Concurrent Disorders Flashcards by Paula Brasen

women with hyperthryoidism usually suffer what for the first 4-8 weeks of pregnancy

severe N/V

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how is hyperthyroidism treated in pregnancy

PTU

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how long does it take for PTU to reach its max effectiveness for the tx of hyperthyroidism

6-8 weeks

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women with hypothyroidism have a high risk of what?

infertility

rupture

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how is hypothyroidism treated in preg

synthroid

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what lab level is monitored with hypothyroidism?

TSH

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what nursing education needs to be stressed to women who are preg w/ hypothyroidism?

timeliness of med admin

strict adherence to meds

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what is maternal phenylketonuria?

a high accumulation of phenylalanine in the moms blood, and a deficiency of phenylalanine hydrolase (enzyme)

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what can maternal PKU cause?

mental retardation, birth defects, and heart disease in babies

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what is the key prevention for PKU?

ID of women in their reproductive years and babies when they are first born

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if a woman has PKU, can they breastfeed?

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if a baby has PKU, can they breastfeed

yes

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name cardiovasc changes that occur during preg

incr intravasc vol
decr systemic vasc resistance
CO changes during labor and birth
intravasc vol changes that occur just after birth

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how is CV disease classified?

class I-class IV

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class I CV disease

asympt @ normal actvity level

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class II CV disease

sympt w/ ordinary activity

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class III disease

sympt w/ decr ordinary activity

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class IV disease

sympt @ rest

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when is CV disease classification evaluated in a preg?

3 months and again @ 7 or 8

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women with CV diseases have a higher risk of what?

miscarriages
preterm birth and labor
intrauterine growth restriction
congenital heart lesions incr in babies
decr CO to the baby

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T/F- more and more heart transplant recipients are successfully completing pregnancies

True

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if a woman is a heart transplant pt, what must they be assessed for before conception?

qual of ventricular fx

- potential rejection of transplant

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what delivery method is preferred for heart transplant moms?

vaginal

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what delivery method is more common among heart transplant recip moms

C sec

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how long should conception be post-poned for after heart transplant?

at least 1 yr

infants of heart transplant mothers may exhibit what during the 1st week of life?

immunosuppressive effects

if a mother is a heart transplant, they cannot breastfeed if they are taking which med?

cyclosporine

what may happen during a vaginal delivery of a heart transplant recipient?

- moms heart may have too much load - mom becomes very tired - HCP's may have to use forceps or vaccuum to assist mom in labor

how does CPR in a pregnant woman differ from CPR in a reg pt?

- defib paddles must be placed one rib interspace higher than usual

what should be monitored during and after cardiac arrest of mom?

fetus

what are ther objectives for mothers who have asthma?

- relieve bronchospasm - limit irritant stimuli - decr pulm response to allergen exposure - limit inflammatory response in airways

what should be at the bedside or nearby of a mom with asthma regardless of when their last attack was?

inhaler

if an infant or mother has CF, they will be ______ of the CF gene?

carriers

what is an important characterization of CF?

exocrine glands produce and release excessive viscous secretions

how does CF complicate a pregnancy?

- chronic hypoxia - frequent pulm infections - resp and digestive system problems

what GI disorders may affect mom during preg?

- cholelithiasis (gallstones) - cholecystitis (inflamm of the gallbladder) - IBD

what birth defects are related to epileptic meds?

cleft lip/palate | neural tube defects

what is a big concern/issue with epileptic moms?

failure to take medication

why do epileptic moms fail to adhere to their RX regime during preg?

- message that meds are harmful to the fetus | - risks to infants exxaggerated

what is the concern if mom seizes while pregnant?

- reduction of blood flow and O2 to the baby

what can be done for moms with MS?

- bed rest and steroids during exacerbations/ progression of the disease

what is Lupus Erythematosus?

autoimmune antibody production that affects skin, joints, kidneys, lungs, CNS, and other body organs

what is the concern for Lupus patients during preg?

immunosuppressive meds not reccommended during preg

what is the objective for care of Lupus patients?

reducing the risk of infections

what is super important for HIV + moms before conception (if possible)

preconception counseling

when is a mom tested for HIV in her preg?

@ 8 weeks

does pregnancy accelerate HIV/AIDS?

how can HIV transmission to baby be reduced?

-if mom stays on meds throughout preg

what groups are at an incr risk for HIV during preg?

-minority races and ethnicities

what do HIV moms have an incr risk for?

- concurrent infecs - std's - sti's - PID

what factors affect how an HIV infected mother is treated?

- patient - rship status - their behaviors - willingness to adhere to mgmt

what HIV med must preg take?

Highly Active Antiretroviral Therapy (HAART)

what else should HIV mothers be tested for?

- sti's | - hepatitis

how should opportunistic infecs be treated in HIV mothers

meds specific to that infec

what is the absolute objective of care for HIV pregnancy?

decreasing the neonates exposure to mom blood and secretions

what medical precautions are taken during care of HIV preg?

standard precautions

what risks are assoc with smoking moms?

- bleeding complications - miscarriage/stillbirth - prematurity - placenta previa - placental abruption - low birth weight - SIDS

what barriers stop sub abuse moms from getting prenatal tx

- fear of losing custody of other kids or baby - criminal prosecution - sub abuse tx programs do not address issues affecting preg women - long waiting lists and lack of health insurance

what is a realistic goal for treating sub abuse mom?

-decr sub abuse

when are women more likely to make lifestyle changes

during a pregnancy

T/F- there no meth tx for pregnant women

false- there is meth tx

when are sub abuse moms difficult to care for?

intrapartum | PP

are DM moms considered high risk?

yes

what is the best approach to tx for DM moms?

multidisciplinary

what is the key to optimum outcome for DM?

glucose control prior to and throughout preg

what is the primary fuel used by the fetus?

glucose

def Gest DM

any degree of glucose intol with onset or recognition during preg

what is the rship bx hormones and insulin during preg?

placental hormones work in opposition to insulin

important tx interventions of DM before preg?

- importance of adhering to a plan - use of a dietary log - glucose control before preg

what are serious risks/complications assoc w/ GDM?

ketoacidosis | hypoglycemia

ketoacidosis is assoc w/

hyperglycemia

when is a GDM mom at highest risk for hypoglycemia and why?

- early in the pregnancy - hepatic production is diminished - insulin/meds may need to be tweaked - N/V - decreased food intake by mom - glucose transfer to embryo

insulin needs during the first trimester and why

- insulin needs reduced - incr insulin production by the pancreas - incr peripheral sens to insulin

insulin needs during 2nd trimester

- insulin needs incr | - placental hormones, cortisol, and insulinase act as insulin antagonists---> decr effectiveness of insulin

insulin needs during 3rd trimester

-gradually incr until approx 36 weeks

insulin needs on day of delivery

- insulin needs drop drastically to pre-preg levels

insulin needs of breastfeeding mothers

low insulin requirements

insulin needs of non-breastfeeding mother

insulin needs of pre-preg level within 7-10 days

insulin needs of mom who is weaning breastfeeding

insulin needs return to pre-preg levels

def macrosomia

big baby at birth

what is a macrosomic baby at risk for?

hypoglycemia

babies of diabetic mothers are at incr risk for

-sudden/unexplained still birth - congenital problems CNS Cardiac defects skeletal defects

diabetic mothers are at incr risk for what and what types?

-infections UTI's yeast

what birth complication are GDM patients at risk for

-shoulder dystocia

what is the minimum glucose level of infants

T/F- there is extensive diabetic tx needed PP for a GDM mom

fasle- no diabetic tx needed