S3 M3 Reproduction week 2 (placenta stuff) Flashcards
(148 cards)
1
Q
Placenta previa
afterbirth first
A
placenta shifts to lower uterus and covers the cervical opening
occurs last 2 trimesters
High risk of hemorrhage
2
Q
Placenta previa risk increases with
Can lead to
A
C sections
Hemorrhage
Abruption (separation) of placenta
Emergency cesarean birth
3
Q
Placenta previa pathophysiology
A
Assumed to be due to embryo implantation in lower uterus and scarring of the upper uterus
4
Q
Is the placenta edge is less than 2cm from internal os but DOES not cover it, this is called
A
Low lying placenta
5
Q
Therapeutic management of placenta previa
A
Prevention of primary cesarean section
Prenatal care and timely diagnosis
6
Q
Placenta previa symptoms
A
Painless bright red vaginal bleeding during 2nd and 3rd trimester, recurring
1st bleeding occurs at 27-32 weeks
Uterine contractions may occur with bleeding
7
Q
Diagnosing Placenta Previa
A
Transvaginal ultrasound
MRI
8
Q
Placenta accreta, increta, parcreta
A
Accreta - adheres to myometrium
Increta - penetrates myometrium
Parcreta - goes past myometrium and into peritoneal lining
9
Q
Myometrium
A
Central/widest layer of the uterus structure
10
Q
Nursing management of placenta previa
A
S/S of vag bleeding
Fetal distress
educate pt about condition and options
Majority of women will need C section
11
Q
Monitoring vag bleeding
A
Perpiad count for changes and frequency
estimate/document amount
12
Q
Monitoring fetal distress
A
Fetal heart rate via doppler
Electronic monitoring
Have O2 ready
Encourage lying on side to increase placenta perfusion
13
Q
Placental abruption
A
Early separation of placenta after the 20th week
bleeding occurs between decidua(thick mucus lining uterus during birth) ad placenta
leads to hemorrhage
14
Q
Maternal consequences of having placental abruption
A
Hemorrhage Hysterectomy Disseminated intravascular coagulopathy DIC Postpartum gland necrosis Renal failure
15
Q
Prenatal consequences of having placental abruption
A
Low weight, preterm birth, asphyxia, death
16
Q
Placental abruption patho
A
Maternal vessels tear away from placenta, bleeding occurs between lining and placenta
As bleeding increases placenta separates and loses function
result is fetal hypoxia/death
17
Q
Placental abruption classifications
0 1 2 3
A
0 - unrecognized, diagnosis made after birth
1 - bleeding less than 500ml, 10%-20% separation
2 - bleeding at 1000-1500ml, 20% to 50% separation
3 - bleeding over 1500ml, 50% separation
18
Q
S/S of mild (1st stage) placental abruption
A
tender uterus
no coagulopathy
no shock
no fetal distress
19
Q
S/S of moderate (2nd stage) placental abruption
A
Continuous abdomen pain Mild shock Normal maternal BP Maternal tachycardia Fetal distress
20
Q
S/S of severe (3rd stage) placental abruption
A
Profound shock Dark vaginal bleeding Severe stomach pain v in maternal BP ^ in maternal HR DIC
21
Q
Placental abruption onset is
A
FAST
unexpected
sudden
intense
Immediate treatment
22
Q
Emergency measures for Placental abruption
A
2 large bore IV line
NS and LR
blood specimen for values and typing
Evidence of fetal distress = caesarian
23
Q
Nursing assessment for placental abruption
A
Hemodynamic status and fetal wellbeing
24
Q
Placenta previa onset is
placenta abruption onset is
A
Insidious
Sudden
25
Bleeding with previa vs abruption
Always visible, increasing episodes over time
Bright red
Can be concealed and severe
Dark red
26
Pain with previa vs abruption
uterine tone previa vs abruption
none
constant
soft
frim
27
Fetus during previa vs abruption
| HR and presentation
HR normal
HR distress/absence
May breech of transverse lie
No relationship
28
Labs/diagnostics for Placental abruption for mom
CBC
Fibrinogen(clotting factor) level
PT aPTT time (coagulation status)
Blood typing
29
Labs/diagnostics for Placental abruption for fetus
Nonstress test - fetal jeopardy
| Bio profile - fetal jeopardy
30
Nursing management of placental abruption
Strict bed rest
LEFT Lateral position, prevents pressure on vena cava.
