[Exam 1] Chapter 19 - Pregnancy at Risk: Pregnancy Related Complications Flashcards
(205 cards)
1
Q
Bleeding During Pregnancy: Biggest killer here?
A
Obstetric Hemorrhage
2
Q
Spontaneous Abortion: What is Abortion?
A
Loss of an early pregnancy, usually before week 20 of gestation
3
Q
Spontaneous Abortion: What is this?
A
Loss of fetus resulting from natural causes, that is not by a procedure
4
Q
Spontaneous Abortion: What is a stillbirth?
A
Loss of fetus after the 20th week of development
5
Q
Spontaneous Abortion: What is a miscarriage?
A
Refers to loss before 20th week. This is a spontaneous abortion
6
Q
Spontaneous Abortion - Patho: Most common causes in first and second trimester?
A
First- Chromosomal Abnormalities
Maternal disease second
7
Q
Spontaneous Abortion - Patho: Women experiencing a first-trimester abortion without dilation and curettage require monitoring of what
A
hCG levels to validate that all conceptus tissues expelled
8
Q
Spontaneous Abortion - Nursing Assessment: What signs by woman may be reported?
A
Vaginal bleeding , low back pain, abdominal cramping, passage of tissue
9
Q
Spontaneous Abortion - Nursing Assessment: Color of vaginal bleeding which is bad?
A
Bright red
10
Q
Spontaneous Abortion - Nursing Assessment: Ask about frequency of changing peripads, but saturation how quickly is bad?
A
One peripad hourly is significant
11
Q
Spontaneous Abortion - Nursing Assessment: What should you do when they arrive to the facility?
A
Assess VS and observe amount, color, and characteristics of the bleeding. Rate current pain and evaluate intensity of cramps
12
Q
Spontaneous Abortion - Nursing Management and Providing Continued Monitoring: What do you monitor?
A
Amount of vaginal bleeding through pad counts and observe for passage of products of conception tissue.
13
Q
Spontaneous Abortion - Nursing Management and Providing Continued Monitoring: What treatments may you prepare woman for?
A
Surgery to evacuate uterus or meds like Misoprostol or PGE2. If Rh Negative, administer RhoGAM within 72 hours
14
Q
Spontaneous Abortion - Nursing Management: Signs of Inevitable Abortion?
A
Vaginal bleeding, rupture of membranes and cervical dilation
15
Q
Spontaneous Abortion - Nursing Management: Signs of Incomplete Abortion?
A
Intense cramping, heavy vaginal bleeding, and cervical dilation
16
Q
Spontaneous Abortion - Nursing Management: What is a missed abortion?
A
Nonviable embryo retained in utero for at least 6 weeks
17
Q
Spontaneous Abortion - Nursing Management: What is habitual abortion?
A
Hx of three or more consecutive spontaneous abortions
18
Q
Ectopic Pregnancy: What is this?
A
Pregnancy where fertilized ovum implants outisde the uterine cavity. Includes fallopian tubes, cervix, and ovary
19
Q
Ectopic Pregnancy: Why is this a problem?
A
Draws blood supply from site of abnormal implantation. As it enlarges, creates potential for organ rupture because only uterus can expand. Leads to hemorrhage, infertility or death
20
Q
Ectopic Pregnancy: What does Misoprostol do?
A
stimulates uterine contractions to terminate a pregnancy.
21
Q
Ectopic Pregnancy: What is Mifepristone?
A
Acts as progesterone antagonist, allowing prostaglandins to stimulate uterine contractions
22
Q
Ectopic Pregnancy: What is PGE2?
A
Stimulates uterine contractions, causing expulsion of uterine contents
23
Q
Ectopic Pregnancy and Patho: What happens on journey to uterus?
A
Fallopian tube path is arrested or altered in some way. May implant in fallopian tubes
24
Q
Ectopic Pregnancy and RF: What specifically can cause this to happen?
A
Physical blockage in the tube, or failure of the tubal epithelium to move the zygote (cell formed after the egg is fertilized) down the tube into the uterus). Or scarring due to PID.
25
Ectopic Pregnancy and Therapeutic Management: Triad of ectopic pregnancies includes what?
Abdominal pain, amenorrhea, and vaginal bleeding. Rare to present with all 3 symptoms.
