Chapter 25: Complications of Pregnancy Flashcards
(92 cards)
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.
2
Q
Where is the most common place that ectopic pregnancies take place?
A
Fallopian Tube
3
Q
Ectopic pregnancies are the major cause of
A
Bleeding during the first half of pregnancy.
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
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)**
6
Q
Which of the symptoms for ectopic pregnancies is the priority to address?
A
Dizziness -> sign of hemorrhage.
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)
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
9
Q
What drug is used for ectopic pregnancies?
A
Methotrexate (folic acid antagonist)
10
Q
Methotrexate for Ectopic Pregnancies
A
Used to dissolve pregnancy in fallopian
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.
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
13
Q
What is important for the patient with an ectopic pregnancy to know?
A
No sex
No alcohol
No folic acid
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.
15
Q
What is placenta previa?
A
Placenta over occipit of cervix/blocks delivery of baby.
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.
17
Q
What are risk factors for placenta previa?
A
- Scar tissue (C-section, recurrent abortions)
- No prenatal care
- Drugs
- AMA
- Multiparas
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)
19
Q
Fetal surveillance in baby’s with mothers that have placenta previa.
A
- FHR
- NST
- BPP
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)
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
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.
23
Q
Why is betamethasone used in treating placenta previa?
A
Increases rate of fetal lung maturity.
Look up more information on how!
24
Q
What is the reason magnesium is used to treat placenta previa?
A
Is used for prophylaxis.
Neuro protection
*What does it do??
25
What drug should not be given to a patient with placenta previa?**
NO TERBUTALINE
26
What is abruptio placentas?
Very painful -> placenta is tearing off wall of uterus
27
What are risk factors for abruptio placentae?
- Trauma
- Infection
- Drugs
- Preeclampic patients
- HTN (vasoconstrictors effect to placenta)
- Tachysystole
- “Blood cannon”
- Smoking
- Multigravida
- Short umbilical cord
- PROM
- AMA
28
What are maternal symptoms of abruptio placentae?
- Pain, severe abdominal pain**
- Bradycardia
- Crazy fast uterine contractions, tachysystole
- Blood will be dark red if there is some
- Rock hard uterus*
29
What FHR patterns should you anticipate in a baby with a mother that has abruptio placentae?
Minimal variability
| Bradycardia
30
What are maternal-fetal risks in mothers with abruptio placentae?
- Mothers have more contractions -> lots of pain and blood loss (possible hemorrhage -> hypovolemic shock)
- Fetal death
- Fetal prematurity d/t placenta ripping off.
31
What drugs would be given to treat abruptio placentae?
- Magnesium (NOT TERBUTALINE d/t bleeding)
| - Can’t give steroids ... if its apart.
32
What are nonpharmacological interventions the nurse can use to treat patient with placenta previa?
- 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)
33
What are non-pharmacological interventions the nurse can use when caring of a patient with abruptio placentae?
- 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.
34
What is preeclampsia (PIH)?
Specific to obstetrics and only happens after 20 weeks**
Need definition.
35
What is the priority in patients with preeclampsia?
- Keep safety seizures
| - Maintain reassuring FHR (d/t decrease perfusion)
36
What are risk factors for preeclampsia?
- First pregnancy
- AMA
- Anemia
- Family hx of HTN
- Obesity
- DM
- Multifetal
- Placental products that predispose patient to HTN: can cause organ involvement
37
What are signs and symptoms of preeclampsia?
- 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
What labs are done in patients with preeclampsia?
- CBC (hemolysis and platelets)
- Livers: ALT, AST
- Kidney: BUN, creatinine, urine output, uric acid (looking for proteinuria**)
39
Proteinuria in patients with preeclampsia
If >5g protein, will deliver mom in order to save kidneys.
40
What patterns in FHR can be expected in a baby whose mother has preeclampsia?
- Bradycardia d/t low blood volume.
- Loss of variability
- Late decelerations
41
What BP incdicates mild preeclampsia?
>140/90
42
What BP indicates severe preeclampsia?
160>110
43
What is used to treat mild preeclampsia?
- BP medications if no other symptoms of liver enzymes or proteinuria (i.e hydralazine)
- More rest
44
What is used to treat severe preeclampsia?
- Magnesium which is used to protect and prevent seizures! (CNS depressant -> quiets CNS -> decreases incidence of seizure)
- Need to assess hourly.
45
What should you assess in mild preeclampsia?
Check kick counts
46
What should be expected in the baby with a mother who has severe preeclampsia?
Fetal variability is expected.
47
What is a therapeutic level of magnesium when treating preeclampsia?
Therapeutic level is 4-8.
| Make sure it doesn’t go above 7 (toxicity)
48
What are nursing assessments for patients with preeclampsia?
- Pulse ox at all times, respiratory assessment
- Labs: CBC
- Magnesium blood levels
- DTR (assessed hourly)
- If renal impairment: I&Os
49
Nursing interventions when caring for patients with preeclampsia
- Seizure precautions
- Modified bed rest
- Magnesium sulfate
- IV
50
How much magnesium sulfate is given to a patient with preeclampsia?
