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NUR 126 > Wk 13 Antepartum Safety > Flashcards

Wk 13 Antepartum Safety Flashcards

1
Q

Define - alpha-fetoprotein (AFP)

A

plasma protein produced by the fetus

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2
Q

Define - amniocentesis

A

trans abdominal puncture of the amniotic sac to obtain a sample of amniotic fluid that contains fetal cells and biochemical substance for laboratory exam

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3
Q

Define - biophysical profile

A

method of evaluating fetal status during the antipartum period based on five fetal variables: fetal heart rate variability, fetal breathing movements, gross body movements, muscle tone and amniotic fluid volume
**combines fetal heart rate monitoring (nonstress test) and fetal ultrasound

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4
Q

Define - chorionic villus sampling

A

transcervical or transabdominal sampling of chorionic villi for analysis of fetal cells

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5
Q

Define - contraction stress test

A

method for evaluating fetal status during the antepartum period by observing the response of the fetal heart to intermittent stress of induced uterine contractions

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6
Q

Define - lecithin/sphingomyelin ratio

A

ratio of two phospholipids in amniotic fluid that is used to estimate fetal lung maturity

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7
Q

Define - cordocentesis

A

known as percutaneous umbilical blood sampling

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8
Q

Define - ultrasonography

A

It uses sound waves to show a picture of your baby in the uterus

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9
Q

Assessment for risk factors

DEMOGRAPHIC FACTORS

A

Younger than 16 yrs or over 35 yrs old
Low socioeconomic status/need public assistance
Nonwhite
Multiparity

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10
Q

Assessment for risk factors

SOCIAL-PERSONAL FACTORS

A 
Low prepregnancy weight
Obesity
Under 5' in height
Smoking
Use of alcohol/drugs
Intimate partner violence
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11
Q

Assessment for risk factors

OBSTETRIC FACTORS

A

Previous infant over 4000g (8lb, 13oz)
Previous preterm birth
Previous fetal or neonatal death
Rh sensitization

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12
Q

Assessment for risk factors

EXISTING MEDICAL CONDITION

A 
Diabetes mellitus
Hypothyroidism
Hyperthyroidism
Cardiac disease
Renal disease
Concurrent infections
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13
Q

Assessment for risk factors

RACIAL AND ETHNIC MINORITIES

A

Experience a disproportionate burden of disease, disability, premature death
Infant mortality rates are highest among Native American, Alaska Native and Puerto Rican women
*Minority women in poverty have higher rates of chronic diseases: heart, cancer, hepatitis, AIDS, mental health issues

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14
Q

Assessment for risk factors

UNDERLYING HEALTH CONDITIONS LEAD TO:

A

High risk for poor obstetric outcomes; self and infant
High rates of preterm labor
Gestational hypertension
Intrauterine growth restrictions

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15
Q 
Assessment for risk factors
ADOLESCENT GIRLS (AGES 15-19)
A

70% report sevual activity by 19
Risky behavior: eating disorders, depression, sexual activity
77% of teen pregnancies are unintended
Unprotected sex
Sexually transmitted infections rates are higher among adolescent and young adults (HPV, Chlamydia, Gonorrhea)
Misinformed about STI’s and AIDS

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16
Q

Assessment for risk factors

INCARCERATED WOMEN

A

Many report a history of sexual/physical abuse
Lack of support family
Have difficulty providing emotional stability, secure housing, health promotion role model

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17
Q

Assessment for risk factors

LIFESTYLE CHOICES INCLUDE

A 
Risky sexual relationships
Illicit drugs
Smoking
Risk for STI, HIV, AIDS
Complicated pregnancies
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18
Q

Intimate Partner Violence

A

Includes: physical, sexual, emotional, social and economic abuse
1 in 6 women are victims
4%-8% to as many as 20% are abused during pregnancy
Women do not disclose violence

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19
Q

Intimate partner violence

PHYSICAL AND EMOTIONAL

A

Physical:
Occurs with mental abuse, threats, coercion
Threats, hitting, rape, weapons, even death
Emotional:
Causes shame, loss of self respect, powerlessness
The abuser blames the victim for the abuse
Social abuse; isolating from friends/family

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20
Q

Intimate partner violence

THREE PHASES

A
  1. Tension building phase
  2. Battering incident: slaps, punches, kicking, burns and mutilation
  3. Honeymoon or calm phase: partner displays kind loving behavior and leas for forgiveness.
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21
Q

