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SEM 1 > W3: Pregnancy at Risk > Flashcards

W3: Pregnancy at Risk Flashcards

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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
Ectopic pregnancy dx
ultrasound serum progesterone b-hCG
26
medical mangement of Ectopic pregnancy
methotrexate: antimetabolite & folic acid antagonist, destroys rapidly dividing cells surgical: salpinostomy, salpingectomy to repair rupture
27
Patient Teaching for methotrexate
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)
28
Premature dilation of cervix
passive/painlexx dilation of the cervix d/t trauma, collagen issues
29
Nursing care for premature cervical dilation
cervical cerclage (12-14weeks) observation report signs of pre-term labor, PROM, infection HOSPITAL: contractions, pPROM, perineal pressure, urge to push
30
Placenta previa
placenta implented in lower uterine segment near/over internal cervical os
31
classifcation of placenta percia
complete placenta previa marginal placenta previa low-lying placenta
32
clinical signs of placenta previa
bright red bleeding pain absent uterine normal normal fetal HR
33
complictions of placenta previa
bleeding (PAINLESS) preterm birth IUGR
34
Expectant Management of Placenta Previa
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
35
active mgt of placenta previa
c-section - mature fetus -excessive bleeding - active labor begins
36
Placenta Abruption
premature seperation of placenta
37
clinical signs ofplacenta abruption
vaginal bleeding (PAINFUL) abd pain uterine tenderness contraction
38
placenta abruption is a major cause of ___
antepartum hemorrhage
39
Placenta Abruption: CLASS 1- mild seperation
bleeding: minimal total blood loss: <500 colour: dark red shock: rare, no uterine tonicity: normal pain: absent fetal status: normal DIC: rare
40
Placenta Abruption: CLASS 2- mod seperation
bleeding: 0-mod total blood loss: 1000-1500 colour: dark red shock: mild uterine tonicity: increase pain: mod-sev fetal status: atypical DIC: occasional
41
Placenta Abruption: CLASS 3- severe seperation
bleeding: 0 - heavy total blood loss: >1500 colour: dark red shock: common uterine tonicity: !!! pain: severe fetal status: abnormal, death? DIC: frequent
42
maternal complications of placenta abruption
hemorrhage hypovelmic shock hypofibrinogenemia, thrombocytopneia couvelaire uterus dic infection rh isoimmunization
43
fetal complications of placental abruption
IUGR preterm birth hypoxemia stillbirth neurological defects cerebral palse SIDS
44
Expectant mgt Placenta Abruption
<36w hospitalized monitor fetal status maternal vitals betamethasone birth if deterioration rho(d)immunogloblin
45
DIC
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
stage 1 DIC
overactive clotting leads to blood clots throughout the blodo vessels clots can reduce/block blood flow which can damage organs
47
stage 2: DIC
the overactice clottign uses up platelets & clotting factors that help blood clot with absence of facors dic leads to bleeding
48
Physical Examination Findings DIC
spontaneous bleeding excessive blood from puncture sites petechiae bruising hematuria GI bleeding tachycardia diaphoresis
49
Coagulation Test Results: DIC
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
NC: DIC
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
diagnosis of hypertensive disorder
>140/90 x2 , 15 min apart
52
severe HTN
160/110<
53
chronic HTN
prepregnancy HTn present prior to 20w
54
gestational HTN
develops after 20w no proteinuria
55
pre-eclampsia, eclampsia
gestational HTN + proteinuria
56
2 components of (pre)eclampsia
HTN + proteinuri (>0.3g/L) addiitonal organ dysfunction - kidney, renal, enurologcal, hematological
57
eclampsia
seizure activity/coma in women diagnosed w/ pre-eclampsia
58
Risk factors for pre-elcampsia/eclampsia
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
pre-eclampsia etiology
-- 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
maternal complications: pre-eclampsia
multi organ faliure CNS, kidney, lungs, hematological
61
fetal complications: pre-eclampsia
pre-term birth still birth (IUFD) fetal distress uteroplacental insufficiency placenta abruption (UGR, hypoxic)
