1: High Risk Pregnant Client Flashcards
(216 cards)
1
Q
High risk status extends
through puerperium for how many days?
A
30 days
2
Q
4 Divisions of Maternal Risk of Pregnancy and
Childbirth
A
- Pre-Existing Risk
- Risk Emerging During Pregnancy
- Risk of Labor and Delivery
- Risk of Postpartum
3
Q
Pre-Existing Risk
A
● Age
● Parity
● Social/environmental factors
● Marital status
4
Q
Risk Emerging During Pregnancy
A
● Anemia
● Antepartum hemorrhage
● Toxemia
● Transverse lie term
● Suspected cephalo-pelvic disproportion
5
Q
Risk of Labor and Delivery
A
● Premature rupture of membranes
● Transverse lie
● Prolonged obstructed labor
● Intra-partum bleeding from placenta previa and postpartum hemorrhage
6
Q
Risk of Postpartum
A
● Puerperal infection
● Hemorrhage
● Subinvolution
● Postoperative complication in the case of cesarean section
● Postpartal depression
7
Q
How to determine hemorrhage?
A
Pad counts (soaked, medium soaked, fully soaked)
Hemorrhage = every hour and fully soaked
8
Q
Categories of High Risk Pregnancy
A
- Biophysical Considerations
- Psychosocial Factors
- Sociodemographic Factors
9
Q
Biophysical Factors
A
- Genetic Considerations
- Nutritional Status
- Medical and Obstetric Disorder
10
Q
May interfere with normal fetal or neonatal development
Results in congenital anomalies or create difficulties for the mother
A
Genetic Considerations
11
Q
Genetic Considerations includes
A
● Multiple pregnancies
● Large fetal size
● Transmissible inherited disorders
12
Q
Conditions that influence nutritional status
A
● Young age
● Three pregnancies in the previous two years
● Inadequate dietary intake because of chronic illness or food fads
● Inadequate or excessive weight gain ;
● hematocrit value less than 33%
● Tobacco, alcohol, or drug use
13
Q
Medical And Obstetric Disorder: Preterm Labor
A
● Age younger than 16 or older than 35
● Low socioeconomic status
● Maternal weight below 50 kg
● Poor nutrition
● Previous preterm birth
● Smoking
● Drug addiction and alcohol use
● Pneumonia
● Multiple gestation
● Anemia
● Abnormal fetal presentation
14
Q
Medical And Obstetric Disorder: Polyhydramnios
A
● Diabetes Mellitus
● Multiple gestation
● Abnormal fetal presentation
● Infection
● Fetal congenital anomalies
15
Q
Medical And Obstetric Disorder: Intrauterine Growth Restriction
A
● Multiple gestation
● Poor Nutrition
● Preeclampsia
● Drug addiction and alcohol use
● Fetal infections
● Chronic hypertension
16
Q
Psychosocial Factors
A
- Smoking
- Caffeine
- Alcohol
- Psychologic Status
17
Q
Risk of Smoking
A
● Low birth weight infants
● Higher neonatal mortality rates
● Increased miscarriages
● Increased incidence of Premature Rupture of
Membrane (PROM)
18
Q
Vitamin K for babies
A
■ 0.05 if infant less than 2000 g
■ 0.1 if infant more than 2000 g
19
Q
High intake of caffeine (___________) has been related to ______________
A
3 or more cups each day
slight decrease in birth weight
20
Q
Adverse effects of alcohol on fetus
A
Fetal alcohol syndrome (FAS)
Learning disabilities
Hyperactivity
21
Q
Psychologic Status includes:
A
● Intrapsychic disturbances and addictive lifestyle
● Unsafe cultural, ethnic or religious practices
● Situational crises
22
Q
If near term and the fetus is still in breech position, mothers are advised to?
A
Transillumination
- put a flashlight on the symphysis pubis, and the baby would try to follow the light
23
Q
Sociodemographic Factors
A
- Low income
- Lack of prenatal care
- Age
- Residence
24
Q
Low income would lead to:
A
● Inadequate financial resources for food and prenatal care
● Poor general health
● Increased risk of medical complications of pregnancy
25
Lack of prenatal care includes:
● Failure to diagnose and treat complications early
● Lack of understanding of the need for early and continued care or cultural beliefs that do not support the need
26
True or False.
More complications are seen in **young mothers** (younger than 15 years old) who have 60% higher than those older than 20 year old
TRUE
27
What is considered too early for pregnancy?
- Age < 15 years
- less than 6 years after menarche
28
True or False.