Cardiac disease

A

Mitral valve prolapse:
1% or woman, usually benign
Valve leaflets prolapse into the left atrium during systole
Allows back flow
Most asymptomatic:
May have chest pain, anxiety, palpitations, dyspnea, risk for endocarditis
Signs:
Auscultate late systolic murmur and midsystolic click
Pregnancy usually well tolerated:
Antibiotic prophylaxis

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22
Q

Infections GBS

A

Group B Strep
Bacteria colonizes in rectum, vagina, cervix, urethra of women
Was the most common cause of neonatal sepsis and meningitis in US
Decreased of 70% with screening and admin penicillin
GBS infection in the neonate occurs in first weeks of life, usually first 24 hours

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23
Q

Infections GBS

Risks

A 
Risk factors for early onset include:
low birth weight
preterm birth
ruptured of membranes >24 hours
maternal fever
previous GBS infant
maternal GBS bacterium and multiple gestation
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24
Q

Infections GBS

Late onset of GBS

A

1 week to 3 months (24 day average)
85% develop meningitis
50% of survivors develop neurological damage

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25
Q

Infections GBS

Therapeutic management

A

Vaginal-rectal culture between 35-37 weeks gestation
Penicillin G during labor for positive mother (no allergy)
Penicillin and an aminoglycoside for neonate with confirmed or possible GBS (ampicillin, cefaxolin, clindamycin or erythromycin are alternative)
48 hour obs of infant if mother did not receive intrapartum prophylaxis

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26
Q

Tobacco use

A

12% of women
causes vasoconstriction
decreases oxygen to fetus
decrease maternal appetite; decreased nutrition

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27
Q

Tobacco use

effects of smoking during pregnancy

A 
Spontaneous abortion
Abruptio placentae
Placenta previa
Premature rupture of membranes
perinatal mortality
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28
Q

Tobacco use

effects on infant

A

30% higher chance of prematurity
low birth weight and length
3x higher risk of sudden infant death syndrome
increased risk of learning disabilities

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29
Q

Tobacco use

Nurse’s role

A

Teaching:
smoking cessation
risks of smoking
benefits of quitting

30
Q

Alcohol use stats

A

1 in 12 women drink alcohol during pregnancy
1 in 30 women drink 5 or more drinks
Excessive amounts recirculated until fetal liver can break it down
Teratogen CNS effects that is identified years later

31
Q

Alcohol use

fetal alcohol spectrum disorder

A

Fetal alcohol syndrome: group of severe physical, behavioral and mental abnormalities

Partial fetal alcohol syndrome

Alcohol related neurodevelopmental disorder: leading cause of cognitive impairment. Effects on brain are permanent

32
Q

Alcohol use

birth defects

A 
small head
low nasal bridge
small eye openings
short nose
thin upper lip
underdeveloped jaw
smooth philtrum
flat midface
epicanthal folds
33
Q

Substance abuse

Marijuana

A

Most common illicit drug in US
Tetrahydrocannabinal (THC) accumulates in the fetus
Cocaine and alcohol often used with Marijuana
Increases carbon monoxide in mother’s blood and reduces oxygen to fetus
Effects to infant: neurobehavioral problems, tremors and sleep disturbances

34
Q

Substance abuse

Cocaine

A
  • blocks re-uptake of norephinephrine and dopamine

- produces euphoria, sexual excitement, increased alertness, hyper-arousal

35
Q

Substance abuse

Cocaine, physical effects

A 
Less likely to seek prenatal care
Poor nutrition
Increased risk of STI
Cardiovascular stimulation
Vasoconstriction
36
Q

Substance abuse

Cocaine, maternal, fetal, neonate effects

A

-Abruptio placentae from vasospams-placental ishemia, reflex vasodilation and disruption of placental vaculature
-severe hypertension, pulmonary edema, fetal hypoxia, meconium staining, still birth
Neonate: CNS irritability, lethargy, poor response to interaction

37
Q

Substance abuse

Opioids

A

Morphine, heroin, methadone, hydromorphone, propoxyphen, oxycodone
Herioin produces severe physical dependence
CNS depressant
Dependence is discontinuing drug causes withdrawal symptoms (abstinence syndrome)

38
Q

Substance abuse

Opioids, maternal effects

A

poor appetite, poor absorption of nutrients
STI, hepatitis, HIV exposure from needle sharing
spontaneous abortion
Cardiac disease
Thrombosis

