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N306-Expanding Family and Community > week 5 Complications of Pregnancy > Flashcards

week 5 Complications of Pregnancy Flashcards

1
Q

What are general reasons to come in for a check-up during pregnancy?

A

mild aches, contractions every 10 minutes, preterm labor (PTL

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2
Q

What is the biggest factor in preterm labor?

A

infection

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3
Q

Risk factor for preterm labor

A

The most consistent factor for preterm labor is a history of preterm birth

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4
Q

medication management to prolong labor: it’s not my time (I.N.M.T.)

A
  • Indomethacin-NSAID- can cause early closing of ductus arteriosus, assess contractions to see if medication is working
    -Nifedipine (CA channel blocker)- assess contractions, B/P prior to administration, although, not an indicator is is working
    -Magnesium sulfate
    -Terbutaline- assess HR/ educate on heart palpitations
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5
Q

What indicates nursing actions?

A

gestational age

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6
Q

Magnesium sulfate, when used, assessments, SEs?

A

-Before 32-weeks, neuroprophylaxis, prevent brain hemorrhage
-every hour set of vitals/ DTR assessment
-SEs; weak, foggy, flushed, warm, uncomfortable, maternal respiratory depression

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7
Q

ondansetron (Zofran)
serotonin antagonist

A
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8
Q

Terbutaline (Brethine)
Beta2-Adrenergic Agonists

A
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9
Q

Nifedipine
Beta2-adrenergic agonist

A
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10
Q

Azoles (3)

A

*ketoconazole
*miconazole (Monistat)
*Clotrimazole (Lotrimin)

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11
Q

Calcium Gluconate

A
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12
Q

Magnesium Sulfate

A
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13
Q

Methotrexate (Trexall and Rheumatrexate)
Nonbiologic (Traditional) DMARDs

A
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14
Q

What is preterm labor? When does it occur?

A

*(PTL)-regular contractions resulting in cervical changes at 20-37-weeks

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15
Q

Late Preterm, Very preterm, and Viability

A

*viability- 25 weeks gestation
*very preterm-before 32 weeks
*late preterm-34-36.6 weeks

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16
Q

S/S of preterm labor

A

-bag of water breaks
-< fetal movement
-low back aches, menstrual-like cramps, or intestinal cramps (w/ or w/o diarrhea)
-increased vaginal discharge
-fever higher than 38 C, 100.4 F
-feeling that something is not right

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17
Q

Half of woman at risk of PTL deliver full term, other half have no identifiable risk factors

A

*prior preterm birth, multiple gestations, uterine cervical abnormalities (DES/ shortened length)

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18
Q

Medical Management of preterm labor

A

*delay delivery for 48-72 hours to give steroids time to allow the baby’s lungs to mature.
*Tocolytics (up to 48 hours, allows for admin antenatal steroids)-no for dilations <2cm or none or > 34-weeks
*progesterone-HX PTB
*Cerclage-before 24 weeks for short cervix)
*Corticosteroids, 24-34 weeks w/in 7 days of delivery (fetal lung maturity)

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19
Q

PTL contraindication-why should labor not be held off?

A

*significantly preterm ROM
*fetal anomaly (lethal)
*intrauterine fetal demise
*severe preeclampsia
*bleeding/ hemodynamic instability
*infection-chorioamnionitis

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20
Q

Nursing actions for PTL

A

*review med rec for risk factors and gestational age
*assessments: infections, ROM, vaginal bleeding, dehydration, FHR, UCs

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21
Q

Magnesium sulfate indication, loading dose, nurse actions, edu, toxicity

A

*most used for neuro protection, is a tocolytic
*stay at bedside, monitor for Mag toxicity (RR<12, SPO2<95%,, stop admin), may cause resp < in neonate), serum mag levels 4-8, DTRs, calcium gluconate

22
Q

Corticosteroids: 24-34 weeks, delivery w/in 7 days

A

*stimulate surfactant
*Adverse-hyperglycemia
*Betamethasone-12 mg IM-24 hoursX2
*Dexamethasone-4X6mg dose-Q12H

23
Q

PROM-premature

A

*before onset of labor->18-24 hours, increase risk infection
*PPROM-before 37 weeks-infection related
*assess FHR, V/s, infection, BPP, AFI, and NST

