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NURS246 OB > Exam 3- OB High Risk > Flashcards

Exam 3- OB High Risk Flashcards

(83 cards)

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1
Q

Spontaneous abortion

A

termination of pregnancy without action taken by woman or another person

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2
Q

Spontaneous abortion s/s

A

abd pain, late menses
Abstain intercourse, record amount/frequency bleeding, watch for passage, IV fluids, antibiotics, DNC

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3
Q

Threatened abortion

A

slight bleeding, cramping, no passage tissue/dilation
Bed rest, repetitive transvaginal ultrasounds, blood test

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4
Q

Inevitable abortion

A

moderate bleeding/cramping, cervical dilation
Prompt termination b/c of infective uterus

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5
Q

Incomplete abortion

A

heavy profuse bleeding, intense bad contraction, not everything has passed
Dilation encourage DNC- scrape inner lining
Nasal prosonole

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6
Q

Complete abortion

A

mild cramp, slight bleeding, pass all products
Transvaginal ultrasound
No interventions as long as no s/s hemorrhage or infection

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7
Q

Missed abortion

A

no bleeding/passage of tissue
DNC, medications

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8
Q

Recurrent abortion

A

3 or more

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9
Q

Ectopic pregnancy

A

fertilized ovum implantation somewhere else other than endo lining in uterus
Decreased maternal mortality

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10
Q

Ectopic pregnancy s/s

A

amenorrhea, positive preg test, abd pain, vag spotting, pain one sided/lower abd pain may be diffused, fainting/dizziness, can have right shoulder pain
Assessment last period, pelvic exams, HCG levels, ultrasound

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11
Q

Ectopic pregnancy- Rupture has occurred

A

right should pain, shock, no vaginal bleeding, may go to ER, HCG drawn every 48hr

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12
Q

Progesterone above 25

A

has pregnancy

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13
Q

Progesterone less than 5

A

suspicious ectopic/abnormal

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14
Q

Methotrexate

A

destroys rapidly dividing cells
PT stable, normal kidney functions
Hazardous drug!

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15
Q

Methotrexate administration

A

Before- height/weight, only given in hospital, IM
Drawing- two gloves, don’t expel air, dispose everything hazardous waste, wash hands

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16
Q

Methotrexate teaching

A

keep follow up appts, no analgesic stronger than acetaminophen/report abd pain

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17
Q

Methotrexate s/s

A

N/V, sore mouth dizziness, severe reversible hair loss
Surgical- removing tube/products at site, give Rhogam, discuss future fertility, contraceptives for 3 period cycles, contact provider if she thinks she’s pregnant to confirm placement

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18
Q

Placenta previa

A

placenta improperly implanted into lower uterus, bleeding scanty profuse
Marginal, Partial, or Total

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19
Q

Placenta previa s/s

A

classic s/s is painless vag bright red bleeding after 20wk

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20
Q

Placenta previa RF

A

multipara, recent abortion, large placenta, age, placenta accreta (placenta grows into wall of uterus), prior c-sec (worry about hemorrhage, fetal death due to pre-term

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21
Q

Placenta previa DX

A

u/s, not going to do digital vaginal exam until DX is made b/c you can touch placenta

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22
Q

Placenta previa Interventions

A

determine amount blood, FHR, corticosteroids (Betamethasone helps fetal lungs mature), pelvic rest/bed rest, teach warning signs, follow up assessment
PT stable 48 hours and comply to activity restrictions to be able to go home, keep all apt, bleeding resumes g back to hospital
Labor/baby compromised/bleeding- c-sec
Greatest concern postpartum hemorrhage, meds may not help

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23
Q

Abruptio placentae

A

placenta separates from uterine wall
Not always normally implanted
Mild, grade 1/2/3
Happens prior to birth, mom has pain disproportionate to pain on contractions, may or may not have bleeding
Always think of cocaine use in the back of your head!