39
Q

Substance abuse

Opioids, fetal effects

A

hypoxia (deprived of adequate oxygen supply at the tissue level)
risk for meconium aspiration
fetal growth restriction
preterm labor, premature rupture of membranes, fetal distress, still birth

40
Q

Substance abuse

Opioids, neonatal effects

A 
abstinence syndrome
neurological and GI system signs
low birth weight
increase incidence of SID's
child neglect and abuse
41
Q

Substance abuse

Management

A

Methadone replacement to prevent withdrawal in pregnancy

Buprenorphine can be used in stead of methadone: less severe neonatal withdrawal

42
Q

Substand abuse

Neonatal Abstinence Syndrome (NAS)

A

neonates demonstraes signs of drug withdrawal
agitation, diarrhea, tremors, hypertonic muscle contraction, inconsolable crying, poor duck and swallow
*newborns must withdraw from methadone after birth

43
Q

Genetic disorders

A

First trimester screening:
Ultrasound test for fetal nuchal translucency (FNT) (fluid under the skin behind the fetal neck in the first-trimester)
Pregnancy associated plasma protein-A (PAPP-A)
Human chorionic gonadotropin (hCG)

44
Q

Screening tests

Maternal Assays

A

Maternal Assays

  • alpha fetoprotein
  • screening for nuerotube disorders and open ab wall defects
  • 80-85% detected early
  • recommended for all pregnant women
  • AFP (Alpha fetoprotein) is produced by the fetal liver and is detectable at 14-34 weeks
45
Q

Screening tests

Maternal serum quad test

A

Quad screen test is a maternal blood screning that looks for four specific substance: AFT, hCG, Estroil, Inhibin-A
performed 16-18 weeks, all should be offered test
Recommended for:
family history of birth defets
35 years or older
used harmful mediation or drugs during pregnancy
diabetes and use insulin
viral infection
exposed to high level of radiation

46
Q

Amniocentesis

how, when, why?

A 
ultrasound guided
to obtain amniotic fluid
contain fetal cells
after week 15-20 weeks
diagnosis of genetic disorders
congenital anomalies, neurotube
pulmonary maturity
fetal hemolytic disease
47
Q

Amniocentesis

Maternal complications

A

hemorrhage, fetomaternal hemorrhage with Rh isoimmunixation (RhoGAM if neg), infection, labor, abruptio placentae, inadvertent damage to intestines, bladder and amniotic fluid embolism
**mom report if having contractions, vag bleeding, leaking of fluid, fever

48
Q

Amniocentesis

Fetus complications

A

Death, hemorrhage, infection (amnionitis), direct injury from needle, miscarriage, preterm labor, leakage of fluid.

49
Q

Chorionic villus sampling

A

Removal of small tissue specimen from the fetal portion of the placenta
Transcervically
Transabdominally

50
Q

Chorionic villus sampling
advantages
disadvantage
complications

A 
Advantages:
earlier diagnosis: fetal chromosomal, metabolic or DNA dx. Rapid results
Disadvantage:
risk to the fetus
Complications:
vag spotting/bleeding
miscarriage
rupture of membranes
Chorioamnionitis (infection)
**Rh negative should receive immune globulin to avoid isoimmunization from fetomaternal hemorrhage (mixing of Rh neg and Rh pos
51
Q

PUD or Cordocentesis

A

PUD- Percutaneous umbilical blood sampling
fetal circulation during 2nd and 3rd trimester
fetal blood sampling
transfusion in severally anemic fetus

52
Q

PUD or Cordocentesis

testing for?

A

inherited blood disorders
Karyotyping of malformed fetus (detect chromosomal abnormalities)
detection of fetal infection
acid base status with IUGR (interutern growth restrictions
assess/treat isoimmunization and thrombocytopnia

53
Q

PUD or Cordocentesis

complications

A 
leaking fo blood
cord laceration
thromboembolism
preterm labor
premature rupture of membranes
infection
54
Q

PUD or Cordocentesis

nursing role

A

FHR monitoring for 1 hour

repeat ultrasound in 1 hour to ensure no bleeding or hematoma

55
Q

Biophysical profile

A

Noninvasive dynamic assessment, physical exam, vital signs
assessment of acute/chronic markers of disesae
fetus response to central hypoxia (acidosis) by alteration of movement, muscle tone, breathing, HR
Accurate indicator of impending fetal death
**combines fetal heart rate monitoring (nonstress test) and fetal ultrasound

56
Q

Biophysical profile scoring

A

An abnormal score and oligohydramninos (small amount of amniotic fluid) indicate labor should be induced
8-10 is reassuring
<4 is nonreassuring (labor should be induced)

57
Q

Nonstress test

A

most widely applied technique

  • noninvasive
  • takes 20-30 min
  • in healthy fetus with an intact CNS, 90% of gross fetal body movements are associated with FHR accelerations
  • **2 fetal heart increases within 20 sec period. 15bpm above baseline within 15 seconds
58
Q

Nonstress test, movement responses may be blunted by?