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Ectopic Pregnancy and Therapeutic Management: What diagnostic procedures performed?
Pregnancy tests and transvaginal ultrasound.
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Ectopic Pregnancy and Medical Intervention: In early diagnosis, can be treated with what?
Methotrexate.
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Ectopic Pregnancy and Medical Intervention: What is Methotrexate?
Folic acid antagonist that inhibits cell division in the developing embryo. .
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Ectopic Pregnancy and Medical Intervention: Adverse effects of Methotrexate?
N/V, Stomatitis, Diarrhea, Gastric Upset, Increased Abdominal Pain, and Dizziness
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Ectopic Pregnancy and Medical Intervention: What to do afterwards after Methotrexate?
Return weekly for follow-up lab studies for several weeks until beta-hCG titers decrease
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Ectopic Pregnancy and Surgical Intervention: What can be done?
Linear Salpingostomy to preserve tube. .
Laparotomy with salpingectomy (removal of tube) if it has been ruptured.
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Ectopic Pregnancy and Labs/Diag: What is performed here diagnostic wise?
Transvaginal Ultrasound to visualize misplaced pregnanyc with low levels of serum beta-hCG
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Ectopic Pregnancy and Preparing Woman for Tx: What is given to relieve discomfort from abdominal pain?
analgesics
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Gestational Trophoblastic Disease: What is this?
Spectrum of neoplastic disorders that originate in placenta. There is abnormal hyperproliferation of trophoblastic cells that would normally develop into placenta during pregnancy
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Gestational Trophoblastic Disease: Most common types of GTD?
hydatidiform mole (partial or complete) and choriocarcinoma
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Gestational Trophoblastic Disease and Patho: What is a hydatidiform mole?
Benign neoplasm of the chorion in which the chorionic villi degerate and become transparent containing clea,r viscid fluid
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Gestational Trophoblastic Disease and Patho: What does complete mole contain?
No fetal tissue and develops from an empty egg fertilized by normal sperm . Embryo not viable and dies
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Gestational Trophoblastic Disease and Patho: What is a partial mole?
Triploid Karyotype because two sperm have double contributed to fertilize the ovum.
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Gestational Trophoblastic Disease and Patho: What signs do women present with partial mole?
Missed or incomplete abortion, including vaginal bleeding and a small or normal size
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Gestational Trophoblastic Disease and Patho: Having a molar pregnancy results in what?
Loss of pregnancy and the possibility of developing choriocarcinoma, a chorionic malignancy from the trophoblastic tissue
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Gestational Trophoblastic Disease and Therapeutic Mx: Treatment here?
Immediate evacuation of uterine contents and long-term follow up to detect remaining tissue.
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Gestational Trophoblastic Disease and Therapeutic Mx: Wha tis used to empty uterus?
D&C
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Gestational Trophoblastic Disease and Therapeutic Mx: hCG levels if tissue remains?
Will not regress. Not usually until week 8-12
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Gestational Trophoblastic Disease and Therapeutic Mx: What may a standard follow-up protocol include?
Baseline hCG levels every week until undetectable.
Chest X-ray every 6 months
Regular pelvic exas
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Gestational Trophoblastic Disease and Nursing Assess: Clinical manifestationf of GTD similar ot those of what?
Spontaneous abortion at about 12 weeks of pregnancy
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Gestational Trophoblastic Disease and Nursing Assess: Be alert for what signs?
Report early signs of pregnancy
Brownish vaginal bleeding
Inability to detect fetal HR after 12 weeks.
Fetal parts not evident
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Gestational Trophoblastic Disease and Nursing Manage: This focuses on what?
Preparing gher for D&C, providing emotional support to deal with loss, and educate about risk of cancer
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Cervical Insufficiency: What is this?
Also called premature dilation of cervix, describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions on second trimester, or early trimester resulting in loss of pregnancy
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Cervical Insufficiency and Therapeutic Mx: How can this be treated?
Bed Rest
Pelvic Rest
Avoidance of HEavy Lifting
Progesterone Supplementation
Cervical Pessary or Surgically
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Cervical Insufficiency and Therapeutic Mx: What is Cervical Cerclage?
Done transvaginally or transabdominally. Involves using a heavy purse-string suture to secure and reinforce the internal os of the cervix
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Cervical Insufficiency and Therapeutic Mx: Short cervix identified when?