Pregnancy at 50 years can be considered **normal** if the woman’s cycle is irregular and the woman had her menarche earlier than normal
FALSE
cycle is **regular**
menarche **later** than normal
29
Basis for menopause
Age when menarche occurred + 35 years = age for possible menopause
30
Medical conditions experienced by mature mothers
● Hypertension and preeclampsia
● Diabetes
● Extended labor
● Cesarean birth
● Placenta previa
● Mortality
31
True or False.
Women in metropolitan areas have more prenatal visits than those in rural areas who have fewer opportunities for prenatal check ups.
TRUE
32
Biophysical Antepartum Testing
1. Daily Fetal Movement Count (DFMC)
2. Non-stress Test (NST)
3. Contraction Stress Test (CST)
4. Ultrasonography
5. Transvaginal Ultrasound
6. Abdominal ultrasound
33
___________________ used to monitor the pregnancies in complications that
may affect fetal oxygenations. Also called "__________". Done after _____________ of gestation to identify potentially hypoxic fetuses. Refer it to the first time the mother feels a kick (quickening) as early as 20-24 weeks
Daily Fetal Movement Count
kick counts
28 weeks
34
Method for DFMC
1. Lie in the left recumbent position after a meal.
2. Record until 10 movements is counted
3. Record the time (this is usually an hour)
4. If an hour passes without 10 movements, walk around
a little and count again
5. If 10 movements can’t be felt for a second 1-hr period, inform the primary health care provider immediately
35
True or False.
A count fewer than three fetal movement within one hour normal. More than 10 movements in an hour is warrants evaluation.
FALSE
< 3 = warrants evaluation
> 10 = normal
36
True or False.
If mother has just eaten, 10 movements in 10 minutes. Movement of fetus is much faster after the mother has
eaten
TRUE
37
True or False.
If 10 movements has been recorded before an hour passes, the mother may stop counting
TRUE
38
**Painless procedure** during pregnancy to evaluate baby’s condition. The healthcare practitioner or a technician monitors baby’s heartbeat, first while the baby is resting and then while he’s moving.
Non-stress test
39
RESULT: ??
2 or more accelerations of 15 beats/min lasting 15 sec or more in 20 min period (associated with fetal movement)
High-risk pregnancy
allowed to continue if twice weekly NSTs are reactive
REACTIVE
40
RESULT: ?
No FHR acceleration, or accelerations less than 15 beats/min or lasting than 15 sec through fetal movement
Need to attempt
to clarify FHR pattern, implement CST and continue external monitoring
NON REACTIVE
41
RESULT: ?
FHR pattern not able to
be interpreted
Repeat NST or do CST
UNSATISFACTORY
42
The hormone oxytocin is given via the vein (intravenously, or IV) or nipple massage to cause labor contractions. This tells the body to release oxytocin.
Contraction Stress Test (CST)
43
True or False.
If the baby’s heart rate slows down (decelerates) in a certain pattern after a contraction instead of speeding up (accelerating), the baby may have problems with the stress of normal labor.
TRUE
44
Preparation for Contraction Stress Test
1. NPO for 4 to 8 hours
2. Empty the bladder
3. If the woman smokes, stop for 2 hours
4. The woman will be asked to sign a consent form before a
contraction stress test.
45
Result: ?
3 contractions, 40-60
sec long within 10-min period, no late decelerations.
Fetus should
tolerate labor if it
occurs within 1 week
NEGATIVE
46
Result: ?
Persistent/consistent
late decelerations
with more than 50%
of contractions
Fetus at increased
risk. May need additional testing. May try induction or CS
POSITIVE
47
Result: ?
Less decelerations in
less than 50% of
contractions
Repeat CST in 24
hours or other fetal
assessment tests
SUSPICIOUS
48
Result: ?
Inadequate pattern or poor tracing.
Repeat CST in 24 hours or other fetal assessment tests
UNSATISFACTORY
49
Ultrasonography provides critical information regarding:
● Fetal activity and gestational age
● Normal versus abnormal fetal growth curves
● Fetal and placental anatomy
● Fetal well being
50
Ultrasonography
(First Trimester)
1. Number, size, location of gestational sac
2. Presence or absence of fetal cardiac and body
movements
3. Presence or absence of uterine abnormalities
4. Date of pregnancy
51
Ultrasonography
(Second and Third Trimester)
1. Fetal viability, number, position, gestational age, growth pattern and abnormalities
2. Placental location and maturity
3. Uterine fibroids and anomalies
4. Adnexal masses (fallopian tube mass )
5. Cervical length
52
Generally performed in the first trimester for earlier visualization of the fetus. A sterile covered probe/transducer is inserted into the
vagina
Transvaginal Ultrasound
53
A full bladder is necessary to elevate the uterus out of the pelvis for better visualization when abdominal ultrasound is performed during the first half of pregnancy
Abdominal Ultrasound
54
Provides excellent pictures of soft tissues
Magnetic Resonance Imaging (MRI)
55
With MRI, the examiner can evaluate:
a. Fetal structure (CNS thorax, abdomen,
genitourinary tract, musculoskeletal system) and overall growth
b. Placenta (position)
c. Quantity of amniotic fluid
d. Maternal structures (uterus, cervix, adnexa, and pelvis)
e. Biochemical status of tissues and organs
f. Soft tissue, metabolic or functional anomalies
56
BIOCHEMICAL ASSESSMENT that is performed to obtain amniotic fluid which contains fetal cells to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down syndrome.
