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NUR 220 > High Risk Antepartum > Flashcards

High Risk Antepartum Flashcards

1
Q

spontaneous abortion

A

Early
* Majority in 1st 12 weeks
* 50% chromosomal abnormalities
Late
* 12-20 weeks
* Maternal conditions

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2
Q

s&s of sab

A
  • Vaginal bleeding; Starts as dark
    blood and changes to bright red
  • Abdominal pain/cramping
  • Low backache
  • Pelvic pressure
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3
Q

threatened abortion

A

Any bleeding before 20 weeks, no
cervical dilation

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4
Q

inevitable abortion

A

Bleeding and dilation, no expulsion of
products of conception

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5
Q

incompleted abortion

A

Partial expulsion of some but NOT ALL
products of conception

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6
Q

complete abortion

A

Complete expulsion of ALL products of
conception

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7
Q

missed abortion

A

Nonviable embryo retained for at least 6
weeks

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8
Q

recurrent abortion

A

3 or more consecutive SABs

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9
Q

sab management

A

Evacuation of uterine contents with
vacuum (D&E) or with curette (D&C)
* D&C likely for missed, incomplete, or
inevitable SAB <14 weeks. Rhogam if
indicated

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10
Q

induced abortion

A

Surgical
* D&C or D&E techniques
* Medical
* Oral pills
* mifepristone then misoprostol

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11
Q

ectopic pregnancy risk factor

A

Compromised fallopian
tube patency
* STIs, tubal
ligation/surgery,
IUD, IVF

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12
Q

s/s of ectopic pregnancy

A

Abnormal vaginal bleeding
* 2nd most common reason
* Nausea
* Amenorrhea
* Breast tenderness/fullness
* Pain
* Lower back, abdomen or
pelvis
* Shoulder on affected side

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13
Q

how common is ectopic pregnancy

A

1 in 50

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14
Q

management of ectopic pregnancy

A

Salpingectomy
* Removal of ruptured fallopian
tube
* Salpingostomy
* Incision into fallopian tube that
preserves future fertility
* Non-surgical management
* Methotrexate
* Chemotherapeutic agent
* Rhogam
* To Rh (-) mother
* Not already sensitized

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15
Q

what is hyperemesis gravidum

A

constant vomiting
exact cause unknown
* >5% weight loss from
pre-pregnancy weight

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16
Q

risk factor for hyperem

A

psychological

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17
Q

s/s of hyperem

A

Severe dehydration
- s/sx
- Weight loss – insufficient
nutrition
- Ketonuria
- Breakdown of fat for
energy
- Emotionally drained

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18
Q

non-pharmacologic management of hyperem

A

Acupressure – sea bands
* Ginger – pops, chews
* Small meals and timing of
snacks
* Registered Dietician

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19
Q

pharmacologic management hyperem

A

Promethazine (antihistamine)
* Pyridoxine and doxylamine (Vitamin B6 and
antihistamine)
* Antiemetics (ondansetron) used cautiously
* IV fluids and electrolytes

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20
Q

nsg interventions hyperem

A

Identify triggers
* Assess for dehydration
* Provide comfort measures
* Oral hygiene, daily wts, labs, F&E imbalance

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21
Q

maternal complications twins

A

Pre-term Labor
* Hypertensive
disorders
* PPROM
* Gestational diabetes
* Hemorrhage

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22
Q

fetal complications twins

A

IUGR
* PTB
* Discordant twin growth
* Congenital anomalies
* Abnormal cord insertion
* Fetal demise

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23
Q

oligohydramnios

A

Too little fluid (<500 ml)
* Monitoring: serial ultrasounds,
nonstress test, BPP, maternal
report of loss of fluid

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24
Q

polyhydramnios`

A

Too much fluid (>2,000 ml)
* Monitoring: ultrasound, signs of
preterm labor

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25
Q

purpose of amniotic fluid

A

temp
cushions
NO NUTRITION

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26
Q

1 risk factor for polyhydramnios

A

gestational dm

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27
Q

gestational diabetes

A

Carbohydrate intolerance diagnosed during pregnancy
Numerous risks to both mother and fetus during pregnancy
*A 2-step process
*One- or two-hour glucose tolerance test (GTT) at 24-28 weeks
*Three-hour GTT if one hour abnormal
Screening:
Puts mother at risk for Type 2 Diabetes later in life
Maternal insulin
cannot pass
through the
placenta.
Maternal Glucose
passes through
the placenta to the
fetus.
Yum….Glucose! I
better make some
insulin so I can use it!
Perhaps I will save
some for later as well!
Glycogen = large
glucose molecules,
created for storage.

