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NURS 405 > Chapter 25: Complications of Pregnancy > Flashcards

Chapter 25: Complications of Pregnancy Flashcards

1
Q

What is an ectopic pregnancy?

A

Pregnancy that occurs anywhere outside of the uterus. (Uterus is the only organ meant to maintain pregnancy.

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2
Q

Where is the most common place that ectopic pregnancies take place?

A

Fallopian Tube

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3
Q

Ectopic pregnancies are the major cause of

A

Bleeding during the first half of pregnancy.

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4
Q

What can cause an ectopic pregnancy?

A
  • Blockage in Fallopian tube
  • Anything that causes scarring and blocks uterus: pelvic inflammation (anything with infection), recurrent STDs, assisted reproduction and reproductive/abdominal surgical procedures.
  • IUD’s
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5
Q

What are signs and symptoms of an ectopic pregnancy?

A
  • Unilateral side pain (in affected Fallopian tube)
  • Bleeding may be internal (mostly in abdomen)
  • Referred shoulder pain (bleeding in belly irritating diaphragm)
  • Dizziness/weakness/faint
  • Writhing
  • Overt vaginal bleeding (may or may not have)
  • Tachycardia and Hypotension if ruptured(could lead to hypovolemic shock)**
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6
Q

Which of the symptoms for ectopic pregnancies is the priority to address?

A

Dizziness -> sign of hemorrhage.

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7
Q

How is an ectopic pregnancy diagnosed?

A
  • Ultrasound: to determine where the pregnancy is.

- Urine pregnancy test HCG (is present but at lower levels than expected)

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8
Q

What labs should we get done on a patient with an ectopic pregnancy?

A

-STAT labs: type and screen (antibody screen, Rh), H&H and platelets

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9
Q

What drug is used for ectopic pregnancies?

A

Methotrexate (folic acid antagonist)

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10
Q

Methotrexate for Ectopic Pregnancies

A

Used to dissolve pregnancy in fallopian

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11
Q

Treatment for a woman with an ectopic pregnancy that has not ruptured

A
  • No rupture -> abortion -> before cutting them open -> Methotrexate (IM)
  • Don’t want to do surgery on them because that can cause more scar tissue.
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12
Q

Treatment for women with ectopic pregnancy that have ruptured

A
  • Needs to go to OR!
  • Because they are ruptured -> hemorrhage. Need to position in trandelenburg position.

*Not sure if they take methotrexate as well. LOOK UP

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13
Q

What is important for the patient with an ectopic pregnancy to know?

A

No sex
No alcohol
No folic acid

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14
Q

Nursing Interventions for patients with ectopic pregnancy

A
  • Position: get her on stretcher, lower head of bed
  • Labs: get blood drawn, check labs prior to type and cross
  • IV: start an IV, bigger the better gauge.
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15
Q

What is placenta previa?

A

Placenta over occipit of cervix/blocks delivery of baby.

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16
Q

What is important for the nurse to known about a patient with placenta previa?

A

Nothing should go in the vagina! Can cause rupture (no vaginal exam/oxytocin), only ultrasound.

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17
Q

What are risk factors for placenta previa?

A
  • Scar tissue (C-section, recurrent abortions)
  • No prenatal care
  • Drugs
  • AMA
  • Multiparas
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18
Q

What are maternal symptoms of placenta previa?

A

-Painless, bright red vaginal bleeding** (this can irritate the uterus which causes more contractions and further bleeding)

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19
Q

Fetal surveillance in baby’s with mothers that have placenta previa.

A
  • FHR
  • NST
  • BPP
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20
Q

What should the nurse anticipate when assessing FHR patterns in a baby whose mother has placenta previa?

A
  • Bradycardia
  • Late decelerations (d/t uteroplacental deficiency)
  • Minimal variability (d/t lack of perfusion)
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21
Q

Nursing assessment/monitoring in mothers with placenta previa

A
  • Maternal and fetal V/S
  • STAT labs: type and cross, fluids (will probably require blood products)
  • Monitor bleeding
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22
Q

What are nursing interventions for mothers with placenta previa?

A
  • Bethametasone corticosteroid (given with magnesium)

- Magnesium to quiet uterus. (However never give tocolytics to bleeders!!) This buys time for steroids to work.

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23
Q

Why is betamethasone used in treating placenta previa?

