Exam 2 Flashcards
(105 cards)
Discuss the use of illegal substances or over the counter medications and how they may affect pregnancy
Alcohol - most common
Abnormalities in brain and neuron development
LBW
Prematurity
Fetal alcohol syndrome
Leading cause of mental retardation
Cocaine
maternal cardiac events
Abruption of Placenta**
Fetal effects = vasocon + neuroexcitation
Opioids
Withdrawal - NAS
*should not immediately give narcan as infant will immediately go into withdrawal
Tobacco
Decreased fertility
Increased risk of miscarriage
Placenta Previa
IUGR
long term cognitive function + risk of brain damage
Describe how diabetes affects the pregnant woman and her fetus; identify nursing interventions
The primary concern for any woman with this disorder is controlling the balance between insulin and blood glucose levels to prevent hyperglycemia or hypoglycemia. Women with gestational diabetes are at an increased risk of complications during pregnancy and delivery.
Gestational: If glucose cant get into the cell
Note signs of hyperglycemia (confusion, increased thirst, frequent urination, changes in visual acuity) or hypoglycemia (dizziness; tremors; lethargy; excessive sweating, pale, cool, moist skin).
Discuss hyperemesis gravidarum including causes, symptoms, treatment, and nursing care
Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss.
-hypokalemia + natremia
- decrease urea
Peaks @ 9-20wks
Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg.
Findings:
● Vomiting that may be prolonged, frequent, and severe
● Weight loss, acetonuria, and ketosis
● Signs and symptoms of dehydration including:
● Lightheadedness, dizziness, faintness, tachycardia, or inability to keep food/fluids down for more than 12 hours
● Dry mucous membranes
● Poor skin turgor
● Malaise
● Low blood pressure
Management:
IV Hydration
B6 or vitamin B6 plus doxylamine
Laboratory studies to monitor kidney and liver function
Correction of ketosis and vitamin deficiency should be strongly considered. Dextrose and vitamins, especially thiamine, should be included in the therapy when prolonged vomiting is present
Discuss hydatidform mole including risk factors, causes, symptoms, treatment, and nursing care
hydatidiform mole is a benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grapelike clusters without a viable fetus.
hydatidiform moles are benign, but they sometimes become cancerous. Having one or more of the following risk factors increases the risk that a hydatidiform mole will become cancer.
Partial: may have some fetal tissue
Complete: no fetal tissue
Risk
<20 yrs >35 yrs
Previous molar preg
Risk for woman
increased risk of choriocarcinoma
Assessment:
bleeding + uterine enlargement (big for gestational age)
Anemia
NV
Ultrasound to diagnose
Treatment:
immediate evacuation with aspiration + suction
Nursing actions
no preg for 1 yr, monitor for malignancy
Discuss hypertension in pregnancy, including risk factors, causes, symptoms, treatment(especially Magnesium sulfate) , and nursing care
Hypertension is identified as systolic pressure 140 mm Hg or greater or diastolic pressure 90 mm Hg or greater. Hypertensive disorders of pregnancy are the most common complication of pregnancy, affecting 10 percent of pregnant women, and are the second leading cause of maternal death and a significant contributor to neonatal morbidity and mortality.
● Preeclampsia is a multisystem hypertensive disease unique to pregnancy, with hypertension accompanied by proteinuria after the 20th week of gestation. Eclampsia is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia.
●Chronic hypertension with superimposed preeclampsia includes the following scenarios:
Women with hypertension only in early gestation who develop proteinuria after 20 weeks of gestation.
Women with hypertension and proteinuria before 20 weeks who develop a sudden exacerbation of hypertension,
● Gestational hypertension: Systolic BP ≥ 140/90 for the first time after 20 weeks, without other signs and systemic finding of preeclampsia
● Chronic hypertension: Hypertension (BP ≥ 140/90) before conception. High blood pressure known to predate conception or detected before 20 weeks of gestation
Treatment:
● Magnesium sulfate, a central nervous system depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus.