2-3g/hr (50ml/hr)
| *Never want to give more than 125 mL!
51
Magnesium Excretion
-Excreted through kidneys -> increased risk for toxicity if kidneys aren’t functioning properly (respiratory depression)
52
What are interventions for magnesium toxicity?
- Shut off magnesium
- Continuous spO2, respiratory rate and lung sounds are taken (prone to pulmonary edema)
- May be given lasix.
53
What is an unintended benefit of magnesium sulfate in preeclampsia?
Has moderate vasodilator effect (not intended for BP so may need more meds to decrease BP).
54
What is an antidote for magnesium toxicity?
Calcium gluconate????? Need to verify.
55
Reduced variability in baby in a mother taking magnesium sulfate
Is OK.
Need to verify.
56
Why is it important to know whether the patient has prepregnancy HTN or preeclampsia?
Because they are treated differently.
| If not treated, there is a risk for stroke.
57
Interventions for a patient having a seizure
- 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
HELLP Syndrome
Part of severe eclampsia.
| Stands for hemolysis, elevated livers, low platelets** (can be indicative for high BP)
59
HELLP Syndrome is treated like
Preeclampsia (I&O, magnesium, vision changes, etc.)
60
What is a normal liver panel range?
30-40 is normal.
61
What are symptoms of HELLP syndrome?
Referred shoulder pain d/t inflamed/enlarged liver.
| *Check for more?
62
What is the cure for HELLP syndrome?
Cure is delivery.
63
What are maternal risks of preeclampsia?
- If BP isn’t treated, STROKE!
| * Check for more??
64
What are fetal risks of preeclampsia?
- Prematurity
- Death in utero
- IUGR
*Check for more???
65
Rh Sensitization
If mom is Rh-, assume baby is Rh+
| Mom is asymptomatic and starts to build antibodies against the baby.
66
What are causes of Rh sensitization?
- Maternal mixing of maternal/fetal blood (car accident, anything that jars uterus)
- Amniocentesis
- Placental complications
- Bleeding
67
What labs should be done in mothers with Rh sensitization?
- 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
Direct Coombs Test
Tells you + if fetus is at risk for developing nonphysiologic jaundice.
69
Why is the baby at an increased risk for jaundice if the mother is Rh sensitized?
Antibodies attack baby’s RBC -> hemolysis -> increase in bilirubin -> jaundice
70
When are tests for Rh sensitization done?
- 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
What can happen to the baby if the mother is Rh sensitized?
-Antibodies attack baby’s RBC -> sequella, hemolysis, fetal death in utero
72
How is Rh sensitization prevented?
Rhogam
73
Rhogam
preventative measure so mom doesn’t develop antibodies (if she already has a titer -> won’t work); administered with really long needle.
74
When is Rhogam given?
Given anytime mother has a bleed (amino, car accident, etc.)
75
How can Rh sensitization affect subsequent pregnancies?
Antibodies get worse and worse with each pregnancy.
76
ABO Incompatibility
Mom is type O and baby is anything other than O; risk for incompatibility.
77
ABO Incompatability is associated with
Contaminated food or infection process**
78
What assessments are done to test for ABO incompatibility?
- Blood drawn from cord to determine baby’s blood type when born.
- Direct Coombs if baby is anything but type O.
79
What are the fetal risks of ABO incompatibility?
-Risk for jaundice, kernicterus -> Encephalophia (too much bilirubin causes this)
80
What are the differences between ABP incompatibility and Rh sensitization?
- Risks are at a lesser degree than Rh sensitization.
| - ABO incompatibility probably won’t affect subsequent pregnancies.
81
What is considered an abortion?
a fetus of less than 20 weeks of gestation or one weighing less than 500 g is not viable.
82
Marginal Placenta Previa
Placenta is implanted in lower uterus but it’s lower border is >3 cm from internal cervical os
83
Partial Placenta Previa
Lower border of placenta is within 3 cm of interval cervical os but does not fully cover it.
84
What causes proteinuria in preeclampsia?
* 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
What causes edema in preeclampsia?
* 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
What causes epigastric pain in preeclampsia?
* 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
What causes visual disturbances and hyperactive DTR in preeclampsia?
Vasoconstriction of cerebral vessels leads to pressure-induced rupture of thin-walled capillaries, resulting in small cerebral hemorrhages.
88
What can cause dyspnea in preeclampsia?
Decreased colloid oncotic pressure can lead to pulmonary capillary leak that results in pulmonary edema. Dyspnea is the primary symptom.
89
Signs of impending seizures include the following:
* Hyperreflexia, possibly accompanied by clonus
* Increasing signs of cerebral irritability (headache, visual disturbances)
* Epigastric or right upper quadrant pain, nausea, or vomiting
90
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:
* 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
Signs of magnesium toxicity include the following:
* 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
The prominent symptom of HELLP syndrome is
- 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.
