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48 Cards in this Set
- Front
- Back
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WHAT ARE SOME PROBLEMS FOR THE WOMAN WHO HAS DIABETES PRIOR TO PREGNANCY
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IN THE FIRST HALF OF PREG., INCREASED INSULIN PRODUCTION AND INCREASED RESPONSE TO INSULIN
2ND HALF OF PREG: INCREASED INSULIN RESISTANCE AND INCREASED GLUCOSE TOLERANCE; MOTHER MAY NEED 2-3 TIMES THE INSULING DOSAGE FETUS USES GLUCOSE FROM MATERNAL STORES = INCREASED DISRUPTION IN MATERNAL CARB METABOLISM INCREASED MATERNAL LIPOLYSIS AND KETONE PRODUCTION |
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MAJOR GOAL OF TX IN PREGNANCY WITH DIABETES
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PREVENT KETOACIDOSIS
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MANAGEMENT OF PREGESTATIONAL DIABETES DURING PREG.
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INSULIN NEED DECREASES IN 1ST TRIMESTER
INSULIN NEED RISES IN 2ND TRI ALL WOMEN SCREENED AT 24-28 WEEKS (USU. FASTING B/S AND HEMOGLOBIN) |
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IF MOM IS NOT MONITORING GLUCOSE DURING PREG. WHAT ARE THE RISKS TO BABY
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IF MOM NOT DOING ACCUCHECKS AND MOITORING GLUCOSE AND GLUCOSE GETS TOO HIGH, BABY WILL PRODUCE INCREASED AMOUNTS OF INSULIN. WHEN BABY IS DELIVERED, HYPOGLYCEMIA OCCURS.
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WHAT IS THE RX FOR DIABETES DURING PREG.
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ORAL AGENTS NOT RECOMMENDED
GLYBURIDE, LISPRO, HUMALOG ONLY RX USED DURING PREG IS RAPID ACTING INSULIN DELIVERY AROUND 39 WEEKS BASED ON BPP |
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DIABETIC RISKS TO BABY AND MOM
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MACROSOMIA
HYPOGLYCEMIA POLYCYTHEMIA AND HYPERBILIRUINEMIA CONGENITAL ANOMALIES IUGR RESPRIATORY DISTRESS SYNDROME HYDRAMINOS KETOACIDOSIS PREECLAMPSIA INCREASED RISK OF UTI/VAGINITIS |
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HOW DOES DIABETES AFFECT THE FETUS
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MATERNAL GLUCOSE CROSSES PLACENTA
INSULIN DOES NOT CROSS PLACENTA HIGH MATERNAL GLUCOSE LEVELS DELIVER HIGH LEVELS OF GLUCOSE TO FETUS MAKING A LARGE FETUS THAT HAS TO PRODUCE LARGE AMT OF INSULIN AFTER DELIVERY NEWBORNS OF UNCONTROLLED DIABETES RUN A SERIOUS RISK OF HYPOGLYCEMIA |
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GESTATIONAL DIABETES
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OCCURS IN 2ND OR 3RD TRI
THOUGHT TO RESULT FROM HPL 4% OF PREG. URINE DIP AT ALL PRENATAL VISITS SCREENING 24-28 WEEKS PATIENT TEACHING IS KEY |
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RESULTS OF ______ BLOOD SUGAR LEVEL WILL REQUIRE FURTHER TESTING AND TREATMENT
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140 OR HIGHER
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PATIENT TEACHING FOR GESTATIONAL DIABETES
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TEACHING ABOUT DIABETES
GLUCOSE TESTING INSULIN ADMIN S/S OF HYPO/HYPERGLYCEMIA AND TX MORE FREQ OFFICE VISITS FETAL SURVEILLANCE (US,NST,CST) WOMEN WITH GD HIGH RISK FOR DEVELOPING TYPE 2 IN 5-10 YEARS (ESP. IF OBESE) |
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DOES PREG. ACCELERATE THE HIV DISEASE PROCESS
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NO
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THE USE OF_____DURING PREG REDUCES THE RISK OF TRANSMITTING HIV TO FETUS
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ARV-ANTIRETROVIRAL THERAPY
ZIDOVUDINE IS RECOMMENDED |
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SHOULD A WOMAN WITH HIV BREAST FEED
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NO
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IF A WOMAN HAS HIV AND IS PREG, WHEN AND HOW IS DELIVERY ACCOMPLISHED?
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CS AT 38 WEEKS IF VIRAL LOAD LESS THAN 1000 OR ON MULTIPLE ARV
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WHY IS A WOMAN WITH PRE-EXISTING CARDIAC PROB. AT ESPICALLY HIGH RISK DURING PREG.
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INCREASED BLOOD VOL AND CARDIAC OUTPUT DURING PREG. AND HER BODY MAY NOT BE ABLE TO HANDLE IT.