Vitals Q15min for blood loss
Start Foley
Start Large bore IV port
31
In placental abruption, fundal height change/increase indicates
bleeding
32
In placental abruption monitor for DIC symptoms which are
Gum bleeding
Tachycardia
Oozing at IV site
Petechia (red spots caused by bleeding into skin)
33
PROM
| Prelabor ruptur of membrane
Spontaneous rupture of amniotic sac(bag of water) before true labor
34
Risk factors for developing PROM
```
Low socioeconomic status
Multiple gestations
Low BMI
Tobacco
History of preterm labor, placenta previa, placental abruption, UTI, Vag bleeding
```
35
```
Prolonged PROM (greater than _h)
increases risk for _
```
24h
infection
36
time period between amniotic rupture(PROM) and contractions is called
Latent period
37
S/S of PROM
Leakage of fluid
Vag discharge and bleeding
Pelvic pressure WITHOUT contractions
38
Diagnosing PROM
speculum exam or cervix and vag
nitrazine paper(pH indicator) testing fluid
39
PROM vs PPROM
PROM is beyond 37 weeks
| PPROM is less than 37 weeks
40
PROM Treatment
UNDER NO CIRCUMSTANCE is a unsterile digital examination performed until the woman enters ACTIVE labor
If fetal lungs are mature, labor is induced
41
What not to do with PROM
UNDER NO CIRCUMSTANCE is a unsterile digital examination performed until the woman enters ACTIVE labor
42
PROM treatment if fetal lungs are immature
^ Hydrate
v physical activity
pelvic rest
observation for infection (labs/vitals)
GIVE antibiotics
43
If pt presents with PROM make sure they don't already have
UTI
| Pelvic or vaginal infection
44
S/S of labor
Cramping
Pelvic pressure
Back pain
look for this after PROM
45
Meconium presence in amniotic fluid indicates
Fetal distress due to hypoxia
46
Meconium stains the fluid
yellow to green brown
47
With PROM start monitoring fetal
HR
48
Diagnosing PROM
Nitrazine (pH)
Fern test (fluid dries like fern)
Ultrasound
49
PROM nursing management
Prevent infection
| ID contractions
50
Fetal tachycardia may indicate
Infection
51
Variable deceleration may indicate
Cord compression
52
Basics of assessing fetal wellbeing that a mother can do
kick counting
53
Preterm labor
regular contractions
cervical effacement and dilation
before 37 weeks gestation
54
Leading cause of death within the first month of life
Premature birth
55
Therapeutic management for PTL
```
Tocolytic drugs (promote uterine relaxation
Steroids to improve fetal lung maturity
Single dose of corticosteroids at 24 go 34 weeks
```
56
Tocolytic drugs
Promote uterine relaxation to prolong pregnancy for 2 to 7 days
Is usually ordered for PTL that is BEFORE 34 weeks
57
Tocolytic drug names
Magnesium sulfate
Indomethacin
Nifedipine
Being tocolytic is an off label use for all of the above
58
Corticosteroid given at 24 to 34 weeks for PTL
reduce frequency and severity of respiratory distress syndrome in premature infants
59
S/S that may indicate preterm labor will happen
```
Change/increase in vag discharge
Pelvic pressure
Back pain
UTI symptoms
N/V/D
More than 6 contractions per 1h
```
60
Lab/diagnostics for PTL
CBC and urinalyses for infection
Amniotic fluid test for lung maturity
Fetal fibronectin
Cervical length Measurement
61
Fetal fibronectin
Biologic glue attaching sac to uterine lining
Not supposed to be present between 24 and 34 weeks of pregnancy.
