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SEM 1 > W3: Pregnancy at Risk > Flashcards

W3: Pregnancy at Risk Flashcards

1
Q

Adolescent pregnancy

A

age 10-19yrs
increased of perinatal complications, maternal death

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2
Q

Adolescent friendly perinatal care

A

nonjudgmental care
forming connection
individualizing care

  • ensure safety
  • positive experience
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3
Q

Geriatic Pregnancy

A

> 35 yrs
increased risk of:
- maternal death
- miscarriage
- pre-term
-LBW
- perinatal mortality
- down syndrome

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4
Q

IPV is assoc w/

A

preterm labour
premature baby
LBW
neonatal/infant/maternal mortality
maternal depression
substance abuse

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5
Q

IPV screening tools

A

RADAR (routine, document, assess, review)
HITS

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6
Q

Role of nurse (IPV)

A
  • report if child <16 in house

-reassure & believe
- don’t judge
not her fault
apologies don’t end abuse
explain effects on fetus
reinforce their safety
explore cocnerns + plan of care
referrals
documentation

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7
Q

Risk assoc. w/ substance abuse

A

bleeding complications
miscarriage
still birth
prematuritty
lbw
SIDS
congenital abnormalities

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8
Q

Is there a legal drug testing requirement during pregnancy in Canada?

A

No

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9
Q

legal considerations associated w/ substance use

A

non-jugemental person centred approach
harm reduction model
encourage prenatal care, counselling, tx

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10
Q

barriers to tx assoc. w/ substance use

A

guilt, fear, shame
tx programs don’t address pregnant women
lack of women-only spaces
long waitlists

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11
Q

NC: Substance Use

A

assess hx
confidentiality
trauma-informed
harm reduction
women more receptive to changes during pregnancy
OAT (opiod agnonist therapy), methadone or buprenorphine tx
cannabis use education
maternal-infant attachment
BF

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12
Q

Early Pregnancy Bleeding

A

miscarriage/spontaneous abortopn before 20w OR fetus <500g

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13
Q

early loss

A

before 12 w

chromosomal abnormalities
teratogenic drugs
faulty implantation
maternal abnormalities
infections

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14
Q

late loss

A

12-20w

advanced age
premature dilation of cervix
chronic infection
use of recreational drugs

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15
Q

Threatened Abortion

A

bleeding: slight, spotting
uterine cramping: mild
cx: closed
expulsion of products: no

bed rests, tests

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16
Q

Inevitable Abortion

A

bleeding: moderate
uterine cramping: mild-severe
cx: open
expulsion of products: yes

bed rest, dilation/cutterage

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17
Q

Incomplete abortion

A

bleeding: heavy, profuse
uterine cramping: severe
cx: open
expulsion of products: yes

dilation -> cutterage (suction)

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18
Q

complete abortion

A

bleeding: slight
uterine cramping: mild
cx: close
expulsion of products: yes

cutterage maybe

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19
Q

missed abortion

A

bleeding: none, spotting
uterine cramping: none
cx: close
expulsion of products: no

monitor

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20
Q

early pregnancy assessment:

A

confirmation of pregnancy
bleeding
pain
vaginal d/c

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21
Q

late pregnancy assessment

A

date of birth
bleeding
pain
vginal d/c
amniotic membrane status
uterine activity
fetal heart rate + movement

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22
Q

MGT of incomplete abortion

A

expectant: allow miscarriage to expel on its own

medical: 2 drug combo
- mifepristone - prepare uterus for miscarriage (blocks progesterone)
- misoprostol - given 24-48 hrs later, helps soften + dilate cervix

surgical: dilation & cutterage

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23
Q

D/C teaching after pregnancy loss

A
  • report heavy, bright-red bleeding
  • scant d/c for 1-2 weeks
  • nothing in vagina for 2 weeks (until bleeding stops)
  • take antibiotics
  • report elevated temp + foul d/c
  • foods high in Fe & protein
  • post-pone pregnancy for at least 2mo
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24
Q

Ectopic pregnancy

A

fertilized ovum implanted outside uterine cavity (amupllar)

medical emergency!

clinical manifestations
- abdominal pain
- missed period
- abnormal vaginal bleeding (rupture)
-referred shoulder pain
-one-sided, deep lower quadrant pain