At or after 20 weeks and no infection (chorioamnionitis) is present
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Cervical Insufficiency and Therapeutic Mx: Complications of cerclage placement?
Suture displacement, rupture of membranes, andchorioamnionitis
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Cervical Insufficiency and Therapeutic Mx: When is cerclage removed?
At around 28 weeks.
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Cervical Insufficiency and RF: Thisincludes what?
Previous cervical trauma, preterm labor, fetal loss, or previous surgies involving cervix
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Cervical Insufficiency and RF: What will women report with this?
Pink-tinged vaginal discharge or an increase in low pelvic pressure, cramping to vaginal bleeding, and loss of amniotic fluid
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Cervical Insufficiency and Diagnostic Test: Transvaginal Untrasound done when and why
16-24 weeks. To determine cervical length, evaluate for shortening and attempt to predict an early preterm birth.
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Cervical Insufficiency and Diagnostic Test: What cervical length is considered abnormal?
Less than 25 mm
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Cervical Insufficiency and Diagnostic Test: For woman at risk for preterm birth, what is done?
Home uterine activity monitoring used to screen for prelabor uterine contractility so tht escalating contractility can be identified, allowing earlier intervention to prevent preterm.
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Cervical Insufficiency and Nursing Management: Monitoring the woman includes what signs of preterm labor?
Backache, increase in vaginal discharge, rupture of membranes, and uterine contractions
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Placenta Previa: What is this?
Bleeding condition that occurs during last two trimesers. Placenta implants over cervical os.
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Placenta Previa: Associated with what serious consequences?
Hemorrhage, abruption of placenta or emergnecy c-section.
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Placenta Previa: What is total placenta previa?
Internal cervical os is completely covered by the placenta
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Placenta Previa: What is partial placenta previa?
Internal os is partially covered by the placenta
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Placenta Previa: What is marginal placenta previa?
placenta is at the margin or edge of the internal os
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Placenta Previa: What is low-lying placenta previa
placenta is implanted in hte lower uterine segment and is near the internal os but does not rearch it
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Placenta Previa and Therapeutic Mx: What is a good way to decrease the incidence of this?
Avoiding primary S-Section whenever possible.
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Placenta Previa and Health Hx and Physical Exam: Classic clinical presentation of this?
Painless, bright-red vaginal bleeding occuring during 2nd or third trimester. Bleeding stops and goes.
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Placenta Previa and Health Hx and Physical Exam: Why is bleeding thought to occur?
Due to the thining of the lower uterine segment in preparation for the onset for labor.
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Placenta Previa and Health Hx and Physical Exam: What happens when bleeding occurs at implantation site in lower uterus?
Uterus cannot contract adequately and stop the flow of blood from the open vessels
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Placenta Previa and Health Hx and Lab and Diag: How is placenta position determined?
Transvaginal ultrasound is done and MRI at delivery.
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Placenta Previa and Monitoring Maternal-Fetal Status: What to do if woman if actively bleeding?
Inspect perineal area for blood that may be pooled underneath the woman. Estimate amount of blood.
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Abruptio Placentae: What is this?
Premature separation of a normally implanted placenta after 20th week of gestation prior to birth, leading to hemorrhage
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Abruptio Placentae: Maternal risks include what?
Obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, disseminated IV coaglopathy and renal failure
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Abruptio Placentae: Perinatal consequences include wwhat
low birth weight, preterm delivery, asphyxia, stillbirth, and perinatal death
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Abruptio Placentae Patho: What may cause this?
Degenerative changes in small maternal blood vessels resulting in blood clotting, degeenration of decidua (uterine lining) and possible rupture of vessel. Bleeding forms blood clot between placenta and uterine wall
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Abruptio Placentae Patho: What is Mild (Grade 1)?
Minimal bleeding (less than 500 mL), marginal separation (10-20%), tender uterus, no coagulopathy, and no signs of shock
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Abruptio Placentae Patho: What is Moderate (Grade 2)?
Modeate bleeding (1000-1500 mL), moderate separation (20-50%), continuous abdominal pain, mild shock, and normal maternal blood pressure
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Abruptio Placentae Patho: What is Severe (GRade 3)?
