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Disorders of Pregnancy Flashcards

(75 cards)

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1
Q

Defining factors of hyperemesis gravidarum

A

Severe nausea and vomiting of pregnancy
Begins before 9 weeks gestation
Associated with weight loss >5% of pre-pregnancy weight
Results in dehydration, nutritional deficiencies, electrolyte imbalances and/or ketosis

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2
Q

Causes/etiology of hyperemesis gravidarum

A

Increased HCG levels
Decreased vitamin B6
Genetics
Psychosocial factors

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3
Q

Risk factors of hyperemesis gravidarum

A

Increased incidence with multiple gestation and molar pregnancies

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4
Q

Duration of hyperemesis gravidarum

A

Peak incidence 8-12 weeks
Typically resolves by 20 weeks
May persist duration of pregnancy

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5
Q

S&S of hyperemesis gravidarum

A

Protracted vomiting
Intolerance of liquids/solids
Weight loss >5%
Increased HR, decreased BP
Poor skin turgor, dry mucous membrances
Ketonuria, increased urine SG (>1.030)
Decreased Na, K, Cl
Increased HCT, RBCs

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6
Q

Nursing management of hyperemesis gravidarum

A

VS, weight, I&O
NPO for gut rest
IV fluids: TPN or enteral feeds if protracted
Antiemetic administration
Pt. education

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7
Q

What is iron deficiency anemia in pregnancy

A

Hgb <11 mg/dL in 1st and 3rd trimesters
Hgb <10.5 mg/dL in 2nd trimester

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8
Q

Nursing management/Pt. education for iron-deficiency anemia in pregnancy

A

Iron supplementation 325 mg 1-3x/daily
-take on empty stomach with OJ/vit c
-do not take with coffee or tea
-increase fluids and fiber to decrease constipation

Iron rich foods
-meats, green leafy veggies, legumes and nuts, enriched breads and cereals

Rest PRN

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9
Q

What are TORCH infections?

A

Toxoplasmosis
Other (syphilis, hepatitis, varicella, parvo, HIV, Zika, listeria)
Rubella
Cytomeglovirus
Herpes simplex virus

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10
Q

Considerations with TORCH infections

A

Prevention is key
Handwashing
Avoid soft cheeses, hot dogs, deli meats, unpasteurized milk, raw meats, undercooked eggs
Avoid cat litter
Wear gloves while gardening
Safe sex
C-section if active genital HSV lesions

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11
Q

What is spontaneous abortion

A

A pregnancy that ends due to natural causes before 20 weeks gestation

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12
Q

S&S of spontaneous abortion

A

Vaginal bleeding
Passage of products of conception
Back pain
Sudden relief of morning sickness
Rupture of membranes (2nd trimester)

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13
Q

Classifications of spontaneous abortion

A

Threatened
Inevitable
Incomplete
Complete
Missed

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14
Q

Nursing management of spontaneous abortion

A

Vital signs
Labs: CBC, HCG
Assess bleeding volume (pad counts/QBL)
Assess passage of products of conception
Assess and manage pain
Prepare and educate for procedures if needed
Administer RhoGAM if Rh negative
Acknowledge grief, active listening

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15
Q

Patient education of spontaneous abortion

A

Anticipatory guidance
-educate at first prenatal visit about signs and symptoms of miscarriage

After-care
-report heavy bleeding, fever, foul-smelling vaginal discharge
-pelvic rest x2 weeks (no tubs, sex, tampons)
-iron supplement education if needed
-provide referral to community grief support groups

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16
Q

S&S ectopic pregnancy

A

Unilateral lower abdominal pain
May have vaginal spotting
Typically occurring 6-8 wks gestation
If ruptured ectopic pregnancy
-s/s of hypovolemic shock
-shoulder pain
-cullen sign- ecchymosis around umbilicus

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17
Q

Treatment of ectopic pregnancy

A

Surgical: salpingectomy or salpingotomy
Medical: IM methotrexate
-inhibits cell division (stops embryo/fetal growth) by disrupting folic acid, cells are then reabsorbed

