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126 Cards in this Set
- Front
- Back
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Occupational teratogens
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lead
mercury medications extremely high temperatures |
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Deficiencies in what levels affect a woman's ability to maintain a healthy pregnancy?
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Iron
Iodine Calcium |
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Psychosocial Health Assessment (ALPHA) is conducted at
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20 weeks
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Domestic Violence Questions:
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How do you and your partner solve arguments?
Do you ever feel frightened by what your partner says or does? Have you even been hit, pushed, shoved, slapped by your partner? Has your partner ever humiliated or psychologically abused you? Have you ever been forced to have sex against your will? |
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First trimester deficiency (significant)
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folic acid (neural tube defects) 50% avoided if supplementation before conception throughout first trimester
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Low birth weight mother can cause a
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low birth weight newborn
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ABCX model
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A - Stressor
B - Existing Resources C - Perception of a crisis X - Crisis |
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Fetal surveillance methods:
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Fetal movement counting
Nonstress Testing Doppler studies Biophysical profiles |
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Bed Rest/early hospitilization/no support can cause
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decreased muscle tone
constipation fatigue fear depression |
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Weight gain during bedrest can cause
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decreased muscle mass
intracellular and extracellular fluid loss calcium loss |
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Stress-related symptoms include (bedrest)
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mood swings
boredom isolation loneliness |
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Asthma is the most common
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obstructive pulmonary disorder
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The most common exacerbation period for asthma patients is at
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24-36 weeks
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The most infrequent and mildest asthma incidents is during the
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last month
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Asthma statistics pregnant women
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increases in 30%
decreases in 30% neutral in 40% |
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Asthma is more severe in (cultures)
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African Americans
poor socioeconomic |
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Ongoing chronic asthmatic changes can result in
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low birth weight
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Asthma (tests)
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pulmonary function tests (abnormalities in pulmonary gas exchange can lead to fetal hypoxia)
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Asthma (treatments - self-care)
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Peak expiratory flow meter 3 times a day
Spirometry |
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Asthma control
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minimal or no chronic symptoms day or night
maintenance of pulmonary function no activity limitations minimal use of short acting inhaled B2 agonists |
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Asthma medications include
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corticosteroids (which may decrease birth weight) and increase the risk for pregnancy induced hypertension
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Asthma maternal assessments during labor include
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Temperature
Coping ability Pain management Stress level |
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Asthma maternal assessments positive findings during labor include
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SOB
increased respiratory rate (above 12/24 breaths/min) increased inspiratory/expiratory efforts |
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Asthma (CONTRAINDICATIONS)
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NO DEMEROL
NO MORPHINE NO PROSTAGLANDIN E |
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Asthma (Drug of choice)
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Syntocinon (oxytocin)
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Severe Persistent Ashma (meds)
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High dose inhaled corticosteroid
AND Long-acting inhaled Beta 2 agonist AND IF NEEDED Corticosteroid tablets or syrup |
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Moderate Persistant Asthma (meds)
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EITHER
Low dose inhaled corticosteroid and long acting beta2-agonist OR Medium dose inhaled corticosteroid |
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Mild Persistent Asthma (meds)
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Low dose inhaled corticosteroid
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Mild Intermittent Asthma (meds)
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No daily medication needed
Exacerbation of mild intermittent course of systemic corticosteroids |
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Short acting bronchodilators
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2-4 puffs
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Asthma - ANY CHANGE FETAL HEART RATE (CONCERNING) OR IF ASTHMA WORSENS
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electronic fetal heart monitoring
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Asthma REASSURING FHR
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variability of 6-25 bpm
baseline rate of 110-160 no decelerations |
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Cystic Fibrosis (observe for signs of EACH VISIT)
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malabsorption
maternal weight pancreatic |
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Cystic Fibrosis (Nursing Interventions)
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Oral supplements
NG feedings Intrapartal - fluid and electrolyte balance lab testing V/S Pulse ox |
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Anesthesia (Cystic Fibrosis)
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Local or epidural anesthesia preferred
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Breastfeeding (cystic fibrosis)
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permitted once sodium content has been determined, if high, breastfeeding contraindicated
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Cardiovascular Disease - what are the two most common subdivisions?