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25
Q

Ectopic pregnancy dx

A

ultrasound
serum progesterone
b-hCG

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26
Q

medical mangement of Ectopic pregnancy

A

methotrexate: antimetabolite & folic acid antagonist, destroys rapidly dividing cells
surgical: salpinostomy, salpingectomy to repair rupture

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27
Q

Patient Teaching for methotrexate

A

avoid folic acid
avoid gas-forming foods
avoid sun exposure
avoid sexual intercourse until b-hCG gone
keep all appointments
CONTACT DOC: severe abd pain (rupture)

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28
Q

Premature dilation of cervix

A

passive/painlexx dilation of the cervix
d/t trauma, collagen issues

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29
Q

Nursing care for premature cervical dilation

A

cervical cerclage (12-14weeks)
observation
report signs of pre-term labor, PROM, infection
HOSPITAL: contractions, pPROM, perineal pressure, urge to push

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30
Q

Placenta previa

A

placenta implented in lower uterine segment near/over internal cervical os

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31
Q

classifcation of placenta percia

A

complete placenta previa
marginal placenta previa
low-lying placenta

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32
Q

clinical signs of placenta previa

A

bright red bleeding
pain absent
uterine normal
normal fetal HR

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33
Q

complictions of placenta previa

A

bleeding (PAINLESS)
preterm birth
IUGR

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34
Q

Expectant Management of Placenta Previa

A

reduced activty + observation

patient <36w
no labor, minimal bleeding
no rectal/vaginal examinations
ultrasound q2w
NST, BPP 1-2 x weekly
antepartum steroids (betamethasone), fetal lung maturity

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35
Q

active mgt of placenta previa

A

c-section

  • mature fetus
    -excessive bleeding
  • active labor begins
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36
Q

Placenta Abruption

A

premature seperation of placenta

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37
Q

clinical signs ofplacenta abruption

A

vaginal bleeding (PAINFUL)
abd pain
uterine tenderness
contraction

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38
Q

placenta abruption is a major cause of ___

A

antepartum hemorrhage

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39
Q

Placenta Abruption: CLASS 1- mild seperation

A

bleeding: minimal
total blood loss: <500
colour: dark red
shock: rare, no
uterine tonicity: normal
pain: absent
fetal status: normal
DIC: rare

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40
Q

Placenta Abruption: CLASS 2- mod seperation

A

bleeding: 0-mod
total blood loss: 1000-1500
colour: dark red
shock: mild
uterine tonicity: increase
pain: mod-sev
fetal status: atypical
DIC: occasional

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41
Q

Placenta Abruption: CLASS 3- severe seperation

A

bleeding: 0 - heavy
total blood loss: >1500
colour: dark red
shock: common
uterine tonicity: !!!
pain: severe
fetal status: abnormal, death?
DIC: frequent

42
Q

maternal complications of placenta abruption

A

hemorrhage
hypovelmic shock
hypofibrinogenemia, thrombocytopneia
couvelaire uterus
dic
infection
rh isoimmunization

43
Q

fetal complications of placental abruption

A

IUGR
preterm birth
hypoxemia
stillbirth
neurological defects
cerebral palse
SIDS

44
Q

Expectant mgt Placenta Abruption

A

<36w
hospitalized
monitor fetal status
maternal vitals
betamethasone
birth if deterioration
rho(d)immunogloblin

45
Q

DIC

A

proteins that control blood clotting become overactive & utilizing clotting factors –> internal bleeding

triggered by tissue thromboplastin d/t placental abruption, retained dead fetus, amniotic fluid embolus, pre-eclampsia, HELLP, sepsis

46
Q

stage 1 DIC

A

overactive clotting leads to blood clots throughout the blodo vessels

clots can reduce/block blood flow which can damage organs

47
Q

stage 2: DIC

A

the overactice clottign uses up platelets & clotting factors that help blood clot
with absence of facors dic leads to bleeding

48
Q

Physical Examination Findings DIC

A

spontaneous bleeding
excessive blood from puncture sites
petechiae
bruising
hematuria
GI bleeding
tachycardia
diaphoresis