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24
Q

Abruptio placentae RF

A

hypertension

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25
Abruptio placentae causes
History of 2 prior abruptions, cocaine, smoking, multigravida, short umbilical cord
26
Abruptio placentae s/s
bleeding or concealed bleeding, uterus tender/board-like/rigid abd, uterine irritability, abd/low back pain, high uterine resting tone, bloody fluid, nonreassuring FHR, monitor s/s hypovolemic shock Suspect abruption if intense localized uterine pain w/ or w/o bleeding, Pain is constant with complete bleeding, Get out baby in 4 minutes with complete bleeding, with complete separation mortality at 100%, baby needs no longer than 5min to get brain damage
27
Abruptio placentae Interventions
assess bleeding, level of discomfort, VS q5-15 min, type crossmatch, s/s hypovolemic shock, O2, empty bladder q2hr or foley, Rhogam
28
Gestational hypertension
onset HTN with no protein in urine Not longer than 12 wks, above 140/90, take 4 hr apart with previous normal HR
29
Preeclampsia
HTN AND protein in urine after 12 wks, prior to seizure
30
Preeclampsia RF
1st pregnancy, men who father preeclampsia preg, older 35, obesity, diabetic, chronic HTN, renal disease
31
Eclampsia
have seizure with HX of preeclampsia Convulsions or seizure before, during, after labor, can happen 24-48 hrs after delivery No HX of preexisting pathology Can develop in immediate postpartum Results in vasoconstriction/vasospasms leading to multiple organ failure Help by deliver placenta
32
Eclampsia prevention
monitor weight gain/BP/urine protein, aspirin 81mg/day to increase perfusion to placenta
33
Eclampsia without severe features
BP higher than 140/90 but lower than 160/110, proteinuria, possible edema Education- activity restriction, daily BP/weight/proteinuria, fetal assessment, ample protein but don’t lower salt or fluid
34
Eclampsia with severe features
160/110, platelets decreased, liver enzymes high, renal insufficiency, cerebral disturbances, epigastric pain, pulmonary edema, fetal growth restriction
35
Eclampsia with severe features interventions
platelet/UAP, quiet dark environ, seizure precautions(padded side rails, O2, suction, turn to side, call RR), fluid doesn’t go above 125 mL/hr, magnesium sulfate(antagonist- calcium)/anti HTN, fetal assessment, educate about meds Seizure- 4-6 gm Mag sulfate over 5 min to break seizure, watch fetal bradycardia, q 15 min check for placental abruption, foley cath
36
Magnesium Sulfate
blocks neuromuscular trans/relax smooth muscle, IV, given as loading dose 4-6gm over 15-20min followed by 1-2gm/hr, check with another nurse, never abbreviate
37
Magnesium Sulfate s/s
lethargy, weakness, N/V, nasal congestion, can cross placenta, decrease FHR
38
Magnesium Sulfate toxicity s/s
depressed/absent reflexes, decreased RR, cardiac arrest, decreased O2, disorientation, blurred vision Turn mag off if any s/s present Therapeutic 4-8 for Mg, can lead to cardiac arrest if too high
39
Magnesium Sulfate interventions
VS q1hr, FHR, I&O, calcium gluconate measure BP, assess edema, DTR, clonus, proteinuria, watch for headache/epigastric pain/RUQ abd pain/visual disturbances
40
HELLP syndrome
Hemolysis, Elevated, Liver enzymes, Low, Platelet count Pulmonary edema
41
HELLP syndrome s/s
flu-like system, RUQ pain, worse at night
42
HELLP syndrome interventions
Give magnesium sulfate, fluid replacement, may need betamethasone for preterm delivery
43
Rh incompatibility
Maternal and fetal blood don’t mix Mom negative and baby positive →sensitization; can happen during placental separation after delivery Next pregnancy with RH positive baby antibodies will cross placenta and destroy fetal cells
44
Rh incompatibility fetal s/s
decreased RBC, increased bilirubin, Kernicterus(brain damage) → bilirubin encephalopathy, hydrops Give within 72 hours of event
45
Gestational diabetes mellitus
carb intolerance of variable severity with onset or 1st recognition during preg, higher risk of getting Type 2 later in life
46
Gestational diabetes mellitus causes
preexisting disease, unmasking compensated metabolic abnormalities, altered maternal metabolism
47
Gestational diabetes mellitus goals