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18
Q

Nursing management of ectopic pregnancy

A

Vital signs
Labs
-HCG (typically lower than expected)
-CBC, blood type/Rh
Assess bleeding
Assess and manage pain
Prepare for procedures/treatment
Administer RhoGAM if Rh negative
Acknowledge grief, active listening

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19
Q

Patient education of ectopic pregnancy

A

Weekly bHCG until non-pregnant range
Defer pregnancy for 3 months
Routine post-op teaching if surgical
If methotrexate treatment:
-No folic acid supplements or PNV/MVI
-Avoid sun exposure
-Teach S/S of ectopic rupture: severe/sharp unilateral abdominal pain, shoulder pain, dizziness/syncope

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20
Q

What is gestational trophoblastic disease (Molar pregnancy)

A

Pregnancy related tumor that forms from an abnormal growth of trophoblastic cells after conception without development of a viable pregnancy
20% will progress to choriocarcinoma

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21
Q

S&S of gestational trophoblastic disease (Molar pregnancy)

A

Uterine size greater than expected
Dark brown bleeding: looks like prune juice, usually 2nd trimester
Excessive vomiting (rule out hyperemesis)
Persistent elevation of bHCG after 10-12 weeks gestation
Preeclampsia diagnosed <24 weeks gestation

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22
Q

Nursing management gestational trophoblastic disease (molar pregnancy)

A

Prepare for surgical intervention
Acknowledge fear and grief

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23
Q

Patient education of gestational trophoblastic disease (molar pregnancy)

A

Stress importance of follow up
bHCG weekly until negative x3, then monthly x1 year
Avoid pregnancy for 1 year
Contraceptive counseling

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24
Q

What is cervical insufficiency

A

Premature dilation of the cervix that occurs without uterine contraction, after the first trimester