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WHAT IS THE GREATEST RISK TO A FETUS WHEN THE MOM HAS CARDIAC COMPLICATIONS
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HYPOXIA
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WHAT ARE SOME SYMPTOMS TO LOOK FOR IN A MOM WITH CARDIAC PROBLEMS
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FATIGUE
CHEST PAIN DYSPNEA EDEMA CYANOSIS ARRHYTHMIAS ANEMIA SOB |
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PERIPARTUM CARDIOMYOPATHY
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WOMAN WITH NO HX OF HEART DISEASE
OCCURS IN LAST MONTH OF PREG OR FIRST 5 MONTHS PP SYMPTOMS SIMILAR TO CHF (DYSPNEA,ORTHOPNEA,FATIGUE,COUGH,CHEST PAIN, PALPATIONS,EDEMA) TX DEPENDS ON UNDERLYIG PATHO AND SEVERITY PT MONITORED CLOSELY DURING PREG AND L & D CONSERVATION OF ENERGY IS STRESSED |
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WHAT IS THE BEST MEASURE TO REDUCE COMPLICATIONS AND MORTALITY IN A PT WITH CARDIAC PROBLEMS
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EARLY DETECTION
GOOD PRENATAL CARE |
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HYPEREMESIS GRAVIDARUM
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AKA PERNICIOUS VOMITING - CONSTANT VOMITING THROUGHOUT PREG. DUE TO HIGH HCG LEVELS
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MAJOR COMPLICATIONS R/T HYPEREMESIS GRAV
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FLUID AND ELECTROLYTE IMBAL
ACID/BASE IMBAL (ALKALOSIS FROM HCL LOSS, ACIDOSIS FROM LOSS OF INTESTINAL FLUIDS) HYPOKALEMIA (CARDIAC ARRHYTHMIAS) HYPOVOLEMIA (DECREASED PLACENTAL PERFUSION) INADEQUATE NUTRIENTS TO SUSTAIN FETAL DEV. |
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TX FOR HYPEREMESIS GRAV
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NPO
IV REHYDRATION/ELECTROLYTES/VIT VIT B6/PYRIDOXINE REPRIVEX BENZODIAZAPINE ANTI-EMETICS ZOFRAN ONDANSETRON CORTICOSTEROIDS ANTIHISTAMINES ANTI REFLUX MEDS TPN MAY BE REQ. FOR MORE CARBS,PROTEINS,FATS |
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NURSING INTERVENTION FOR HYPEREMESIS GRAV.
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SMALL FREQUENT MEALS
LOWFAT COMPLEX CARBS NPO-GRADUALLY INCREASE MONITOR I AND O, URINE QUALITY,DAILY WEIGHT,TURGOR,CALORIE COUNT LABS: HCT,BUN,LYTES MINIMUM 1000 CC URINE Q 24 HR GOOD ORAL HYGEINE MONITOR FETAL HEART TONES |
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ECTOPIC PREG
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IMPLANTATION IN A SITE OTHER THAN THE ENDOMETRIAL LINING OF THE UTERUS
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MOST COMMON CAUSE OF ECTOPIC PREG.
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SILENT INFECTIONS - USU STD
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WHAT IS THE LEADING CAUSE OF 1ST TRI MORTALITY
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ECTOPIC PREG
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HOW IS ECTOPIC PREG DX
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TRANSVAGINAL U/S
TX: MED OR SURGICAL |
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RUPTURED ECTOPIC PREG
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WHENT THE EMBRYO OUTGROWS THE SPACE IN THE SITE OF IMPLANTATION, THE TUBE RUPTURES AND THERE IS BLEEDING INTO THE ABD CAVITY.
THIS IS A LIFE THREATENING DIRE EMERGENCY S/S: SHARP, ONE-SIDED RADIATING PAIN,SHOULDER PAIN, LOWER ABD PAIN,VAG PAIN |
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GESTATIONAL TROPHOBLASTIC DISEASE
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PATHOLOGIC PROLIFERATION OF TROPHOBLASTIC CELLS (TROPHOBLAST IS OUTER LAYER OF EMBRYONIC CELLS)
INCLUDES: HYDATIDIFORM MOLE,INVASIVE MOLE,AND CHORIOCARCINOMA INCOMPLETE # OF CHROMOSOMES GROSSLY ABNORMAL # OF CHROMOSOMES BUT COMPONENTS OF PREG ARE PRESENT |
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S/S OF TROPHOBLASTIC PREG
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SOME S/S OF NORMAL PREG. AND S/S OF ABNORMAL PREG.
HUGE AMT OF HCG N/V ABNORMAL PLACENTAL DEV OR NO PLACENTAL DEV FLUID FILLED VESCICLES |
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HYDATIDIFORM MOLE OR MOLAR PREGNANCY
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ABNORMAL DEVLOPMENT OF PLACENTA
FLUID-FILLED, GRAPELIKE CLUSTER TROPHOBLASTIC TISSUE PROLIFERATES LOSS OF PREG AND POSSIBILITY OF CANCER |
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TWO TYPES OF MOLAR PREG
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COMPLETE MOLE DEVELOPES FROM AN OVUM CONTAINING NO GENETIC MATERIAL. IT'S BASICALLY AN EMPTY EGG WHICH IS FERTILIZED BY SPERM. THE EMBRYO DIES VERY EARLY, NO CIRCLUATION IS ESTABLISHED, AND NO EMBRYONIC TISSUE IS FOUND. CARCINOMA IS ASSOCIATED.