Absent to moderate bleeding (more than 1500 mL), severe separation, profound shock and dark vaginal bleeding
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Abruptio Placentae Therapeutic Mx: Emergency measures include what?
Starting two large-bore IV lines with normal saline or lactated Ringer soltuion to combat hypovolemia, obtaining blood specimens, and cross-matching . After, C-section performed
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Abruptio Placentae Therapeutic Mx: DIC may occur, what is this?
Disseminated IV Coagulation
Bleeding disorder characterized by an abnormal reduction in the elements involved in blood clotting resulting from their widespread IV clotting. Client develops clots, too much clots
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Abruptio Placentae Health Hx and Physical Exam: What factors predispose someone to this?
Over 35, poor nutrition, multiplegestation, excessive intrauterine pressure, chronic hypertension, cigarette smoking, and severe trauma
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Abruptio Placentae Health Hx and Physical Exam: What happens as placenta separates from uterus?
hemorrhage ensues. Can be seen as vaginal bleeding or it can be concealed.
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Onset
Insidious vs Sudden
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Type of Bleeding
Always visible vs can be concealed/visible
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Blood Description
Bright Red vs Dark
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Discomfort/Pain
None (Painless) vs Constant; uterine tenderness
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Uterine Tone
Soft and Relaxed vs Firm to Rigid
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Fetal HR
Usually in normal rage vs fetal distress or absent
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Abruptio Placentae Health Hx and Physical Exam: Placenta Previa vs Abruptio Placentae and Fetal presentation
May be breech or transverse vs no relationship
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Abruptio Placentae Health Hx and Physical Exam: Signs of this?
Painful, dark-red vaginal bleeding because bleeding comes from the clot that was formed behind the placenta , and knife-life abdominal pain
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Abruptio Placentae Labs and Diagnostic: What labs can be performed?
```
CBC
Fibrinogen Levels (Dip indicates DIC)
Prothrombin Time (PT) (determines coagulation status)
Nonstress Teest
Biophysical Profile
```
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Abruptio Placentae and Ensuring Adequate Tissue Perfusion: What will you do when woman arrives?
Place her on strict bed rest and leave in left lateral position to prevent presure on vena cava
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Abruptio Placentae and Ensuring Adequate Tissue Perfusion: Increase in fundal height would indicate what?
Bleeding
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Abruptio Placentae and Ensuring Adequate Tissue Perfusion: Be alert for signs of DIC including what?
Bleeding gums, tachycardia, ozzing form IV site, petechiae, and administer blood products
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Placenta Accreta: What is this?
Potentially life-threatening obstetrical hemorrhagic condition.Placenta attaches itself too deeply to the wall of the uterus but does not penetrate the uterine muscle.
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Placenta Accreta: What is placenta ncreate?
Placenta invades the myometrium
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Placenta Accreta: Common risk during birthing process is what?
Possibility of hemorrhaging during manual attempts to detach the placeta.
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Placenta Accreta: when is this diagnosed?
After birth when the placenta fails to normally separate from the uterine wall
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Hyperemesis Gravidarum: What is this?
Severe form of N/V associated with sig costs of psychosocial impacts
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Hyperemesis Gravidarum: Difference between this and normal N/V?
Persistent, uncomtrollable N/V that begins in first trimester that causes dehydration, ketosis, and weight loss of more than 5%
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Hyperemesis Gravidarum: Risk factors for this include what
previous pregnancy complicated by hyperemesis, molar pregnancies, hx of H. pylori infection, and multiple gestation.
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Hyperemesis Gravidarum Patho: How can this affect fetus?
With decreased placental blood flow, decreased maternal blood flow, and acidosis
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Hyperemesis Gravidarum Patho: hCG levels here?
Are often higher and extend beyond first trimester.
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Hyperemesis Gravidarum Therapeutic Mx: What changes can you make at home?
Focuses on dietary and lifestyle changes
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Hyperemesis Gravidarum Therapeutic Mx: What is ordered upon admission?
blood tests to assess dehydration, electrolyte imbalance, ketosis, and malnutrition
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Hyperemesis Gravidarum Therapeutic Mx: First choice for fluid replacement
Normal saline, which aids in preventing hyponatremia, which vitamisn and electrolytes added.
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Hyperemesis Gravidarum Therapeutic Mx: What is withheld in hospital?
