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Mgmt Test 2 - OB > pregnancy at risk > Flashcards

pregnancy at risk Flashcards

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1
Q

1st trimester preg disorders

A

hyperemesis gravidarum

early preg bld’g disorders (spontaneous abortion, ectopic preg, gestational trophoblastic disease)

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2
Q

hyperemesis gravidarum

A

persistent uncontrollable vomitting usually occurs at the beginning of preg but can last the duration
may be related to increased estrogen/hcg; vit B deficiency; hyperthyroidism; psych fxrs
dx by 5% weight loss, ketonuria, dehydration

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3
Q

mgmt of hyperemesis

A

B6, anti-emetics

tpn, iv hydration (hospital)

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4
Q

care of hyperemesis

A

stabilize
hydrate
weight mgmt

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5
Q

spontaneous abortion classified as

A

loss prior to 20 weeks

most occur within first 12 wks

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6
Q

risk fxr for spontaneous abortion

A

maternal infection
inadeq. progesterone production
pre-existing cond. (DM, lupus)
fetal abnormalities

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7
Q

characteristics of spontaneous abortion

A

threatened - spotting, cramping (long duration, high prob)
inevitable - spotting, cramping, ROM, cerv. dilation
incomplete - bld, cramp, dilation - passage of tissue
complete - passage of product of conception, no further trt needed
missed - fetus expired, labor not begun
recurrent - 3+ preg

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8
Q

ectopic preg risk fxrs

A

ovulation inducing drugs
smoking
hx of ectopic preg

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9
Q

manifest of ectopic preg

A

abd pain
dark blood
referred shoulder pain

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10
Q

trt of ectopic preg

A

surgical removal

trt w/methotrexate

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11
Q

Gestational Trophoblastic Disease aka/is

A

Hydatidiform mole or Molar pregnancy
complete mole = no fetus
partial mole = some fetal parts
resembles cluster of grapes (proliferation of chronic villi)

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12
Q

manifest of GTD

A

uterine size greater than gestational age
dark red bld’g
n/v & cramping

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13
Q

trt for GTD

A

immed evac of mole
oxytocin to promote involution
monitor HcG levels
no preg. for 1yr

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14
Q

care for pt. w/GTD

A

prevent hemorrhage/infection
pain mgmt
emotional status/support
educate

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15
Q

late preg bld’g disorders

A

placenta previa

placenta abruptio

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16
Q

placenta previa characterized by

A 
complete or partial covering of cervix by the placenta painless bright red bld'g
3 types (low lying or marginal, partial, complete)
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17
Q

placenta previa risk fxrs

A

smoking/drug use
hx of previa
maternal age
uterine surgery

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18
Q

mgmt of placenta previa

A

delivery via c-section

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19
Q

abruptio placentae

A

premature separation of placenta from uterine wall

painful bleeding

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20
Q

manifest of abruptio placentae

A 
board like abdomen
abnormal FHR
fetal death
uterine hyperactivity
may be concealed or apparent; marginal, partial or complete
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21
Q

3 grades for abruptio placentae

A

grade 1 - 10-20% separation
grade 2 - 20-50% separation
grade 3 - >50% separation

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22
Q

risk fxr for abruptio placentae

A 
maternal htn
short cord
drug use/smoking
hx
abd. trauma
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23
Q

mgmt of abruptio placentae

A

condition of fetus
cardiovascular of mom
immed delivery w/fetal compromise/excessive bld’g

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24
Q

late preg bld’g care

A

status of fetus & mom
educate
immed delivery w/fetal compromise, excessive bld’g or maternal compromise

