Antepartum Complications Flashcards
(45 cards)
What are some pre gestational onsets that can put a pregnancy at risk?
DM
HIV
anemias
heart disease
What is the pathophysiology of GDM in 1st trimester?
decreased need for insulin b/c hormones enhance insulin production and tissue response to insulin
late in 1st and on: increased need for insulin b/c hormones act like insulin antagonists
glucose crosses fetal membrane, fetus produces own insulin
Maternal risks r/t GDM
polyhydramnios
preeclampsia-eclampsia
ketoacidosis
dystocia
increased susceptibility to infections
fetal/neonatal risks r/t DM
perinatal mortality
congenital anomalies
macrosomia
IUGR
RDS
polycythemia
hypoglycemia after delivery
hyperbilirubinemia
screening for DM in pregnancy
assess risk at first visit
low risk - screen at 24-28 weeks
high risk - screen ASAP
What result of a 1 hour glucose tolerance test requires further testing?
greater than 140 mg/dl
What result of a 3 hour glucose tolerance test diagnoses GDM?
if two levels are exceeded
What are the goals of DM treatment?
maintain a physiologic equilibrium of insulin availability and glucose utilization
ensure optimally healthy mother and newborn
What are the treatments for DM?
diet therapy and exercise
glucose monitoring
insulin therapy
goal: fasting - <95, 2hrs PP - <120
nursing management of DM - antepartal
assessment of glucose
nutrition counseling
education of process and manage
education of monitoring and admin
assessment of fetus
support
nursing management of DM - intrapartal
assessment of fetal and maternal status for timing of delivery
assessment of glucose
nursing management of DM - postpartal
assessment of glucose - maternal insulin requirements drop significantly
breastfeeding encouraged
What is iron deficiency anemia and tx during pregnancy?
inadequate iron intake
take supplemental iron
What is sickle cell anemia and tx during pregnancy?
recessive autosomal disease - sickling of RBCs when decreased O2 present
prevent crisis by treating with IVF, 02 antibiotics, folic acid, and analgesics
What is folic acid deficiency anemia and tx during pregnancy?
in the absence of folic acid, RBCs fail to divide - enlarged and fewer number. Fetal risk of neural tube defects.
take 400 mcg folic acid daily before pregnant, then 1mg folate during.
How much does treatment of HIV positive women in pregnancy reduce perinatal transmission?
1-2%
What are some things you can do if ordered for mother with HIV?
ZDV administration
elective cesarean delivery
bottle feed
examples of cardiac disorders in pregnancy
congenital heart disease
peripartum cardiomyopathy
Eisenmenger syndrome
mitral valve prolapse
What to monitor during pregnancy with cardiac disorders?
functional capacity, vital signs, cough, dyspnea, edema, murmur, palpitations, rales, weight gain
What factors to assess or that increase stress on heart?
anemia, infection, lack of support, home and career demands
What should activity, visits, and diet look like with cardiac?
restricted activities, 8-10hrs sleep, rest periods, avoid infection
visits every 2 weeks during first half, then every week
high iron, high protein, low sodium, adequate calories
How to manage cardiac disorders intrapartum?
asses vital signs and lung sounds
encourage side-lying/semi-fowlers
continuous support and EFM
oxygen, diuretics, sedatives, analgesics, prophylactic antibiotics, digitalis
pushing - shorter, moderate pushes
epidurals recommended
How to manage cardiac disorders postpartum?
asses VS and signs of cardiac decompensation
encourage side-lying/semi-fowlers
activity gradually increased
appropriate diet and stool softeners
educate signs of cardiac problems
What are some gestational onsets that cause a pregnancy to be at risk?
spontaneous abortion (miscarriage)
ectopic pregnancy
gestational trophoblastic disease
hyperemesis gravidarum
Rh alloimmunization
ABO incompatibility
