High risk pregnancy & complications Flashcards Preview

OB > High risk pregnancy & complications > Flashcards

Flashcards in High risk pregnancy & complications Deck (106):
1

What is high risk pregnancy?

Already sick, then pregnant

2

What are pregnancy complications?

Complications caused by pregnancy

3

Common factors of high risk pregnancy

Age
Poverty
Homelessness
Late prenatal care
Genetics

4

Most common group to have premies?

Teenage girls

5

1 in __ newborns has an inherited genetic disorder

20

6

Is left handed considered genetic?

Yes

7

Assessing genetic disorders

Physical assessment
Diagnostic testing (blood test)

8

Genetic diagnostic testing types

-Karyotyping

-Maternal Serum Screening (MSAFP)

-Chronic villi sampling (CVS)

-Amniocentesis

-Percutaneous umbilical blood sampling

-Fetal imaging

-Fetoscopy

-Preimplantation diagnosis

9

Genetic diagnostic testing:
Karyotyping

Look at chromosomes and genes

10

Genetic diagnostic testing:
Chronic villi sampling (CVS)

tissue under placenta-belongs to baby!

11

Genetic diagnostic testing:
Amnocentesis

Genetic study after 14 weeks

-check chromosomes
-bilirubin with baby
-relieve pressure from excess fluid (polyhydramnios)
-measure surfactant

12

Surfactant

needed for baby's lungs

1-normal
3:1-diabetic mom
1:1-premie

13

Common chromosomal Disorders

#1 Down syndrome (trisomy 21)

#2-Fragile X syndrome

14

What are teratogens?

-Environmental (maternal stress),
-Infectious agents, or
-Therapeutic agents (Dilantin, live viruses)
causing malformation of an embryo.

15

What 3 factors determine the results of exposure?

-timing
-strength
-affinity (organ specific)

16

What is TORCH?

Toxoplasmosis-uncooked meat, cat litter
Others, to include-STDs, beta strep
Rubella
Cytomeglovirus
Herpes-If active, C-section.

17

Which STIs (teratogens) have an effect on baby?

Chlamydia and gonorrhea-eyes
Syphilis-shingles

18

Rubella

Titer is done when pregnant to check if immune or not.
If not immune, vaccine is given after delivery.

Can effect eyes, ears and heart of baby

19

Other important teratogens

DE5 (prevent miscarriage)-girl babies-vagina, ovary or breast cancer

Vitamin A-accutane

Lead-brain

Tetracycline-teeth brown

Thylitamine-arms and legs

20

Most important treatment of STIs

Prevent reinfection
Treat partner
Teach mode of transmission

21

What would we give to cardiac OB patient in labor?

Prophylactic antibiotics

22

Classifications of heart disease in pregnant woman

1 or 2: normal pregnancy and birth

3: complete pregnancy with complete bed rest

4: poor candidate, in cardiac failure even at rest

23

Most dangerous time for cardiac pregnant woman

28-32 weeks

Peak blood volume

24

What do you need to watch for a cardiac pregnant woman in labor?

Signs of ischemia

Check lung sounds-pulmonary edema

25

Assessment of cardiac pregnant patient?

Dyspnea
Rapid RR
Cough
Cyanosis
Cap refill >5 sec

26

What size baby will cardiac patient have?

Small

27

Nursing interventions during L&D for cardiac patient

Epidural with 400 mL bolus
IV-not running fast
NO pushing!
Watch for water intoxication
Head of bed needs to be up!

28

What meds do you need on hand for cardiac patient?

-Beta blocker
-Nitroglycerine
-Dig
-stool softener

29

Most common signs of anemia (below 10)

**Pica

-tired
-activity intolerance

30

What to do for anemic patient?

Special diet-increase protein-meat and spinach

Take iron with OJ and food (GI upset)

31

Folic acid deficiency in pregnant patient

More volume due to enlarged RBCs

32

When is baby impacted by folic acid deficiency in mom?

first few weeks of pregnancy

33

What is folic acid deficiency associated with?

neural tube defects

34

What food should you eat to get folic acid?

-oranges
-dried beans
-green, leafy veggies

35

Sickle cell anemia management

O2 and fluids to prevent hypoxia and dehydration to keep mom out of crisis

36

Sickling of blood in sickle cell mom can impact what?

Placenta

37

What is a diabetes mellitus mom prone to having?

Preeclampsia (kidney) and polydramnios

38

What is important for diabetes mellitus mom to do?

-diet
-exercise
-check CBG (goes back to normal after delivery)

39

The need for insulin goes ____ at first in pregnancy, then gradually _________.

down; increases

40

Does baby or mom manufacture insulin?

baby

41

Insulin is ____ effective due to placental lactogen

less

42

What would you do if baby's CBG is below 40?

Feed baby!

43

What is the #1 and #2 cause for abdominal trauma in pregnant mom?

#1 car accident

#2 physical abuse

44

What is the first and last vital signs to go when in shock?

First-pulse

Last-blood pressure

45

Rhogam needs to be given after what?

How many hours after?

Delivery, car wreck, miscarriage, amniocentesis

72 hours

46

CPR in pregnant woman

Higher on chest.
More forceful.

*Call for help

47

When does a spontaneous abortion usually happen?

Within first 12-16 weeks

48

Types of abortions

-threatened
-inevitable
-incomplete
-complete (everything comes out)
-missed (DIC)
-habitual (constant-incompetent cervix/endocrine)
-septic (unclean abortion)

49

S/S of spontaneous abortions

-cramps
-little spotting (bleeding will continue if something was left in there)

50

Bleeding heavy

IV started with big gauge (18 or above)

51

Ecoptic pregnancy

-unilateral pain
-burning in belly and shoulder with pain=ruptured

surgery is needed

52

As a nurse, what will you ask woman with belly pain?