If present over 0.05mcg, may indicate PTL within 7 to 14 days
62
Cervical length measurement
done via transvaginal ultrasound
measures cervical length/width, funnel length/width and percentage of funneling
Best for weeks 16 to 24
63
Cervical length of 3cm or more indicates delivery within
14 days
64
Nursing management of preterm labor
```
Early detection
Monitor vitals
Intake/output measuring
Encouraging bed rest on left side
Monitor FHR
```
65
Tocolysis
Use of contraction inhibiting drugs
goal is to delay birth for up to 48h
66
Diagnosis of preterm labor requires both
contractions AND cervical change
67
Prevention of PTL
Adequate nutrition and weight gain
Pregnancy interval of 18 months
Progesterone therapy
68
Overdose indicators of Magnesium sulfate
Resp problems and deep tendon reflexes
69
Side effects of magnesium sulfate
```
N/V
headache
weakness
hypotension
Cardiopulmonary arrest
```
70
With magnesium sulfate, fetus may experience
vHR
Drowsiness
Hypotonia
71
Calcium channel blockers
| Nifedipine side effects
```
Hypotension
Tachycardia
Headache
Nausea
Facial flushing
```
72
Indomethacin
| Cyclooxygenase inhibitor
Reduces prostaglandin synthesis
73
Indomethacin side effects on fetus
oligohydramnios
| decrease in fetal renal blood flow
74
Indomethacin maternal side effects
N/V
Gastritis
NOT for gestation of 32 weeks or longer
75
With indomethacin monitor
urine output
mom temp
Amniotic fluid index
76
Preeclampsia
Leading cause of maternal morbidity
New onset hypertension w/proteinuria and maternal organ dysfunction
77
Preeclampsia/eclampsia affects what orgnas/systems
cardiovascular
hepatic
renal
CNS
78
1st stage of preeclampsia
widespread vasospasms
| platelet/fibrin adherence
79
2nd stage of preeclampsia
s/s appear
Woman's response to abnormal placentation
```
hypertension
proteinuria
N/V/H
blurred vision
hyperreflexia due to hypoperfusion
```
80
In preeclampsia the vasospasms result in elevated BP and reduce blood flow to
```
Brain
Liver
Kidneys
Placenta
Lungs
```
81
BP in
preeclampsia moderate
preeclampsia severe
eclampsia
140/90 after 20 weeks
160/110 on 2 occasions at least 6h apart while on bed rest
160/110 is standard
82
Seizures/come and hyperreflexia for
Moderate preeclampsia
Severe preeclampsia
Eclampsia
no and no
no and yes
yes and yes
83
Eclampsia s/s
Severe headache
Generalized edema
right upper quadrant and epigastric pain
Visual disturbances
cerebral hemorrhage
renal failure
84
Cure for pre/eclampsia
birth
85
To reduce preeclampsia symptoms lie in the
this improves
lateral recumbent position
uteroplacental blood flow
reduces bp
promotes diuresis
86
What labs are done for preeclampsia
```
CBC
Serum electrolytes
BUN,
Creatinine
Hepatic enzymes
Platelet count
```
87
With preeclampsia advise mother to
do daily kick counts
monitor bp
report decrease in fetal movement
88
Does preeclampsia need sodium restricted diet
NO
89
Fetal surveillance for preeclampsia
Fetal movement
Nonstress testing
Ultrasound
Amniotic fluid
90
With preeclampsia monitor for
hypoxemia
seizures
^ intracranial pressure
91
What med is given to women with severe preeclampsia prior to 34 weeks gestation
Betamethasone
92
Prophylactic meds for preeclampsia
Prenatal asp and prenatal magnesium sulfate
93
S/S of severe preeclampsia
```
Cerebral/visual symptoms
Pulmonary edema
Epigastric pain
Liver failure
Thrombocytopenia
Kidney failure
```
94
In labor with preeclampsia
oxytocin is given to
antihypertensive are given to
Magnesium sulfate is given to
stimulate contractions
control bp
prevent seizures
95
Antidote for magnesium sulfate overdose
Calcium gluconate
96
S/S of magnesium toxicity
Resp depression
Hypocalcemia
Hypotonia
97
Eclampsia
Hallmark of preeclampsia complications
Onset of SEIZURE ACTIVITY
98
Eclampsia seizures start at _ and present as...
They than continue to _
Face
twitching ,eye bulging, mouth foaming
Body
99
During eclampsia seizure patient cant _
After eclampsia seizure patient goes into _
Breath
Coma
100
Managing eclampsia
Lay on left
Admin O2
Protection from injury due to seizure
Suction secretions
101
Magnesium sulfate is given for _h after eclampsia seizure, to prevent recurrence
24
102
Most significant sign of pre/eclampsia
Proteinuria
| Hypertension
103
Diet for preeclampsia should be high in
Protein
104
Preeclampsia and reflexes
DTR
Hyperreflexia
indicates CNS involvement in condition
105
In pre/eclampsia, HYPOreflexia indicates
Magnesium sulfate toxicity
106
During eclampsia seizure breathing_
stops
107
Nursing management of eclapmsia
Raise all side rails and provide padding
Dim lights
suction nasopharynx
admin O2
Fetal monitoring
108
After birth, monitor for pre/eclampsia for at least
48h
109
SCD
| Sickle cell disease
hemolytic anemia due to inheritance of Sickle Hemoglobin HbS
110
Since blood cells become sickle due to low O2 this can happen due to natural decrease or in what blood vessels
Veins
111
Sickle cell trait vs anemia
trait means carrier
anemia is the actual sickness
112
Clinical manifestation of sickle cell anemia
Low hemoglobin values 5-11dL (13-17dL normal)
Jaundice
Enlargement of bones
Tachycardia
murmurs
enlarge heart
HF
113
Which organs usually suffer from SCD
Those with slow circulation
| Spleen Lungs CNS
114
Complications with SCD
Hypoxic tissue damage
Ischemic necrosis
Pneumonia
Osteomyelitis
115
Three types of sickle cell crisis
Vaso Occlusive crisis - Sickle cells block blood supply
Aplastic crisis - Human Parvovirus infection, hemoglobin drops fast
Sequestration crisis - an organ fills with bad cells. Spleen most common for kids. Liver and lungs most common for adults.