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25
S&S of cervical insuffuciency
Painless and passive cervical effacement and dilation Cervix <25mm and/or cervical funneling on ultrasound Pelvic pressure Backache Increased mucoid or pink tinged vaginal discharge
26
Nursing management of cervical insufficiency
Prepare for procesure- Cerclage Assess for s/s PTL
27
Patient education with cervical insufficiency
Activity restriction Cerclage removed at 36 weeks Report S/S of PTL -cramping/contractions -ROM -backache -significant increase in vaginal discharge
28
What are some causes of bleeding in late pregnancy?
Placenta previa Placental abruption Vasa previa
29
Nursing managment of late pregnancy bleeding
Recognize risk factors Early identification of s/s Maximize maternal/fetal perfusion -side lying -increase IV fluids -O2 via NRB mask Assess blood loss- OBL
30
What are S/S of placenta previa
PAINLESS bright red bleeding in 2nd/3rd trimester
31
Risk factors of placenta previa
Previous placenta previa Prior c-section or uterine surgery Multiple gestation Closely spaced pregnancies Age >35 Smoking
32
S/S of placental abruption
PAINFUL dark red vaginal bleeding Sudden onset of localized abdominal pain Uterine tenderness Uterine contractions/hypertonicity Board-like abdominal rigidity Fetal distress
33
Risk factors of placental abruption
maternal hypertension/preeclampsia Trauma Smoking Cocaine use Muliple gestation Abnormal fluid levels Prolonged PROM
34
Signs and symptoms of DIC
Bleeding from 3+ unrelated sites: -spontaneous epistaxis -oozing from incisions or IV sites -petechiae/ecchymosis/hematomas Hypotension and tachycardia Signs of thrombosis -renal impairment -peripheral cyanosis -confusion>coma -cardiorespiratory failure
35
Treatment of DIC
Treat underlying cause Oxygen admin Fluid replacement Blood products
36
What is preterm labor
1. Gestational age 20 )/7 to 36 6/7 weeks 2. Regular UCs accompanied by a change in dilation and/or effacement OR Initial presentation with regular UCs and dilation >2cm
37
What is preterm birth
Any birth that occurs between 20 0/7 and 36 6/7 weeks gestation
38
Preterm birth classifications
Extremely preterm: <28 weeks Very preterm: 28-31 weeks Moderately preterm: 32-33 weeks gestation Late preterm: 34-36 weeks
39
Risk factors for preterm labor
50% of women will have no risk factors or indicators Lots of risk factors: -black women -underweight -obesity -smoking -and all that
40
Diagnostic predictors of preterm birth
Cervical length -changes in cervical length MAY identify women at risk Fetal fibronectin test (fFN) -vaginal swab -better predictor of who will NOT go into labor
41
S/S of preterm birth
regular or frequent contractions or uterine tightening pelvic or lower abdominal pressure constant dull, low backache mild abdominal cramps with/without diarrhea obvious rupture of membranes increase or change in vaginal discharge
42
Patient education for preterm birth
Teach S/S of preterm labor early in pregnancy If s/s of preterm labor: -stop activity and lie down on side -drink 2-3 glasses of water or juice -if after one hour s/s countinue call provider or go to L&D -if after one hour s/s stop, notify provider at next visit Activity restriction -bedrest -pelvic rest -work restrictions
43
Medications used in preterm labor
promotion of fetal lung maturity -glucocorticosteroids: betamethasone Tocolytics -magnesium sulfate -Nifedipine (Adalat) -Indomethacin -Terbutaline Inevitable birth: -neuroprotection with magnesium sulfate
44
Indications for betamthasone
Action: increases fetal lung maturity by stimulating fetal surfactant production Reduces incidence of respiratory distress syndrome (RDS) Administration/monitoring: -given between 24-34 weeks gestation if risk of delivery within 7 days -2 doses given IM 24 hours apart -expect elevated WBC and platelets -blood glucose, if DM may require increased insulin
45
Action of tocolytic: magnesium sulfate
CNS depressant, relaxes smooth muscle
46
Adminstration/monitoring tocolytic: magnesium sulfate
-HIGH RISK DRUG -->label bag and lines -->two person dose calculation check -->disconnect from line if not infusing -monitor serum magnesium: therapeutic range of 4-7 mEq/L -educate pt about expected and common ADRs -->hot flushes and sweating -->burning at IV site -->blurred vision -->N/V -->lethargy
47
What is preterm prelabor rupture of membrane (PPROM)
Membrane rupture before 37 weeks gestation
48
What causes PPROM
Inflammation Uterine contractions Infection Intrauterine pressure
49
Complications of PPROM
Infection Cord prolapse Cord compression due to oligohydramnios Placental abruption
50
Nursing managment of PPROM
If lungs mature: anticipate induction -lung maturity = 34-36 weeks or <34 weeks with L/S ratio of >2 If lungs immature -administer antenatal glucocorticoids as ordered -administer antibiotics -obtain GBS swab -limit vaginal exams -monitor for s/s of labor -monitor for s/s of infection -fetal surveillance -anticipate delivery if s/s of infection or fetal distress
51
Non-stress test indications
Monitor pregnancy at risk as indicator of uteroplacental sufficiency and intact fetal CNS