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28
Q

non-pharm treatment for gestational dm

A

Maternal nutrition therapy
* Metabolic monitoring
* Exercise therapy

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29
Q

pharm treatment for gdm

A

Metformin
* Glyburide
* Insulin

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30
Q

chronic htn

A

presents b4 20 weeks
>140/90

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31
Q

gestational htn

A

after 20 weeks
NO PROTEINURIA
>140/90 on 2 occasions at least 4-6 hrs apart

32
Q

preeclampsia

A

after 20 weeks
PROTEINURIA

33
Q

s/s of preeclampsia

A

Increased BP
* Proteinuria
* Edema
* Assess lung sounds!
* Hepatic changes
* Epigastric pain
* Thrombocytopenia
* HA, Blurred vision
* Small vessels in eyes/brain are affected
* Clonus – neuromuscular irritability

34
Q

labs preeclampsia

A

Urinalysis – proteinuria
* Liver enzymes (ALT, AST)
* Elevation indicates liver injury
* Serum Creatinine/Uric acid
* Increased serum level with kidney
disfunction
* CBC
* Thrombocytopenia
* Decreased H&H

35
Q

severe features preeclampsia

A

Hypertension
* Systolic: > 160 Severe Pre-E =
DELIVER
* Diastolic > 110
* Thrombocytopenia
* Platelets < 100,000
* Impaired Liver function – abdominal pain
* New development of renal insufficiency
* Creatinine > 1.1
* Pulmonary edema
* New onset cerebral or visual disturbances
* Hyperactive reflexes
Preeclampsia + seizures = eclampsia

36
Q

HELLP syndrome

A

Hemolysis
Due to: Fragmented
RBCs trying to pass
through narrowed
vessels
Elevated Liver
Enzymes
Due to:
Endothelial
damage and fibrin
deposition in liver
= necrosis
Low Platelets
Due to: Vascular
damage, vasospasm,
aggregation at sites of
damage

37
Q

management preeclampsia

A

Seizure prophylaxis: Magnesium sulfate
* Labetolol – beta blocker, lowers BP and HR
* Hydralazine - vasodilator
* Nifedipine – Ca channel blocker

38
Q

mag sulfate considerations

A

Seizure prevention in preeclamptic patients
High-risk medication
* VS, I&O, lung sounds, reflexes, neuro checks, assess for side effects, signs of toxicity
* Headache, lethargy, N/V are common side effects
* Signs of toxicity:
* Absent DTRs, decreased respirations/respiratory distress, decreased urine output
* Antidote for toxicity: Calcium Gluconate
Frequent assessments
Monitor fetal heart rate
Newborn side effects: sedation, hypotonia, hypothermia, respiratory depression, hypocalcemia

39
Q

what to treat mag toxicity

A

calcium sulfate

40
Q

placenta previa

A

placental is covering the cervix
cannot deliver

41
Q

risk factors for placenta previa

A

Scars on uterus
Hx of previa
Drug use
multiples

42
Q

complications of placenta previa

A

Bleeding/hemorrhage
Painless, bright red
vaginal bleeding

43
Q

management of placenta previa

A

Dx – by US
Pelvic rest – nothing in the vagina
Monitor fetal well-being/bleeding
Assess need for Rhogam
Cesarean birth necessary

44
Q

abruption placentae

A

Premature separation of
the placenta after 20
weeks

45
Q

risk factors for abruption placentae

A

Drug use – cocaine, methamphetamines
Cigarette use
Hypertension disorders
Hx of abruption
PPROM
Uterine anomalies – fibroids
Trauma

46
Q

abruptio placentae s/s

A

Uterine pain/rigid abdomen
* Increased fundal height
* Frequent contractions
* Possibly bright red bleeding
* FHR changes

47
Q

management for abruptio placenae

A

preapre for birth

48
Q

types of rupture of membrane

A

A-ROM = Artificial rupture of membranes
S-ROM = Spontaneous rupture of membranes
P-ROM = Prelabor rupture of membranes

49
Q

prelabor rom

A

ROM before labor starts @ any
gestational age

50
Q

preterm rom

A

ROM before 37 weeks gestation

51
Q

preterm prelabor rom

A

a combination of both
terms (PPROM)

