseline uterine tone may also be noted during eclampsia, leading to what

A

placental abruption

112
Q

the pathophysiology of HELLP is the same as

A

preeclampsia with severe features

113
Q

Clinical Presentation of HELLP syndrome

A

right upper quadrant abdominal pain and general fatigue

114
Q

additional manifestations of HELLP syndrome

A

increased abdominal girth, visual changes (such as blurred vision), jaundice, pedal edema, and blood pressure greater than or equal to 140/90 mm Hg

115
Q

what is jaundice

A

Increase amount of bilirubin circulating in the bloodstream that dissolves in the subcutaneous fat causing a yellow tint to skin and sclera. Also known as icterus.

116
Q

Maternal Complications of HELLP Syndrome

A

Placental abruption
Eclampsia
Disseminated intravascular coagulopathy (DIC)
Postpartum hemorrhage
Thrombosis
Liver hematoma/rupture
Liver failure
Cerebral hemorrhage and infarction
Cardiovascular instability
Acute kidney damage
Infection and sepsis
Retinal detachment
Death

117
Q

Fetal complications from HELLP syndrome

A

fetal growth restriction, respiratory distress syndrome, preterm birth, neonatal thrombocytopenia, neonatal neutropenia, neonatal leukopenia, and perinatal death.

118
Q

in pregnancy, an expected physiological process begins in the second trimester that will increase

A

insulin resistance at the cell wall to increase the transport of available glucose across the placenta to the developing embryo.

process intitated by the secretion of human placental lactogen (hPL) from the placental control of hormone secretion that takes full effect in the early second trimester

119
Q

human placental lactogen (hPL)

A

Hormone during pregnancy that the placenta releases in preparation for breastfeeding.

120
Q

The level of hPL remains relatively consistent throughout

A

the second trimester, but it will increase again in the third trimester until it peaks around the 30th week of pregnancy, when fetal weight gain markedly increases and glucose transport across the placenta is vital.

121
Q

Pregnant clients who have type 1 DM will likely have significant

A

changes to their insulin dosing and will require more frequent blood glucose testing, possibly four to six times a day, to prevent wide fluctuations in their blood glucose levels throughout the day.​​​​​​​​​​​​​​​​​​​​​​​​​​​​

122
Q

education for clients who have PDM should include

A

nutrition, exercise, medication, how often to see the provider during pregnancy, and monitoring of glucose levels

123
Q

individuals who have PDM often have difficulty

A

conceiving or may have had multiple first-trimester pregnancy losses due to congenital anomalies or unstable blood glucose levels.

124
Q

Some of the most common manifestations of PDM

A

polyphagia, polydipsia, polyuria, dry skin, blurred vision, slow-healing wounds, fatigue, and more infections than average.

125
Q

Gestational diabetes mellitus (GDM)

A

increased insulin resistance at the cell wall that typically occurs in the second and third trimesters of pregnancy and essentially mimics the features of type 2 DM

126
Q

risk for developing when having GDM

A

gestational hypertension or preeclampsia, preterm labor, complications associated with birth (including an operative birth and postpartum hemorrhage), and development of type 2 DM across a lifetime.

127
Q

manifestations of GDM

A

Increased thirst, increased urination, fatigue, and nausea are a few of the manifestations that may occur with increased serum glucose level

128
Q

Along with dietary modifications, pregnant clients who have GDM must monitor

A

blood glucose levels four times daily.

129
Q

patho of HG

A

placenta secretes hCG which rises rapidly over the first 10 weeks
in response to that, the corpus luteum secretes estradiol
Rising levels of progesterone will cause relaxation of the cardiac sphincter, which increases the incidence of gastric reflux and, thus, nausea

130
Q

common risk factor for HG

A

nulliparous

131
Q
A

Mother Baby (6 decks)

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