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25
nursing dx for late preg bld'g
risk for injury/infection | ineffective tissue perfusion
26
perinatal infections
infections having devastating affect on fetus/min on mom
27
fxrs governing affects of perinatal infections
gestational age trt options specific organism route of transmission - vertical=across placenta- horizontal=through breast-feeding
28
perinatal infections maternal risks
premature labor PROM UTI
29
perinatal infections fetal risks
``` prematurity malformations IUGR(intrauterine growth restriction) IUFD (intrauterine fetal death) sepsis ```
30
sexually transmitted infections
chlamydia gonorrhea trichomoniasis
31
chlamydia maternal affects
PROM | chorioamnionitis
32
chlamydia fetal affects
IUGR vertical transmission conjunctivitis otitis media
33
chlamydia nurs considerations
presumptively trt for gonorrhea | erythromycin eye oint for newborn
34
gonorrhea maternal affects
dysuria; freq chorioamnionitis PTL; PROM
35
gonorrhea fetal affects
vertical transmission rare perm. visual damage or systemic disease conjunctivitis
36
gonorrhea nurs considerations
presumptively trt for chlamydia | erythromycin eye trt for newborn
37
trichomoniasis maternal affects
increased risk for preterm labor/birth | PROM
38
trichomoniasis fetal effects
vertical transmission at birth asymptomatic or resp. infection low birth weight
39
trichomoniasis nursing considerations
mom & partner must be treated
40
genitourinary infections
bacterial vaginosis group b hemolytic strep (GBS) cystitis & pyelonephritis
41
bacterial vaginosis maternal affects
imbalance in vaginas normal flora by hormonal chg or antibiotic trt asymptomatic or white/yellow discharge w/fishy odor assoc w/preterm labor, PROM, UTI
42
bacterial vaginosis fetal affects
limited- assoc w/ preterm birth
43
bacterial vaginosis nurs considerations
prenatal screen | hx of preterm delivery
44
GBS maternal affects
often asymptomatic (15-40% are colonized) discharge uti preterm labor
45
GBS fetal affects
most common cause of neonatal infections, morbidity and mortality acquired by vertical transmission during birth causing sepsis, pneumonia, meningitis early (within 48hrs) or late onset (after 1wk of life)
46
GBS nurs considerations
maternal screen 35-37 weeks
47
cystitis & pyelonephritis maternal affects
cystitis may cause dysuria - freq, hematuria, urgency premature l&d progression to pyelonephitis - fever, n/v, chills, cva tenderness
48
cystitis & pyelonephritis fetal affects
effects related to preterm labor/birth
49
cystitis & pyelonephritis nurs considerations
teach importance of finishing meds | if turns into pyelonephritis, hospitalization necessary for iv trt w/antibiotics
50
Torch Infections
``` toxoplasmosis other (syphilis/Hep B) Rubella Cytomegalovirus Herpes Simplex Virus ```
51
toxoplasmosis Maternal/Preg Affects
consuming poorly cooked meat exposure to cat feces acutely infected can cause congenitally infected 90% are asymptomatic general malaise, premature L&D, miscarriage
52
toxoplasmosis Fetal Affects
transmitted across placenta may be asymptomatic at birth long term blindness, mr, impaired vision IUGR
53
toxoplasmosis Nursing Considerations
Maternal treatment with pyrimethamine, sulfadiazine and folinic acid (leucovorin) during 2nd & 3rd trimesters Neonates treated w/leucovorin
54
other (syphilis/Hep B) Maternal/Preg Affects
HEPATITIS B - Preterm labor &/or delivery, Stillbirth | SYPHILIS - Can cause spontaneous abortion, fetal death, and congenital syphills
55
other (syphilis/Hep B) Fetal Affects
HEPATITIS B - Vertically transmitted-Infants infected at birth have 90% risk of becoming a carrier, 25% risk of developing significant liver disease 90-95% of those infected are symptomatic SYPHILIS- Fetal infection may involve multiple organs and can cause fetal growth restriction, non-immune hydrops, and increases risk of premature birth. May also be asympotmatic at birth; symptomatic in 1st 3 months
56
other (syphilis/Hep B) Nursing Considerations
