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180 Cards in this Set

  • Front
  • Back
Of girls who become pregnant, how many will have a second pregnancy within 1 year
1 of 6
Programs that make difference in preventing adolescent pregnancy are those that:
1. have sustained commitment to the adolescents over a long time 2. involve parents and other adults in the community 3. promote abstinence and personal responsibility 4. assist adolescents to develop clear strategies for reaching future goals, such as college or a career
Adolescents who become pregnant are:
Less likely to receive adequate prenatal care (often none at all). More likely to delay entry to prenatal care through late recognition of pregnancy, or denial . More likely to smoke. Less likely to gain adequate weight. Have infants who are at increased risk for LBW, serious and long-term disability, and dying during first year of life. Higher risk for complications of pregnancy, such as PIH
Nursing goals for adolescents teens
Encourage early and continued prenatal care. Refer to appropriate social services
Women Over Age 35, Two groups:
Women with children who have additional children in the perimenopausal period. Women who have delayed childbearing until late 30’s or early 40’s
Older Multiparous Women. May be having irregular menstrual cycles and mistakenly believe
Primiparous Women
May be delayed because of education/career commitments. May be delayed because of previous infertility
Positive and negative potential impact of first pregnancy after 35
Well-established in career and relationship, financially stable. Generally involved in planning and their commitment to the pregnancy and parenthood. Reality of child care may prove difficult. Must prepare for possibilities and responsibilities of changing identities and new roles
Multiple Gestation
Both mother and fetuses are at increased risk for adverse outcomes. Increased strain on maternal CV system (esp. anemia). Placenta previa is more common. Premature separation of the placenta before delivery of second or more fetuses. Diastasis recti
Twin pregnancies frequently
premature, with SROM before term common
Congenital malformations are twice as common in
monozygotic twins than singletons (or dizygotic twins)
Two vessel cords, Twin to twin transfusion (local shunting of blood between placentas)
recipient twin is larger, donor twin small, pallid, dehydrated, malnourished, hypovolemic; larger twin may develop CHF in first 24 hours
Index of suspicion for multiple gestation is higher in one or more of the following:
1. History of dizygous twins in female line 2. Use of fertility drugs 3. Uterine size greater than dates 4. Polyhydramnios 5. Asynchronous fetal heartbeats 6. Ultrasound evidence of more than one fetus
Prenatal visits will be more frequent in what semester?
Support for the parents includes:
Support for the emotional shock. Nutritional counseling. Preterm birth counseling. Possible selective reduction in presence of more than 3 fetuses. Counseling on discomforts of pregnancy (back pain, varicose veins, potential need for bedrest). Referral to support services for guidance/assistance in care of infants at home
High risk pregnancy is one in which
the life or health of the mother or fetus is jeopardized by a disorder coincidental with or unique to pregnancy.
High risk status for the mother continues for how long after childbirth?
High risk status for the mother continues for 30 days after childbirth (although perinatal morbidity may continue for months or years)
High Risk Preg is a critical problem for modern medical and nursing care b/c
1. New social emphasis on quality of life and the “wanted” child 2. Reduction in family size 3. Technological advances for infertile couples 4. Emphasis on safe birth if normal infants who can develop to their potential
Three major causes of maternal death
1. Hypertensive disorders 2. Infection 3. Hemorrhage
50% of perinatal mortality is
antepartum fetal death (FDIU
Leading cause of death in neonatal period is (5)
congenital anomalies
Other causes of perinatal mortality
1. Prematurity 2. Low birth weight 3. Sudden infant death syndrome (SIDS) 4. Respiratory distress syndrome (RDS) 5. Effects of maternal complications
Improvement in prenatal care and perinatal services, including neonatal intensive care, have accounted for a 50% decrease in mortality in neonates weighing
less than 1500 g
Categories of High Risk Factors
Biophysical factors, Psychosocial factors, Sociodemographic factors, Environmental factors
Biophysical factors
"1. Genetic considerations 2. Maternal nutritional status 3. Medical and obstetric disorders, including complications of previous pregnancies
Psychosocial factors
1. Smoking 2. Caffeine 3. Alcohol 4. Drugs 5. Psychological status (e.g., addictive lifestyles; mood disorders; history of abuse; inadequate support systems; situational crises; cultural conflicts)