A

Increases rate of fetal lung maturity.

Look up more information on how!

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24
Q

What is the reason magnesium is used to treat placenta previa?

A

Is used for prophylaxis.
Neuro protection

*What does it do??

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25
Q

What drug should not be given to a patient with placenta previa?**

A

NO TERBUTALINE

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26
Q

What is abruptio placentas?

A

Very painful -> placenta is tearing off wall of uterus

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27
Q

What are risk factors for abruptio placentae?

A
  • Trauma
  • Infection
  • Drugs
  • Preeclampic patients
  • HTN (vasoconstrictors effect to placenta)
  • Tachysystole
  • “Blood cannon”
  • Smoking
  • Multigravida
  • Short umbilical cord
  • PROM
  • AMA
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28
Q

What are maternal symptoms of abruptio placentae?

A
  • Pain, severe abdominal pain**
  • Bradycardia
  • Crazy fast uterine contractions, tachysystole
  • Blood will be dark red if there is some
  • Rock hard uterus*
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29
Q

What FHR patterns should you anticipate in a baby with a mother that has abruptio placentae?

A

Minimal variability

Bradycardia

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30
Q

What are maternal-fetal risks in mothers with abruptio placentae?

A
  • Mothers have more contractions -> lots of pain and blood loss (possible hemorrhage -> hypovolemic shock)
  • Fetal death
  • Fetal prematurity d/t placenta ripping off.
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31
Q

What drugs would be given to treat abruptio placentae?

A
  • Magnesium (NOT TERBUTALINE d/t bleeding)

- Can’t give steroids … if its apart.

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32
Q

What are nonpharmacological interventions the nurse can use to treat patient with placenta previa?

A
  • Keep her on left side
  • IV bolus, blood transfusion
  • O2 mask if it is starting to separate (8-10 L)
  • Prepare for c-section if bleeding doesn’t stop. If preterm (steroids take 48-72 hours to work)
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33
Q

What are non-pharmacological interventions the nurse can use when caring of a patient with abruptio placentae?

A
  • Keep her on left side
  • Magnesium probably won’t work but is used for neuroprotection in this case.
  • Large bore IV (second line made for blood produce), maintain IV fluids
  • Type and cross (anticipate blood)
  • Prepare for c-section.
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34
Q

What is preeclampsia (PIH)?

A

Specific to obstetrics and only happens after 20 weeks**

Need definition.

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35
Q

What is the priority in patients with preeclampsia?

A
  • Keep safety seizures

- Maintain reassuring FHR (d/t decrease perfusion)

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36
Q

What are risk factors for preeclampsia?

A
  • First pregnancy
  • AMA
  • Anemia
  • Family hx of HTN
  • Obesity
  • DM
  • Multifetal
  • Placental products that predispose patient to HTN: can cause organ involvement
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37
Q

What are signs and symptoms of preeclampsia?

A
  • Visual Disturbances**
  • Headaches**
  • Epigastric pain (liver pain)** (DO NOT TOUCH KIDNEY OR LIVER)
  • Proteinuria (false positive with ruptured membranes)
  • BP
  • Edematous (hands/face)
  • V/S dyspnea
  • DTR (hyperrreflexive), may or may not have clonus
38
Q

What labs are done in patients with preeclampsia?

A
  • CBC (hemolysis and platelets)
  • Livers: ALT, AST
  • Kidney: BUN, creatinine, urine output, uric acid (looking for proteinuria**)
39
Q

Proteinuria in patients with preeclampsia

A

If >5g protein, will deliver mom in order to save kidneys.

40
Q

What patterns in FHR can be expected in a baby whose mother has preeclampsia?

A
  • Bradycardia d/t low blood volume.
  • Loss of variability
  • Late decelerations
41
Q

What BP incdicates mild preeclampsia?

A

> 140/90

42
Q

What BP indicates severe preeclampsia?

A

160>110

43
Q

What is used to treat mild preeclampsia?

A
  • BP medications if no other symptoms of liver enzymes or proteinuria (i.e hydralazine)
  • More rest
44
Q

What is used to treat severe preeclampsia?

A
  • Magnesium which is used to protect and prevent seizures! (CNS depressant -> quiets CNS -> decreases incidence of seizure)
  • Need to assess hourly.
45
Q

What should you assess in mild preeclampsia?

