Pregnancy w/ Complications Flashcards Preview

NUR 359: OB > Pregnancy w/ Complications > Flashcards

Flashcards in Pregnancy w/ Complications Deck (114):
1

def abortion

-fetus < 20 wks gest
or
-fetus weighing < 500 grams
- that is not viable

2

what does SAB stand for

spontaneous abortion

3

when does SAB usually occur

within first 12 weeks

4

risk of SAB increases w/ _______ ________

paternal age

5

what is the most common cause of SAB's

severe congenital anomalies

6

other causes of SAB's

low progesterone levels
fibroids
scar tissue

7

after a woman experiences her first SAB, when can she try getting pregnant again

- wait a couple (3) months
-get back on normal menstrual cycle
- try getting pregnant again within a few months afterward

8

if a woman experiences more than 2 or 3 SAB's, what is the protocol?

- fertility testing
-genetic testing
- testing on the tissues of conception

9

what is the difference bx threatened abortion and inevitable/imminent abortion?

- threatened abortion may have cramps, small amt of fluid/blood leakage

10

how do HCP's know if mom is losing the pregnancy?

HCG goes down

11

if a woman experiences a missed abortion, they are ta high risk for

- DIC with retained POC (products of conception)

12

def recurrent SAB's

3 or more consecutive SAB's

13

what can cause recurrent SAB's

- genetic/ chromosomal abnormalities
- anomalies of the female rep tract
-insuff progesterone
- immunologic factors - Rh factor, immunosuppression
-cervical incompetence

14

what do nurses asses for in the woman who experienced an SAB?

hypovolemia

15

what do HCP's ask woman to do after experiencing an SAB?

save all POC's

16

def ectopic pregnancy

implantation of fertilized ovum in a site other than the endometrial lining of the uterus

17

possible causes of ectopic pregnancies

- PID
-STI's/ STD's
-build up of scar tissue
-IUD's

18

T/F- ectopic pregancy is always an emergency

true

19

why us an ectopic pregnancy an emergency

high risk of rupture

20

s/s of ectopic preg

-sharp, one sided pain
-syncope
-referred shoulder pain
-lower abdominal pain
-scant dark/reddish brown vaginal spotting

21

how is ectopic preg dx'd

-US
-LMP
- low hcg levels

22

medical mgmt of ectopic preg

- methotrexate
- Salpingostomy via lap
- salpingostomy

23

under what conditions can methotrexate be used to terminate an ectopic pregancy

- unruptured tube
- embryo < 3.5 cm in size
- stable maternal conditions
-no fetal cardiac motion

24

how does methotrexate terminate an ectopic pregnancy

- stops the growth of fetal cells

25

admin of methotrexate

- given IM
-may be given up to 2 times

26

what is considered a good outcome of termination of ectopic preg

- removal of the embryo without removing the tube

27

what is considered a bad outcome of termination of ectopic pregnancy

- if you have to remove the tube with the embryo
- loss of tube through rupture

28

Gestational Trophoblastic Disease is also known as________ __________

Molar Pregnancy

29

what is Molar preg caused by

abnormal trophoblastic cells

30

def complete hydatidiform mole

no fetus present

31

def partial hydatidiform mole

presence of fetal tissue/membranes

32

Molar pregnancy etiology

- sperm and egg meet and travel down uterus
-cells start growing and multiplying
-uncontrolled multiplication of cells

33

which molar pregnancy is considered viable?

-none
-both complete and partial are non viable pregnancies

34

women who have had a Molar pregnancy are at a high risk of developing

choriocarcinoma

35

dx of Molar pregnancy

- vaginal bleeding: dk brown spotting to perfuse hemorrhaging
-US
- passing of hydropic vessels (grape-like clusters)
- uterine enlargement greater than expected for gest age
- absence of fetal heart sounds
- ***ELEVATED HCG!!!!!***
-excessive N/V
-elevated BP

36

Molar pregnancies are more common among which women?