Sociodemographic factors
"1. Low income 2. Lack of prenatal care 3. Age 4. Parity5. Marital status 6. Residence 7. Ethnicity
Environmental factors
"1. Infection 2. Radiation 3. Chemicals 4. Stress 5. Workplace teratogens
high risk is a high stress time for woman and family which may affect
parental attachment, accomplishment of the tasks of pregnancy and family adaptation to the pregnancy
Women in high risk may experience:
"Anxiety, Low self-esteem, Guilt , Frustration, Inability to function, Bed rest/hospitalization may cause: Separation from family, Financial stress, Worry about children and home, Uncertainty and feeling lack of control, Loneliness and depression, Alterations in the usual birth plan, which may not allow for choices that would have been selected if the pregnancy was normal
Gestational HTN (Pregnancy-induced HTN or PIH)
Defined as onset of HTN without proteinuria, after week 20 of pregnancy
Retrospective diagnosis postpartum: Transient HTN
"no signs of preeclampsia at birth, and resolved by 12 weeks postpartum. If persists 12 weeks postpartum, becomes chronic HTN
Preclampsia
A pregnancy-specific syndrome, classified as mild or severe for management purposes
First sign of preeclampsia
"First sign is usually elevated BP. Systolic greater than 140, diastolic greater than 90. Increase of 30 mm Hg systolic OR 15 mm Hg diastolic warrants close observation
Second sign of preclampsia
Proteinuria. ≥ 1+ on dipstick, in absence of UTI. Pathologic edema (harder to quantify, so no longer diagnostic of preeclampsia)
Severe Preeclampsia. In a woman already dx with preeclampsia, the presence of any of the following:
"1. Systolic BP at least 160 or diastolic at least 110 2. Proteinuria greater than 2+ or 3+ on dipstick 3. Oliguria, less than 400-500 mL per 24 hours 4. Cerebral disturbances (altered LOC; HA; scotomata or blurred vision) 5. Hepatic involvement (epigastric or RUQ pain or ↑liver enzymes) 6. Cardiac, pulmonary, HELLP or ↑serum creatinine
Eclampsia
Onset of seizure activity or coma in a woman dx with preeclampsia, and no history of pre-existing pathology that would cause seizure activity
Risk Factors Associated with Preeclampsia
"Chronic renal disease, Chronic HTN, Family history of preeclampsia, Multiple gestation or Rh incompatibility, Primigravity or new partner, Maternal age < 19 or > 40, Diabetes, Obesity
HELLP Syndrome
"A variant of severe preeclampsia dx by laboratory data: 1. Hemolysis (H) 2. Elevated liver enzymes (EL) 3. Low platelets (LP)
HELLP Syndrome
"Appears in only 1 out of 1000 pregnancies. More common in older, Caucasian, multiparous . Often initially confused with other medical disorders, as not every woman will have significant elevated BP or proteinuria. Maternal mortality rate as high as 24%. Perinatal mortality rates range from 79 to 367 per 1000 live births
Nursing Management of preeclampsia
Early detection is key to prevent catastrophic maternal or fetal outcomes. Assess for risk factors on prenatal intake interview
Routine assessment at subsequent prenatal visits that will help detect preclampsia
"1. Weight 2. BP 3. Edema (pitting or periorbital/facial) 4. Unusual HA, visual disturbances, epigastric pain 5. DTR’s if preeclampsia suspected (biceps, patellar, ankle clonus)
Fetal assessment (for uteroplacental insufficiency)
"1. FHR 2. NST 3. Biophysical profile 4. Serial ultrasounds
Lab tests for preclampsia (7)
"1. CBC (with diff) 2. Clotting studies (bleeding time, PT, PTT, fibrinogen) 3. Liver enzymes (LDH, AST, ALT) 4. Chemistry panel (BUN, creatinine, glucose, uric acid) 5. Urinalysis (clean-catch or cath specimen) 6. Dipstick for protein 7. 24-hour urine for protein and creatinine clearance is more reflective of renal status
Interventions for Mild Preeclampsia (4)
"1. Activity restriction 2. Rest at home – modified bed rest (improves BP and diuresis) 3. Lateral recumbent position for best blood flow to uterus 4. Diet changes: a. Increase fluids and fiber b. Limit excessive salt
Interventions for Severe Preeclampsia and HELLP
"1. Hospitalization 2. Focus on stabilization and preparation for birth (the treatment for preeclampsia is delivery) 3. Will need C-section if unfavorable cervix
Reduce risk of seizure, how? (5)
"1. Quiet environment, with low lighting 2. Suction equipment and oxygen ready to use 3. Call button in easy reach 4. Emergency medication tray immediately accessible 5. Emergency birth pack accessible
Magnesium Sulfate is used for
Drug of choice for prevention and treatment of convulsions
Magnesium Sulfate is administered as
Administered as secondary infusion by infusion pump
Assess for S & Sx of mag toxicity, which are (4)
"1. Loss of patellar reflexes 2. Respiratory depression 3. Decreased LOC 4. Feeling of warmth, flushing, muscle weakness, slurred speech.