49
Q

Coagulation Test Results: DIC

A

decreased: platelets, fibrinogen, factor V, factor VIII
increased: fibrin degradation products, d-dimer test
prolonged: prothrombin time, partial thrombin time
red blood smear: fragmented rbcs

50
Q

NC: DIC

A

tx underlying cause
volume expansion
labs
vit K & rcombianr activated factor Vlla, fibrinogen concentrate
protect from injury
I/O (30ml/hr)
fetal monitoring
side-lying- maximize blood to uterus
o2
keep pt warm

51
Q

diagnosis of hypertensive disorder

A

> 140/90 x2 , 15 min apart

52
Q

severe HTN

A

160/110<

53
Q

chronic HTN

A

prepregnancy HTn present prior to 20w

54
Q

gestational HTN

A

develops after 20w
no proteinuria

55
Q

pre-eclampsia, eclampsia

A

gestational HTN + proteinuria

56
Q

2 components of (pre)eclampsia

A

HTN + proteinuri (>0.3g/L)
addiitonal organ dysfunction
- kidney, renal, enurologcal, hematological

57
Q

eclampsia

A

seizure activity/coma in women diagnosed w/ pre-eclampsia

58
Q

Risk factors for pre-elcampsia/eclampsia

A

nulliparity
age >40
pregnancy w/ assisted tech
interpregnancy internal >7yrs
family hx
pt born small for gestational age
obesity, DM
multifetal gestation
hx of pre
previous poor pregnancy
chronic HTN
renal disease
type 1 DM

59
Q

pre-eclampsia etiology

A

– poor perfusion resulting from vasospasm NOT BP increase

arteriolar vasospasm diminishes diameter of blood vessels, which impedes blodo flow to all organs & increases BP

organ function depressed

60
Q

maternal complications: pre-eclampsia

A

multi organ faliure
CNS, kidney, lungs, hematological

61
Q

fetal complications: pre-eclampsia

A

pre-term birth
still birth (IUFD)
fetal distress
uteroplacental insufficiency
placenta abruption (UGR, hypoxic)

62
Q

HELLP Syndrome

A

Hemolysis (H)
elevated liver enzymes (EL)
low platelets (LP)

63
Q

s/s of HELLP

A

HTN
Proteinuria
epigastric RUQ pain
n/v
headache
malaise

64
Q

HELLP is associated w/ increased risk for

A

placental abruption
renal faliure
pulmonary edema
ruptured liver hematoma
DIC

65
Q

NC: Pre-eclampsia & HELLP

A

BP
Reflexes: bicep, patellar, ankle clonus
Fetal: NST, CST, BPP, FHR, ultrasounf, fetal movement
activity restriction

66
Q

NC Pre-eclampsia- BP

A

hydralazine
labetalol
methyldopa
adalat

67
Q

NC: Pre-eclampsia- Magnesium Sulphate

A

antiseizure
assess for toxicity (loss of reflexes), respiratory depression
oliguria
decreased LOC

68
Q

Patient teaching: Pre-eclampsia

A

report inc BP, proteinuria, decreased FM (less than 6/2hr)
dipstick clean catch sample (for proteinuria)

69
Q

Seizure Precautions

A

quiet
non-stimulating room
lighting subdued
magnesium sulphate ready to go
o2 equippment
suction equipment
call bell

70
Q

NC; Eclampsia

A

ensure patent airway
medication (magnesium sulphate)
assess fetal status

71
Q

Signs preceeding Eclampsia

A

headache
blurred vision
photophobia
severe RUQ pain
fits
altered mental status

72
Q

Seizure : immediate care

A

airway patency: turn head to one side, place pillow under one shoulder/back
call for ehlp
don’t leave bedside
protect pt from injurt, raise rails
oberve & record convulsion activity

73
Q

seizure: aftercare

A

do not leave until alert
observe for post-seizure coma, incontinence
use suction
o2
magnesium sulphate
catheter for i/o
monitor BP
monitor fetal/uterine staatus
labs
hygiene

74
Q

Gestational Diabetes

A

elevated glucose levels first recognized during pregnancy
higher risk of glucose intolerance later
adverse incidents