Amniocentesis
57
Amniocentesis Maternal Complications
● Labor
● Abrutio placenta
● Amniotic fluid embolism
● Inadvertent damage to the intestines and bladder
● Hemorrhage
● Infection
58
Amniocentesis Fetal Complication
● Death
● Hemorrhage
● Infection
● Direct injury from the needle
● Miscarriage or preterm labor
● Leakage of amniotic fluid
59
Pregestational Conditions
1. Anemia
2. Diabetes Mellitus
60
true anemia is present when hemoglobin concentration is:
● _________ (hematocrit is _________) in the 1st and 3rd
trimester
● _________ (hematocrit is _________) in the 2nd trimester
● <11 g/dl (hematocrit is <33%)
● <10.5 g/dl (hematocrit is <32%)
61
➔ drop in hematocrit in pregnancy
➔ plasma volume increased by 50%, whereas the red blood
cell count increases by 30%
Pseudoanemia
62
The most common anemia in pregnancy, complicating as
many as 15% to 25% of all pregnancies. Hemoglobin level is below 12 mg/dl (hematocrit is <33%). Confirmed by a corresponding low serum iron level
Iron Deficiency Anemia
63
Iron medication side effects
Constipation
Black tarry stool
64
Diuretic medication
Monitor electrolytes
65
Causes of Iron Deficiency Anemia
● Diet low in iron
● Heavy menstrual periods
● Weight-reducing programs
● Getting pregnant in less than 2 years before the current pregnancy
● Low socioeconomic level who have not had iron-rich diets
66
Assessment for Iron deficiency anemia
● Easy fatigability
● Pallor
● Exercise intolerance
● Dizziness
● Pica
● Laboratory findings
67
Effects of Anemia to Pregnancy
● Decrease resistance to infection
● Predispose to heavy bleeding during labor and puerperium
● Associated with prematurity and low birth weight infants
68
Iron deficiency anemia.
Take prenatal vitamins containing an iron supplement of
_______ elemental iron as prophylactic therapy during pregnancy
27 mg
69
Iron deficiency anemia.
Eat a diet high in ______________ (green leafy vegetables, meat)
iron and vitamins
70
Women who develop iron deficiency anemia will be prescribed therapeutic levels of medication (________________), usually in the form of ________________ or ________________.
120-200 mg
elemental iron per day
ferrous sulfate
ferrous gluconate
71
Advise women to take iron supplement with ______________________, which supplies ascorbic acid for easy absorption of iron. Indication of iron absorption is _____________________
orange juice or vitamin c supplement
black tarry stool
72
For constipation or gastric irritation - advise pregnant women to ___________________ and always take pills with ________. Choose ________________ instead of ascorbic acid as ascorbic acid causes hyperacidity.
increase roughage in the diet
food
sodium ascorbate
73
If iron deficiency anemia is severe and a woman has difficulty with iron therapy, intramuscular or intravenous _______________ can be prescribed. Iron can be taken with ________________________.
**Iron Dextran**
ice cream after or before sleeping
74
True or False.
Folic Acid Deficiency Anemia is seen in 1% to 5% of pregnancies.
TRUE
75
___________________ is necessary for the normal formation of RBC in the mother as well as being associated with preventing neural tube defects in the fetus
**Folic acid or Folacin**
76
Formation of large and **immature blood cells**
Folic Acid Deficiency Anemia
77
Folic Acid Deficiency Anemia occurs most often in:
1. **Multiple pregnancies** - because of the increased fetal demand
2. **Women with secondary hemolytic illness** - there is a rapid destruction and production of new RBC
3. **Women who are taking hydantoin** - an anticonvulsant agent that interferes with folate absorption (decrease absorption of folic acid)
4. **Women who have poor gastric absorption**, such as in those who have had a gastric bypass for morbid obesity
78
Diet high in folic acid:
● Beans and legumes
● Citrus fruits and juices
● Green leafy vegetables
● Pork
● Poultry
● Shellfish
● Wheat bran
79
An endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose level
DIABETES MELLITUS
80
A condition of abnormal glucose metabolism that arises during pregnancy
GESTATIONAL DIABETES (GDM)
81
True or False.
