Health Conditions and Vulnerable Populations Flashcards Preview

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Flashcards in Health Conditions and Vulnerable Populations Deck (113)
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1
Q

What maternal conditions cause at-risk pregnancies?

A
Diabetes
Cardiac and Respiratory Disorders 
Anemia 
Autoimmune Disorders
Specific Infections
2
Q

Who are considered “vulnerable populations” for pregnancy?

A

Adolescents
Women 35 and older
Women HIV+
Women who substance abuse

3
Q

Diabetes Mellitus

A

chronic disease characterized by a relative lack of insulin or absence of the hormone that is necessary for glucose metabolism

4
Q

Type 1 Diabetes

A

absolute insulin deficiency due to an autoimmune process

-usually ages < 30

5
Q

Type 2 Diabetes

A

insulin resistance or deficiency related to obesity or sedentary lifestyle
-diagnosed primarily in older adults >30, but now being seen in children

6
Q

Impaired Fasting Glucose and Impaired Glucose Intolerance

A

characterized by hyperglycemia at a level lower than what qualifies as a diagnosis of diabetes

7
Q

Gestational Diabetes Mellitus

A

glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy

8
Q

What are the 2 classifications of diabetes during pregnancy?

A

Pregestational and Gestational

9
Q

Pregestational Diabetes

A

alteration in carbohydrate metabolism before conception which includes women with type 1 or 2 diabetes

10
Q

Gestational Diabetes

A

Develops during pregnancy

-associated with either neonatal complications or maternal complications

11
Q

What neonatal complications are associated with Gestational Diabetes?

A

macrosomia
hypoglycemia
birth trauma

12
Q

What maternal complications are associated with Gestational Diabetes?

A

preeclampsia and cesarean birth

13
Q

Patho for Gestational Diabetes

A

the existence of pancreatic beta-cell dysfunction before pregnancy and the unmasking of this problem by the development of insulin resistance during pregnancy

14
Q

What is a normal fasting blood glucose level?

A

92 mg/dL

15
Q

What is a normal oral glucose tolerance test result 1, 2, and 3 hours later?

A

1 hr- 180 mg/dL
2 hrs- 153 mg/dL
3 hrs- 140 mg/dL

16
Q

What placental hormones can cause insulin resistance?

A

hPL and growth hormone increase in direct correlation with the growth of placental tissue, rising throughout the last 20 weeks of pregnancy causing insulin resistance

17
Q

Gestational Diabetes effects on Mother

A
hydramnios
gestational hypertension
ketoacidosis
preterm labor
stillbirth
hypoglycemia 
UTI's/Vaginitis 
Difficult labor; c/s; hemorrhage
18
Q

Gestational Diabetes effects on Baby

A
cord prolapse
congenital anomalies 
macrosomia 
birth trauma
fetal asphyxia 
childhood obesity
death
respiratory distress syndrome
19
Q

What should the moms HbA1C level be to so control?

A

< 7%

20
Q

What type of diet should a pregnant woman with diabetes be on?

A

low carbohydrate diet with a carbohydrate content of 40% of the calories

21
Q

Maternal Surveillance for Diabetes

A
  • urine for protein, ketones, nitrates, and leukocyte esterase
  • evaluation of renal function/trimester
  • eye exam in first trimester
  • Hba1c q 4-6 weeks
22
Q

Fetal Surveillance for Diabetes

A
ultrasound 
alpha-fetoprotein levels
biophysical profile
nonstress testing
amniocentesis
23
Q

Congenital Heart Conditions

A

involves structural defects that are present at birth, but may not e identified at that time

24
Q

What are examples of congenital heart conditions that affect pregnancy?

A

Tetralogy of Fallot
Arterial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus arteriosus

25
Q

What are some complications for baby associated with moms congenital heart condition?

A

growth restriction
preterm/premature births
fetal/neonatal mortality

26
Q

Which conditional heart condition should you advise the mom to avoid pregnancy?