PARTIAL MOLE USUALLY HAS A TRIPLOID KARYOTYPE (69 CHROMOSOMES). FETAL SACK OR FETUS WITH A HEART BEAT. FETUS HAS MULTIPLE ANOMOLIES, LITTLE CHANCE OF SURVIVAL. USUALLY SPONTANEOUS ABORTION OCCURS |
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RISK FACTORS OF MOLAR PREG
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OVER 40
PREV. MISCARRIAGES OR ECTOPIC MIXICO,PHILLIPINES, SE ASIA 80% NON-AGRESSIVE 15% AGRESSIVE 2% CANCEROUS |
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S/S OF MOLAR PREG
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ABNORMALLY HIGH HCG
BROWNISH VAG DC ABD PAIN/DISTENTION HYDROPIC VESICLES MAY BE PASSED UTERINE ENLARGEMENT MAY BE GREATER THAN EXPECTED WITH PREG. HYPEREMESIS/ANEMIA DIAGNOSED W/ TRANSVAG US AND HCG TESTING |
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TX OF MOLAR PREG
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D AND C OR D AND E (MICROSCOPIC EXAM)
SERUM HCG AND PELVIC Q2 WEEKS FOR 3 MONTHS THEN Q 1 MONTH FOR UP TO 1 YEAR. ADVISED NOT TO CONCEIVE FOR 1 YEAR PERSISTANT GTD 100% CURABLE METHOTREXATE AGENT USED FOR CARCINOMA |
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SPONTANEOUS ABORTION
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TERMINATION OF PREG. PRIOR TO AGE OF VIABILITY R/T FETAL/PLACENTAL GROWTH ABNORMALITIES, CHROMOSOMAL DEFECTS, FAULTY IMPLANTATION, DRUGS/INFECTION, ENDOCRINE/REPRODUCTIVE TRACT PROBLEMS
20% OF ALL PREG. PRIOR TO WEEK 20 END IN SPONT. ABORT |
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SPONTANEOUS ABORTIONS ARE SUBDIVIDED INTO WHAT CATEGORIES
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THREATENED ABORTION
IMMINENT ABORTION COMPLETE ABORTION MISSED ABORTION RECURRENT PREG. LOSS SEPTIC ABORTION |
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THREATENED AB
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UNEXPLAINED VAG BLEEDING/CRAMPING
BACKACHE CERVIX IS CLOSED BLEEDING MAY PERSIST FOR DAYS MAY BE FOLLOWED BY PARTIAL OR COMPLETE EXPULSION OF EMBRYO OR FETUS, PLACENTA, AND MEMBRANES RX: LIMIT ACTIVITIES, BEDREST,NO SEX |
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IMMINENT OR INEVITABLE AB
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BLEEDING INCREASES
INTERNAL CERVICAL OS DILATES MEMBRANES MAY RUPTURE |
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COMPLETE AB
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ALL PRODUCTS OF CONCEPTION ARE EXPELLED
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INCOMPLETE AB
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PRODUCTS OF CONCEPTION ARE RETAINED
PT WILL NEED D AND C |
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MISSED AB
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FETAL DEMISE IN UTERO
MAY OR MAY NOT ABORT SPONTANEOUSLY MAY NEED INDUCTION OF LABOR OR D&C |
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SEPTIC AB
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UTERINE INFECTION
ELEVATED TEMP MALODOROUS BLEEDING ABD TENDERNESS OFTEN DUE TO MISSED AB SERIOUS CONDITION **RECURRENT PREG LOSS MAY SIGNAL CHROMOSOMAL OR HORMONAL ABNORMALITY |
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NURSING INTERVENTIONS FOR FETAL LOSS
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EMOTIONAL SUPPORT
LISTEN, ENCOURAGE VERBALIZATION PROVIDE OPPORTUNITY TO HOLD FETUS, FOOT PRINTS, PHOTO SUPPORT GROUP MATERNAL CARE SAME AS PP RHOGAM |
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INCOMPETENT OR DYSFUNCTIONAL CERVIX
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PREMATURE DILATION OF CERVIX. USUALLY AROUND 4TH OR 5TH MONTH
ASSOCIATED WITH REPEATED SECOND TRIMESTER ABORTIONS |
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CAUSES OF INCOMP./DYSFUNCTIONAL CERVIX
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WEAK, TORN, OR ABSENT SPHINCTER MUSCLE AT CERVICAL OS
CAUSED BY CERVICAL TRAUMA,INFECTION,MULTIPLE GESTATION,LEEP PROCEDURE, CONE BX,LATE TERM ABORTION |
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TX FOR INCOMPETENT CERVIX
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BEDREST
POSSIBLE CERCLAGE PELVIC REST |
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CERCLAGE TO PREVENT EARLY DELIVERY IS PERFORMED WHEN
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13-15 WEEKS
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