3 days after delivery, if the mother has GDM, her blood sugar should go back to normal.
FALSE
24 hours
82
Normal Glucose Homeostasis
(After meal)
1. carbohydrates metabolize into glucose
2. insulin will store glucose in the muscle (glycogen)
83
Normal Glucose Homeostasis
(After several hours had passed)
1. pancreas will release glucagon
2. breakdown of glycogen stores in glucose
3. returned into blood stream
84
Assessment of GDM
**Polyuria** (Frequent urination)
**Polyphagia** (excessive hunger/increased appetite)
**Polydipsia** (excessive thirst)
**Involuntary weight loss**
85
Risk factors of GDM:
● Obesity
● History of large babies (10 lbs or more)
● History of unexplained fetal or perinatal loss
● Family history of diabetes (one close relative or two
distant ones
● Member of a population with a high risk for diabetes (Native American, Hispanic, Asian)
86
Laboratory Assessment for GDM
● Urinalysis
● Fasting Blood Sugar (FBS)
● OGTT (Oral Glucose Tolerance Test)
87
Fasting plasma glucose of ____________________ meets the threshold for diagnosis of diabetes
200 mg/dl or above
88
Normal level of Fasting Blood Sugar (FBS)
80-100 mg/dl
89
A venous blood sample is taken for glucose determination 60 minutes later. If serum glucose level at 1 hour is more than 140 mg/dl, the woman is scheduled for a 100 g, 3-hour fasting glucose tolerance test; if less than 140 mg/dl, the doctor may not prescribe a 100 g tolerance test
50 g Oral Glucose Challenge Test
90
If two or more of the blood samples collected for this test are abnormal or the fasting
value is above 95 mg/dl, a diagnosis for diabetes diabetes is made.
100 g Glucose Tolerance Test
91
Oral Glucose Tolerance Test (OGTT) procedure:
1. Fasting for 8-12 hours
2. Blood is withdrawn to test fasting blood glucose level
3. Glucose drink
4. Blood sample are drawn for three times more with an interval of one hour each
92
Negative Maternal Health Outcomes of Diabetes Mellitus
● Greater increase in **cesarean delivery rates** - 22 to 30% for mothers with GDM and 17% for those without GDM
● Higher risk of **third or fourth-degree laceration** in women with GDM
● **Polyhydramnios** (an excess of amniotic fluid)
● **Pregnancy induced hypertension**
● Increased risk of **gestational diabetes** in subsequent pregnancies
● Possible increased risk for **preeclampsia**
93
True or False.
**Ophthalmic examination** should be done **once** during pregnancy for a woman with gestational diabetes and with **each trimester** for women with known diabetes. Retinal changes such as **increased exudate** (this appears as **“cloud-like”** finding obscuring a retinal vessel) is experienced.
TRUE
94
True or False.
Urine culture may be done each trimester to detect asymptomatic UTI as the increased glucose concentration in urine leads to infection.
TRUE
95
True or False.
A **1800 to 2,400 calorie diet** (or one calculated at 30 Kcal per kg of ideal weight), divider into **three meals** and **three snacks** as usual regimen for a woman with gestational diabetes
TRUE
96
True or False.
Her diet should include a **increased** amount of **saturated fats** and **cholesterol** and an **reduced** amount of **dietary fiber**
FALSE
reduced
increased
97
Therapeutic management of GDM.
usually a short-acting (regular) combined with intermediate type
Insulin
98
Weight gain during pregnancy if the pregnant woman has GDM
24 lbs or 10-11kg
99
Insulin Therapy.
Early in pregnancy, a woman with diabetes may need ______ insulin. Insulin requirement is highest during _________________.
less
third trimester
100
___________________ are contraindicated to insulin therapy
Oral hypoglycemics
101
The insulin choice during pregnancy. 2/3 in
the morning, 1/3 at dinner administered SQ 30 minutes before meals.
Humulin
102
Sites for insulin injection
upper thigh, outer arm and abdominal
103
True or False.
Insulin is adjusted to keep a fasting blood glucose level below 95-100 mg/dl and a 2-hour post-prandial level below 120 mg/dl
TRUE
104
Does stress increases blood glucose levels?
YES
105
_____________ is recommended because it has a potential of provoking a lesser antibody response than a beef or pork insulin
Human insulin
106
Maintain a ________________________, to maintain as consistent a level of absorption as possible
consistent rotating injection routine
107
A fasting blood glucose level below ____________ and a 2-hour postprandial level below __________ are well-adjusted values.