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acquired and congential
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20% of women with cardiac disease give birth to newborns who are
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preterm
small for gestational age or both |
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Blood volume and cardiac output increase as early as the first trimester (with some conditions such as Marfan syndrome), the additional volume may increase the risk for
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congestive heart failure
aneurysm or both |
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Cardiovascular (toward the end of pregnancy), the increased uterine size encroaches on the inferior vena cava
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decreasing venous return and lowering cardiac output when SUPINE
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Pregnant women with artificial valves and atrial fibrillation are at increased risk for
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arterial thrombosis
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Any type of therapeutic anticoagulation increases the risk for
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hemorrhage
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Electrocardiograph changes also are common in pregnancy, including
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sinus tachy
shift in the QRS axis atrial dysrhythmias ventrial dysrhythmias |
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Risk factors cardiovascular disease:
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History of a prior cardiac event/dysrhythmia
Prepregnancy heart disease grater than or equal to class III on the New York Heart Association system EJECTION FRACTION LESS THAN 40% Heparin/Warfarin use Smoking Multiple gestation |
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Cardiovascular Disease (Types)
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Class I: asymptomatic at all activity levels, uncompromised
Class II: symptomatic with increased activity, slightly compromised Class III: symptomatic with ordinary activity, markedly compromised Class IV: symptomatic when resting, incapacitated |
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Cardiovascular Disease - Class I or II
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usually favorable prognosis but functional status may worsen, for example, 44% of women with cardiac disease develop congestive heart failure and pulmonary edema in the third trimester
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Newborns of clients with congenital heart disease have a
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2% to 5% risk for congenital heart malformations
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Mitral stenosis is trhe most common
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rheumatic valvular lesion; approximately 25% of women become symptomatic for the first time while pregnant
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Mitral stenosis decreases
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left atrial outflow as well as left ventricular diastolic filling, resulting in fixed cardiac output (shortens the diastolic period decreasing time for blood to flow across the mitral valve)
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Treatment (mitral stenosis)
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Activity restriction to prevent tachy
B blockers to control heart rate Monitor diuretic therapy to treat pulmonary edema |
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Mitral valve prolapse is the most common
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congential heart lesion (asymptomatic or cause palpitations, chest pain or both.
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Increased blood volume and decreased systemic vascular resistance of pregnancy actually
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improve mitral valve function and allow women to tolerate pregnancy well
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Mitral valve prolapse (auscultation) may hear
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murmur or midsystolic click (may decrease with advancing pregnancy due to increased peripheral vasodilation)
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Peripartum cardiomyopathy
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heart failure last month of pregnancy or within 5 months of childbirth without previous heart disease (mortality rate 56%)
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Risk factors for peripartum cardiomyopathy
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multiparity
multiple gestation gestational hypertension African American advanced maternal age |
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Signs/symptoms of peripartum cardiomyopathy
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nocturnal dyspnea
chest pain cough increasing fatigue peripheral edema, rales and murmurs |
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Atrial septal defects are usually
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asymptomatic (increased plasma volume can cause dysrhythmias) but generally condition well tolerated.