Oral foods and fluids for first 24-36 hours to allow GI tract to rest
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Hyperemesis Gravidarum Therapeutic Mx: What happens if client doesn't improve after several days?
TPN or feeds through a percutaneous endoscopic gastrostomy tube is instituted.
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Hyperemesis Gravidarum Health Hx: What complaints do you ask pt about
complaints of ptyalism (excessive salivation), anorexia, indigestion, and abdominal pain or distention
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Hyperemesis Gravidarum Labs: Why test liver enzymes?
rule out hepatitis, pancreatitis, and cholestasis
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Hyperemesis Gravidarum Labs: Why test CBC?
elevated levls of rbc and hematocrit indicate dehydration
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Hyperemesis Gravidarum Labs: Why test TSH and T4?
Rule out thyroid disease
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Hyperemesis Gravidarum Labs: Why test blood urea nitrogen?
Increased in presence of salt and water depletion
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Hypertensive Disorders of Pregnancy: Hypertensive disorders of pregnancy include what?
Chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with superimposed preeclampsia
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Hypertensive Disorders of Pregnancy: What is chronic hypertension?
Hypertension that exists prior to pregnancy or that develops before 20 weeks gestation
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Hypertensive Disorders of Pregnancy: What is Gestational Hypertension?
Blood pressure elevation (140/90) identified after 20 weeks gestation without proteinuria. Returns to normal by 12 weeks postpartru
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Hypertensive Disorders of Pregnancy: What is preeclampsia?
Most common hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks. Classified as mild or severe
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Hypertensive Disorders of Pregnancy: What is Eclampsia?
Onset of seizure activity in a woman with preeclampsia
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Hypertensive Disorders of Pregnancy: What is Chronic hypertension?
Onset of seizure activity in woman with preeclampsia
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Chornic Hypertension: What is this defined by?
BP exceeding 140/90 mmHg before pregnancy or before 20 weeks gestation.
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Chornic Hypertension: What happens if BP exceeds 160/100?
Drug tx recommended
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Gestational Hypertension: What is this?
Pathophysiologic disturbances of the preeclampsia syndrome do not develop before giving birth. Temporary diagnossi for women who are hypertensive who do not meet criteria for preeclampsia or chronic hypertension
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Gestational Hypertension: Characterized by what?
>140/90 without proteinuria after 20 weeks resolving by 12 weeks postpartum
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Preeclampsia/Eclampsia: Preeclampsia can be described as what?
Multisystem, vasopressive disorder that targets the cardiovascular, hepatic, renal, and CNS
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Preeclampsia/Eclampsia Patho: Mild , Severe , Eclampsia
BP?
140/90 , > 160/110 , >160/110
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Preeclampsia/Eclampsia Patho: Mild , Severe , Eclampsia
Proteinura?
300 mg/24 hr , > 500 mg/24 hr , Marked Proteinuria
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Preeclampsia/Eclampsia Patho: Mild , Severe , Eclampsia
Seizures?
No, No, Yes
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Preeclampsia/Eclampsia Patho: Mild , Severe , Eclampsia
Hyperreflexia?
No, Yes, Yes,
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Preeclampsia/Eclampsia Patho: First stage in preclampsia?
Widespread vasospasm.
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Preeclampsia/Eclampsia Patho: Second stage in preclampsia?
womans response to abnormal placentation, such as hypertension, proteinuria, and edema
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Preeclampsia Patho: First stages results in what
elevation of blood pressure and reduced blood flow to the brain, liver, kidneys. Decreased liver perfusion leads to impaired liver function.
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Preeclampsia therapeutic Managemenet: Care for preeclampsia/eclampsia is all else fails?
Delivery of the placenta.
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Management for Mild Preeclampsia: constant monitoring of what will occur?
Blood pressure every4-6 hours while awake and report any increased readings. Will also measure amount of protein found in urine .
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Management for Mild Preeclampsia: Why is IV Magnesium Sulfate infused?
To prevent any seizure activity, along with hypertensives if blood pressure values begin to rise. Calcium Gluconate kept at bedside in case magnesium levels become toxic
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Management for Severe Preeclampsia: Only cure for this?
Birth, because preeclampsia depends on the presence of trophoblastic tissue.