95-100 mg/dl
120 mg/dl
108
An automatic pump about the size of an mp3 player. A syringe of regular insulin is placed in the pump chamber and a small gauge needle is attached to a length of a thin polyethylene tubing and implanted into the subcutaneous tissue of a woman’s abdomen or
thigh.
Insulin Pump Therapy
109
According to Jovanovic (2001) “the blood glucose level at _________ after the beginning of the meal is the best predictor of subsequent ___________________. The recommended level should be less than ______________ one hour postprandial (after meal).”
one hour
fetal macrosomia
120 mg/dl
110
True or False.
Exercise increases **insulin sensitivity**. Daily exercise benefits the mother and fetus. Encourage daily exercise unless other contraindications exist.
TRUE
111
________________________ maybe ordered each month. A normal creatinine suggests that the woman’s vascular system is intact because kidney function is normal.
Creatinine Clearance Test
112
Inability to meet major role obligations, an increase in legal problems or risk-taking behavior because of an addicting substance
Substance Abuse in Pregnancy
113
True or False.
Illicit drugs readily cross the placenta
TRUE
114
Symptoms of Substance Abuse
➔ Loss of control over use of the substance
➔ Continued use of the substance despite adverse maternal/fetal consequences:
○ Poor nutrition/weight gain
○ Anemia
○ Predisposition to infection
○ Pregnancy-induced hypertension (PIH)
○ Fetal defects/Intrauterine Growth Restriction (IUGR)
○ Fetal alcohol syndrome (FAS)
➔ The drugs most often abused are alcohol, cocaine (crack), heroin, methamphetamine, barbiturates, marijuana, and phencyclidine (PCP)
115
A rock type of methamphetamine that is smoked. Can produce high levels of drug in the maternal circulation
Common name: ?
Amphetamines
Ice
116
Amphetamines.
Women develop ____________________ teeth
blackened and infected
117
Amphetamines effect on newborns
**Jitteriness and poor feeding** at birth may
be growth restricted
118
This drug produce tachycardia and sense of well-being. Obtained from __________, ___________
Marijuana and Hashish
hemp plant, cannabis
119
Some women use marijuana to counteract _________ in early pregnancy
nausea
120
Frequent users of marijuana and hashish may not be able to
____________ because of ____________________ from excretion of the drug to the milk
breastfeed
reduced milk production
121
An animal tranquilizer that is frequently used as a street drug in polydrug abuse. It has potential for causing _______________________. Tend to leave maternal **circulation and concentrate in fetal cells**, it maybe particularly injurious to the fetus.
Phencyclidine (PCP)
long term hallucinations
122
Used for treatment of pain (___________) or meperidine (_________) and cough suppression. Widely abused because of their potent analgesic and euphoric effect
Narcotic Agonist
Morphine
Demerol
123
Abuse to this drug can result:
➢ Severe **withdrawal symptoms** in the infant after birth
➢ **Gestational hypertension** and— because the substance is often injected with shared needles— **phlebitis, subacute bacterial endocarditis, and hepatitis B and HIV infection** may occur
HEROIN
124
Infant of **opiate-abusing** women:
➢ Small gestational age
➢ Has an increased incidence of fetal and
meconium aspiration
➢ Fetal liver may mature faster than usual
➢ Can seem better able to cope with bilirubin at
birth than other babies
➢ Fetal lung tissue also appears mature more
rapidly than in other infants, apparently from the stress of the intrauterine substance exposure
125
Refers to the “sniffing” or “huffing” of aerosol drugs. Effects of this drug are similar to alcohol abuse
Inhalants
126
Frequently abused substances (Inhalants) includes:
➢ Airplane glue
➢ Cooking sprays
➢ Computer keyboard cleaner
127
Inhalants contain ________ as a **propellant**, which can lead to severe respiratory and cardiac irregularities. The respiratory depression they can cause could be enough to limit fetal oxygen supply to a serious level
freon
128
Physical s/sx of drug abuse
● Slow weight gain
● Unexplained fluctuations in BP and heart rate
● Sleep pattern maybe altered
● There maybe needle marks at different parts of the body
129
Psychological s/sx of drug abuse
● Euphoria to depression can be seen
● Rapid mood swings, paranoia, and panic attacks
● For narcotics, there can be lethargy, stupor and coma.
130
Ways on how to help the woman stop using the substance
1. If the woman is an occasional user, the intervention is making the available information of the effects of the substance to herself and the fetus
2. Motivate the woman to make lifestyle changes
3. When there is a need to assist a woman in seeking treatment, the help of other professionals is sought
131
An inflammatory connective tissue disease which may develop in untreated group A B-hemolytic streptococcal infections
Rheumatic fever
132
Rheumatic Fever can involve:
○ Heart
○ Joints
○ CNS
○ Subcutaneous tissue
133
True or False.
