Care Of The Obstetric Pt

Question 1

What are the changes to the heart rate of a pregnant pt?

Answer 1

Increased heart rate

Question 2

What are the changes in cardiac output in a pregnant pt?

Answer 2

Pt needs to go to the loo more

Can lead to heart failure

Question 3

What are the changes caused by the uterine blood flow for a pregnant pt?

Answer 3

Baby takes 10% of cardiac output

Can lead to rapid haemorrhage

Question 4

What do you do when a pregnant pt has a cardiac arrest?

Answer 4

Don’t lay the pt in her side
Tilt, lay on side or push bump to left
You have 4 mins to get baby out
Only have 30 secs to intubate before the pt becomes hypoxic

Question 5

What are the direct causes of death related to pregnancy?

Answer 5

Pre-eclampsia

Haemorrhage

Question 6

What are the indirect causes of death?

Answer 6

Other conditions not related to pregnancy

Question 7

What are the ECG changes in a pregnant pt?

Answer 7

The heart shifts and the apex is tilted to the left = inverted T wave

Question 8

What are the blood changes in a pregnant women?

Answer 8

They differ in every trimester

Question 9

What are the 4 specific conditions to be aware of?

Answer 9

1. Pre eclampsia
2. Post partum haemorrhage
3. Sepsis
4. Cardiac

Question 10

What does pre eclampsia cause?

Answer 10

Increased BP and protein urea (if systolic is >150, give antihypotensives)
Kidneys shut down
Subarachnoid stroke
Factor is released from placenta due to the placenta not getting enough blood
Endothelium cell damage causing an increase in inflammation and clotting
Fluid shift causing moon face
Hypovolaemia

Question 11

What are the symptoms of pre-eclampsia?

Answer 11

Brain vasospasms (headaches that aren't stopped by analgesia, seeing things, seizures)
Liver hypoxia/damage (ruptured liver, swelling, pain)

Question 12

What are the complications of pre-eclampsia?

Answer 12

Eclampsia (fitting)

Question 13

What are the fetal complications of pre-eclampsia?

Answer 13

Low fluid around baby

Preterm birth

Question 14

What are nursing care and awareness for pre eclampsia?

Answer 14

Headaches
Flashing lights
Increased BP
Protein urea in dipstick test

Question 15

What are the 2 causes of postpartum haemorrhage?

Answer 15

Tone - uterus not contracting down

Trauma - peritoneal trauma, vaginal wall trauma

Question 16

What is the treatment for postpartum haemorrhage?

Answer 16

Uterine tamponade

Question 17

What is the treatment for per eclampsia?

Answer 17

Early delivery is not a cure as the women will still have the hormones in her body for 24-48 hrs post delivery

Question 18

How do pregnant pt prevent genital tract sepsis?

Answer 18

They need to wash their hands before touching any tears

Question 19

What should pregnant pts do if they develop d+v?

Answer 19

They need to be seen within 24 hrs of onset

Question 20

What are the 3 stages of birth?

Answer 20

1st stage: dilation 10cm
2nd stage: delivery
3rd stage: delivery of the placenta and management of bleeding

Question 21

What are the cardiac issues during the 3rd stage of birth?

Answer 21

Increased cardiac output leading to increased chance of bleeding

Question 22

What is important remember about diabetes and a pregnant pt?

Answer 22

Women become naturally resistant to insulin so that the baby gets glucose
Can develop gestational diabetes
Will lose signs of having a hypo
Doubles risk of miscarriage
Baby sometimes makes more glucose

Question 23

What is important to remember about pregnant women and asthma?

Answer 23

The severest stage is at 29-36 weeks (progesterone peak)
They need to continue drugs as normal
Key is to
Manage symptoms

Question 24

What is important to remember about pregnant pts and sickle cell?

Answer 24

The pts may not recognise the symptoms
Can be forced into having a crisis
Ripping, nawing pain
Avoid pethidine - give diamorphine

Question 25

What should you do if you have any problems with a pregnant pt?

Answer 25

Call the obstetrics team asap!!!!

Question 26

What are the changes in plasma volume in a pregnant pt?

Answer 26

Haemadilation
Increase in clotting factors
Protective
Reduced O2 carrying capacity