A

Check kick counts

46
Q

What should be expected in the baby with a mother who has severe preeclampsia?

A

Fetal variability is expected.

47
Q

What is a therapeutic level of magnesium when treating preeclampsia?

A

Therapeutic level is 4-8.

Make sure it doesn’t go above 7 (toxicity)

48
Q

What are nursing assessments for patients with preeclampsia?

A
  • Pulse ox at all times, respiratory assessment
  • Labs: CBC
  • Magnesium blood levels
  • DTR (assessed hourly)
  • If renal impairment: I&Os
49
Q

Nursing interventions when caring for patients with preeclampsia

A
  • Seizure precautions
  • Modified bed rest
  • Magnesium sulfate
  • IV
50
Q

How much magnesium sulfate is given to a patient with preeclampsia?

A

2-3g/hr (50ml/hr)

*Never want to give more than 125 mL!

51
Q

Magnesium Excretion

A

-Excreted through kidneys -> increased risk for toxicity if kidneys aren’t functioning properly (respiratory depression)

52
Q

What are interventions for magnesium toxicity?

A
  • Shut off magnesium
  • Continuous spO2, respiratory rate and lung sounds are taken (prone to pulmonary edema)
  • May be given lasix.
53
Q

What is an unintended benefit of magnesium sulfate in preeclampsia?

A

Has moderate vasodilator effect (not intended for BP so may need more meds to decrease BP).

54
Q

What is an antidote for magnesium toxicity?

A

Calcium gluconate????? Need to verify.

55
Q

Reduced variability in baby in a mother taking magnesium sulfate

A

Is OK.

Need to verify.

56
Q

Why is it important to know whether the patient has prepregnancy HTN or preeclampsia?

A

Because they are treated differently.

If not treated, there is a risk for stroke.

57
Q

Interventions for a patient having a seizure

A
  • Keep her on left side to prevent aspiration.
  • Pad side rails
  • Make sure equipment is present/working (suction)
  • Maintain airway -> give another bolus of magnesium sulfate
58
Q

HELLP Syndrome

A

Part of severe eclampsia.

Stands for hemolysis, elevated livers, low platelets** (can be indicative for high BP)

59
Q

HELLP Syndrome is treated like

A

Preeclampsia (I&O, magnesium, vision changes, etc.)

60
Q

What is a normal liver panel range?

A

30-40 is normal.

61
Q

What are symptoms of HELLP syndrome?

A

Referred shoulder pain d/t inflamed/enlarged liver.

*Check for more?

62
Q

What is the cure for HELLP syndrome?

A

Cure is delivery.

63
Q

What are maternal risks of preeclampsia?

A
  • If BP isn’t treated, STROKE!

* Check for more??

64
Q

What are fetal risks of preeclampsia?

A
  • Prematurity
  • Death in utero
  • IUGR

*Check for more???

65
Q

Rh Sensitization

A

If mom is Rh-, assume baby is Rh+

Mom is asymptomatic and starts to build antibodies against the baby.

66
Q

What are causes of Rh sensitization?

A
  • Maternal mixing of maternal/fetal blood (car accident, anything that jars uterus)
  • Amniocentesis
  • Placental complications
  • Bleeding
67
Q

What labs should be done in mothers with Rh sensitization?

A
  • Antibody screen (titer) (the higher the titer, the more sensitization)
  • Indirect Coombs test (antibodies on mom)
  • Direct Coombs test: once baby is born, blood is drawn.
68
Q

Direct Coombs Test

A

Tells you + if fetus is at risk for developing nonphysiologic jaundice.

69
Q

Why is the baby at an increased risk for jaundice if the mother is Rh sensitized?

A

Antibodies attack baby’s RBC -> hemolysis -> increase in bilirubin -> jaundice

70
Q

When are tests for Rh sensitization done?

A
  • On the very first visit prenatal to check for desensitization.
  • And another at 24-48 weeks. To check if blood has mixed or not.
71
Q

What can happen to the baby if the mother is Rh sensitized?

A

-Antibodies attack baby’s RBC -> sequella, hemolysis, fetal death in utero

72
Q

How is Rh sensitization prevented?

A

Rhogam

73
Q

Rhogam

A

preventative measure so mom doesn’t develop antibodies (if she already has a titer -> won’t work); administered with really long needle.

74
Q

When is Rhogam given?