How to intervene to prevent respiratory/cardiac arrest
"1. Discontinue mag infusion immediately 2. Administer calcium gluconate by slow IV push over 3 minutes (usually done by MD)
Drug of choice for HTN in pregnancy is
methyldopa (Aldomet).
Pre-pregnancy planning for women with pre-existing HTN is to switch them to….
methyldopa before conception (ACE inhibitors are contraindicated in pregnancy)
What may also be used for HTN, but not for severe HTN?
nifedipine
In severe preeclampsia, what is the tx of choice?
IV hydralazine
In severe preeclampsia, what tx can also be used?
labetalol
What is the drug of choice for breastfeeding
Methyldopa
Symptoms of preeclampsia/eclampsia usually resolve within
48 hours after birth
Precaution about the symptoms of preclampsia/eclampsia in portpartum care:
symptoms may persist for several weeks, or sudden change in lab data in 72-96 hours
Convulsions may still occur within 48 hours after birth, so...
Mag sulfate usually continued for 12-24 hours
Chronic HTN is defined as
as HTN present before pregnancy, or developing before 20 weeks’ gestation, or continuing longer than 12 weeks postpartum
Women with chronic HTN may acquire
preeclampsia or eclampsia (chronic HTN with superimposed preeclampsia)
Miscarriage
(spontaneous abortion)
Threatened Miscarriage
spotting of blood, but cervix closed; may have mild cramping
Inevitable Miscarriage
moderate to heavy bleeding, with an open cervical os; may have moderate to severe cramping
Incomplete Miscarriage
involves expulsion of the embryo or fetus, but retention of the placenta
Complete Miscarriage
all fetal tissue is passed, cervix is closed and may have slight bleeding with mild cramping
Missed Miscarriage
fetus has died, but products of conception (POC) are retained in the uterus for up to several weeks
Laboratory data used in miscarriage
"hCG serum levels – 2 readings 48 hours apart. Pathology for POC
Interventions for miscarriage
"1. Most miscarriages in first trimester will complete without surgical intervention 2. D & C (dilation and curettage) up to 16 weeks 3. D & E (dilation and evacuation) after 16 weeks 4. Prostaglandins may be given vaginally to assist in inducing or augmenting contractions to expell POC
Incompetent Cervix, Recurrent premature dilation of the cervix
defined as passive and painless dilation of the cervix in the second trimester
Ultrasound diagnosis of an incompetent cervix:
cervical length less than 2 cm, or funneling (effacement of the internal cervical os)
Conservative management for incompetent cervix includes
bed rest, hydration, and tocolysis
Prophy cerclage
is what?
Prophy cerclage may be done at
10-14 weeks for woman with previous history; she must refrain from intercourse, prolonged standing (> 90 min.) and heavy lifting; serial cervical measurements by ultrasound
Ectopic Pregnancy
"Pregnancy implanted outside of the uterus (most commonly [95%] in the fallopian tube). Is cause of 10% of all maternal mortality, and a leading cause of future infertility – subsequent pregnancies at higher risk of ectopic
How is a ectopic pregnancy classified?
by site of implantation: tube, ovary, abdomen, uterine locations other than endometrial cavity
Symptoms of ectopic pregnancy:
missed menses; adnexal fullness, tenderness proceeding to colicky pain, some dark red or brown vaginal bleeding (50-80%)
Ruptured ectopic causes
"severe pain in the abdomen, and may have referred shoulder pain; woman may go into shock from blood loss **Sudden cessation of pain is ominous.