A

Tetralogy of Fallot

27
Q

Tetralogy of Fallot

A
  • Hospitalization and bedrest possible after the 20th week with hemodynamic monitoring via a pulmonary artery catheter to monitor volume status
  • Oxygen may be necessary during birth and labor
28
Q

Arterial Septal Defect

A

treatment with atrioventricular nodal blocking agents and at times with electrical cardioversion

29
Q

Ventricular Septal Defect

A

rest with limited activity if symptomatic

30
Q

Patent Ductus Arteriosus

A

Surgical ligation of the open ductus during infancy; subsequent problems minimal after surgical correction

31
Q

Acquired Heart Conditions

A

conditions affecting the heart and its associated blood vessels that develop during a person’s lifetime

32
Q

What are examples of acquired heart conditions =?

A
Mitral valve prolapse 
Mitral valve stenosis 
Aortic stenosis 
Peripartum cardiomyopathy
Myocardial infarction
33
Q

Mitral Valve Prolapse

A

most asymptomatic–diagnosis is made incidentally
occasional palpations, chest pain or arrhythmias
possibly need beta blockers
usually no special precautions

34
Q

Mitral Valve Stenosis

A

general symptomatic improvement with medical management involving diuretics, beta blockers, and anticoagulant therapy
-activity restriction, reduce sodium, and potentially bedrest if condition is severe

35
Q

Aortic Stenosis

A

Diagnosed w/ echocardiography
beta blockers, antiarrhythmic agents to reduce risk of heart failure or dysrhythmias
bedrest, limited activity, and close monitoring

36
Q

Peripartum Cardiomyopathy

A

preload reduction w/ diuretic therapy
afterload reduction w/ vasodilators
inotropic agents
salt restriction, daily exercise

37
Q

Myocardial Infarction

A

anticoagulant therapy, rest, and lifestyle changes

38
Q

Class I

A

asymptomatic w/ no limitation of physical activity

39
Q

Class II

A

symptomatic: dyspnea, chest pain w/ increased activity

40
Q

Class III

A

symptomatic: fatigue, palpitations w/ normal activity

41
Q

Class IV

A

symptomatic at rest or with any activity

42
Q

Patho for Congenital/Acquired heart conditions

A

hemodynamic changes overstressing women’s cardiovascular system

43
Q

Therapeutic Management for Heart Conditions

A

risk assessment
prenatal counseling
increased frequency of prenatal visits

44
Q

Nursing Assessment for Heart Conditions

A
vital signs 
heart sounds-murmurs, irregular rhythms, heart rate 
weight
fetal activity 
lifestyle
45
Q

Cardiac Decompensation

A

the heart’s inability to maintain adequate circulation

46
Q

When is the pregnant women most vulnerable to cardiac decompensation?

A

28-32 weeks gestation and in the first 48 hours postpartum

47
Q

Signs and Symptoms of Cardiac Decompensation

A
shortness of breath/dyspnea
cyanosis
swelling of hands, feet, and face
jugular vein engorgement 
rapid respirations 
abnormal heartbeats
chest pain
syncope 
fatigue 
cough
48
Q

Nursing Management Heart Conditions

A
stabilization of hemodynamic status 
risk reduction
cardiac medications
energy conservation/nutrition
fetal activity monitoring
S/S of cardiac decompensation
monitor during labor
49
Q

Chronic Hypertension

A

hypertension before pregnancy or before 20th week gestation or persistence > 12 weeks postpartum

50
Q

Therapeutic Management Hypertension

A
preconception counseling
lifestyle changes
antihypertensive agents if severe
fetal movement monitoring
serial ultrasounds
51
Q

Nursing Management Hypertension

A

lifestyle changes=DASH diet
frequent antepartal visits
monitoring for abruptio placentae, preeclampsia
daily rest periods
home BP monitoring
close monitoring during labor, birth, and postpartum

52
Q

DASH Diet

A

adequate intake of potassium, magnesium, and calcium and limits sodium to 2.4 g

53
Q

Why is asthma treated aggressively in pregnant women?

A

because the benefits of averting an asthma attack outweigh the risks of medication

54
Q

What is the ultimate goal of asthma therapy?

A

prevent hypoxia

55
Q

What are the 3 specific drugs chosen to treat asthma during pregnancy?

A

budesonide
albuterol
salmeterol

56
Q

Nursing assessment for asthma includes?

A

asthma triggers and lung auscultation

57
Q

Should treatment of TB be the same for pregnant women as nonpregnant women? What is the exception?

