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Complications of Maternity Flashcards

(80 cards)

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1
Q

What are the major complications related to maternity

A
  1. Miscarriage
  2. hydatidiform mole
  3. Ectopic pregnancy
  4. placenta previa
  5. Abruptio Placenta
  6. Incompetent Cervix
  7. Hyperemesis Gravidarum
  8. Preeclampsia
  9. Eclampsia
  10. Premature Labor
  11. Prolapsed Cord
  12. Shoulder dystocia
  13. Group B Streptococcus (GBS)
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2
Q

When someone has spotting and cramping what are these s/s indicative of

A

Miscarriage

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3
Q

What are the treatments for miscarriage

A
  • Bedrest and pelvic rest
  • if miscarriage imminent–>IV, Blood, D&C
  • Worry when levels of hcG start to drop
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4
Q

What is hydatidiform mole (molar pregnancy)

A

-It is when you have a benign neoplasm which could turn malignant.
-Grape like clusters of vessicles
-No fetus involvement
If uterus enlarges too fast, this is how the pregnancy start

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5
Q

When there is no fht and some bleeding with vesicles what can this be a s/s of

A

hydatiform mole (molar pregnancy)

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6
Q

What confirms a molar pregnancy

A

U/S

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7
Q

How do we treat a molar pregnancy

A
  • With a D and C cutting and emptying uterus
  • Do not get pregnant during f/u time
  • check hcg levels weekly until normal, recheck q2-4weeks, then 1-2 months for 6months to a year
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8
Q

What is it called if a molar pregnancy becomes malignant

A

Choriocarcinoma, cxr to see if it has mestastasized

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9
Q

What occurs in an ectopic pregnancy

A

It is when the gestation occurs outside uterus, in the fallopian tube

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10
Q

What confirms an ectopic pregnancy

A

U/S

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11
Q

When someone is going through pain, spotting, bleeding into peritoneum what is this a s/s of

A

Ectopic pregnancy

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12
Q

What is the Tx for ectopic pregnancy

A

1) Methotrexate- to stop growth of embryo and save tube
2) otherwise a laproscopic incision will be made into tube and embryo will be removed
3) Laprotomy if tube has ruptured or if ectopic pregnancy is advanced.

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13
Q

What do we worry if a tube has ruptured in an ectopic pregnancy

A

Hemorrhage

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14
Q

What is placenta previa

A

It is when the placenta has implanted wrong

it is when the placenta prematurely begins to separate during dilation and the fetus doesn’t get enough oxygen

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15
Q

What is the most common cause of bleeding in the later months

A

Placenta previa

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16
Q

What test should be done to confirm placental location

A

U/S

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17
Q

Normally where should the placenta be attached

A

Up high in the uterus

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18
Q

When you have painless bleeding in the 2nd half of pregnancy (spotting or profuse bleeding) what is this a s/s of

A

Placenta previa

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19
Q

What are the treatment options for someone with placenta previa

A

1) hospitalization to prevent blood loss and fetal hypoxia
2) bed rest
3) Rule out other sources of bleeding like abruption
4) Pad count
5) monitor blood count and body close
6) monitor for contractions call MD (wont be vaginal delivery)
7) C-section
8) Do not perform vaginal exam

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20
Q

What are some fetal complications related to placenta previa

A

1) Preterm delivery
2) Intrauterine growth retardation
3) Fetal Distress
4) Anemia

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21
Q

What are some maternal complications

A

1) Hemorrhage

2) Potential DIC risk

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22
Q 
is placenta position on 
-side of the uterus (low lying placenta)
-halfway covering cervix(partial previa)
-completely covering cervix (complete previa)
okay?
A