A

Given anytime mother has a bleed (amino, car accident, etc.)

75
Q

How can Rh sensitization affect subsequent pregnancies?

A

Antibodies get worse and worse with each pregnancy.

76
Q

ABO Incompatibility

A

Mom is type O and baby is anything other than O; risk for incompatibility.

77
Q

ABO Incompatability is associated with

A

Contaminated food or infection process**

78
Q

What assessments are done to test for ABO incompatibility?

A
  • Blood drawn from cord to determine baby’s blood type when born.
  • Direct Coombs if baby is anything but type O.
79
Q

What are the fetal risks of ABO incompatibility?

A

-Risk for jaundice, kernicterus -> Encephalophia (too much bilirubin causes this)

80
Q

What are the differences between ABP incompatibility and Rh sensitization?

A
  • Risks are at a lesser degree than Rh sensitization.

- ABO incompatibility probably won’t affect subsequent pregnancies.

81
Q

What is considered an abortion?

A

a fetus of less than 20 weeks of gestation or one weighing less than 500 g is not viable.

82
Q

Marginal Placenta Previa

A

Placenta is implanted in lower uterus but it’s lower border is >3 cm from internal cervical os

83
Q

Partial Placenta Previa

A

Lower border of placenta is within 3 cm of interval cervical os but does not fully cover it.

84
Q

What causes proteinuria in preeclampsia?

A
  • Decreased renal perfusion reduces the glomerular filtration rate. Blood urea nitrogen, creatinine, and uric acid levels rise.
  • Reduced renal blood flow results in glomerular damage, allowing protein to leak across the glomerular membrane, which is normally impermeable to large protein molecules.
85
Q

What causes edema in preeclampsia?

A
  • Loss of protein from the kidneys reduces colloid osmotic pressure and allows fluid to shift to interstitial spaces.
  • This may result in edema and a reduction in intravascular volume, which causes increased viscosity of the blood and a rise in hematocrit level. Generalized edema often occurs.
86
Q

What causes epigastric pain in preeclampsia?

A
  • Reduced liver circulation impairs function and leads to hepatic edema and subcapsular hemorrhage, which can result in hemorrhagic necrosis.
  • This is manifested by elevation of liver enzymes in maternal serum.
87
Q

What causes visual disturbances and hyperactive DTR in preeclampsia?

A

Vasoconstriction of cerebral vessels leads to pressure-induced rupture of thin-walled capillaries, resulting in small cerebral hemorrhages.

88
Q

What can cause dyspnea in preeclampsia?

A

Decreased colloid oncotic pressure can lead to pulmonary capillary leak that results in pulmonary edema. Dyspnea is the primary symptom.

89
Q

Signs of impending seizures include the following:

A
  • Hyperreflexia, possibly accompanied by clonus
  • Increasing signs of cerebral irritability (headache, visual disturbances)
  • Epigastric or right upper quadrant pain, nausea, or vomiting
90
Q

In the presence of cerebral irritability, generalized seizures may be precipitated by excessive visual or auditory stimuli. Nurses should reduce external stimuli by doing the following:

A
  • Admit the woman to a room in the quietest section of the unit and keep the door to the room closed.
  • Pad the door to reduce noise when the door must be opened and closed.
  • Keep lights low and noise to a minimum. This may include blocking incoming telephone calls and turning the noises of the electronic monitors (fetal monitor, pulse oximeter, IV pump) as low as possible.
  • Group nursing assessments and care to allow the woman periods of undisturbed quiet.
  • Move carefully and calmly around the room and avoid bumping into the bed or startling the woman.
  • Collaborate with the woman and her family to restrict visitors.
91
Q

Signs of magnesium toxicity include the following:

A
  • Respiratory rate of less than 12 breaths per minute (hospitals may specify a rate of less than 14 breaths per minute)
  • Maternal pulse oximeter reading lower than 95%
  • Absence of DTRs
  • Sweating, flushing
  • Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
  • Hypotension
  • Serum magnesium value above the therapeutic range of 4 to 8 mg/dL
92
Q

The prominent symptom of HELLP syndrome is

A
  • Pain in the right upper quadrant, the lower right chest, or the mid-epigastric area.
  • There may also be tenderness because of liver distention.
  • Additional signs and symptoms include nausea, vomiting, and severe edema.

NURS 405 (17 decks)

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