A

yes

streptomycin is the exception because it is ototoxic to fetus

58
Q

What are the medications used to treat TB?

A

isoniazid, rifampin, ethambutol

59
Q

Risk factors for TB

A

immunocompromised
recent immigration status
homeless or overcrowded living conditions
injectable drug use

60
Q

Signs and Symptoms of TB

A
fatigue
fever
night sweats
nonproductive cough
weakness
slow weight loss
anemia
hemoptysis 
anorexia
61
Q

Screening for TB includes?

A

TB test and if positive chest x-rays

62
Q

Nursing Management for TB

A

compliance w/ drug therapy
education; health promotion
transmission prevention

63
Q

Should moms with TB be encouraged to breastfeed?

A

yes as long as they are compliant with their medication

64
Q

If the mother is untreated for TB at birth or is NOT compliant with medication what will happen?

A

they will not be allowed to breastfeed and should not be in direct contact with their newborn until at least 2 weeks after starting medications

65
Q

What is the most common pathological cause of anemia during pregnancy?

A

Iron Deficiency

66
Q

Anemia

A

reduction in red blood cell volume

67
Q

What are some consequences of iron-deficiency anemia in pregnancy?

A
preterm delivery
perinatal mortality
low birth weight
poor mental and psychomotor performance 
postpartum depression
68
Q

Signs and Symptoms of Iron Deficiency

A
fatigue 
pica 
weakness
malaise
anorexia 
susceptibility to infections
pale mucus membranes
tachycardia 
pallor
69
Q

What abnormal lab results are usually present with iron deficiency?

A

low hemoglobin, hematocrit, serum, iron, microcytic and hypochromic cells, and low serum ferritin

70
Q

Why should you encourage taking iron supplements with orange juice instead of milk?

A

Orange juice will promote absorption while milk can inhibit absorption

71
Q

Nursing Management for Iron Deficiency

A
  • encourage compliance w/ drug therapy: prenatal vitamins and iron supplements
  • dietary instruction and counseling
  • education for drug therapy
72
Q

What foods are recommended for iron deficiency?

A

foods high in iron such as: dried fruits, whole grains, green leafy vegetables, meats, peanut butter, and iron fortified cereals

73
Q

Thalassemia

A

group of hereditary anemic disorders in which synthesis of one or both chains of hemoglobin molecules alpha and beta are defective

74
Q

Alpha (Minor)

A

little effect on pregnancy except for mild anemia

75
Q

Beta (Major)

A

usually no pregnancy due to lifelong, severe hemolysis, anemia, and premature death

76
Q

What does the management for Thalassemia depend on?

A

severity of disease

77
Q

Sickle Cell Anemia

A

an autosomal recessive inherited condition that results from a defective hemoglobin molecule

78
Q

What adverse maternal outcomes are associated with Sickle Cell?

A
preeclampsia
eclampsia
preterm labor
placental abruption
intrauterine growth restriction
low birth weight 
mortality
79
Q

Therapeutic Management for Sickle Cell

A

dependent on status

  • supportive therapy
  • blood transfusions if severe
  • analgesics for pain
  • antibiotics for infections
80
Q

Sickle Cell Crisis

A
severe abdominal pain
muscle spasms
leg pain
joint pain
fever
stiff neck
nausea/vomiting 
seizures
81
Q

Nursing management for sickle cell during labor

A

rest
pain management
oxygen and IV fluids
close FHR monitoring

82
Q

Nursing management for sickle cell postpartum

A

antiembolism stockings and family planning options

83
Q

Localized Autoimmune Disease

A

targets specific organ

-thyroid gland in Hashimoto’s thyroiditis and Grave’s disease

84
Q

Systemic Autoimmune Disease

A

target multiple organs

-Systemic Lupus Erythematosus targets lungs, heart, joints, kidneys, brain, and red blood cells

85
Q

What is the focus of therapy for Systemic Autoimmune Diseases (Lupus)?