116
Acute chest syndrome
S/S
Infection, embolism, infarction related to SCD
Tachypnea, cough, wheezing, fever
117
Managing Acute Chest Syndrome
Red cell transfusion
Antimicrobials
Bronchodilators
Mechanical ventilation
118
SCD pulmonary hypertension
S/S
High blood pressure in lungs
```
Fatigue
dyspnea
Dizziness
chest pain
Syncope
```
119
Pulmonary hypertension
| pulse oximetry and breath sounds
typically normal and clear despite the sickness
120
Screening for SCD pulm hypertension
Doppler echocardiography
BNP levels
CT Scan
121
SCD Stroke
S/S
Ischemic (block in blood supply to brain) in kids and old adults
Hemorrhagic (bleeding into brain) in young adults
Declining neurocognitive function in beguiling symptom
122
Treating SCD stroke
Red cell transfusion to reduce hemoglobin S
123
Reproductive problems with SCD
Men - impotence, low libido, infertilities
Women - delayed menarche
Use contraption if on Hydroxyurea
124
Teratogenic med for SCD
Hydroxyurea
125
Patient with SCD will have what blood labs
Low hematocrit, sickled cells on the smear
High WBC due to chronic inflammatory state
126
Hematopoietic stem cell transplans
May cure SCD but low availability due to lack of donors
127
Hydroxyurea for SCD
Chemo agent
increases fetal hemoglobin thereby decreasing hemoglobin S
Will need folic acid replacement
Lowers Leukocyte formation so Infections will need to be treated promptly
128
Transfusion therapy for SCD
RBC transfusion
Good for severe situations like anemia crisis (any one of the 3), acute chest syndrome, organ failure or stroke.
129
Risks of Transfusion therapy
infection
delayed reactions
Iron overload, which primarily accumulates in liver, WILL need chelation therapy
130
Chelation therapy
Rids blood of excess irons and metals
131
Exchange transfusion
Replacing existing blood for blood without HbS to a target of 10g/dL
132
Alloimmunization
development of antibodies toward different kinds of blood due to frequent transfusions
133
Distinguishing between anemic crisis and delayed blood reaction
S/S will be the same except patient will be LESS anemic with delayed blood reactions
134
With SCD swollen joints should be_
after swelling goes down...
Elevated
Aggressive physical therapy, whirlpool baths, TENS to preserve function
135
Meds for SCD Pain
```
NSAIDS
Aspirin
SNRIs
Antidepressants
Gabapentin
```
136
Tocodynameter
Measures contraction frequency
NOT strength
Strength can only be measured through contact with belly
137
Contractions
```
Involuntary
Have systole (building up and peaking) and diastole (going down)
```
138
What to document about contractions
Frequency
Duration
Intensity
Resting tone- are there relaxation periods
139
What to reference for contraction strengt
Nose
Chin
Forehead
140
Montevideo unites
Unit of measurement used with an internal uterine catheter to measure contraction pressure
141
Normal contractions per 10 min
Tachysystole/hyperstimulation
5
more than 5
SHUT OFF PITOCIN
142
TOCO vs IUPC
Toco-external
IUPC-internal (and pressure)
measure contraction frequency
143
Fetal heart rate variability
change from baseline
low- below 6bpm
moderate- 6 to 25bpm
high- over 25bpm
144
Acceleration
2 or more increases of 15bpm above baseline at least 15 sec apart in 20 min
145
With nifedipine as a tocolytic monitor
BP
146
With indomethacin as a tocolytic dont give to women with
Peptic ulcer disease
Will irritate GI
CONTRAINDICATED if fetus is greater than 32 weeks
147
Nitrizine strips when in contact with amniotic fluid turn what color
Blue
148
DIC
Disseminated Intravascular Coagulation
No more clotting factor, mom will most likely die.