is not a good sign

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23
Q

In abruptio placenta is the placenta implanted normally

A

yes

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24
Q

What an occur in a abruptio placenta

A

The placenta could be partial or completely abrupted

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25
what happens when the placenta abrupts
the placenta separates prematurely and bleeding occurs, it could be external or concealed
26
What is concealed bleeding
it's bleeding into the uterus
27
what confirms the diagnosis of abruptio placenta
ultra sound and the severity is based on the scale 1-3 3 is the worse
28
What can a MVC, domestic violence, previous cesarean, rapid decompression of uterus, cocaine use, PIH and smoking be a cause of
Abruptio placenta
29
When someone has a rigid board like abdomen with or without vaginal bleeding. Abdominal pain and increased uterine tone, and have a difficult time palpating fetus what do you think is happening
Abruptio placenta
30
What is the treatment for a abruptio placenta
C-section delivery and do not try to do any vaginal examinations
31
What are the 2 priorities with abruptio placenta
manage fetal status and maternal shock
32
What occurs with an incompetent cervix
It is when the cervix dilates prematurely | and can result in repeated, painless, second trimester miscarriages
33
When does an incompetent cervix occur
4th month of pregnancy
34
Why does a miscarriage occur in the 2nd trimester
weight of baby causes pressure on the cervix to prematurely dilate
35
What is the treatment for incompetent cervix
-purse-string suture (cerclage) at 14-18 weeks to reinforce cervix -may have a c-section to preserve suture and 80-90 percent chance of carrying baby to term with the cerclage
36
What is a cerclage
It is used for incompetent cervix, suture to help reinforce cervix
37
What is hyperemesis gravidarum
It is when you have more than the typical morning sickness, excessive vomitting, dehydration, starvation and death could occur
38
What are the causes of hyperemesis gravidarum
high levels of estrogen and hcG
39
When someone's BP, UO, K, weight drops, and h/h go up and the patient has ketones in their urine what could this be related to
hyperemesis gravidarum
40
What are the treatments for hyperemesis gravidarum
- NPO for 24 hours - quiet environment - oral hygeine - IVF 3000ml for 24 hours - Antiemetics - Vitamins - Don't mention food, keep emesis basin out of sight - 6-8 small meals followed by clear fluid - foods should be either icy cold/hot - well ventilated room
41
If a person has increased bp, proteinuria edema after 20 weeks what is this considered to be
Preeclampsia
42
What is mild preeclampsia
130/90 or 30/15 of their baseline
43
s/s of proteinuria include
-sudden weight gain -swollen hands and face -headache, blurred vision, seeing spots, -hyper-reflexia (increased DTR) -clonus- seizures VASOSPASMS
44
What do we know about a clinical s/s of PIH
if a patient increases weight by 2 or more pounds per week
45
How do we treat mild pre-eclampsia
- bed rest | - increase protein
46
What would your BP be with severe PIH
160/110
47
What are the tx for severe preeclampsia
sedations to delay seizures magnesium sulfate Apresoline is given with magnesium sulfate if diastolic is greater than 100 Delivery is the only cure
48
What are the functions of magnesium sulfate
It acts as a vasodilator | it is a simple salt solution, attracts fluid back into vascular space from tissue
49
What should you be monitoring with magnesium sulfate
Magnesium toxicity, check BP, Resps, DTR's, LOC every 1-2 hours Urine output hourly and serum mg periodically
50
What is used for preterm labor
magnesium
51
What is a client at risk for with magnesium sulfate
Pulmonary Edema
52
What should a client's care be for someone with preeclampsia
Quiet single room, dim lights and no tv
53
Why is betamethasone used for preeclampsia
stimulates sufactant production in the alvelor space and causes less tension when the infant breathes
54
When should steroid therapy be given
between 24 and 34 weeks gestation
55
What is expectant management
Balance risk between mom and baby
56
What occurs from preeclampsia to eclampsia
Seizure occurs
57
What should you be monitoring with eclampsia
Watch for fetal heart tones Watch for labor Watch for heart failure, stroke, heart attack, renal failure, DIC, HELLP syndrome, neurological damage, multisystem organ failure
58
When you have proteinuria and it's after 20 weeks what are you thinking
PIH
59
When you have no proteinuria and it's after 20 weeks what are you thinking
Gestational Hypertension
60
When the client was hypertensive before pregnancy what is this called
Chronic Hypertension
61
When the client was hypertensive prior to pregnancy but hypertension is getting worse with developing proteinuria after 20 weeks what is this called
Chronic hypertension with superimposed PIH
62
When labor occurs 20-37 weeks what is this called
Premature labor
63
What are the treatments for stopping labor
1) Tocolytics: Terbutaline (Brethine): Side effects increased pulse and hyperactivity 2) Magnesiumm sulfate: relaxes uterus 3) Bethamethazone (Celestone): given to moms to stimulate maturation of baby's lung in case preterm occurs It can also be stopped by hydrating mum and treating vaginal and urinary tract infections
64
What happens when you get a prolapsed cord
The umbilical cord falls down the cervix, most likely because the presenting part is not engaged and the membranes ruptured
65
What is important to check when membranes rupture either spontaneously or artificially
FETAL HEART TONE
66
What is the next step to do if you have a compressed cord and you see variable deccelration in FHT
C-section
67
What indicates death
When cord is not pulsating
68
What treatment options are for Prolapse cord
- Lift head off cord until physician arrives mannually - Trendelenburg or knee chest position - Oxygenation - Monitor fetal heart tones
69
Do we push back the cord
No
70
What is a shoulder dystocia
it is when the fetal head is delivered and shoulder gets impacted with pelvis
71
Risks to shoulder dystocia
- Hypoxia- leads to cerebral palsy and asphyxia - Brachial Plexus injury-leading to Erb's palsy - Broken clavicle - Bell's pallsy
72
What is Bells' Palsy and what is it caused from
It is when you have paralysis of the face with drooping to one side of the face Forcep use
73
What are some potential maternal risks related to shoulder dystocia
- Traumatic delivery leading to permanent damage - Bruised bladder - Extention of episiotomy - Rectal Tear - Torn cervix and or uterus
74
-What do LGA or macrosomic infants greater than 4000 grams -Gestational diabetes -Previous history of shoulder dystocia -Post date delivery ,large fetus All have in common
Risk for having a shoulder dystocia
75
What are some nursing care regarding shoulder dystocia
McRoberts Maneuvers | Mazzanti techniques suprapubic pressure (never apply fundal presure)
76
GBS what can you do to reduce risk
Routinely assess for GBS, risk factors during pregnancy (cultured around 35-37 weeks) and on admission L & D Prophylactic antibiotic therapy; penicillin
77
How is GBS transmitted
Through birthing canal
78
When is there a risk to the fetus with GBS
When the rupture of the membrane occurs
79
Is GBS a sexually transmitted disease
No
80
Who is at risk for GBS
- Preterm births less than 37 weeks - positive prenatal cultures in pregnancy - premature rupture of membrane - positive history for early-onset neonatal GBS - intrapartum maternal fever higher than 100.4 - previous infant with GBS

NCLEX (21 decks)

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