52
Q

maternal risk factors for pprom

A

Previous history
- Bleeding
- Polyhydramnios
- Infection
- Smoking
- Multiples
- Drug use

53
Q

risk to fetus pprom

A

Fetal Sepsis
- Pre-term birth
- Umbilical cord prolapse
- Intraventricular hemorrhage

54
Q

risk to mother pprom

A

Chorioamnionitis
- Placental abruption
- Cord prolapse
- Pre-term labor/birth

55
Q

pregnant female w/ sti

A

can lead to PRETERM LABOR
weaken wall of amniotic sac

56
Q

pprom confirmation

A

Ferning
Salts from amniotic fluid
dry in a fern pattern.
Nitrazine
Basic Amniotic fluid turns
pH paper blue
* Vaginal pH is 4.5 – 5.5
* Amniotic fluid is more
alkaline (6.5-7.5)
Speculum exam
Visualize pooling of
amniotic fluid

57
Q

pprom management

A

Establish gestational age
* Ultrasound: fetal growth and fluid levels
* Assess for infection, fetal well-being, labor
* Reasons for delivery:
* Advanced labor
* Vaginal bleeding
* Non-reassuring fetal heart rate

58
Q

s/s of infection

A

Increased maternal and/or
fetal heart rate
* Uterine tenderness
* Malodorous amniotic fluid
* Maternal fever

59
Q

preterm labor

A

Uterine contractions
and cervical change
between 20-37wks

60
Q

why does ptl happen

A

Bleeding:
* Placenta previa
* Placental abruption
Uterine Stretching:
* Polyhydramnios
* Multiples
* Large for gestational
size
* Utereine abnormailites
Infections/Inflammation:
* STIs
* UTIs
* Amniotic fluid
Maternal/fetal stress:
* Stress hormones trigger
contractions

61
Q

ptl labs/diagnostics

A

Fetal Fibronectin (FfN)
* “Glue” that holds amniotic sac to
uterine lining
* Sterile swab of cervical lining
* Cervical Length by transvaginal US
* Short means increase risk for PTL
* Ensure empty bladder
* Cervical cultures – r/o infection
* GC, Chlamydia

62
Q

medical management of ptl

A

Corticosteroid
administration  given to
mom for baby
Tocolytic medications
* Magnesium sulfate
* Prostaglandin synthesis inhibitors
* Ca Channel blockers
* Beta mimetics

63
Q

how os betamethasone given

A

Betamethasone 12 mg
IM 24 hours apart for 2
doses
Dexamethasone given
IM every 12 hours for 4
doses
Monitor bg

64
Q

why is betamethasone given

A

for fetal lung maturity

65
Q

what are the 3 tocylytics

A

idomethacin
nifedipine
mag sulfate

66
Q

indomethacin

A

Nonspecific COX inhibitor
* Maternal SE: nausea, reflux
* Feal SE: Premature
narrowing or closure of the
ductus arteriosus,
oligohydramnios
* Not to be used for more than
48 hours

67
Q

nifedipine

A

Calcium channel blocker
* Maternal SE:
nausea, headache, flushin
g
* Contraindicated in patients
with known hypotension

68
Q

mag sulfate

A

Antidysrhythmic (relaxes smooth
muscle)
* Maternal SE: Diaphoresis,
flushing
* Symptoms of Mag
Toxicity: Absent DTRs,
Decreased RR, Respiratory distr
ess
* Antidote for Mag toxicity is
Calcium Gluconate
* This is not a first line tocolytic-
More commonly used for preeclmpsia

69
Q

terbutaline class

A

beta adrenergic receptor agonist

70
Q

action of terbutaline

A

Derived from epinephrine
* Acts on beta adrenergic receptors related to flight fight reaction (like epinephrine)  some muscles
relax (uterus) while other contract (heart)

71
Q

maternal effects of terbutaline

A

Increase HR, flushing, tremors, restlessness

72
Q

fetal effects terbutaline

A

Increase HR, Increase glucose

73
Q

nsg considerations

A

Hold HR > 120
* HR > 120 causes a decrease in ventricular filling time and can lead to maternal MI

74
Q

safety for terbutaline

A

Never give PO (given Sub-Q), Never give for > 72 hrs
NEVER GIVE IF MOTHER HAS A CARDIAC ISSUE

75
Q
A

NUR 220 (6 decks)

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