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20 Cards in this Set
- Front
- Back
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Pregnany hyperdynamic state
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hypermetaboloc-hyperthyroidism. Thyroid gland more active, produces large amounts of growth hormone. Diabetogenic-HpL increase risk for DM. Decreased renal threshold for glucose. Hypercoagulable state-increased production of clotting factors, stasis of major and periphreal bl vessels d/t effects of estrogene and progesterone
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Anemia
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physiologic anemia normal d/t hypervolemic state. If before pregnancy, problems with oxygenation between mother and fetus and increase risk of bleeding.
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DM
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1st half of pregnancy increased insulin production and increased response to insulin. In 2nd half, increased insulin resistance and increased glucose tolerance mother may need 2-3 xs dosage. Fetus uses glucose from maternal stores and an increase disruption in maternal CHO metabolism. Increased maternal lipolysis and keytone production and a risk with it in uncontrolled DM in preg. Ketoacidosis is teritogenic and will occur @ lower glucose serum levels in preg than a normal person.
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Management of PGDM
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screened at 24-28 wks with fasting glucose test or HgA1c or both. STRICT GLYCEMIC CONTROL. Oral glyburide may be used after 1st trimester. 2nd tri-fastacting Lispro/humalog to caloric intake. 15-20 min ac meals. 2yr check after for control. During labor pt may be on an insulin gtt to manage bl glucose along with glucose IV to maintain energy level hr glucose check. IV glucose,insulin and saline. GDM does not require IV insulin and glucose.
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GDM
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screened 24-28 wks 1hr GTT done using 50g of oral glucose>140 further tx.
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HIV and pregnancy
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zidovudine is recommended during labor to decrease transmittion to fetus.
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Cardiac complications
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Influence of estrogen and progesterone cause dilation of peripheral vessels. Symptoms:fatigue,chestpain,dyspnea,edema,cyanosis,arrhythmias/palpitations. Greatest risk is HYPOXIA to the fetus=brain damage. Peripartum cardiomyopathy-most common condition autoimmune in preg. Occurs is non cardiac pts in the last month/post partum. Symptoms similar to CHF.
Immune system attacks the heart. |
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HG
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elevated HCG/estrogen #1 cause? Hypokalemia, hypovolemia=decreased placental perfusion, inadequate nutrients to development causing IUGR
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TX of HG
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NPO-first 24 hrs until F/E balance. Fluid balance maintained by IV rehydration/Electrolytes/vitamins. VIT B6/pyridoxine reprivex combined with ginger plus b6 to decrease nausea. Rapid serotonin antagoinsits 5HT3 receptor blockers:zofran ondansetron-work on brainstem to decrease nausea. Antihistamines;diphenhydramine,meclizine-prevent gastric secretion
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Nursing Intervention for HG
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remove unpleasant odors,NPO gradual small freq feedings high in carbs. Monitor I/O,urine quality,wt,skin turgor,calorie count,labs:Hct,BUN,lytes for level of deydration watching for K level. Min of 1000ml urine op in 24hrs. good oral hygiene. Monitor FHT-dehy increases uterine irritablity,may cause pre-term labor. Q4hrs or Qshift
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Molar Pregnancy
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trohoblast/chorian develop grossly abnormal # of chromosomes. Risk factors:>40, miscarriages, ectopic pregnancy. Dx with transvaginal ultrasound, HCG(quanitive testing)
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TX of MP
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D/C or D/E; microscopic exam(done when cells removed) Serum Hcg/pelvic q2wks for 3mon,then qmon for 1yr. CXR q4-6wks to r/o metastsis. Methotreate agent used for carcinoma. reduces neoplasms also used for etopic preg.
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abortion
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etiology: fetal/placental growth abnormalities. Including:chromo defects, faulty implantation,drugs/infection, endocrine/reproductive tract probs.
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Threatened AB
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unexplained vaginal bleeding, cramping. May or may not have fetal demise. Membranes remain intact/cervical os closed.RX: limit act, bedrest, no sexual relations
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Imminent or inevitable
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bleeding increases, os dilates-non preventable
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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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some products of conception are retained(placental) Pt will need D&C
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Missed AB
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fetal dimise in utero, may or may not abort spontaneously, may need induction of labor or D&C
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septic/infection
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PT presents with uterine infection, elevated temp, malodorus bleeding, abdominal tenderness. Often dt missed abortions. STAT IV antibiotics. *recurrent preg loss may signal chrom/hormonal abnormality as well as ovarian cancer.
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Incompetent/dysfunctional cervix
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Inter: find out about cramping: is it irregular/regular often or not. Usually a result from weak, torn, or absent spinctor muscle at cervical os. Causes include: cervical trama,infection,multiple gestation,LEEP procedure,cone bx, late term abortion/foreceps delivery.
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