Rheumatic disease results when recurrent inflammation from the bouts of rheumatic fever causes scarring formation in the valves.
TRUE
134
Failure of the valve to open completely
Stenosis
135
Failure of the valve to close completely or a combination of both thereby increasing the workload of the heart
Regurgitation
136
How many classifications of functional capacity of patient with cardiac disease?
4 Classes:
Class I
Class II
Class III
Class IV
137
Classification of functional capacity of patient with cardiac disease.
○ Asymptomatic
○ no limitation of physical activity
Class I
138
Classification of functional capacity of patient with cardiac disease.
○ marked limitation of physical activity
○ comfortable at rest but symptomatic during less than ordinary
Class III
139
Classification of functional capacity of patient with cardiac disease.
○ slight limitation of physical activity
○ asymptomatic at rest
○ symptoms occur with ordinary physical activity
Class II
140
Classification of functional capacity of patient with cardiac disease.
○ inability to carry on any physical activity without discomfort
○ discomfort increases with any physical activity
Class IV
141
Rheumatic Fever.
Antepartal Nursing Care
1. The woman and her family should thoroughly
understand her condition
2. The nurse explains the purposes of the dietary and activity changes that are required
3. During the 1st half of the pregnancy, the woman is seen every two weeks to assess cardiac status
142
Rheumatic Fever.
Intrapartum Nursing Care
1. The nurse should evaluate maternal vital signs frequently determine a woman’s response to labor
2. A semi fowler's or side lying position with her shoulder elevated is assumed
3. Continuous fetal electronic monitoring is used to provide ongoing assessment of the fetal response to labor
143
Rheumatic Fever.
Postpartum Nursing Care
1. The woman remains in the hospital longer than the low-risk woman
2. The nurse gives to the woman an opportunity to discuss her birth experience and help her deal with any feelings of concern that distress her
3. The nurse should ensure that the woman and her family understands signs of possible problems from her heart disease or other postpartum complications
144
Sometimes called **pernicious or persistent vomiting**. A relatively rare condition of **excessive vomiting** during pregnancy. Usually begins in the __________________ of pregnancy
Hyperemesis Gravidarum
first 10 weeks
145
True or False.
Hyperemesis Gravidarum.
The cause is unknown, but women with the disorder may have increased thyroid function because of the thyroid-stimulating properties of hCG
TRUE
146
In most normal pregnancies with hCG levels below 1200 mIU/mL, the hCG usually doubles every _______________ and increases by at least _____ every __________
48 to 72 hours
60%
two days
147
Hyperemesis Gravidarum is associated with:
○ Nulliparous women
○ have increased body weight
○ have a history of migraine
○ are pregnant with twins or H mole
148
Clinical Manifestations of Hyperemesis Gravidarum
● significant weight loss and dehydration
● decreased blood pressure
● increased pulse rate
● Poor skin turgor
● frequently unable to keep down clear liquids taken by mouth
● Laboratory test may reveal electrolyte imbalance
● Urine may test positive for ketones
● Unusual stress, emotional immaturity, passivity, or ambivalence about the pregnancy
149
Rheumatic Fever.
_____________is used if the client is thirsty
Ice chips
150
Rheumatic Fever.
_____________________ may cause problems with cardiac contractility
Electrolyte imbalances
151
Possible causes of Rheumatic Fever
● increasing levels of estrogen
● High hCG levels
● Transient maternal hyperthyroidism
● Stress
● Interrelated psychosocial components
● Gastric dysrhythmias
152
Factors related to current pregnancy that make a woman more likely to develop Rheumatic Fever
● Carrying a female fetus
● Multifetal gestation
● Gestational trophoblastic disease
● Maternal family history of hyperemesis
153
Rheumatic Fever.
Severe but rare maternal complications
● Esophageal rupture
● Pneumomediastinum
● Deficiencies of vitamin K and thiamine with resulting Wernicke encephalopathy
154
Rheumatic Fever.
Laboratory tests that may be ordered
urinalysis, CBC,
electrolytes, bilirubin levels, and liver enzymes
155
True or False.
She should be kept on **NPO** status until **dehydration** has been **resolved** and for **at least 48 hours after vomiting has stopped** to prevent rapid recurrence of the problem.
TRUE
156
Medications given if nausea and vomiting are uncontrolled
1. Pyridoxine (B6) alone or in combination with doxylamine (Unisom) - Antacids
2. Promethazine (Phenergan) - Antiemetic
3. Metoclopramide (Reglan) - Antiemetic
157
Refers to the **premature dilation** of the cervix, usually in the fourth or fifth month. Associated with repeated second – trimester abortions.