Diagnostic evaluation of ectopic pregnancy
1. Ultrasound 2. hCG 3. Bimanual exam (gently, as it can cause rupture)
Treatment of ectopic pregnancy
1. Surgical removal by salpingostomy for an unruptured tubal ectopic, followed by methotrexate (a folic-acid analogue that destroys rapidly developing cells) or 2. Use of methotrexate without surgery, if diagnosed early, has results similar to surgery, with high success rate, low complication rate and good reproductive potential
methotrexate
a folic-acid analogue that destroys rapidly developing cells
women taking methotrexate ar instructed to
not to take vitamins with folic acid, or drink alcohol
Also, women with hx of ectopic pregnacies need:
early surveillance in future pregnancies, since high risk of repeat ectopic
Hydatidiform Mole (Molar Pregnancy)
"Is a gestational trophoblastic disease. Higher risk in women who have used Clomid, or are in their early teens or older than 40; possibly higher risk in Asians. Risk of second mole is 1-2%
Complete Mole
Caused by fertilization of an egg with a lost or inactive nucleus—nucleus of the sperm duplicates itself
Mole look like:
"resembles a bunch of white grapes. The fluid-filled vesicles grow rapidly, causing uterine size greater than dates. Usually contains no fetus, placenta, amniotic membranes or fluid—leads to hemorrhage into the uterine cavity, causing vaginal bleeding
20% of complete moles will progress to
choriocarcinoma
Partial Mole is caused by:
"Caused by two sperm fertilizing one ovum (69 XXX, etc). Often have embryonic or fetal parts and amniotic sac, and congenital anomalies. Malignant transformation less than 6%.
Symptoms of hydatiform mole:
"1. 95% with vaginal bleeding 2. Dramatically high serum hCG (remaining after usual hCG peak of 70-100 days) 3. Excessive nausea and vomiting 4. Gestational HTN before 24 weeks (15% have preeclampsia in 9-12 weeks’ gestation)
Treatment for molar pregnancy:
"1. Suction D&C (labor not recommended because of risk of embolization of trophoblastic tissue) 2. Biweekly measurement of serum hCG until normal and remaining normal for 3 weeks 3. Monthly measurements of hCG for 6 months, then every 2 months for a total of one year.
Rising hCG and an enlarging uterus may indicate
choriocarcinoma – may be treated with serial methotrexate if early rising hCG
Important: Women must aviod pregancy for one year because..
as a rising hCG in a new pregnancy can cause confusion – any contraceptive method is good, except IUD – oral contraceptives are particularly effective.
Placenta previa
placenta implants in the lower uterine segment near or covering the internal cervical os
Marginal placenta previa
edge of placenta extends to internal os, but may cover the os when cervix begins to dilate
Low-lying placenta
implanted in lower uterine segment, but doesn’t reach the os
Vasa previa
a velamentous insertion of the umbilical cord – the umbilical blood vessels are not surrounded by Wharton’s jelly and have no supportive tissue – places the vessels at risk for laceration (most frequently during ROM)
Vasa previa monitor for:
"sudden appearance of bright red blood at the time of ROM (spontaneous or artificial) and a sudden change in fetal heart rate without other known risk factors. High incidence of fetal morbidity and mortality secondary to exsanguination. Difficult to diagnose before birth, although occasionally seen on u/s
For any bleeding after 24 weeks, suspect what?
previa
With previa, vital signs may be normal, even with loss of up to 40% of blood volume, so observe for what?
observe clinical presentation and urinary output as a better indicator
Standard for previa diagnosis is
a transabdominal ultrasound; if placenta in normal position, will need to rule out other causes of bleeding
with previa, NO pelvic examination until when?
No pelvic examination until viability reached (usually about 34 weeks) because of the risk of hemorrhage
If pelvic exam is needed with previa…?
she is taken to a delivery room set up for C-section delivery, as profound bleeding can occur (double-setup procedure)
With previa, If a woman is at term (37+ weeks), will need..?
