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69 Cards in this Set

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biggest drugs for substance abuse?
cocaine & heroin
Most common prenatal complication is ____
CHF - due to inc blood vol
1- Symptoms of left-sided CHF?
2- Right-sided CHF?
1- lung congestion
2- edema in feet , ie "fat feet"; also tired
what are the 3 styles of heart failure caused by inc blood vol from pregnancy?
1- rheumatic fever - comes from untreated strep; damages heart valves which can't handle xtra blood vol
2- older hypertensive woman
3- kidney transplant- pt's 1 kidney can't handle inc blood vol
How to prevent CHF in preg?
- take iron supplements to avoid anemia since anemia inc workload of heart
- avoid excessive wt gain
- avoid exertion & plan freq rest stops
- adequate pain relief to avoid cardiac stress
What are good heart drugs?
1- Digoxin - increases ability of heart ot contract & push out blood; good for both non-preg & preg; DON'T GIVE IF UNDER 60 BPM
2- antidysrhythmics- verapamil (calcium channel blocker)- good for both preg & non-preg
If edema is excessive, give lasix (but don't bolus) and position mother to maintain uteroplacental perfusion. How?
EX- if young woman w damaged heart valves and 26 wks preg goes into CHF; give lasix which will dec placental fluid; baby will become hyper because no blood flow to baby due to dec BP; so place mom on left side to get baby off abdominal aorta so that blood flow to baby increases
why should pregnant women sleep and lay on their left side?
Lying on your left side is best:
1- makes your heart's job easier because it keeps the baby's weight from applying pressure to the large vein (called the inferior vena cava) that carries blood back to the heart from your feet and legs.
2- helps keep the uterus off your liver which is on your R side.
3- Lying on the left side allows for the best blood flow to the fetus.
If blood thinners are required for preg woman, would you give coumadin or heparin?
Heparin or Lovenox; since coumadin is risk factor as it's teratogenic (causes fetal abnormalities)
If you give Lasix to nonpreg woman, what will happen?
- she'll pee; BP will dec; she'll get headache
1- eating a high ___ diet will make you retain fluid
2- eating a high ___ diet will make you lose fluid
1- carb
2- protein
Also don't restrict salt from diet from preg diet, but don't add salt either
Hyperemesis Gravidarum?
severe form of morning sickness
- extreme N&V during first 20 wks
- creates maternal dehydration, wt loss, electrolyte imbalances
- cause unknown
what are interventions if too much vomiting due to, for instance, Hyperemesis Gravidarum?
-retain fluid & electrolyte balance otherwise woman goes into premature labor
- treat w D5 LR IV therapy & multivitamin; always give LR due to electrolytes
- And to reduce N&V, give Reglan, Zofran, Compazine
- Reglan- prevents N&V
- Zofran- antiemetic- prevents N&V
- Compazine- antiemetic & antipsychotic- controls N&V
- Ginger crystals and flat ginger ale are also helpful
TPN is typically loaded with sugar; can't stop abruptly on any pt or will become hypoglycemic
- if baby is born very early, may give baby TPN which is not good; hang D10 after dc'ing TPN so pt does not become severely hypoglycemic
T
if woman is home and goes into premature labor, drink lots of water.. 8 bottles x 16 oz each
T
Diff betw Coke & Pepsi?
- Coke is high in potassium, so drink flat Coke to replace K lost during vomiting
-Pepsi doesn't have it.
Why can cocaine use cause placental abruption?
- SE of cocaine makes people hypertensive which rips placenta right off uterine wall
Freq substances abused are:
tobacco, alcohol, pot, coke, heroin
what are pregnancy issues due to substance abuse?
- spontaneous abortion
- IUGR - lntra Uterine Growth Retarded,
- preterm labor, placental abruption,
- fetal alcohol syndrome - gives baby neuro issues
Gimmick: substance abuse is always about _____
placental abruption
- belly is rock hard
- kid is also born addicted
A baby in nursery who is inconsolable has 1 of 3 issues:
- Blood sugar issue
- low Calcium levels
- Drug problem - which happens because when the kid is born, he's cut off from drug source and goes into withdrawal
- intervention if drug prob: perform urine analysis; if drug abuse, give kid phenobarbital - drug of choice for babies
macrosomic baby?
very large baby from diabetic mother (sugar is like miracle gro)
Best way to get rid of gestational diabetes?
give birth
Gestational diabetes is always Type ___
Type 2
- Type 2 is handled by diet, same for preg or non-preg woman
Risk factors for gestational diabetes?
- family hx
- maternal obesity
- previous LGA infant (Large for Gestational Age)
- prev unexplained stillbirth
Why does a woman get gestational diabetes?
During pregnancy, your hormones make it tougher for your body to use insulin, so your pancreas needs to produce more of it. For most moms-to be, this isn't a problem: As your need for insulin increases, your pancreas dutifully secretes more of it. But when a woman's pancreas can't keep up with the insulin demand and her blood glucose levels get too high, the result is gestational diabetes.