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Management for Severe Preeclampsia: Woman in labor typically recieves what?
Oxytocin to stimulate uterine contractions and magnesium sulfate to prevent seizure activity
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Management for Severe Preeclampsia: How much Magnsium Sulfate given?
Loading dose of 4-6 g over 5 minutes. Then maintenance dose of 2g/hr is given
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Management for Eclampsia: What develops with eclamptic seizure?
Convulsive activity begins with facial twitching, followed by generalized muscle rigidity. Face distorted, with protrusion of eyes and foaming at mouth.
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Management for Eclampsia: What will you do for woman haivng seizure
place on left side. Suction from mouth if necessary. IV fluids administered after seizure at rate to replace urine output.
Magnesium sulfate given
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Intervening for Severe Preeclampsia: What tests are used to determine if progressing into HELLP syndrome?
Liver Enzymes, Chemistry Panel like creatinine bun uric acid and glucose, CBC including platelet count and coagulation studies
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Intervening for Severe Preeclampsia: What doesHELLP stand for?
Hemolysis Elevated Liver Enzymes Low Platelet Count
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Intervening for Severe Preeclampsia: Clients with preeclampsia commonly present with what?
Hyperreflexia
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Intervening for Severe Preeclampsia: What happens in someone develops magnesium toxicity?
Diminished or absent reflexes.
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Intervening for Severe Preeclampsia: What are some signs of magnesium sulfate to watch out for?
RR < 12 , absence of DTRs, and decrease in urinary output. Also monitor serum magnesium levels
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Intervening for Severe Preeclampsia: What magnesium levels considered therapeutic?
4-7
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Intervening for Severe Preeclampsia: Magnesium level of 10 results in what
possible loss of DTRs
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Intervening for Severe Preeclampsia: Magneisum level of 15 results in what
possible respiratory depression
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Intervening for Severe Preeclampsia: Magnesium level of 25 results in what
possible cardiac arreest
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Intervening for Severe Preeclampsia: How do you know if ankle clonus present?I
If when moving your hand away from the foot, the movement is jerky and rapid when coming down
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Intervening for Eclampsia: How do you know if someone has this?
Seizure activity. Generalized and start with facial twitching. Body then becomes rigid and in state of tonic muscular contraction
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Intervening for Eclampsia: What to give after seizure activity?
Magnesium sulfate infusion
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HELLP Syndrome: Women with this are at increased risk for
cerebral hemorrhage, retinal detachment , hematoma rupture and acute liver fialure
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HELLP Syndrome: Early diagnosis critial to prevent
liver distention, rupture, and hemorrhage and onset of DIC
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HELLP Syndrome Patho: What causes this cascade of events?
When RBCs become fragmented as they pass through small, damaged blood vessels. Elevated liver enzymes are the result.
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HELLP Syndrome Patho: Endothelial damage and fibrin deposition in the liver may lead to
liver impairment and can result in hemorrhagic necrosis, indicated by upper quadrant tenderness, nausea, and vomiting
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HELLP Syndrome Therapeutic Mx: Mainstay of treatment is what?
Lowering of high blood pressure with rapid-acting antihypertensive agents, prevention of convulsions, or further seziures with magnesium sulfate
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HELLP Syndrome Nursing Assessment: Be alart for what from woman?
Complaints of nausea, malaise, epigastric or right upper quadrant pain, and demonstrable edema
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HELLP Syndrome Nursing Assessment: Diagnossi is based on lab results that show was?
Low hematocrit, platelet count
Elevated LDH, AST, ALT , BUN, Bilirubin, Uric Acid, Creatinine Levels
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Blood Incompatibility: When does this arrise?
When mother with blood type O becomes pregnant with fetus with a different blood type
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Blood Incompatibility: What is RhIsoimmunization?
when pregnant womans immune system creates antibodies against fetal Rh blood factors. Can cause fetal heart problems, breathignn difficulties, jaundice, and a form of anemia.
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ABO Incompatibility Patho: What is this?
Limited to type O mother with fetuses who have type A or B blood.
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RH Incompatibility Patho: What is this?
Condition that develops when woman with RH- is exposed to RH+ blood cell and subsequently develops circulating titers of Rh antibodies.
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RH Incompatibility Patho: What does this most commonly arise?