● Antihypert
● Assess CNS changes, visual, reflexes
Risks for Woman
● Cerebral edema/hemorrhage/stroke
● Disseminated intravascular coagulation (DIC)
● Pulmonary edema
● Congestive heart failure
● Maternal sequelae resulting from organ damage include renal failure, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), thrombocytopenia and disseminated intravascular coagulation, pulmonary edema, and eclampsia (seizures), hepatic failure
● Abruptio placenta
● Women with a history of preeclampsia have a 1.5 to 2 times higher risk of developing heart disease later in life
● obesity
● Chronic HT, kidney disease, lupus, diabetes
Fetal Risk:
● Fetal/neonatal morbidity and mortality are consequences of intrauterine growth restriction (IUGR), prematurity, and placental abruption.
● Fetal intolerance to labor because of decrease placental perfusion
● Stillbirth
At Risk: Cardiac Disease
Increases the demand for cardiac output
Demand on the heart increases – 50%
Signs cardiac issues are worsening
Progressive generalized edema
Crackles at bases of lungs
Rapid, weak irregular pulse (100 bpm or higher)
Difficulty catching breath
Cough
Increased fatigue
Care:
EKG + FHR
Anticoag: warfarin + heparin
O2 + Pulse Ox
Pain management
Make sure placenta is properly perfused
AVOID FLUID OVERLOAD
NO METHERGINE
Treatment for Heroin
Methadone: Most common in pregnancy
Buprenorphione: less side effects than methadone
Naltrexone: opioid antagonist
Diabetes
Type1 : body isnt making insulin - body attacks destroys insulin producing cells.
Autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed with insulin. About 5%-10% of patients diagnosed with diabetes are type I
Type 2: body is producing enough insulin but not properly produced overweight can’t stop insulin production. fat deposits on cell can’t open. Characterized by insulin resistance and inadequate insulin production. This is the most prevalent form of diabetes and is linked to increased rates of obesity and sedentary lifestyle. It is managed primarily with diet and exercise; the addition of oral antihyperglycemic or insulin may be indicated if hyperglycemia continues.
- glucose can’t get into cells + trys to get rid of extra w. kidney
Challenge to manage because of
HPL
P
HgH
Corticotropin-releasing hormone
Shift energy source from ketone -> free fatty acid
Treatment:
Euglycemic control
minimize complication
prevent prematurity
-> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia
Cardinal Signs
Polyuria
Polydipsia
Weight Loss
Polyphagia
Changes of insulin during pregancy
1st Tri: decreases
2nd-3rd: rises
HPL + Somatropin - hormones from the placenta create insulin resistance
Fetal Risk with Diabetes
Macrosomia – BIG baby >5000g
- baby is big but isnt as mature
IUGR
RDS
Preterm Labor
Regular contractions of uterus resulting in changes in the cervix before 37 wks
PTB = 20 -36 wks
Leading cause of neonatal mortality
Spontaneous: unintentional/planned delivery before 37wks –> can be caused from inflam + infection
Medically Indicated: Provider recommends preterm birth – preecalmpsia
Nonmedically indicated: Elective (NOT RECOMMENDED)
Risks:
Multiple gestation
Uterine/cervical abnormalities
Fetal anomalies
Hydramnios + Oligohydraminos
Infection
Premature rupture of membranes
HT, Diabetes, clotting disorders
<17yrs or >35 yrs
Obesity
Smoking + illicit drug use
Contradictions:
Intrauterine fetal demise
Lethal fetal anamoly
nonreassuring fetal status
Severe preeclampsia + eclampsia
Chorioamnionitis
Warning signs:
Water breaks
decrease fetal movement
Increase vaginal discharge
Fever
Preterm Classifications
Late Preterm: Born 34-37wks
Very Preterm: <32wks
Viability: @ 25wks
Perviability: 40% of infant deaths 20-25wks
Cervical insufficiency
describe the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester
Preeclampsia
Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.
Imbalance of vasodilator hormones (prostacyclin) and vasoconstrictor hormones (thromboxane)
- Leading cause of maternal death
- 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease.
