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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
Q

Medical Management = deliver VS prolonging gestation

A

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
Q

Chorioamnionitis

A

*Inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection)-from prolonged labor
*induce-quicken birth, ampicillin/ gentamicin

27
Q

Incompetent cervix

A

*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
Q

Treatment-incompetent cervix

A

*cerclage suture
*w/ true labor, bleeding, infection, remove cerclage
*schedule removal 36-37 weeks

29
Q

Multiple gestations

A

*mono/mono twins high risk for infant mortality

30
Q

Multiple gestation assessment findings

A

*increased hCG (increase N/V)
*US confirmation
*other signs are obvious

31
Q

Multiple gestation-medical management-intrapartum, medical management

A

*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
Q

Hyperemesis gravidarum-uncontrolled vomiting-hospitalization

A

*cause by increased HCG/progesterone/ estrogen
*B6 meds, histamine blockers., etc.
*peaks week 9, subside by weeks 12

33
Q

Cholestasis of Pregnancy

A

*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
Q

Pre-gestational diabetes-risks form woman/ newborn

A

*mom-spontaneous abortion, polyhydramnios (fetal hyperglycemia, oligohydramnios)
newborn-congenital defects, macrosomia from hyperinsulinemia, hypoglycemia, hypocalcemia, IUGR, birth injury, stillbirth (**after 36 weeks)

35
Q

Diabetes management

A

*extensive education
*arrange antenatal testing (NST, BPP)

36
Q

Gestational Diabetes-diet controlled or insulin controlled

A

*risk for mom-hypoglycemia/ DKA/ pre-eclampsia, C/S
*baby: macrosomia, IUGR, hypoglycemia, shoulder dystocia, resp distress, still birth

37
Q

Glucose Tolerance Test (GTT(

A

*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
Q

Hypertensive Disorders of Pregnancy

A

*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
Q

Preeclampsia Treatment- Mag-Sulfate

A

*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
Q

Ecplamsia

A

*by cerebral edema and vasospasm
*warning signs-other known, N/V, hyperreflexia with clonus
*EMERGENCY

41
Q

Magnesium Sulfate-BURP

A

*Magnesium sulfate is indicated for women with severe features of preeclampsia.
*BP decrease
Urine output decreaserespiratory decrease
*patellar reflex absent

42
Q

HELLP

A

-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
Q

Placenta Previa-Placenta attaches to lower uterine segment or at the cervical os.

A

*painless vaginal bleeding…no SVE
*C/s indicated

44
Q

Placenta Abruption: Bleeding at the connection of the placenta to uterine lining that causes partial or complete detachment prior to delivery of fetus

A

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
Q

Placenta Accreta: Abnormal Implantation of the placenta to the uterine wall.

A

*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
Q

Ectopic pregnancy

A

*abdominal pain that radiates to the shoulders
*management, methotrexate
*possible RhoGAM

47
Q

Hydatidiform mole-gestational thromboplastic disease (GTD)

A

*grape cluster
*assessment findings; vaginal bleeding, pelvic pain, anemia, hyperemesis
*management D&C, routine hCG levels for 6 months, give Rhogam

48
Q

Many times STIs show no S/S

A

*perform routine screening

49
Q

Urinary Tract Infection (UTI)

A

*most common
*Infection can cause PTL/PTB.
*If not treated, can turn into pyelonephritis.

50
Q

GBS

A

*treat with ampicillin during labor, minimum of 2 doses before delivery
**vaginal/ rectal culture screening 36-37 weeks gestation

51
Q
A

N306-Expanding Family and Community (4 decks)

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