With epxosure of Rh- mother to Rh+ fetal blood during pregnancy or birth. Maternal antibodies produced against the foreign Rh antigens
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RH Incompatibility Patho: Babies born after the first child will have what issues?
More serious hemolytic anemia
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RH Incompatibility Nursing Assessment: If history revels Rh- mother with Rh+ fetus, prepare client for what
Antibody screen to determine whether she has developed isoimmunity to the Rh antigen
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RH Incompatibility Nursing Assessment: What happens if COOMBS test negative?
Woman candidate for RHoGAM.
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RH Incompatibility Nursing Assessment: What does RhoGAM do?
Helps destroy any fetal cells in the maternal circulation before sensitization occurs, thus inhibiting maternal antibody production
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Amniotic fluid Imbalances - Polyhydramnios: What is this?
Too much amniotic fluid surrounding fetus between weeks 32-36
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Amniotic fluid Imbalances - Polyhydramnios: What is this associated with?
Fetal anomalies of development like upper GI obstruction or atresias, neural tube defects, and anterior abdoinal wall defects
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Amniotic fluid Imbalances - Polyhydramnios and Therapeutic Mx: What to d if severe?
Amniocentesis or artifical rupture of membranes is done to reduce the fluid and pressure.
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Amniotic fluid Imbalances - Polyhydramnios and Nursing Assessment: Focus on ongoing assesment and monitoring for symptoms of
abdominal pain, dyspnea, uterine contractions, and edema in lower extremities.
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Amniotic fluid Imbalances - Oligohydramnios: What is this?
Decreased amount of amniotic fluid between 32-36 weeks.
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Amniotic fluid Imbalances - Oligohydramnios: What may this result from?
Any condiiton that prevents fetus from making urine or blocks it from going into amniotic sac
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Amniotic fluid Imbalances - Oligohydramnios: Puts fetus in increased risk for what?
Perinatal morbidity and mortality. Fetus cannot move around freely
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Amniotic fluid Imbalances - Oligohydramnios and Therapeutic Mx: How can they be managed outpatient?
With serial ultrasounds and fetal surveillance through nonstress testing and biophysical profiles.
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Amniotic fluid Imbalances - Oligohydramnios and Therapeutic Mx: What happens if fetal well-being compromised?
Birth planned along with amnioinfusion. Fluid introduced into uterus through intrauterine pressure catheter
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Amniotic fluid Imbalances - Oligohydramnios and Therapeutic Mx: What is amnioinfusion thought to do?
Improve abnormal fetal heart rate patterns, decrease cesarean births and possibly minimize risk of neonatal aspiration syndrom e
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Multiple Gestations: Concern why?
High risk for preterm labor, polyhydramnios, hyeremesis gravidarum, anemia, and preeclampsia.
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Multiple Gestations: Fetal newborn risks here?
prematurity, respiratory distress syndrome, birth asphyxia, and CNS anomalies.
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Multiple Gestations: How do Monozygotic twins develop?
When a single, fertilzied ovum splits during the first 2 weeks after conception
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Multiple Gestations: What are dizygotic twins??
Two sperm fertilziing two ova
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Premature Rupture of Membranes: What is this?
Rupture of waters before the onset of true labor.
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Premature Rupture of Membranes: Condiitons and complications associated with this?
Infection, prolapsed cord, abruptio placentae and preterm labor
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Premature Rupture of Membranes: If prolonged, greater than 24 hours, what happems to the woman?
Risk for infection (chorioamnioitis, endometritis, sepsis, and neonatal infections) increases and continues to increase the logner the time since the bag of waters ruptured
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Premature Rupture of Membranes: what is latent period?
The time interval from rupture of membranes to the onset of regular contractions
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Premature Rupture of Membranes: Women with this present with what??
Leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure but do not have contractions.
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Premature Rupture of Membranes: Diagnosed by?
Speculum vaginal examination of the cervix and vaginal cavity.
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Premature Rupture of Membranes: What is preterm premature rupture of membranes?
Rupture of memrbranes to the onset of labor in a woman who is less than 37 weeks gestation
189
Premature Rupture of Membranes: This may be associated with what?
Vaginal bleeding, placental abruption, microbial invasion of the amniotic cavity, and defective placentation.