"immediate c-section. Then observe for hemorrhage, as bleeding may continue after delivery
With previa, expectant management (les than 36 weeks)
1. Bed rest and close observation 2. Assess bleeding amounts carefully 3. Fetal surveillance once or twice weekly 4. Venous access in case blood products needed 5. Antepartum steroids (betamethasone) to promote fetal lung maturity if less than 34 weeks 6. No vaginal or rectal exams 7. Once she reaches 37 weeks, and fetal lung maturity documented, she will be scheduled for c-section
With previa, home care is decided on..?
"Decidec by case by case basis. May be appropriate if stable, no active bleeding and able to return to hospital immediately if resumes bleeding
abruptio placentae
Premature separation of the placenta
abruptio placentae
Detachment of all or part of the placenta in the area of the decidua basalis after 20 weeks of pregnancy and before birth. Accounts for significant maternal and fetal morbidity and mortality
Risk factors for abruptio placentae
Risk factors include maternal HTN, cocaine use, blunt trauma (MVA or battering)
Classic symptoms of abruptio placentae
include vaginal bleeding, abdominal pain, uterine tenderness and contractions
“silent abruption”
Symptoms may be absent in abruptio placentae
Abruptio placentae symptoms
"1. Bleeding may result in maternal hypovolemia and coagulopathy (at risk for DIC) 2. Mild to severe uterine hypertonicity 3. Pain mild to severe, localized over one part of the uterus or diffuse over the uterus with a boardlike abdomen.
Boardlike abdomen is a symptom of what?
abruptio placentae
With abruptio placentae, increased fundal height indicates what?
indicates concealed bleeding. So measure fundal height over time
With abruptio placentae, 60% of live fetuses will show what?
nonreassuring signs on fetal heart monitor (loss of variability, late decels)
With abruptio placentae, monitor for what else besides fundal height?
"Monitor for coagulopathy (clotting studies). All women will be hospitalized and treatment depends on severity of the abruption
With abruptio placentae, if at term or if bleeding is moderate to severe, and mother and fetus are in jeopardy- what is the treatment of choice?
Delivery is the treatment of choice
What is nursing mamngement for abruptio placenta?
"Frequent maternal vital signs and continuous fetal monitoring. Vaginal birth is usually feasible (especially desired if fetal demise) – surgical delivery is reserved for cases of fetal distress – surgical delivery should not be attempted if woman has severe coagulopathy
With abruptio placentae, surgical delivery reserved for when?
cases of fetal distress – surgical delivery should not be attempted if woman has severe coagulopathy
Nursing care during a abrutio placenta needs to pay close attetnion to what?
Nursing care in this situation is demanding, as it requires meticulous assessment of maternal and fetal condition, as well as emotional support to woman and family
DIC
a pathologic form of diffuse clotting that uses up large amounts of clotting factors, leading to widespread external and internal bleeding
Nursing care of woman at risk for DIC
1. Be aware of risk factors (HELLP syndrome, gram negative sepsis, abruption) 2. Observe for signs of bleeding
Signs of bleeding
1. Petechiae 2. Oozing from injection sites and IV sites 3. Hematuria 4. Monitor for decreased urinary output with indwelling Foley catheter 5. Assess vital signs frequently 6. Maintain woman in side-lying position 7. Administer oxygen as ordered
Diabetes mellitus- Type I
absolute insulin deficiency due to pancreatic islet beta cell destruction
Diabetes mellitus- Type 2
relative insulin deficiency due to insulin resistance
Pregestational DM
diabetes that existed before pregnancy
Gestational DM (GDM)
any degree of glucose intolerance first recognized in pregnancy – woman will be reclassified at 6 weeks postpartum
understand the interventions for pregnancy, labor and birth, postpartum (breastfeeding)
Why is preconception counseling for pre-gestational DM is critical?
woman needs to be in very tight metabolic control before conception, and for the first weeks of gestation, to avoid congenital anomalies. Some oral hypoglycemic agents (sulfonylureas) need to be discontinued, and insulin started.
Maternal risks with DM (7)
1. Early pregnancy loss 2. Marked increase in fetal macrosomia (with increased risk of shoulder dystocia) – more likely to need c-section or operative vaginal birth 3. Hypertensive disorders more frequent. Preterm labor/birth, especially when poor glycemic control 4. Polyhydramnios 5. Infections (vaginal and UTI) 6. Ketoacidosis or hypoglycemia
Fetal risks with DM (10)
1. Sudden, unexplained stillbirth 2. Congenital anomalies 3. Cardiac defects 4. CNS defects 5. Skeletal defects 6. Macrosomia 7. Hypoglycemia 8. RDS 9. Polycythemia 10. Hyperbilirubinemia
With DM, ACOG recommends that all pregnant women be screened by either..?
screened by either history, clinical risk factors or lab screening of blood glucose levels
Glucola load of 50 g of glucose administered orally, with a 1-hour plasma level drawn…when can this test be done and what is a postive result?