- teens
- women over 40
-women who have taken Clomid

37

Medical tx of Molar pregnancy

- D&C
- possible hysterectomy if invasive
-*** Careful Follow Up***
-serial HCG's for the next year
-chemo for choriocarcinoma

38

nursing care of woman who experienced a Molar Pregnancy

- monitor VS and vaginal bleeding
- assess abdominal pain
-assess emotional state and coping ability
-convey the importance of adhering to follow up care!!!

39

def placenta previa

placenta is improperly implanted in the lower uterine segment

40

classification of placenta previa

marginal
partial
total

41

marginal placenta previa

placenta just at the edge of the opening

42

partial placenta previa

placenta partially in the opening

43

total placenta previa

placenta completely covers entire cervix

44

what is the hallmark sign of placenta previa

painless bleeding after 20 weeks

45

s/s of placenta previa

-sudden onset of painless bleeding after 20 weeks of gestation
- scanty or profuse bleeding

46

placenta previa pts are at high risk for

- bleeding
-infec

47

how will placenta previa patients be birthed?

c sec

48

def abruptio placenta

premature separation of a normally implanted placenta from the uterine wall

49

maternal risk factors a/w abruptio placenta

bleeding
shock
hypovolemia
death

50

fetal risk factors a/w abruptio placenta

- hypoxia
-neuro deficits- CP
-pre term

51

what can cause abruptio placenta

*** cocaine abuse***
maternal HTN
abdominal trauma- fall, MVA

52

T/F- women who have had an abruptio placenta are not at an incr risk for a recurrences for their next pregnancies

false- they are at an incr risk

53

s/s of abruptio placenta

vaginal bleeding
pain
uterine tenderness, irritability, high resting tone
port wine colored amniotic fluid
uterine contractions
decr fetal activity
fetal demise

54

what is the focus of med mgmt for abruptio placenta

- CV status of the mother
- status of the fetus

55

nursing care for abruptio placenta

- assess amt and nature of bleeding
-assess and manage pain
- monitor maternal VS
- monitor status of fetus
- assess uterine contractions
- collect OB hx and length of gestation
- obtaining lab data
- assessing and providing psychosocial support

56

early s/s of hypovolemic shock

low bp
tachycardia
decr urinary output

57

late s/s of hypovolemic shock

bradycardia
renal failure
low bp
multisystem organ failure

58

medical mgmt of hypovolemic shock

monitor fetus
promote tissue oxygenation
fluid replacement

59

def placenta accreta

the chorionic villi attach directly to the myometrium of the uterus

60

def placenta increta

-the myometrium is invaded
- the placenta is growing into the wall of the uterus

61

def placenta percreta

- the myometrium is penetrated
- the placenta grows through the wall of the uterus and into the abdominal cavity

62

primary complications of placenta accreta

maternal hemorrhage
failure of placenta to separate following birth

63

how is placenta accreta diagnosed and what is the problem with diagnosis

- dx by US
-can easily be missed if slight

64

def Gest HTN

-syst bp >140
- diast bp >90
-after 20 wks of preg with BO returning to normal within 6 wks post partum

65

are all hypertensive mothers considered high risk

yes

66

risk factors for developing GHTN

obese
less than 20 yrs
over than 40 yrs
diabetic mother

67

def pre-eclampsia

-syst bp >140/ diast bp >90 after 20 wks gestation
-accompanied by proteinuria (>0.3 g in 24 h urine)

68

if a woman is dx'd w/ pre-eclampsia, what may be the protocol for her care

-mom may be admitted to antepartum for the remainder of her preg

69

def eclampsia

the progression of pre-eclampsia to generalized seizures

70

def chronic HTN

- elevated BP before preg or development of HTN before 20 wks of gestation

71

what lab levels should be monitored closely for women w/ HTN/ pre-eclampsia?

sodium

72

pre-eclampsia pathophys

- maternal vasospasm affecting every organ
- incr PVR
- decr perfusion to almost all organs