190
Premature Rupture of Membranes and Therapeutic Management: What is done?
No unsterile digital cervical exam done. If fetal lungs mature, labor is initated.
191
Premature Rupture of Membranes and Health Hx and Physical Exam: Assess for signs of labor inlcuding
cramping, pelvic pressure, or back pain. Also assess for infection like fever or elevated WBC
192
Premature Rupture of Membranes and Health Hx and Physical Exam: What is done if PPROM exists?
Sterile speculum exam (inspects cervix but no palpate) is done rather than digital because it may dimish latency and increase newborn morbidity
193
Premature Rupture of Membranes and Health Hx and Physical Exam: What is meconium?
Foul odor, present in the amniotic fluid an dindicates fetal distress related ot hypoxia. Stains the fluid yellow to greenish brown.
194
Premature Rupture of Membranes and Lab/Diag Test: What tests used to diagnose this?
Nitrazine Test, Fern Test, or Ultrasound
195
Premature Rupture of Membranes and Lab/Diag Test: What is the Nitrazine test?
pH of fluid is trested, amniotic fluis is more basic than normal vaginal secretions. Paper turns blue in presence of amniotic fluid .
196
Premature Rupture of Membranes and Lab/Diag Test: what is the fern test?
Sample of vaginal fluid placed on a slide to be viewed directly under a microscope. Well develop fern-like pattern when it dries because of sodium chloride crystallization.
197
Premature Rupture of Membranes and Nursing Management: Focuses on what?
Preventing infection and identifying uterine contractions.
198
Premature Rupture of Membranes and Nursing Management: What happens if labor does not start within 48 hours?
May be discharged home on expecting management which includes
Antibiotics
Acitivty restrictions
Education about S&S aboutu infection
Ultrasound every 3-4 weeks
199
Which of the following women should receive RhoGAM postpartum?
Nonsensitized Rh-negative mother with a Rh-negative newborn
Nonsensitized Rh-negative mother with a Rh-positive newborn
Sensitized Rh-negative mother with a Rh-positive newborn
Sensitized Rh-negative mother with a Rh-negative newborn
Nonsensitized Rh-negative mother with a Rh-negative newborn
200
A woman is suspected of having abruptio placentae. Which of the following would the nurse expect to assess as a classic symptom?
Painless, bright-red bleeding
“Knife-like” abdominal pain
Excessive nausea and vomiting
Hypertension and headache
“Knife-like” abdominal pain
201
RhoGAM is given to Rh-negative women to prevent maternal sensitization. In addition to pregnancy, Rh-negative women would also receive this medication after which of the following?
Therapeutic or spontaneous abortion
Head injury from a car accident
Blood transfusion after a hemorrhage
Unsuccessful artificial insemination procedure
Therapeutic or spontaneous abortion
202
After teaching a woman about hyperemesis gravidarum and how it differs from the typical nausea and vomiting of pregnancy, which statement by the woman indicates that the teaching was successful?
“I can expect the nausea to last through my second trimester.”
“I should drink fluids with my meals instead of in between them.”
“I need to avoid strong odors, perfumes, or flavors.”
“I should lie down after I eat for about 2 hours.”
“I need to avoid strong odors, perfumes, or flavors.”
203
A pregnant woman, approximately 12 weeks’ gestation, comes to the emergency department after calling her health care provider’s office and reporting moderate vaginal bleeding. Assessment reveals cervical dilation and moderately strong abdominal cramps. She reports that she has passed some tissue with the bleeding. The nurse interprets these findings to suggest which of the following?
Threatened abortion
Inevitable abortion
Incomplete abortion
Missed abortion
Inevitable abortion
204
When administering magnesium sulfate to a client with preeclampsia, the nurse explains to her that this drug is given to:
Reduce blood pressure
Increase the progress of labor
Prevent seizures
Lower blood glucose levels
Prevent Seizures
205
A woman is being discharged after receiving treatment for a hydatidiform molar pregnancy. The nurse should include which of the following in her discharge teaching?
Do not become pregnant for at least a year; use contraceptives to prevent it
Have the client’s blood pressure checked weekly in the clinic
RhoGAM must be given within the next month to her at the clinic
An amniocentesis can detect a recurrence of this disorder in the future
Do not become pregnant for at least a year; use contraceptives to prevent it