HEPATITIS B -Neonatal treatment isHBV vaccine (within 12hrs of birth, at 1-2 months & 6-18 months) •HBV immunoglobulin (HBIG) plus vaccine if mother is a carrier or HbsAG+ •All pregnant women are screened prenatally SYPHILIS -Infected newborns are treated w/PCN over 10- 14 days•AAP states that no newborn be discharged without knowing mother’s serologic status for syphilis• Provide support to parents related to their feelings about how infection was transmitted
57
Rubella Maternal/Preg Affects
transmitted across placenta | infection during 1st trimester can cause spontaneous abort
58
Rubella Fetal Affects
more severe disease if acquired in 1st trimester | cns/heart defects, stillbirth, jaundice, cataracts
59
Rubella Nursing Considerations
isolate exposed neonate | vaccine contraindicated during preg., vaccine after delivery, do not become preg within 1st 4 weeks
60
Cytomegalovirus Maternal/Preg Affects
transmitted across placenta at birth or thru breast-milk | only 1-5% develop symptoms (malaise)
61
Cytomegalovirus Fetal Affects
no trt for infants 90% unaffected mr 5-15% w/hearing loss, microcephaly
62
Cytomegalovirus Nursing Considerations
good hygiene isolate infected infants no effective drug therapy
63
Herpes Simplex Virus Maternal/Preg Affects
Type I: Non genital type, although can infect genital area Type II: Genital type; more often associated with neonatal disease. Causes painful vesicle lesions on maternal external genitals, buttocks, cervix
64
Herpes Simplex Virus Fetal Affects
Greatest risk is from maternal primary infection at birth; 85-90% acquired at time of vaginal birth•Acquired post-natally through oral lesions, breastfeeding, and from other infected infants• Mortality of 50-60% if neonatal exposure is w/active primary infection• W/congenital transmission: SGA, low birth weight, diffuse brain damage, microcephaly and intracranial calcification
65
Herpes Simplex Virus Nursing Considerations
Neonates treated w/acyclovir x2-3weeks; topical ophthalmic drug in addition to IV therapy• Prevention: if positive lesions or culture at time of delivery –cesarean section•Avoid routine use of scalp electrodes during labor•Strict hand washing for mothers with active infections•Contact isolation w/infected infants• Educate parents on precautions to use after discharge
66
HIV transmission
intravenous drug use #1 route of transmission | perinatal transmission through trans-placental during delivery or breastfeeding
67
HIV maternal/preg affects
preterm l&d | s/e from arv & haart drugs
68
HIV fetal affects
perinatal transmission IUGR asymptomatic at birth (antibodies 1-18 mos)
69
HIV nursing considerations
Antepartum•Use of ARV/HAART usually after week 14• Prevention of opportunistic infection Intrapartum•ACTG 076 Protocol: (mother) AZT 2mg/kg IV over 1 hour, then 1mg/kg IV continuous infusion until cutting of cord. •Avoid procedures that increase the risk of perinatal transmission, such as amniocentesis, and fetal scalp sampling by minimizing fetus/neonate’s exposure to maternal blood and body fluids.•Trend toward scheduling cesarean birth prior to the onset of labor decreases transmission to 2% (depending on viral load). Women should be counseled and supported in their decision Postpartum•Monitor mother for signs of infection; restrict breast-feeding•Instruct mother on how to avoid the spread of HIV•Provide supportive care.•Mother will continue her anti-retroviral meds as prescribed.•Administer PO AZT or ZVD to neonate as prescribed.•AZT 2mg/kg P.O. q 6hrs x 6 weeks 8-12 hours after birth•Current guidelines suggest testing newborn within 48 hours of birth, at 1-2 months and 3-6 months of age. •Diagnosis is confirmed with two positive tests on two separate blood draws Psychosocial support•Disclosure of a woman’s HIV status to family/significant other can put her at risk for domestic violence, rejection•Requires assistance in identifying coping strategies and managing day to day life
70
nursing considerations for perinatal infections
focus is on screen/prevention culture at initial appt & 3rd trimester educate regarding effect of infect on pregnancy
71
nursing dx for perinatal infections
ineffective coping, health maint. | risk for infection, injury/fetal

Mgmt Test 2 - OB (14 decks)

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