A

control disease flare-ups, suppress symptoms, and prevent organ damage

86
Q

Cytomegalovirus

A

Most common congenital and perinatal viral infection in the world

  • transmitted via body fluids
  • typically asymptomatic
87
Q

Rubella

A

German measles

-spread by droplets or direct contact w/ contaminated object

88
Q

Herpes Simplex Virus

A

Genital Herpes

-greatest risk of infection is developing primary infection right before birth

89
Q

Hep B Virus

A

Everyone should be tested

-If mom is Hep B positive expect to administer HBIG and Hep B vaccine within 12 hours of birth

90
Q

Varicella Zoster Virus

A

Transmitted to fetus through placenta resulting in congenital varicella syndrome

91
Q

Parvovirus B19

A

common, self-limiting, benign childhood virus that causes erythema infectiosum, also known as Fifth’s Disease

  • severe anemia in fetus
  • infected child will have flaming red cheeks and rash
  • contagious before rash
92
Q

Group B Streptococcus

A

Most common cause of sepsis, meningitis, and pneumonia in newborns
-mother will be given PENG and IV antibiotics 4 hours before birth

93
Q

Toxoplasmosis

A

Parasitic infection

-transmitted from cat feces, undercooked meat, and contaminated water

94
Q

HIV

A

Mothers can NOT breastfeed

at risk for preterm delivery, fetal growth restriction, PROM, hemorrhage, infection, poor wound healing, UTI

95
Q

Therapeutic Management for HIV

A

Oral antiviral drugs twice daily from 14 weeks until birth; IV administration during labor; oral syrup for newborn in first 6 weeks of life; decision for birthing method

96
Q

Nursing Assessment for HIV

A

history and physical exam
HIV antibody testing
STI screens

97
Q

Nursing Management HIV

A

pretest and posttest counseling
education
support

98
Q

What should you offer support for with HIV?

A

Preparation for labor, birth, and afterward
Elective c/s
Compliance with antiretroviral therapy
Family Planning methods

99
Q

Nursing Assessment for Pregnant Adolescent

A
  • vision of future
  • realistic role models; emotional support
  • level of education
  • financial and resource management
  • anger and conflict resolution skills
  • knowledge of health/nutrition for self and baby
  • challenges of parenthood
  • community resources
100
Q

Nursing Management for Pregnant Adolescent

A
  • Support
  • Future planning: return to school; career/job counseling; options for pregnancy
  • Frequent evaluation of physical and emotional well being
  • Stress management/self care
  • Education
101
Q

Nursing Assessment for pregnant women 35 and Older

A
  • preconception counseling
  • lifestyle changes-beginning in optimal health
  • labs/diagnostic testing for baseline
  • amniocentesis
  • quadruple blood test screen
102
Q

Nursing Management for Women 35 and Older

A
promote healthy pregnancy
education
early and regular prenatal care
dietary teaching
continued surveillance
103
Q

Substance Abuse Impact on Pregnancy

A

fetal vulnerability
teratogenic effect
addiction consequences

104
Q

Alcohol and Pregnancy

A

fetal alcohol syndrome/spectrum disorder
abortion
inadequate weight gain

105
Q

Caffeine and Pregnancy

A

vasoconstriction and mild diuresis in mom
fetal stimulation
should not consume more than 300 mg a day

106
Q

Nicotine and Pregnancy

A
vasoconstriction
reduced uteroplacental blood flow
decreased birth weight
abortion/premature 
abruptio placentae
107
Q

Cocaine and Pregnancy

A
vasoconstriction
gestational hypertension 
abruptio placentae 
snow baby syndrome 
CNS defects
108
Q

Marijuana and Pregnancy

A
anemia 
inadequate weight gain
amotivational syndrome
hyperactive startle reflex 
tremors
premature
109
Q

Opiates and Narcotics (Heroine)

A
withdrawal
abruptio placentae
preterm labor
PROM
perinatal asphyxia 
sepsis and death 
intellectual impairment 
malnutrition
110
Q

Sedatives

A
CNS depression
newborn withdrawal
maternal seizures in labor 
newborn abstinence syndrome 
delayed lung maturity
111
Q

Nursing management for Substance Abuse

A
  • nonjudgmental approach
  • state protection agency investigation for positive newborn drug screen
  • counseling
  • education
112
Q

Nursing Assessment for Substance Abuse

A

history and physical exam

urine toxicology

113
Q

The most common harmful effect of heroin and other narcotics is what?

A

withdrawal and neonatal abstinence syndrome