Pregnancy w/ Complications Flashcards
(114 cards)
1
Q
def abortion
A
-fetus < 20 wks gest
or
-fetus weighing < 500 grams
- that is not viable
2
Q
what does SAB stand for
A
spontaneous abortion
3
Q
when does SAB usually occur
A
within first 12 weeks
4
Q
risk of SAB increases w/ _______ ________
A
paternal age
5
Q
what is the most common cause of SAB’s
A
severe congenital anomalies
6
Q
other causes of SAB’s
A
low progesterone levels
fibroids
scar tissue
7
Q
after a woman experiences her first SAB, when can she try getting pregnant again
A
- wait a couple (3) months
- get back on normal menstrual cycle
- try getting pregnant again within a few months afterward
8
Q
if a woman experiences more than 2 or 3 SAB’s, what is the protocol?
A
- fertility testing
- genetic testing
- testing on the tissues of conception
9
Q
what is the difference bx threatened abortion and inevitable/imminent abortion?
A
- threatened abortion may have cramps, small amt of fluid/blood leakage
10
Q
how do HCP’s know if mom is losing the pregnancy?
A
HCG goes down
11
Q
if a woman experiences a missed abortion, they are ta high risk for
A
- DIC with retained POC (products of conception)
12
Q
def recurrent SAB’s
A
3 or more consecutive SAB’s
13
Q
what can cause recurrent SAB’s
A
- genetic/ chromosomal abnormalities
- anomalies of the female rep tract
- insuff progesterone
- immunologic factors - Rh factor, immunosuppression
- cervical incompetence
14
Q
what do nurses asses for in the woman who experienced an SAB?
A
hypovolemia
15
Q
what do HCP’s ask woman to do after experiencing an SAB?
A
save all POC’s
16
Q
def ectopic pregnancy
A
implantation of fertilized ovum in a site other than the endometrial lining of the uterus
17
Q
possible causes of ectopic pregnancies
A
- PID
- STI’s/ STD’s
- build up of scar tissue
- IUD’s
18
Q
T/F- ectopic pregancy is always an emergency
A
true
19
Q
why us an ectopic pregnancy an emergency
A
high risk of rupture
20
Q
s/s of ectopic preg
A
- sharp, one sided pain
- syncope
- referred shoulder pain
- lower abdominal pain
- scant dark/reddish brown vaginal spotting
21
Q
how is ectopic preg dx’d
A
- US
- LMP
- low hcg levels
22
Q
medical mgmt of ectopic preg
A
- methotrexate
- Salpingostomy via lap
- salpingostomy
23
Q
under what conditions can methotrexate be used to terminate an ectopic pregancy
A
- unruptured tube
- embryo < 3.5 cm in size
- stable maternal conditions
- no fetal cardiac motion
24
Q
how does methotrexate terminate an ectopic pregnancy
A
- 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
```