62
HELLP Syndrome
Hemolysis (H) elevated liver enzymes (EL) low platelets (LP)
63
s/s of HELLP
HTN Proteinuria epigastric RUQ pain n/v headache malaise
64
HELLP is associated w/ increased risk for
placental abruption renal faliure pulmonary edema ruptured liver hematoma DIC
65
NC: Pre-eclampsia & HELLP
BP Reflexes: bicep, patellar, ankle clonus Fetal: NST, CST, BPP, FHR, ultrasounf, fetal movement activity restriction
66
NC Pre-eclampsia- BP
hydralazine labetalol methyldopa adalat
67
NC: Pre-eclampsia- Magnesium Sulphate
antiseizure assess for toxicity (loss of reflexes), respiratory depression oliguria decreased LOC
68
Patient teaching: Pre-eclampsia
report inc BP, proteinuria, decreased FM (less than 6/2hr) dipstick clean catch sample (for proteinuria)
69
Seizure Precautions
quiet non-stimulating room lighting subdued magnesium sulphate ready to go o2 equippment suction equipment call bell
70
NC; Eclampsia
ensure patent airway medication (magnesium sulphate) assess fetal status
71
Signs preceeding Eclampsia
headache blurred vision photophobia severe RUQ pain fits altered mental status
72
Seizure : immediate care
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
seizure: aftercare
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
Gestational Diabetes
elevated glucose levels first recognized during pregnancy higher risk of glucose intolerance later adverse incidents
75
Gestational Diabetes Risk factors
35+ POC corticosteriod medications pregestational dm obesity hx of GDM given birth to baby>4kg family hx of T2 DM PCOS
76
GDM Anteparum
blood glucose control diet exercise monitor levels pharmacological therapy fetal surveillance
77
intrapartum GDM
macrosomia birth injuries due to shoulder newborn hypoglycemia
78
postpartum GDM
women dx w/ GDM, test again 6-12w PP
79
Rh isoimmunization
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
Rh isoimmunization prevention
hx determine blood type and & antibody screening Rh (d) given (dad is + or unknown) - given at 28w 72 hrs PP
80
hyperemesis gravidarum
vomiting that causes severe dehydration, wight loss, electrolyte imbalance, nutrtional deficiency, ketonuria
81
hyperemesis gravidarum maternal & fetal complictions
f: LBW, SGA, preterm m: vit k deficiency, thiamine
82
NC: Hyperemesis Gravidarum
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
medications for hypermesis gravidarum
pyridoxine diphenhydramine metoclopiramide antiemetic antacids antihistamines proton pump inhibitors ondansetron
84
Coomb's Test
test for Rh incompatibility
85
amniocenthesis
taking amniotic fluid for genetic testing
86
maternal & fetal complications assoc/ w amniocenthesis
M leakage f amniotic fluid hemorrhage infection isoimmunization placental abruption damage to organs amniotic fluid embolism f: death hemorrhage infection (amninitis) injury
87
chronic villus sampling:
test chromsomal abnormalities and other genetic disorders earlier dx & rapid results 10-13w remocal of small portion of placental tissue from fetal portion
88
third trimester asssessment for fetal well-being
determine whether intrauterine environment continues to be supportive to the fetus fetal movement counting NST CST BPP ulrasound
89
Non-Stress Test
FHR in response to movement of the fetus heart rate should increase when fetus moves
90
normal findings NST
2 fhr accelerations lasting 15 seconds and rising 15bpm above basline
91
abnormal findings NST
lacks accelerations over 40 mins = further testing
92
Biophysical Profile
recommended for women at increased risk non-invasive low score = more testing
93
indications for BPP
post-term multiple gestations previous stillbirth polyhydroamnios, oligohydramnios GDM preeclampsia/HTN IUGR
94
components of BPP
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
Contraction Stress Test
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
Normal: negative CST
does not show deceleration or late decelation
97
Abnormal: positive CST
FHR showing decelerations and late decelerations
98
oligohydramnios
less than 300> ml amniotic fluid renal abnormalities
99
polyhydraamnios
more than 2L of amniotic fluid GI malformations

SEM 1 (11 decks)

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