“PREECLAMPSIA WITHOUT SEVERE FEATURES” (MILD)
“PREECLAMPSIA WITH SEVERE FEATURES” (SEVERE)
Diagnosis Criteria
>140/>90 mmhg after 20 wks
proteinuria
thrombocytopenia <100,000
renal insufficiency
impaired liver f(x)
PE
Visual symptoms
High Risk:
>35 yr
AA + low socioeconomic
previous preeclampsia with another preg
pregnant w. multiples
have diabetes + HT, kidney disease, AI
obese
GTD
SS
Headache that doesnt go away
Blurred vision
Epigastric pain
trouble breathing
NV
swelling in face + hands
weight gain - 2-5lbs per week
Proteinuria
Thrombocytopenia
Renal insufficiency
Impair live function
Pulmonary edema
Visual symptoms
Risk for fetus
Morbidity
intolerance of labor
still birth
placenta abruption
IUGR
Low birthweight
Treatment
Early detection
Delivery monitor
Hydra Liz one
Mg sulfate
Oral nifedipine
Labetalol
Consequences Maternal
w. eclampsia 20% morality rate – can occure up to 48hrs post
increase risk of
- abruptio placenta
- retinal detachment
- acute renal failure
- cardiac failure
- hemorrhage + stoke
Consequences Fetal
Fetal growth retardation
Hypoxia
Death
Multiple Gestations
+1 fetus - either from the fertilization of one zygote that subsequently divides (MONOZYGOTIC) or fertilization of multiple ova.
● Monozygotic twins are from one zygote that divides in the first week of gestation. They are genetically identical and similar in appearance and always have the same gender.
● Dizygotic twins result from fertilization of two eggs and may be the same or differing genders. If the fetuses are of differing gender, they are dizygotic and therefore dichorionic.
● Either of these processes can be involved in the development of higher order multiples.
In neonatal abstinence syndrome- which of the following potential symptoms are measured by the Finnegan scale?
Temperature
Tone
Tremors
Excoriation
Nasal Stuffiness
https://www.thecalculator.co/health/Finnegan-Score-For-Neonatal-Abstinence-Syndrome-(NAS)-Calculator-1025.html
Whats the rationale for using Eat, Sleep, Console?
- Supports infants and mothers rooming in together during
infant hospitalization - Focuses on non pharmacologic treatments
- Increases breastfeeding rates of opioid exposed newborns (OEN)s
- Decreases pharmacologic treatment and duration of
treatment for OENs - Decreases the average length of stay (LOS) for OENs.
Pre gestational diabetes
Blood glucose is elevated but below clinical threshold
Components:
Central adiposity > 35 in
Dyslipidemia
Hyperglycemia
HT
Maternal Risk:
DKA - 2nd tri
HT
Spontaneous Abortion
Polyhydramnios
Induction of Labor
UTI, Hypergly, Postpartum, post hemorrhage
exacerbation of diabetes symptoms
Fetal Risk:
Congenital defect
Prematurity
Hypogly, cal + mag
asphyxia
respir distress
Still birth
hyperbilirubinemia
polycythemia
● Development of metabolic syndrome, prediabetes, and type II diabetes
● Impaired intellectual and psychomotor development
Gestational Diabetes
hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance
Two main contributors to insulin resistance are:
● Increased maternal adiposity
● Insulin desensitizing hormones produced by the placenta
risk:
<25 yr
HT, PCOS
Increase in maternal adiposity
insulin desensitizing hormone
Family history/ age/ race/ obesity history of macrosomia
Diagnosis: glucose testing 24-28 wk
Complications:
Macrosomia
Shoulder dystocia
HT + preeclampsia
preterm birth + stillbirth
C-section
Risks for baby
excessive birth weight
preterm
breathing difficulties
hypoglycemia
obesity + type 2 later in life
stillbirth
hyperbilirubinemia
birth trauma
RDS
Prevention:
maintain healthy lifestyle, keep active, don’t gain more weight than recommended
Findings:
Glucose screening 24-28 wks of gestation
Management:
For most women with GDM, the condition is controlled with a well-balanced diet and exercise.
● Up to 40% of women with GDM may need to be managed with insulin.
● Oral hypoglycemic agents may be used, but there is not agreement on their recommended use during pregnancy.
● Cesarean birth is recommended for estimated fetal weight >4,500 g.