Incompetent Cervix
158
Which statements are correct?
- An incompetent cervix means that it **opens too early** because of the** pressure exerted by the growing fetus**.
-An incompetent cervix can be treated by **stitching the cervix** close to her in the second trimester or by **bed rest** for the last several months of pregnancy
BOTH are CORRECT
159
Possible causes of Incompetent cervix
● cervical trauma
● infection
● increase uterine volume
● congenital cervical or uterine anomalies
160
Procedure which reinforces the weakened cervix by encircling at the level of the internal with suture material.
McDonald's Procedure
161
Discharge goals of Incompetent Cervix
1. client/little condition stable following procedure
2. uterine contractions absent
3. therapeutic needs and concerns
162
Majority of spontaneous abortion and related to
________________________
chromosomal abnormalities
163
Classifications of abortion
1. Threatened abortion (threatened spontaneous
miscarriage)
2. Imminent abortion
3. Complete Abortion
4. Missed Abortion
5. Recurrent pregnancy loss
6. Septic abortion
164
Threatened abortion (threatened spontaneous
miscarriage)
● Embryo or fetus is jeopardized by unexplained bleeding,
cramping, and backache
● Cervix is closed
● Bleeding may persist for days
● Maybe followed by partial or complete expulsion of the embryo or fetus, placenta, and membranes.
165
Imminent abortion
● Bleeding and cramping increase
● Internal cervical OS dilates
● Membranes may rupture
166
Complete Abortion
● All products of conceptions are expelled (fetus, membranes, & placenta).
167
Missed Abortion
The fetus dies in utero but was not expelled. Uterine growth ceases, breast changes regress and the woman may report a brownish vaginal discharge.
168
Recurrent pregnancy loss
● Formerly called **habitual abortion**
● Abortion occurs consecutively in three or more pregnancies.
169
Septic Abortion
● presence of infection may occur with prolonged:
○ unrecognized rupture of the membrane
○ pregnancy with intrauterine device (IUD) in utero
○ attempts of unqualified individuals to terminate a pregnancy
170
___________ and ___________ are one of the more reliable indicators of spontaneous abortion
Pelvic cramping and backache
171
If bleeding persists and abortion is imminent or
incomplete, the woman may be hospitalized, _______________ or ________________ may be started to replace fluid, and ______ (___________________) or ____________________ is performed to remove the remainder of the products of conception.
IV therapy
blood transfusion
D&C (Dilatation & Curettage)
suction evacuation
172
True or False.
If the products of conception are not expelled within 4-6 weeks after embryo or fetal death, hospitalization is necessary
TRUE
173
placenta is implanted in the lower uterine segment rather than the upper portion of the uterus. Statistically occurs in 4 per 100 births and approximately 5 per 1,000 pregnancies.
Placenta Previa
174
Factors associated with Placenta Previa
● Multiparity
● Increasing age
● A large placenta
● Smoking and cocaine in pregnancy
● Previous CS or abortion
● Male fetus
175
Categories or Degrees of Placenta Previa.
Internal OS is completely covered
Total or Complete
176
Categories or Degrees of Placenta Previa.
Internal OS is partially covered
Partial
177
Categories or Degrees of Placenta Previa.
Edge of the internal OS is covered
Marginal
178
Categories or Degrees of Placenta Previa.
Placenta is implanted in the lower uterine segment in close proximity but not covering the OS
Low-lying
179
Care of woman with late gestational bleeding depends on:
1. Week of gestation during which the first bleed episodes occur.
2. Amount of bleeding.
3. If pregnancy is less than 37 weeks, expectant mother is to delay the birth until about 37 weeks gestation to allow the fetus to mature; mother is in complete bed rest
180
Premature separation of a normally implanted
placenta from the uterine wall. Occurs in approximately 1 in 100 births and occurs more
frequently in pregnancies complicated by hypertension and cocaine abuse
Abruptio Placenta
181
Abruptio Placenta.
Contributing Factors
● multiple gestation pregnancy
● maternal hypertension
● Cigarette smoking
● alcohol ingestion
● increased maternal age and parity
● trauma
182
Types of Abruptio Placenta
Marginal
Central
Complete
183
Type of Abruptio Placenta.
The placenta separates at its edges, the blood passes between the fetal membranes and the uterine wall, and the blood escapes vaginally. Also called ____________________
Marginal abruption
marginal sinus rupture
184
Type of Abruptio Placenta.
The placenta separates centrally and the blood is trapped between the placenta and the uterine wall. Entrapment of the blood results in concealed bleeding.