decrease fetal macrosomia, should dystocia, birth trauma, c-sec, vascular damage Control circulating BG levels, pt goes from oral to insulin
48
Gestational diabetes mellitus complications
hydramnios preeclampsia, dystocia
49
Gestational diabetes mellitus- baby
HbA1C >10% higher risk for fetus with malformations (heart, CN, skeletal), LGA, macrosomia, Check BG on baby heel and warm the stick, want to be greater than 40 first hr, then higher than 45
50
Gestational diabetes mellitus- Glucose Challenge Test
1-hr 24-28wks, RF should be screened earlier 1hr GCT high, then 3hr Gtt DX based on 2 or more elevated levels 1-hour GCT- 50 g oral glucose Abnormal if 1 hr glucose 140 or greater 3-hr HTT- 100 g oral glucose Fasting- 95 1 hr- 180 2 hr- 155 3 hr- 140 Failed 2 or more= gestational diabetes Work w dietician, exercise, BG monitoring(fasting, 2hr after eating), fetal surveillance
51
Gestational diabetes mellitus- Evaluate fetus
U/S gestational age, fetal growth, amniotic fluid
52
Perinatal loss
death of fetus before birth or during first year of life After deliver up to 1 yr Mother feels alone, different type of loss
53
Early loss
before 20 wks
54
Late loss
after 20 wks
55
Perinatal loss interventions
Initial reactions- crying, anger, guilt, watch for postpartum depression esp in father Recognize baby, use their name, mom see/touch/hold baby, put baby to rest w dignity Present infant to parents- be positive, wrap baby in blanket, allow privacy
56
PROM
spontaneous rupture of membranes prior to onset of labor
57
PROM RF
58
PROM fetal effects
neonatal morbidity, facial, anomalies, fetal growth restriction, umbilical cord compression, sepsis, pre-term Ask complaint about vaginal fluid loss or continuous peeing
59
PROM DX
Nitrazine paper, Ferning Test
60
PPROM
preterm premature rupture of membranes before 37 wks
61
PPROM Interventions
Prevent contractions! Bed rest, kick counts, betamethasone, avoid breast stimulation/anything into vag Prevent chorioamnionitis CBC, urinalysis, GBS, VSq4hr, antibiotics Tocolytics not used except where you want to delay labor
62
Preterm Labor
20-37 wks RF pg. 438
63
Preterm Labor s/s
ctx w/wo pain, back pain, balling up, pelvic pain/pressure, period-like cramps, vag bleeding, increased vag discharge, frequency, diarrhea, “feeling bad”
64
Preterm Labor- when not to stop
demise, nonviable fetal anomaly, severe preeclampsia, hemorrhage, chorioamnionitis, fetal maturity
65
Preterm Labor- predicting
cervical length <25 mm, fetal fibronectin
66
Preterm Labor- Fetal Fibronectin
protein normally found in fetal membranes and decidua Found after 20 wks is abnormal until term, can indicate labor will be early Negative- less chance to deliver in the next 2 wks
67
Preterm Labor interventions
dilation >3cm, assess contractions, bedrest, uterine perfusion, hydration, tocolytics
68
Terbutaline
relax smooth muscle
69
Terbutaline dosage
PO 2.5-5 mg TID(don’t use more than 48-72 hr), SQ 0.25 mg q1hr until contractions cease
70
Terbutaline s/s
increased pulse, tremors, shakiness, N, flushing, palpitations, edema, tachycardia, CP, chills, sweating
71
Terbutaline interventions
Educate mom on s/s Assess contractions/FHR, VS, BG, fluids
72
Indomethacin
premature infants with cardiac disorders
73
Indomethacin- dosage
Loading dose- 100 mg rectal or 50 mg PO Maintenance- 25-50 mg q6hr PO
74
Indomethacin- s/s
epigastric pain, N, gi bleeding, worsening asthma, elevated BP, closure of ductus arteriosus, impairs renal function
75
Nifedipine
treats severe HTN CAN’T GIVE SAME TIME AS MG SULFATE
76
Nifedipine dosage
Loading- 10-20 mg PO Maintenance- 10-20 mg PO q3-6hr
77
Nifedipine s/s
flushing, dizziness, headache, tachycardia, hypotension, increased BG
78
Betamethasone
glucocorticoid ONLY IM
79
Betamethasone dose
Dose- 1mg IM q24hr X2
80
Betamethasone contraindications
maternal infection, diabetes
81
Betamethasone s/s
increased infection, maternal hyperglycemia
82
Betamethasone interventions
Give deep in gluteal, avoid deltoid, assess BP/P/weight/edema, labs
83
When contractions start at home
empty bladder, lie on side, 3-4c water, palpate for ctx, rest for 30 min after s/s leave, call if s/s persist

NURS246 OB (1 decks)

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