Most women with gestational diabetes don't remain diabetic once the baby is born. Once you've had it, though, you're at higher risk for getting it again during a future pregnancy and for becoming diabetic later in life.
diabetics who have too high blood sugar during pregnancy are at higher risk to make kids with congenital heart anomalies (ex: 3-chambered heart) or with neural tube defects (spina bifida).
- Therefore, need to control sugar; oral hypoglycemic meds are not given since these are teratogenic, so control sugar with insulin--- either via insulin pump or sliding scale
T
Mom with gestational diabetes wants to keep sugar levels level via insulin. The moms who have really big babies due to this also want to give birth as soon as possible. What do they do?
- can only deliver when baby's lungs are mature
- use amniocentesis to measure LS ratio (shows how much mucus is in lung)
- if LS ratio is neg (no mucus in lung so lungs can't expand), give betamethasone (2 IM shots 12 hrs apart)
- if LS ratio is positive (mucus in lungs so lungs can expand) then deliver baby before it gets even bigger
Fetus produces own insulin but gets glucose from mom
T
polyhydramnios?
excess of amniotic fluid
- mom's uterus is scanned, and if mom has too much amniotic fluid, usually something wrong with baby
pregnancy complications with insulin dependent diabetes are:
- polyhydramnios
- pregnancy-induced hypertension
- stillbirths
REMEMBER: Diabetes and hypertension go hand in hand
preg women sh be screened for Gest Diab betw 24-28 wks via ____
oral glucose tolerance test
- GDM is dx if BG =
- 95 at fasting
- 180 after 1 hr of oral glucose dose
- 155 after 2 hrs
140 after 3 hrs
Preg women w Gest Diab and if in hypoglycemic attack, respond better w milk vs OJ since OJ gives rapid highs & lows (of BG); the protein in milk lasts longer with a more steady blood sugar rise
- with (high/low) sugar, lots of vaginal infections such as UTIs and yeast infections
- high sugar
to manage Gest Diab, insulin given w 4-dose approach - before each meal (reg or lispro) and at bedtime (NPH or Lente)
T
what test is done to assess for neural tube defects?
maternal serum alpha fetoprotein screening done at 16-20 wks
When are ultrasounds done?
at 18 wks to establish gestational age & repeated at 28 wks to monitor for macrosomia and anomalies
Possible induction at 38 wks to women with insulin-dependent Diabetes to reduce risk of stillbirth caused by premature placental aging
T
Pregnancy-Induced Hypertension aka ____ aka ____
PIH
Pre-eclampsia; eclampsia means "seizure" in latin; so pre-eclampsia means pre-seizure
Cause of pre-eclampsia?
unknown
More common in:
- young primagravidas
- women over 35
- mothers of multiples- since more blood and both kids sit on abd aorta (so blood circ is cut off)
- moms with diabetes
moms with pre-eclampsia are at risk for:
1
2
3
4
5
1- CVA - Cerebrovascular accident ie, stroke
2- DIC - Disseminated Intravascular Coagulation
3- renal failure
4- hepatic rupture
5- can also throw amniotic fluid emboli - this is a killer - can't rescue mom, but baby lives
Gestational hypertension (pre-eclampsia) occurs during preg & is resolved by del of fetus.
- what is pre-eclampsia triad?
1- BP > 140/90 or inc > 30 systolic or 15 diastolic
2- edema all over body
3- proteinuria
1- ____ is pre-eclampsia that has progressed to maternal tonic-clonic seizures
2- what is danger to fetus of seizures?
3-
1- Eclampsia; tonic, or stiffening phase of the seizure; clonic or jerking movements
2- each seizure takes blood away from baby (& oxygen). Ex: Cerebral Palsy is due to birth trauma
HELLP Syndrome?
- woman usually dies
- at risk for hemorrhage, pulmonary edema, hepatic rupture
- fetus would show late decelerations
part of PIH
- H - hemolysis of RBCs
- EL- elevated liver enzymes
- LP - low platelets
S&S of MILD pre-eclampsia?
HTN, WHOLE-BODY EDEMA, PROTEINURIA
- Htn > 140/90 or inc of 30/15 systolic/diastolic from baseline
- proteinuria: trace to 1+
- mild-mod edema
- wt gain: 2 to 2.5 lbs/wk
S&S of SEVERE pre-eclampsia?
- Htn > 160/110
- proteinuria 3+ to 4+ in urine
- sudden large wt gain w facial edema
- pitting edema
- signs of CNS irritation
If preg woman gains lots of wt in short time, then likely ____
pre-eclampsia
DTR ?
How are these measured?
Deep tendon reflexes are often rated according to the following scale:

