High Risk Pregnancy

Question 1

List the findings associated with placenta previa (5)

Answer 1

1) Painless
2) Bright red bleeding
3) Large amount of blood loss
4) Maternal condition consistent with apparent blood loss
5) Apparent on ultrasound

Question 2

what is unsafe to do with placenta previa?

Answer 2

anything in the vagina is unsafe!!!

Question 3

A patient came in with placenta previa, and the bleeding was able to be resolved so she is being sent home. What should the nurse teach her?

Answer 3

NOTHING goes into the vagina until she is 6 weeks postpartum

Question 4

A pt presents with placenta previa and the nurse’s priority is to stop the bleeding. what should the nurse do first? what is next in priority? what is the last priority?

Answer 4

first → delegate to someone else to call the provider while staying with the pt

next → when the provider is on the way, you want to establish IV access with fluid volume replacement (bc the heart cannot pump effectively w/o fluids)

lastly → we think about the baby last because without a living mother we are not going to have a living baby

Question 5

Lis the findings associated with placental abruption (7)

Answer 5

1) Dark red bleeding
2) Smaller amounts
3) Moderate to severe pain (abdominal pain)
4) Maternal vital signs may deteriorate even when measurable blood loss is small
5) Ultrasound is unreliable
6) Rigid board-like abdomen
7) Tetanic contractions

Question 6

If a pt has hyperemesis gravidarum, what is the priority? list the nursing actions for this pt (3)

Answer 6

Priority is dehydration → fluids and electrolytes

Nursing actions:
1) Replace fluid & electrolytes → especially K+
2) Measure I&O
3) TPN via central line may be necessary in some cases

Question 7

If preterm labor is caused by cervical insufficiency, what is done?

Answer 7

cerclage → Surgical stitching of the cervix (sews it shut) to prevent early dilation.

Question 8

If a pt has a cerclage, when would the suture be cut? (3)

Answer 8

1) if the membrane ruptures
2) the pt is in active labor
3) we determine we want her to be in active labor

Question 9

what is given to pts who are not in preterm labor yet, but are at high risk? why?

when are they started?

Answer 9

progesterone supplements → quiets (calms) the smooth muscle in the uterus so it doesn’t expel the fetus

started around 20 wks

Question 10

What are two risk factors for preterm labor that would call for the use of progesterone supplements?

Answer 10

1) pt with prior preterm birth
2) pt with a short cervix

Question 11

If a patient comes in and they are contracting and we are worried about preterm labor, what is the first thing we do and why?

Answer 11

IV hydration → we want to promote oxygen delivery to uterine muscles, and IV hydration increases blood volume & oxygen delivery to uterus

Question 12

IV hydration can treat dehydration that sometimes makes the uterus ______

Answer 12

irritable

Question 13

A pt in preterm labor must be on what? why?

Answer 13

bed rest → left lateral position may improve blood flow and quiet down preterm labor

Question 14

What class of medications can be used in preterm labor?

Answer 14

Tocolytics

Question 15

what meds can be used as tocolytic agents in preterm labor?

Answer 15

1) magnesium sulfate
2) terbutaline
3) nifedipine

Question 16

why is magnesium sulfate used for preterm labor? (2)

Answer 16

1) it lowers the nervous excitability across the smooth muscle of the uterus
2) it is a neuroprotective agent for fetus → good blood flow to brain

Question 17

if magnesium sulfate is administered 24-48 hrs prior to delivery, there are decreased rates of what? (2)

Answer 17

1) Decreased rates of cerebral palsy in baby
2) Decreased rates of intraventricular hemorrhage to the baby

Question 18

why is terbutaline used in preterm labor?

Answer 18

it reduces resistance on the smooth muscle of the uterus & relaxes uterine muscles.

Question 19

what are the side effects of terbutaline? (4)

what are the risks? (2)

Answer 19

Side effects:
1) increased HR
2) increased BP
3) palpitations
4) shakiness

Risks:
1) can cause cardiac crisis
2) can cause ICU admission

Question 20

what are the contraindications for terbutaline? (2)

Answer 20

1) tachycardia in both mother and baby
2) adventitious breath sounds (decreased or crackles)

Question 21

if a mom is in labor and we’ve given Pitocin but she goes into a ___________ ______ where the baby is not reacting well to labor, we can give terbutaline to relax the uterus and quiet that activity down

Answer 21

hyper-stimulating pattern

Question 22

what must be checked prior to administration of terbutaline? (3)

Answer 22

1) apical pulse (full minute)
2) fetal HR
3) lung sounds

Question 23

what med for preterm labor is less effective than magnesium sulfate & terbutaline?

Answer 23

nifedipine

Question 24

what must be checked prior to administering nifedipine?

Answer 24

BP

Question 25

Nifedipine can NEVER be given with what med bc it causes a toxic reaction?

Answer 25

magnesium sulfate

Question 26

In preterm labor, after we’ve done tocolytics (if that’s indicated) we can administer what?

Answer 26

some agents to improve neonatal outcomes

Question 27

what med is given to the mom during preterm labor to mature the fetal lungs?

Answer 27

betamethasone (steroid)

Question 28

what are the possible side effects of betamethasone? (3)

Answer 28

1) Steroids can increase the white blood cell count. 2) They can mask an infection. 3) They can also increase blood glucose levels.