73

prevention of GHTN

-low dose ASA
- calcium
-magnesium
- fish oil supplements

74

in-pt mgmt for pre-eclampsia: bed rest

quiet room
limit visitors/stressful visitors
keep light low
strict I/O's & daily weights
monitor lungs, inc spir, teds
monitor liver enzymes
fetal monitor once 2 h or twice per shift

75

name 2 anticonv meds

mag sulfate
hydralazine (apresoline)

76

action of mag sulfate

prevents and treats convulsions caused by pre-eclampsia

77

loading dose of mag sulfate

4-6 grams in 100 cc IVPB

78

what is the goal of mgmt for pts on mag sulfate?

keep pt on ther level

79

what is the ther range for mag sulfate

serum level should be bx 4-7.5 meq's

80

major adverse rxns to mag sulfate

***CNS Depressant***
decr DTR's
nausea/ vomitting
weakness
dizziness
slurred speech

81

what is the antidote for mag sulfate?

calcium gluconate

82

how long does mom need to be on mag sulfate after they deliver

24 hrs

83

what must be closely monitored and how often

-BP and VS
-Q Hr!!!!

84

what is the med of choice for the tx of HTN during preg?

hydralazine

85

other meds used to treat GHTN

phenytoin
diazepam

86

s/s of HELLP

-sudden weight gain
-HTN
-edema in the upper extremilites more than in the lower extremities
- hemolysis---> anemia and jaundice
- elevated Liver enzymes
epigastric pain
NV
-Low platelets
thrombocytopenia
abnormal bleeding and clotting time
petechiae

87

if mom is dx'd w/ HELLP, what are the delivery options

-mom may have to deliver baby early

88

def hypertonic labor

-ineffective uterine contractions

89

when does hypertonic labor occur

in the latent phase of labor

90

hypertonic labor pathophys

contractions become more frequent
intensity increases---> incr pain and prolonged labor

91

medical mgmt of hypertonic labor

bed rest
sedation
pitocin
amniotomy

92

def precipitous labor

labor lasting more than 3 hrs

93

what are the risks a/w precipitous labor

laceration from rapid descent
accelerated cervical dilation

94

nursing dx r/t precipitous labor

risk for injury r/t rapid labor and birth
acute pain r/t rapid labor

95

def prolonged pregnancy

a preg lasting more than 42 weeks

96

maternal risks a/w prolonged pregnancy

incr risk for induction
LGA infant
surgical delivery
use of forceps/vaccuum
psyhological stress
infec

97

infant risks a/w prolonged pregnancy

decr placental perfusion
oligohydramnios--> incr risk for:
-cord compression
- meconium aspiration
- low apgar

98

nursing dx r/t prolonged preg

- fear r/t unknown outcome of baby
- ineffective individual coping r/t anxiety abt status of baby

99

when there is a mo with a prolonged preg, how often is a biophys done?

q 24-48 hrs

100

when is external version used

for breech or shoulder presentation

101

when is external version performed

- at 36 wks following:
-US
- NST

102

why is US and NST done prior to external version

to eval fetal well being and confirm fetal/placental position

103

when can an external version not be performed?

if the presenting part is engaged

104

what med is admin before external version is performed and why

tocolytics
- relax the uterus

regional anesthesia

105

name an example of a tocolytic

terbutaline

106

when is an external version abruptly stopped

- fetal decels
-fetal bradycardia

107

nursing mgmt during an external version

VS
NST
FHR monitoring
IVF
comfort
post procedure fetal and maternal monitoring

108

def amniotomy

AROM

109

when is an amniotomy done

@ 2 cm or >

110

indications for amniotomy

shorten/augment labor
manipulate hormone release--> stim cxn
apply IUPC and/or fetal scalp electrode

111

what are the risks a/w amniotomy

cord prolapse

112

medical mgmt during amniotomy

FHR
decr vaginal exams
temps q 2 h
comfort
hygeine

113

ways to induce labor

-AROM
pitocin
intercourse
nipple stim
mechanical dilation- foley
herbs
enemas
castor oil
evening primrose @ 36 wks to soften cervix

114

nursing role during induction of labor

VS
EFM
NST
FHR
Pain mgmt