■0: absent reflex
■1+: trace, or seen only with reinforcement
■2+: normal
■3+: brisk
■4+: nonsustained clonus (i.e., repetitive vibratory movements)
■5+: sustained clonus
Deep tendon reflexes are normal if they are 1+, 2+, or 3+ unless they are asymmetric or there is a dramatic difference between the arms and the legs. Reflexes rated as 0, 4+, or 5+ are usually considered abnormal.
S&S of eclampsia?
- severe or continuous HA - means brain is swelling
- hyperreflexia , ie inc reflex reactions
- absence of clonus, ie completely flaccid
- visual disturbance- see aura which typically precedes seizure
- oliguria signalling renal damage
- epigastric pain - means portal HTN and seizure
Epigastric pain in pregnant woman with eclampsia is always an indicator of ____
seizure; need to turn on side in case she vomits and so she doesn't choke
Clonus?
- a series of involuntary muscular contractions usually initiated by a reflex. Only sustained clonus (5 beats or more) is considered abnormal
antepartal?
conception & labor
Care for the antepartal pre-eclamptic?
- very quiet to prevent seizures
- high protein diet to get rid of fluid
- freq neuro checks
1- Magnesium sulfate is used for ____
2- SE?
1- SEIZURE prevention; also dec BP;
2- lowers LOC in brain (is she tuned in?); also dec resp rate;
Can only give Magnesium Sulfate if resp rate is _____
- over 8/min
What is normal level of magnesium sulfate in blood?

3 signs of Magnesium sufate toxicity are?
normal = 5-8 mg/dl; level > 8 is toxic
- diminished or absent reflexes
- depressed resp
- very lethargic
When you give magnesium sulfate, remember it relaxes everything.
What is antidote ?
- calcium gluconate

- interesting fact - magnesium sulfate is also epsom salts to reduce itching; can be taken orally to relieve constipation
Care of woman in labor with PIH?
- only cure for PIH is delivery
- C-section
- woman can go into DIC during surgery
- keep on left side to inc utero-placental perfusion until ready to section
What 2 IV meds are given to post partum woman with PIH (pregnancy-induced Htn) and why?
1- Mag Sulfate since woman can have seizures up to 48 hrs after birth; but this med will make woman hemorrhage after birth since it relaxes the uterus
2- Pitocin - counteracts relaxing effect of mag sulfate & prevents woman from bleeding to death
- newborn sh be monitored for cardiac & resp depression due to mag sulfate
1- with hypothyroid condition, woman can't ___ pregnant
2- with hyperthyroid, woman can't ___ pregnant
1- get pregnant
2- stay pregnant
define 1) premature rupture and 2) preterm rupture of membranes?
3) what can cause it ?
1- defined as amniotic rupture before labor begins
2- rupture prior to term or before 38 wks
3- untreated Group B Beta 1- Strep infection- sh screen mom at 35-37 wks; treat with ampicillin
- chlamydia
- incompetent cervix
- trauma
To prevent premature labor and to prevent pressure on cord if preterm rupture of membranes occurs, doc refills placenta with normal saline (NS) via needle guided by amniocentesis.
T - called amnio infusion
PROM stands for? Means?
- Prolonged Rupture of Membranes
- membranes rupture more than 12 hrs before birth
Major risk of PROM?
- septic shock for mother
In presence of prolapsed cord, you'll get variable decelerations since sometimes baby's sitting on cord and sometimes not
- keep baby off cord by placing mom on L side with hips elevated (pillow under hips)
- don't put anything wet or warm on cord since it will chill the cord and cord will constrict
- rather cover with sterile covering but not wet
- keep mom hosp; low residue diet;
- if mom runs fever, baby must be delivered since baby can be stillborn if fever w ruptured membrane.
T
cerclage?
ring that keeps cervix closed & keeps baby in
A pregnant woman who is hemorrhaging won't go into shock as quickly, why?
- has 30-50% more blood vol to bleed out vs non-preg, so will be more alert and less shocky for longer
Key symptom in ectopic pregnancy?
- sharp, 1-sided (unilateral) pain
- tube ruptures, woman becomes septic and ends up in ICU
- typically, the woman won't even know she's pregnant, except she's not getting her period and is spotting
Where does embryo implant in ectopic pregnancy?
- in fallopian tube
What med is given to save fallopian tube before it ruptures?
-Methotrexate - cancer drug that kills rapidly dividing cells (will destroy embryo); will save tube if preg is caught before it ruptures
- you can lose both fallopian tubes and still keep ovaries; this way you can 1) harvest eggs to get pregnant via infertility clinic and 2) need estrogen to keep calcium in woman's bones