● Women with GDM need to be monitored for type 2 diabetes after the birth.
Nursing Actions:
Teach the woman to test glucose four times a day, one fasting and three postprandial checks/day (suggested glucose control is to maintain fasting glucose less than 95 mg/dL before meals, and between 120 to 135 mg/dL after meals)
HELLP Syndrome
HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems:
H–Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
EL–Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems.
LP–Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.
HELLP may develop in women who do not present with the cardinal signs of severe preeclampsia.
Risk for woman:
Abruptio placenta
Renal failure
liver hematoma / rupture
Death
Risk for fetus
Preterm birth
Death
Assessment:
general malaise, nausea, and right upper gastric pain.
unexplained brusing, mucosal bleeding, petechaie
Treatment:
Delivery of fetus + placenta — resolve 48hrs post partum
Eclampsia
occurrence of seizure activity in the presence of preeclampsia
- can be ante, intra + post partum
It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema
Warning:
persistent headaches
epigastric pain
NV
hyperreflexia w. clonus
restlessness
Treatment
Mg sulfate + hypertensive
Placenta Previa
1/200
The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus
Painless intermittent bleeding
Confirmed by ultrasound
Risk Factors:
scarring
large placenta
infertility, nonwhite, low socio, short interpreg
diabetes, smoking cocaine use
Painless bleeding
Large placenta, Multiple gestation
>35 yrs
Maternal risk:
Hemorrhagic + hypovolemia shock
Blood loos
Fetal Risk:
Disruption of blood flow
Morbidity + morality
Fetal:
Malpresentation
IUGR fetal anemia
Management:
Avoid vaginal exam
Monitor fetal vitals
Check Amniocentesis + BPP - lung maturity
When active bleeding:
* Large bore IV access
* Measure I&O
* Weigh pads — counting or visual estimate is not sufficient (1gm=1ml)
* CBC, coagulation studies, T&X
* Oxygen to keep pulse ox > 95%
* Anticipate possible emergent cesarean birth
Bright red bleeding
Placenta Abruption
Partial complete detachment of placenta
- hematoma forms + destroys the placenta around it
dark red bleeding
The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions, uterine tenderness, and a nonreassuring fetal heart rate (FHR) pattern
Grade:
1(mild) least amount of separation
2 (moderate)
3 (Severe) more separation + blood
Risk Factor
decreased placenta perfusion
HT
Seizure
Blunt trauma to the maternal abdomen
history of abruption
smoke/cocaine use
Risk for Fetus:
LBW, asphyxia, still birth
SS
Sudden onset of intense pain
board-like rigidity to the abdomen
uterine irritability
tachystole
vaginal bleeding
port wine stain amniotic fluid
Management
assess fundal height
girth measurement
shock
weigh pads
Restoring blood loss
Anticipation and prepare for emergency delivery.
check for DIC
Partial abruption: concealed bleeding – retroplacental
Partial abruption: marginal bleeding placenta is halfway torn - bleeding is apparent
Complete abruption: bleed could be concealed or apparent
Placenta Accreta
The partial/complete placenta invades and becomes inseparable from the uterine wall.
0 leads to hemorrhage + may need a hysterectomy
- 3000 - 5000 mL blood loss
As many as 90% of patients with placenta accreta require blood transfusion, and 40% require more than 10 units of packed red blood cells
Risk factors
myometrial damage caused by C/S
Advanced maternal age
Multiparity
Risks for woman
Hemorrhagic + hypovolemic shock ~ 25-30% morbidity
Increase risk of infection, thromboembolism, pyelonephritis, pneumoia, ARDS + renal failure
Surgical complications
Risk for Fetus
Preterm ~ normally 34-36wks
Assessment: Ultrasound
Treatment:
Planned c/s + hysterectomy
Actions:
Monitor CBC + clotting
emotional support
Abortion
Spontaneous or elective termination of pregnancy <20wks
Induced: medical/surgical abortion before fetal viability
Elective: at the request of the woman but not for a medical reason
Therapeutic: abortion because of abnormalities
Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks —> miscarriage
Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum
Meds: mifepristone +misoprostol