When was your last period?

53

Hyperemesis Gravidarium aka what?

Morning sickness gone wild

54

What are the main things to worry about with Hyperemesis Gravidarium?

Dehydration and screwed up electrolytes from vomiting.

55

What is the first thing to do when a patient with Hyperemesis Gravidarium comes in?

Start IV

56

What is a molar pregnancy?

Abnormal rapid production of chorionic villi (Rapid and HIGH HCG)

57

Risk factors for molar pregnancies

-older women
-low protein diets

58

S/S molar pregnancy

Normal at first
-some bleeding early
-exaggerated uterine growth
-NO FHT
-Cranberry sauce-like

59

What is premature cervical dilation?

-Cannot hold fetus until term
-Incompetent cervix
-Habitual abortion

60

What is the procedure for a premature cervical dilation?

McDonalds or Schirodkar cervical cerclage

61

When is the cervical cerclage procedure done?

Approximately 12 weeks.

Removed at 37 weeks or if in labor (cut strings or csection)

62

What is the main goal for cervical cerclage?

To keep baby in until after 38 weeks

63

What is placenta previa?

When the placenta covers the cervix

-complete, partial or marginal

64

S/S of placenta previa

Painless bleeding-usually starts about 28 weeks.

65

What is placental abruption?

Premature separation of placenta from uterine wall

-Marginal, central, complete

66

Risk factors of abruption

-Older woman
-short cord
-HTN
-trauma
-cocaine
-smoking
-thrombosis

67

Is abruption painful?

YES-uterus will grow within hours

68

What is DIC associated with?

-Intrauterine fetal demise
-Abruption
-Previa
-PIH
-HELLP
-Sepsis
-Fluid embolism

69

S/S of DIC

massive hemorrhage

70

Treatment of DIC

Correct underlying issues, transfuse, heparin!

71

What is a pregnant patient always at risk for?

DVT and PE

72

S/S of Pre-eclampsia

-Elevated B/P

-Proteinuria

-Rapid weight gain

-Facial/hand edema

-Hyperreflexia

-Headache

-Visual disturbances

-Epigastric pain

-Facial twitch

-Seizures

(if <20 wks, probably molar pregnancy)

73

Where would you put patient with PIH?

at the end of the hall, because it's quiet.

Pad side rails and place fetal monitors in case of seizures.

74

What must you check for protein?

URINE

75

What medication must you have on hand?

Magnesium sulfate

76

If on mag drip, how often should you check pt?

every hour

77

What should you assess with PIH?

-reflexes
-resp rate
-epigastric pain
-hand strength

78

Signs of Mag sulfate toxicity

Slurred speech, muscle weakness, reflex decrease

79

If pt has seizure, what would you check because what could happen?

Mom and baby for injury-could abrupt

80

What does HELLP stand for?

Hemolysis (destruction of RBCs)
Elevated
Liver enzymes
Low
Platelets

81

What would you do for HELLP?

Give platelets and glucose

82

What would you check on a pt with HELLP?

Stool, IV and urine for blood

83

When can you give an epidural to a pt with HELLP?

ONLY AFTER platelets are given

84

Toxic level of Mag sulfate

Above 10

85

Antidote for mag sulfate

Calcium gluconate

86

Mag sulfate doses

4 gram loading dose

1-2 gram/hour

87

First trimester bleeding

Spontaneous abortions

Ectopic pregnancies

Hyperemesis Gravidarium

88

Second trimester bleeding

Molar pregnancy

Premature cervical dilation

89

Third trimester bleeding

Placenta Previa

Placenta Abruption

DIC

PIH

HELLP

90

Complications in 3rd trimester

Preterm labor-20-37 weeks

Post term pregnancy-beyond 42 weeks

PROM

91

What med is given to try to stop preterm labor?

Terbutaline (beta blocker)-it helps to prevent and slow contractions

92

Side effects of Terbutaline

Hyperglycemia

Chest pain

PC-pulmonary edema

93

What to do when mom has contractions due to dehydration?

Give 1000mL fluids via IV, send home

If 6cm with contractions every 10 minutes, give steroids (hopefully 2 doses)

Could do amniocentesis to check baby's condition, especially lung

94

What to do if PROM?

keep in hospital

Check temp q2hr, risk for infection

95

What is post term baby at risk for?

Aphyxia

Hypoxic ischemic encephalopathy

Meconium aspiration

Hypoglycemia

Hypocalcemia

Hypothermia

96

What is common for post term moms?

Daily kick counts

Extra OB visits

NST

97

Post term baby

Minimal fat-long, skinny

No vernix-peeling skin

Long nails, lots of hair, low glucose, wide eyed, temp regulation problems

98

DANGER SIGNS
-preeclampsia signs

-visual disturbances
-edema-hands/face/over sacrum
-headaches
-muscular irritability
-epigastric pain

99

DANGER SIGNS
-persistent vomiting

possible molar pregnancy

100

DANGER SIGNS
-Fluid discharge from vagina

Possible placenta previa or miscarriage

101

DANGER SIGNS
-Elevated temp

possible infection

102

DANGER SIGNS
-abdominal pain

possible abruption

103

DANGER SIGNS
-decrease in fetal movement

fetal distress

104

What is isoimmunization given for?

Rh-negative carrying Rh-positive baby

(Rh, ABO incompatibility)

105

What to do when coomb's test is negative?

Give rhogam

106

Coomb's test positive and baby positive=

baby jaundice