A 
hypoxia
acidosis
drugs (analgesics, barbiturates, B-blockers)
fetal sleep
congenital anomalies
59
Q

Nonstress test disadvantages

A

high rate of false positive results for nonreactivity as a result of fetal sleep cycles, chronic tobacco smoking, medications, fetal immaturity

60
Q

Nonstress test reactive and nonreactive tracings

A

Reactive: 2 or more fetal heart increases of 15bpm above baseline within 15 seconds over a 20 min period
normal baseline rate
moderate variability
Nonreactive: test does not meet criteria in 40 minutes

61
Q

Contraction stress test

A

To identify the jeopardized fetus that is stable at rest but evidence of compromise after stress

  • uterine contractions decrease uterine blood flow and placental perfusion
  • time consuming and expensive
  • invasive procedure if oxytocin stimulation is required
  • contraindicated in those at risk fo preterm labor, previous C-section, placenta previa
62
Q

Contraction stess test

A
  • Nipple stimulated contraction test- massaging nipples release of oxytocin. with adequate contractions, stop stimulus
  • Oxytocin stimulated- IV at low dose until 3 contractions within 10 min
  • Negative: no late deceleration observed with contractions (want negative)
  • Positive: repetitive lat decelerations
63
Q

TORCH stands for?

A 
Toxoplasmosis
Other
Rubella infection
Cytomegalovirus infection
Herpes simplex virus
64
Q

TORCH “T”

A

Toxoplasmosis
-carried in cats that hunt infected birds/mice, excreted in feces
-hand to mouth infection, ingesting raw meat from cattle/sheep grazing on contaminated fields, unwashed/unpeeled fruits/vegetables
->70% infants are asymptomatic
-perinatal mortality/morbidity (10-15% die)
-85% severe psychomotor problems or cognitive impairment by age 2-4
-50% visual problems by 1
Treatment: pyrimethamine and oral sulfadiazine and folic acid to prevent anemia

65
Q

TORCH “O”

A 
Gonorrhea
Hepatitis B
Syphilis
Varicella-zoster virus
Parvovirus B19
HIV
66
Q

TORCH “R”

A

Rubella infection aka German or 3 day measles
Risk: vaccination failures, lack of compliance, immigration of unimmunized
Postpartum:
Rubella titer and IgM and IgG
HI antibody titer <1:8 with little/no immunity
HI antibody titer >1:10-1:20 successfully imunized or had disease
IgM (recent infection) IgG (prior infection/vaccination) interpretation

67
Q

TORCH “R” Rubella vaccine: postpartum

A

Live attenuatd virus, not communicable, can breastfeed
Virus shed in urine/body fluids
DO NOT GIVE if mother/person in household is immune compromised
Made of duck eggs
Avoid pregnancy for 1 month
Infant born with rubella may culture positive for up to 18 months after birth
Should be isolated until pharyngeal/urine are free of virus

68
Q

TORCH “C”

A

Cytomegalovirus infection
-can lead to miscarriage, still birth, congenital illness
-asymptomatic at birth but may sensorineural hearing impairment/learning disabilities later
10% may have IUGR and microcephaly
Rash, jaundice, hepatosplenomegaly

69
Q

TORCH “H”

A

Herpes simplex virus
-transplacental infection
-contamination during passage through infected birth canal
-transmission from infected personnel/family
-organ involvement: liver, adrenal glands, lungs
-skin vesicles in 33%
sepsis symptoms in 1st or 2nd week of life
-25% death from CNS involvement, respiratory distress, pnemonititis, shock, bleeding

70
Q

TORCH “H” treatment

A 
Herpes Simplex Virus
standard precautions
inspect eyes, oral, skin for lesions
blood, urine and CSF cultured
circumcision delayed
breastfeed ok if no lesions
prophylactic eye ointment for 5 days
parenteral acyclovir for neonatal herpes

NUR 126 (23 decks)

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