Question 29

if a mom is reporting contractions and we are worried about preterm labor, what do we have to do? (3)

Answer 29

1) Put her on a monitor. 2) Palpate those contractions with our hands. 3) Assess how the fetus is tolerating what’s going on.

Question 30

what is the biggest risk of bed rest? what can we do to prevent this? (4)

Answer 30

The biggest risk is deep vein thrombosis (DVT). 1) We put on SCDs (sequential compression devices). 2) We teach mom to do leg exercises to pump her calves. 3) We encourage bathroom privileges when possible. 4) Hydration is important to prevent blood from becoming too viscous.

Question 31

what are other complications to bedrest? (3)

Answer 31

1) Respiratory issue → use incentive spirometry 2) Constipation → encourage fluids, fiber, and Colace 3) Psychosocial issues → boredom, depressed mood, lifestyle adjustments.

Question 32

what is the first way we tx gestational diabetes?

Answer 32

diet and exercise diet → controlled carb diet where carbs spread out throughout the day; healthy diet with six small meals exercise → 30 mins a day 5 days a week of moderate activity like brisk walking

Question 33

what do we do when diet & exercise does not work to tx gestational diabetes? (2)

Answer 33

1) insulin is gold standard 2) metformin is ok

Question 34

what kind of insulin is usually used for gestational diabetes?

Answer 34

usually a combo of short and long acting insulins

Question 35

in pts with preeclampsia, urine protein is the first sign of what?

Answer 35

kidney damage

Question 36

in pts with preeclampsia, low platelets suggest _____ damage

Answer 36

liver

Question 37

in pts with preeclampsia, elevated liver enzymes indicate what?

Answer 37

liver dysfunction

Question 38

in pts with preeclampsia, elevated creatinine indicate what?

Answer 38

kidney dysfunction

Question 39

what is a possible finding regarding DTRs in pts with preeclampsia?

Answer 39

hyperreflexia → sign of CNS irritability

Question 40

pts with preeclampsia can have clonus. how does it present? what does this mean?

Answer 40

Tapping movement when dorsiflexing foot Bad sign → precedes seizures.

Question 41

what is expected in preeclampsia WITHOUT severe features? (4)

Answer 41

1) BP elevated 140/90 2) Proteinuria 3) Normal labs (AST, ALT, LDH, creatinine). 4) Edema

Question 42

what is the priority for a pt with preeclampsia WITHOUT severe features? (5)

Answer 42

1) Education on danger signs → Report headaches, visual changes, RUQ pain, severe nausea/vomiting. 2) Increased maternal/fetal surveillance 3) BP monitoring (home or in clinic). 4) Non-stress test (NST) x2 per week. 5) Biophysical profile (BPP) to check fetal well-being.

Question 43

what is expected in pts with preeclampsia WITH severe features? (7)

Answer 43

1) Severe Range Hypertension 160/110 2) Persistent headache or visual disturbance 3) Epigastric Pain 4) HELLP syndrome → Hemolysis, Elevated Liver Enzymes, Low platelets 5) Elevated creatinine (Worsening Renal Function) 6) Oliguria → low urine output <30 mL/hr (Worsening Renal Function) 7) Non-reassuring fetal testing

Question 44

In severe cases of preeclampsia where does edema present? what locations would edema be concerning?

Answer 44

severe cases → hands, feet, face concerning → tight rings, swollen eyes

Question 45

list nursing care for pts with severe preeclampsia (10)

Answer 45

1) Monitor for s/s worsening preeclampsia 2) Quiet, dark environment 3) Decrease environmental stimuli 4) Seizure Precautions Hypertensive crisis: 5) Hydralazine or Labetalol IV push for BP crisis 6) Nifedipine oral has been added 7) Fetal monitoring 8) Monitor labs - platelets, AST, ALT, LDH, creatinine 9) Administer magnesium sulfate 10) Immediate delivery is condition worses

Question 46

Magnesium levels: 1) normal? 2) therapeutic for preeclampsia? 3) risk of toxicity?

Answer 46

1) Normal → 1.5-2.5 mEq/L 2) Therapeutic for preeclampsia → 4-7 mEq/L 3) Risk of toxicity → level 8 mEq/L or above

Question 47

what are the signs of magnesium toxicity? (8)

Answer 47

1) Hyporeflexia (absent reflexes) 2) Decreased Respiratory Rate (<12/min) 3) Oliguria (<30 mL/hr) 4) Decreased LOC (drowsy, hard to arouse) 5) Respiratory depression 6) Pulmonary edema 7) Renal failure 8) Coma/death

Question 48

what is the antidote for magnesium sulfate?

Answer 48

Calcium Gluconate (MUST be available on the unit)

Question 49

how is magnesium sulfate administered?

Answer 49

1) 4 g Bolus over 20 minutes (HIGH RISK med) 2) 2 g/hour maintenance via IV pump (NEVER gravity)

Question 50

what should be done by the nurse during hourly "mag" checks? (5)

Answer 50

1) I&O 2) DTRs 3) LOC 4) respiratory assessment 5) BP

Question 51

what side effects of mag sulfate should the nurse be aware of? (2) what can the nurse do? (3)

Answer 51

Side effects: 1) Pt. feels hot, “flu-ish” 2) Fall risk Nurse actions: 1) Have bucket of ice and cold wash cloths for pts 2) fan in room 3) take off blankets