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Women with congenital heart disease
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provide necessary information preconception regarding maternal/fetal risks
Once pregnancy established, fetal echocardiography is critical to prenatal diagnosis of congenital heart disease |
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Patients with cardiovascular problems need particular attention paid to
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heart sounds/pulse rate
childhood illnesses, exercise episodes of dyspnea surgery |
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Differentiate (between pregnancy effects and cardio) for the following symptoms
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fatigue, difficulty breathing, palpitations, lower-extremity edema
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Cardiovascular, patients should be asked about
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heart murmurs before pregnancy
activity limitations chest pain, cyanosis, rheumatic fever |
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Antepartal blood volume progressively increasing peaking at
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28 to 32 weeks, patients with cardiac problems need to see the doctor weekly
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Diagnostic studies (cardiac)
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chest x-ray, electrocardiogram
ABG, echocardiogram consult with cardiologist |
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Aortic stenosis
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a narrowed opening of the aortic valve results in obstructed left ventricular ejection - ANTIARRHYTHMIC DRUGS, BETA BLOCKERS
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atrial septal defect
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congenital opening between the atria, with left to right shunting of blood and greater left sided pressure - ATRIOVENTRICULAR NODAL BLOCKING AGENTS
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mitral valve prolapse
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prolapse of the leaflets of the mitral valve into the left atrium during ventricular contraction - NO SPECIAL PRECAUTIONS
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mitral valve stenosis
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obstructed blood flow from atria to ventricle, with possile resultant pulmonary hypertension and edema as well as right ventricular failure - DIURETICS, ANTICOAGULANTS AND BETA BLOCKERS
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peripartum cardiomyopathy
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heart failure of unknown etiology in the last month or 5 months after - DIURETIC THERAPY, VASODILATORS, INOTROPIC AGENTS
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ventricular septal defect
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opening in the ventricular septum
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SUPPLIES FOR DELIVERY - cardiac
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HEMODYNAMIC MONITORING
ENDOCARDITIS PROPHYLAXIS METHOD OF ANESTHESIA ANTICOAGULANT THERAPY |
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General treatment measure cardiac:
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Bedrest, activity restriction
avoidance of anemia (lab testing) iron supplemenation intensive maternal/fetal monitoring |
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Cardiac (fetus)
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fetal echocardiogram at 18-22 weeks
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Placental separation and uterine involution cause
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physiologic autotransfusion of approximately 500 ml of blood, increasing risks for pulmonary edema and cardiogenic shock
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Cardiac (Epidural Anesthesia) is beneficial in
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decreasing intrapartum fluctuations in cardiac output, maternal blood pressure and pulse
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Cardiac (Goal)
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Vaginal birth after 36 weeks (fewer hemodynamic changes than cesarean)
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Monitoring of a woman with cardiac disease may include readings of
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central venous pressure, pulmonary wedge pressure and oxygen saturation. Intake and output and anticoagulant therapy, contingent on severity - continuous maternal ECG monitoring
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Vital signs (cardiac)
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every 15 to 60 minutes, auscultation of lung fields every 1-4 hours.
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During insertion of monitoring lines, the nurse looks for changes in
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waveforms or dysrhythmias, which may signify a need for repositioning.
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Measuring urine output (cardiac) to ensure at least
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30 ml/hr is essential for adequate circulating volume, oxygen therapy and LEFT LATERAL (CARDIAC RECUMBANT POSITION) may help
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In some cases (cardiac), what kind of monitoring for fetus?
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Intrauterine pressure catheter (IUPC) and a fetal scalp electrode (FSE)
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Nonreassuring patterns (cardiac) - late decelerations, labor progress and a fetal scalp pH sample
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need to be evaluated
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Anemia, which affects
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50% of pregnant women, occurs when the quantity or quality of circulatory RBC's decreases....problems occur when RBCs are destroyed or lost earlier than their 120-day cycle.
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Problems related to anemia RBC quality include
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microcytic, macrocytic, hypochromic (hemoglobin concentration too low) or hyperchomic (too high)
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Signs/symptoms anemia
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fatigue, palpitations, chest pain, SOB on exercise
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Iron requirements pregnancy is
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3 to 4 mg/day and increases with gestations as the woman's body works to build the maternal RBC mass, expand plasma volume and facilitate placental growth
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Risks for iron deficiency anemia is increased
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in black women, clients using antacids or tetracyclines, low-income and clients with concurrent zinc deficiency
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Signs/symptoms of anemia are
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fatigue, decreased endurance, compromised work efficiency, cognitive deficits and mood swings, problems with short-term memory, verbal learning, depression
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Iron deficiency anemia has been linked with
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preterm birth, low birth weight.
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To assess for iron-deficiency anemia,
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hemoglobin and hematocrit tested in all pregnant clients, preferably performed first trimester to separate true anemia from physiologic changes
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other evaluations for anemia include
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serum ferritin
transferrin saturation free erythrocyte protoporphyrin |
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other evaluations for anemia may include a
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dietary review, prenatal vitamins with supplemental iron, finances to ensure adequate diet (importance of iron for energy, weight gain and fetal well-being)
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Sickle cell anemia is the most common
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genetic disorder in the US - predominantly African American
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Sickle cell anemia is a
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homozygous recessive illness characterized by chronic hemolytic anemia.
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A woman with sickle cell anemia has a decreased
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hemoglobin level (7 to 8 g/dL) as well as a decreased oxygen carrying capacity, to which she likely has adjusted.