75
Q

Gestational Diabetes Risk factors

A

35+
POC
corticosteriod medications
pregestational dm
obesity
hx of GDM
given birth to baby>4kg
family hx of T2 DM
PCOS

76
Q

GDM Anteparum

A

blood glucose control
diet
exercise
monitor levels
pharmacological therapy
fetal surveillance

77
Q

intrapartum GDM

A

macrosomia
birth injuries due to shoulder
newborn hypoglycemia

78
Q

postpartum GDM

A

women dx w/ GDM, test again 6-12w PP

79
Q

Rh isoimmunization

A

when 0.1 ml od rh+ fetal blood mixes with maternal rh negative blood

rbcs from fetus invade maternal circulation stimulating production of antibodies against rh+

doesn’t affect 1st child, but in second pregnacy = fetal demise d/t hemolysis + anemia (antibodies cross placenta)

80
Q

Rh isoimmunization prevention

A

hx
determine blood type and & antibody screening
Rh (d) given (dad is + or unknown)
- given at 28w 72 hrs PP

80
Q

hyperemesis gravidarum

A

vomiting that causes severe dehydration, wight loss, electrolyte imbalance, nutrtional deficiency, ketonuria

81
Q

hyperemesis gravidarum maternal & fetal complictions

A

f: LBW, SGA, preterm
m: vit k deficiency, thiamine

82
Q

NC: Hyperemesis Gravidarum

A

clear liquids, slow intro to small/bland meals (low in fat)
avoid odors, tastes, activities that trigger nausea (stuffy rome, lights, perfume)
IV therapy

83
Q

medications for hypermesis gravidarum

A

pyridoxine
diphenhydramine
metoclopiramide
antiemetic
antacids
antihistamines
proton pump inhibitors
ondansetron

84
Q

Coomb’s Test

A

test for Rh incompatibility

85
Q

amniocenthesis

A

taking amniotic fluid for genetic testing

86
Q

maternal & fetal complications assoc/ w amniocenthesis

A

M
leakage f amniotic fluid
hemorrhage
infection
isoimmunization
placental abruption
damage to organs
amniotic fluid embolism

f:
death
hemorrhage
infection (amninitis)
injury

87
Q

chronic villus sampling:

A

test chromsomal abnormalities and other genetic disorders

earlier dx & rapid results
10-13w
remocal of small portion of placental tissue from fetal portion

88
Q

third trimester asssessment for fetal well-being

A

determine whether intrauterine environment continues to be supportive to the fetus

fetal movement counting
NST
CST
BPP
ulrasound

89
Q

Non-Stress Test

A

FHR in response to movement of the fetus

heart rate should increase when fetus moves

90
Q

normal findings NST

A

2 fhr accelerations lasting 15 seconds and rising 15bpm above basline

91
Q

abnormal findings NST

A

lacks accelerations over 40 mins
= further testing

92
Q

Biophysical Profile

A

recommended for women at increased risk

non-invasive

low score = more testing

93
Q

indications for BPP

A

post-term
multiple gestations
previous stillbirth
polyhydroamnios, oligohydramnios
GDM
preeclampsia/HTN
IUGR

94
Q

components of BPP

A

1-NST
2-fetal breathign movements ( 1+ ryhtmic breathing for 30s+ in 30 mins)
3-fetal mocement (2-3 discrete movements / 30m)
4-fetal tone (1+ extension then flexion / opening+ closing of hand)
5- amniotic fluid movement (1 vertical pocket of 2cm+)

each component given score
2- normal
1- present
0- abnormal, absent

95
Q

Contraction Stress Test

A

used to measureresponse of fetus (FHR) after uterus is stimulated to contract
to ensure during labor the fetus can handle contractiona dn get the o2 needed form placenta

when: abnormal BPP, NST

  • niple stimulated contraction test
    -oxytocin stimulated contraction test
96
Q

Normal: negative CST

A

does not show deceleration or late decelation

97
Q

Abnormal: positive CST

A

FHR showing decelerations and late decelerations

98
Q

oligohydramnios

A

less than 300> ml amniotic fluid
renal abnormalities

99
Q

polyhydraamnios

A

more than 2L of amniotic fluid
GI malformations

SEM 1 (11 decks)

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