24
Q

Ferning-PROM

A

diagnostic of amniotic fluid, swabbed uterus/ microscope, no ferning/ activity

25
Medical Management = deliver VS prolonging gestation
34-36.6 weeks gestation - delivery 24-33.6 weeks gestation - prolong 23-24 weeks gestation - provide counseling for decision ABX = Ampicillin and Erythromycin Corticosteroids = Betamethasone Mag Sulfate= neuro-protectant for fetus less than 32 weeks
26
Chorioamnionitis
*Inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection)-from prolonged labor *induce-quicken birth, ampicillin/ gentamicin
27
Incompetent cervix
*Inability of the uterine cervix to retain a pregnancy in the absence of S/S of UCs or labor in the 2nd and 3rd trimester *dilation after 1st trimester, with expulsion in the 2nd trimester, before 24 weeks *cervical funnel, cramping, backache, cramping/ spotting, painless cervical dilation
28
Treatment-incompetent cervix
*cerclage suture *w/ true labor, bleeding, infection, remove cerclage *schedule removal 36-37 weeks
29
Multiple gestations
*mono/mono twins high risk for infant mortality
30
Multiple gestation assessment findings
*increased hCG (increase N/V) *US confirmation *other signs are obvious
31
Multiple gestation-medical management-intrapartum, medical management
*risk for preterm labor, abnormal presentation, cord prolapse, abruption and PPH (postpartum hemorrhage) *Type and cross blood, US to confirm position, cont EFM, C/S option should be readily available (OR and staff), hemorrhage meds (pit/Methergine/Hemabate/Cytotec
32
Hyperemesis gravidarum-uncontrolled vomiting-hospitalization
*cause by increased HCG/progesterone/ estrogen *B6 meds, histamine blockers., etc. *peaks week 9, subside by weeks 12
33
Cholestasis of Pregnancy
*A reversible, hormonally influenced cholestasis. Develops in late pregnancy. Most common pregnancy related liver disease. * Monitor labs, FKC, NST importance, Medical induction at 37-38 weeks. Bi-weekly NST *Bile acids above 40 HIGH RISK for severe fetal complications
34
Pre-gestational diabetes-risks form woman/ newborn
*mom-spontaneous abortion, polyhydramnios (fetal hyperglycemia, oligohydramnios) *newborn-congenital defects, macrosomia from hyperinsulinemia, hypoglycemia, hypocalcemia, IUGR, birth injury, stillbirth (***after 36 weeks)
35
Diabetes management
*extensive education *arrange antenatal testing (NST, BPP)
36
Gestational Diabetes-diet controlled or insulin controlled
*risk for mom-hypoglycemia/ DKA/ pre-eclampsia, C/S *baby: macrosomia, IUGR, hypoglycemia, shoulder dystocia, resp distress, still birth
37
Glucose Tolerance Test (GTT(
*step 1-50 gm glucose solution, 1-hour post measure venous plasma and serum glucose->130 requires second attempt *step 2-measure fasting venous plasma or serum glucose, 100 grams-measure again at 1,2,3 hours, positive if > 2 or more times
38
Hypertensive Disorders of Pregnancy
*chronic HTN-before 20-weeks *gestational HTN, after 20 weeks >140/90 no proteinuria *preeclampsia-24-hour collection, after 20-weeks, BP >140/90 with lab changes *preeclampsia with severe features; >160/110 Crt>1.1, plat<100,00, increase LE/ visual disturbances, RUQ pain *eclampsia-seizures *superimposed/ CHTN: w/ new onset of proteinuria decreased platelets
39
Preeclampsia Treatment- Mag-Sulfate
*4gm (6 if neuro protectant), loading in 20 minutes *BP above 160-110; labetalol (IVP, hydralyzine IVP MD order, Nifedipine (after control) *ASA (low dose aspirine) treat. if previous Pre-E or high risk
40
Ecplamsia
*by cerebral edema and vasospasm *warning signs-other known, N/V, hyperreflexia with clonus *EMERGENCY
41
Magnesium Sulfate-BURP
*Magnesium sulfate is indicated for women with severe features of preeclampsia. *BP decrease *Urine output decrease*respiratory decrease *patellar reflex absent
42
HELLP
-usually resolves within 48-hours PP -1st stage-hemolysis, < o2, > RUQ pain -2nd; thrombocytopenia -last liver stuff -moms risk, placenta abruption, renal failure, death
43
Placenta Previa-Placenta attaches to lower uterine segment or at the cervical os.
*painless vaginal bleeding...no SVE *C/s indicated
44
Placenta Abruption: Bleeding at the connection of the placenta to uterine lining that causes partial or complete detachment prior to delivery of fetus
Risk Factors: previous hx, trauma, drugs (meth/coke/smoking) Risks for Mom: Hemorrhage, hysterectomy, DIC Risks for Fetus/Newborn: asphyxia, death, PTL, low birthweight Assessment Findings: darker vaginal bleeding, clots, severe abdominal pain, abd. rigid, and tachysystole (>5 in 10 minutes) *stat C/S
45
Placenta Accreta: Abnormal Implantation of the placenta to the uterine wall.
*Risks for Mom: hemorrhage, hysterectomy, increased risk for infection. Risks for Fetus/Newborn: 34-26-week gestation delivery, high risk, placenta does not deliver intact. *Assessment Findings: hypotension, tachy, shallow irregular breathing, cold/clammy skin. Blood loss 3,000-5,000 ml after delivery Medical Management: hysterectomy, surgical injury to organs. Nursing Actions: monitor bleeding.
46
Ectopic pregnancy
*abdominal pain that radiates to the shoulders *management, methotrexate *possible RhoGAM
47
Hydatidiform mole-gestational thromboplastic disease (GTD)
*grape cluster *assessment findings; vaginal bleeding, pelvic pain, anemia, hyperemesis *management D&C, routine hCG levels for 6 months, give Rhogam
48
Many times STIs show no S/S
*perform routine screening
49
Urinary Tract Infection (UTI)
*most common *Infection can cause PTL/PTB. *If not treated, can turn into pyelonephritis.
50
GBS
*treat with ampicillin during labor, minimum of 2 doses before delivery **vaginal/ rectal culture screening 36-37 weeks gestation
51

N306-Expanding Family and Community (4 decks)

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