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Sickle cell anemia (pregnancy) adds
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increased blood volume which increases her anemia.
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Sickle cell anemia (goal)
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assist the client to maintain healthy hemoglobin levels without acute episodes of vascular occlusion (monitor blood work and fetal assessment)
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Client with sickle cell may experience
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chronic hemolytic anemia and acute episodes of vascular occlusion (sickle cell crises) or both
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Those with chronic anemia may appear
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jaundiced and suffer from gallstones, splenomegaly and slow healing ulcers, pyelonephritis and pneumonia are also common
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Clients with acute crisis (vascular occlusion) may describe
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pain resulting from sickled cells clustering together in the microvasculature, particularly in the bones and chest - OCCLUSION IN THE BRAIN INCREASE THE RISK FOR STROK
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ACUTE CRISIS (SICKLE CELL) MAY include the
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heart, liver and spleen, crisis may increase in frequency and severity with gestation.
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Sickle cell crisis may also cause
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placental infarction
fetal hypoxia preterm labor intrauterine growth restriction stillbirth |
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Lab tests SICKLE CELL
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CBC
DIFFERENTIAL RETICULOCYTE COUNT BUN GLUCOSE DIRECT BILIRUBIN URINALYSIS |
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DRUG TO REDUCE ACUTE CRISIS SICKLE CELL
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HYDROXYUREA (DROXIA, HYDREA)
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Systemic Lupus Erythematosus is a
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complex, chronic, inflammatory autoimmune disease that can affect numerous organs.....deposits of antigen-antibody complexes in capillaries and various viscerl structures are characteristic
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SLE often begins or worsens
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during the childbearing years.....intermittent remissions and exacerbations
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Clients with SLE are prone to:
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clotting problemis, with increased rates of pulmonary emboli, DVTs and cerebrovascular accidents
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Fertility in women with SLE is usually
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normal.
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Pregnancy related risk SLE:
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IUGR
prematurity stillbirth miscarriage maternal hypertension proteinuria |
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SLE (report that 80%) of those in remission for at least 1 year
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before conceiving were free from exacerbations during pregnancy
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Major problem for women with SLE involves the
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placenta, autoimmune response leads to placental vasculopathy with fibrin deposition and areas of infarction resulting in decreased placental circulation - FETUS MAY SUFFER FROM MALNUTRITION
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In pregnant women with SLE
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placental weight tends to be smaller and the placental villi are thinner and slimmer
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Health visits (SLE)
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every 2 weeks 1st and 2nd semester
every week during 3rd semester |
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Evaluations (SLE)
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renal function
blood pressure fetal growth |
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Treatment (SLE)
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corticosteroids - drug of choice GLUCOCORTICOSTEROIDS.....smallest dose should be prescribed increased during L&D
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Risks SLE
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preterm birth
IUGR gestational hypertension |
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Initial assessment (L&D) - SLE
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routine blood tests
BP edema? proteinuria? creatinine clearance urine output ECG auscultation breath and lung sounds CHECK FOR DIC BY evaluating CBC, platelet count, PTT and INR, blood may be needed for type and crossmatch |
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SLE (labor)
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vaginal exam is performed unless contraindicated....possible administration of ANTIHYPERTENSIVE DRUGS AND HIGH-DOSE PREDNISONE
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Antiphospholipid Syndrome (Medication)
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Heparin
90% pregnancy loss |
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Most pediatric transmissions of HIV are acquired
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perinatally (transmission rate mom to fetus without treatment 25%)
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Maternal HIV status should be determine during pregnancy with appropriate
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consent and testing, maternal treatment initiated before birth and infant treatment at birth
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HIV - wear
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goggles during L&D
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The nurse should use (HIV)
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open-ended questions - knowledge about infection and plans for newborn care
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50-80% of HIV transmission occurs dirth
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birth - ANTIRETROVIRAL THERAPY may have been started during pregnancy and will be given IV during childibrth.....goal is to reduce the maternal viral load reducing risk of transmission
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HIV (AVOID)
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ROM
FETAL SCALP CLIP Vaginal exams should be minimized |
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Prolonged ROM increase the risk
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of HIV transmission
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HIV - antibiotic therapy should be considered at least
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4 hours before birth
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