Central Abruption
185
Massive vaginal bleeding is seen in the presence of total separation.
Complete Abruption
186
Classic signs of and symptoms of placental abruption include:
● Vaginal bleeding
● Abdominal pain
● Back pain
● Uterine tenderness
● Rapid uterine contractions, often coming one right after another
187
The rupture of the amniotic sac and leakage of amniotic fluid beginning at least 1 hour before the onset of labor at any gestational age. If membranes rupture before **37 weeks** of gestation.
Premature Rupture of Membranes (PROM)
188
S/Sx before rupture
Abdominal Pain
Amenorrhea
Abdominal tenderness
Abnormal Vaginal Bleeding
189
True or False.
PROM.
Abdominal pain occurs close to 100% of the time. It is usually first manifested by a pain caused by tubal stretching followed by a sharp colicky tubal pain caused by further tubal stretching and stimulated contractions. It is diffuse and is bilateral or unilateral
TRUE
190
A history of a late period for approximately 2 weeks or a higher than usual or irregular period is reported by 75% to 90% of the patients.
Amenorrhea
191
True or False.
Abdominal tenderness occurs in approximately 95% of the cases of PROM
TRUE
192
S/Sx after rupture
● Faintness or Dizziness
○ Occurs in the presence of significant bleeding
● Abdominal Pain
○ Pain is caused by blood irritating the peritoneum
● Signs of Shock
○ It is related to the severity of the bleeding into the abdomen
193
One in which implantation occurs outside the uterine cavity. The most common site (in approximately 95% of such pregnancies) is the ________________.
Ectopic Pregnancy
fallopian tube
194
Causes of Ectopic pregnancy
● Adhesion of the fallopian tube from previous infection (chronic salpingitis or PID) tubal
● Congenital malformations
● Scars from surgery
● Uterine tumor pressing on the proximal end of the tube
195
True or False.
Ectopic Pregnancy.
Shoulder pain while lying down is a red flag for ruptured ectopic pregnancy
TRUE
196
An unruptured ectopic pregnancy is usually treated with ___________, a folic acid antagonist chemotherapeutic
agent, which attacks and destroys fast growing cells. Women are treated until a negative hCG titer is achieved.
methotrexate
197
An abortifacient, effective at causing sloughing of the tubal implantation site
Mifepristone
198
Therapy for ruptured ectopic pregnancy
Laparoscopy
199
A rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD)
Gestational Trophoblastic Disease (Hydatidiform Mole: H-mole)
200
True or False.
H-moles are malignant
FALSE
Typically h-moles are deemed benign, they are premalignant and have the potential to become malignant and invasive
201
H-moles occurs in women:
- low protein intake
- older than 35 years of age
- Asian heritage
- Blood group A woman who married blood group O men
202
Two types of Molar growth
Complete mole
Partial mole
203
Type of molar growth that has an abnormal placenta and no fetus
Complete Mole
204
A type of molar growth that has an abnormal placenta and some fetal development
Partial Mole
205
S/Sx of H-mole
● Abnormal growth of the womb (uterus)
● Nausea and vomiting
● Vaginal bleeding in pregnancy during the first 3 months of pregnancy
● Lack of fetal movement
● Increased human chorionic gonadotropin level (hCG level)
206
207
The most common medical complication of pregnancy. A significant contributor to maternal and perinatal morbidity and mortality.
Pregnancy Induced Hypertension (PIH)
Hypertension (HPN)
208
An elevated blood pressure **(140/90 mmHg)** but has no
proteinuria or edema.
Gestational HPN
209
A woman is said to be mildly preeclamptic when her blood pressure rises to _____________, taken on two occasions at least six (6) hours apart. In addition to hypertension, there is _____________.
140/90 mmHg
proteinuria
210
In severe preeclampsia, blood pressure has risen to ________________or above on at least two occasions 6 hours apart at bed rest.
160 mmHg systolic and 110 mmHg diastolic
211
In severe preeclampsia, The woman may manifest ________ (altered renal function
= _____________ urine output in 24 hours), elevated serum creatinine (more than __________); cerebral or
visual disturbances (headache, blurred vision); thrombocytopenia, and epigastric pain. (normal urine output: __________)
oliguria
500 ml or less
1.2 mg/dL
30 cc/hr
212
Diet for Eclampsia
High protein
high carbohydrate
moderate salt
213
medication to prevent edema
Diuretics
214
Medication that increases the force of contraction of the heart thereby decreasing the heart rate
Digitalis
215
Medication to prevent hypokalemia
NaCl
216
Medication, an anticonvulsant, injected intramuscularly into the mother (10 cc). Is a tocolytic, to prevent seizure
Magnesium Sulfate
