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High risk pregnancy & complications Flashcards

Test #3 (106 cards)

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1
Q

What is high risk pregnancy?

A

Already sick, then pregnant

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2
Q

What are pregnancy complications?

A

Complications caused by pregnancy

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3
Q

Common factors of high risk pregnancy

A 
Age
Poverty
Homelessness
Late prenatal care
Genetics
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4
Q

Most common group to have premies?

A

Teenage girls

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5
Q

1 in __ newborns has an inherited genetic disorder

A

20

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6
Q

Is left handed considered genetic?

A

Yes

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7
Q

Assessing genetic disorders

A 
Physical assessment
Diagnostic testing (blood test)
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8
Q

Genetic diagnostic testing types

A
  • Karyotyping
  • Maternal Serum Screening (MSAFP)
  • Chronic villi sampling (CVS)
  • Amniocentesis
  • Percutaneous umbilical blood sampling
  • Fetal imaging
  • Fetoscopy
  • Preimplantation diagnosis
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9
Q

Genetic diagnostic testing:

Karyotyping

A

Look at chromosomes and genes

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10
Q

Genetic diagnostic testing:

Chronic villi sampling (CVS)

A

tissue under placenta-belongs to baby!

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11
Q

Genetic diagnostic testing:

Amnocentesis

A

Genetic study after 14 weeks

  • check chromosomes
  • bilirubin with baby
  • relieve pressure from excess fluid (polyhydramnios)
  • measure surfactant
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12
Q

Surfactant

A

needed for baby’s lungs

1-normal

3: 1-diabetic mom
1: 1-premie

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13
Q

Common chromosomal Disorders

A

1 Down syndrome (trisomy 21)

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14
Q

What are teratogens?

A

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

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15
Q

What 3 factors determine the results of exposure?

A
  • timing
  • strength
  • affinity (organ specific)
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16
Q

What is TORCH?

A 
Toxoplasmosis-uncooked meat, cat litter
Others, to include-STDs, beta strep
Rubella
Cytomeglovirus
Herpes-If active, C-section.
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17
Q

Which STIs (teratogens) have an effect on baby?

A

Chlamydia and gonorrhea-eyes

Syphilis-shingles

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18
Q

Rubella

A

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

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19
Q

Other important teratogens

A

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

Vitamin A-accutane

Lead-brain

Tetracycline-teeth brown

Thylitamine-arms and legs

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20
Q

Most important treatment of STIs

A

Prevent reinfection
Treat partner
Teach mode of transmission

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21
Q

What would we give to cardiac OB patient in labor?

A

Prophylactic antibiotics

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22
Q

Classifications of heart disease in pregnant woman

A

1 or 2: normal pregnancy and birth

3: complete pregnancy with complete bed rest
4: poor candidate, in cardiac failure even at rest

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23
Q

Most dangerous time for cardiac pregnant woman

A

28-32 weeks

Peak blood volume

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24
Q

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

A

Signs of ischemia

Check lung sounds-pulmonary edema

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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

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