52
Nursing interventions for non-stress test (NST)
Position patient in reclining chair or left-lateral Instruct to push marker button when feels fetal movement If no fetal movement, use vibroacoustic stimulator x3 sec
53
Reactive vs nonreactive non-stress test
Reactive: good -2 or more accelerations in 20 minutes Nonreactive: bad -less than 2 accelerations in 20 minutes
54
Indication for contraction stress test
Earlier and more reliable test of health fetoplacental unit than NST as puts fetus under stress Require stimulation of uterine contractions: oxytocin or nipple stimulation Contraindications: -Premature labor -Multiple gestations -Cervical insufficiency -Placenta or vasa previa -Prior classical cesarean section incision
55
Nursing interventions for contraction stress test/ oxytocin challenge test (OCT)
Obtain baseline FHR Initiate IV oxytocin Discontinue oxytocin if: -UC longer than 90 sec -UC > q2 min -Administer tocolytic prn
56
Interpretation of contraction stress test
Negative: good -No late or significant variable deceleration -At least three UC in a 10-min period Positive: bad -Late decelerations occur with 50% or more of contractions
57
Five biophysical variables of biophysical profile (BPP)
Rated 2 or 0 each NST Fetal Breathing Fetal body movements Fetal tone Amniotic fluid index
58
Maternal risk of diabetes in pregnancy
HTN Preeclampsia Cesarean birth Preterm birth Maternal mortality Polyhydramnios Infection DKA and hypoglycemia
59
Fetal risks of diabetes in pregnancy
Miscarriage Congenital malformations Extreme prematurity Respiratory distress syndrome IUFD Placental insufficiency Growth restrictions Gestational: -macrosomia: birth trauma (shoulder dystocia) -neonatal hypoglycemia/hyperinsulinemia
60
Gestational diabetes: screening and diagnosis
Initial 1 hr screening at 24-28 weeks: -non fasting, any time of day -no regard to last meal time 3 hour Oral glucose tolerance test: -in AM fasting (>8 hrs) -avoid caffeine and smoking x12 hrs
61
Blood glucose goals
Fasting/premeal: <95 Postpradial (1 hr): <140 Postprandial (2 hr): <120
62
Gestational DM: fetal surveillance
Low risk pt with diet controlled GDM <40 weeks do not generally need routine fetal surveillance Kick counts If oral meds, insulin, or high-risk: -twice weekly NSTs starting at 32 weeks -US prn to monitor fluid and growth
63
Hypoglycemia vs DKA
Hypoglycemia: -rapid onset -normal BP -normal or shallow respirations -pale and sweating -tremors, mental confusion, sometimes convulsions -blood sugar lower than 70 DKA: -slow onset- over several days -ketoacidosis -BP is subnormal or in shock -Air hunger respirations -Hot and dry skin -general depression -blood sugar elevated above 200 -Ketones elevated
64
Nursing considerations for postpartum insulin considerations
Check blood sugars q 2-4 hr in first 48 hr Give dose of subcutaneous insulin before stopping IV insulin Most with GDM can discontinue insulin after birth
65
Gestational hypertension
Begins after 20 weeks gestation in a previously normotensive women BP >140 systolic or >90 diastolic NO proteinuria
66
Preeclampsia
Hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman New-onset hypertension >20 weeks with any of the following: -throbocytopenia -renal insufficiency -impaired liver fx -pulmonary edema -cerebral or visual symptoms
67
What is eclampsia
Development of seizures or coma in a preeclampic pt
68
Preeclampsia with severe features
Preeclampsia diagnosis with BP >160/110 Pulmonary edeam: CP, SPB Thrombocytopenia: plt <100,000 Hepatic dysfunction: persistent RUQ/epigastric pain, liver enzymes >2x ULN Progressive renal insufficiency: oliguria, serum creatinine >1.1 CNS dysfunction: hyperreflexia, visual changes, severe HA HELLP syndrome
69
S/S of HELLP
Fatigue N/V, RUQ pain Bleeding (epistaxis) Weight gain Blurry vision
70
Lab findings with HELLP
Decreased H&H Increased bilirubin Abnormal peripheral smear Increased AST/ALT Decreased platelets
71
Preeclampsia nursing assessment
Accurate measurement of BP Breath sounds, respiratory effort Edema- pitting DTRs Clonus Proteinuria: >300 mg in 24-hr urine specimen
72
Preeclampsia nursing assessment
Evaluate for s/s of severe preeclampsia -HA -Epigastric pain -RUQ abd pain -Visual disturbances
73
Preeclampsia management without severe features
Outpatient if asymptomatic Instruct pr on daily BP checks and fetal kick counts Increased surveillance: weekly BP, labs Activity restriction Induction of labor at 37 weeks Patient education of warning s/s to report
74
Preeclampsia management with severe features
Inpatient management Magnesium Sulfate -to prevent seizures -reduce dz progression -NOT to lower BP Antihypertensive meds if BP >160/110 Deliver if occurs at >34 wks Expectant management if <34 wks and stable Corticosteroids for fetal lung maturity if <34 wks
75
Nursing care for preeclampsia with severe features
Environment -quiet, dim lights -side rails up and padded Seizure precautions -Ox and suction equipment Emergency medications available: -Calcium gluconate (antidote for MgSO4) -Hydralizine -Labetolol -Nifedipine

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