Test done between 24-28 weeks. A level of 140 mg/dl or greater is considered positive
3-hour GTT to confirm
to confirm any positive 1-hr glucola test – woman has GDM is any 2 of the 4 levels exceed expected limits
Interventions of DM are:
1. Diabetes educator referral 2. Most GDM can be managed with diet and exercise, but 20% will need insulin therapy 3. regarding monitoring blood glucose levels 4. Teaching regarding insulin administration and management of hypoglycemia 5. Teaching regarding signs of infection 6. Frequent fetal surveillance, with NST
Goals of GM therapy: Fasting levels between what? And 2-hour postprandial levels between what?
Fasting levels between 60 and 90, 2-hour postprandial levels between 90 and 120
with DM, Frequent fetal surveillance, with NST beginning around
28-32 weeks, and twice weekly after 32 weeks, with planned induction around 38-40 weeks
Hyperemesis gravidarum
Excessive vomiting, leading to weight loss of at least 5% of prepregnancy weight, accompanied by dehydration, electrolyte imbalance, ketosis
Hyperemesis gravidarum causes are
Causes are obscure: high levels of hormone or liver enzymes; transient hyperthyroidism; vitamin B deficiencies may be possible causes
With hyperemesis gravidarum, Psychologic factors may also impact:
high stress, ambivalence about the pregnancy
Hyperemesis gravidarum, Clinical symptoms are: (5)
1. Significant weight loss and dehydration 2. Decreased BP, increased pulse rate 3. Poor skin turgor 4. Unable to keep down even clear liquids by mouth 5. Electrolyte imbalances on lab data
Hyperemesis gravidarum, management care:
1. Rule out other pathological disorder (GI or thyroid) 2. IV hydration 3. Antiemetics (Tigan, Reglan, Zofran) 4. Stress management 5. For severe cases, may need feeding tube or TPN 6. Teach regarding management of discomforts (oral care, minimize odors) 7. Slowly advance diet as tolerated 8. May benefit from home care therapy
Hyperthyroidism symptoms;
Fatigue, heat intolerance, warm skin, diaphoresis, emotional lability, tremulousness, Unplanned weight loss, loose nails, pulse rate > 100 that does not decrease with Valsalva maneuver
Hyperthyroidism lab results:
suppressed TSH; elevated Free T4
Hyperthyroidism untreated or inadequately treated can lead to:
LBW and minor fetal anomalies. Higher risk for severe preeclampsia and hyperemesis
Untreated hypothyroidism may lead to:
1. Preeclampsia 2. Abruption 3. Stillbirth 4. LBW
With hypothyroidism, supplement thryoid hormone to maintain
TSH in normal range (take 2 hours apart from iron supplements)
thryoid hormone, take two hours apart from what?
iron supplements!
When is it recommened to check for TSH levels?
periodically (usually once a trimester) and adjust thyroid supplement dosage accordingly
Women with congenital cardiac anomalies need preconception counseling, since
incidence of anomalies in their children is 4-16%
cardiac decompensation
inability of the heart to maintain a sufficient cardiac output
With women with preexisting cardiac anomalies who want to become pregnant, why is there a risk for cardiac decompensation?
Risk of cardiac decompensation (inability of the heart to maintain a sufficient cardiac output) due to increased CV workload of pregnancy – some conditions are contraindications for pregnancy
Women who require prophylaxis for bacterial endocarditis for dental work or invasive procedures because of valvular disease will also need
medication for delivery
Interventions during PP with mothers with cardiac conditions:
Limit activity postpartum:rest, stool softeners
Hemoglobinopathies, Iron-deficiency anemia:
90% of pregnancy anemia – supplement with iron prn; instruct regarding constipation, dark stools
Hemoglobinopathies, Folic acid deficiency anemia:
Second most common – even in well-nourished women. Supplement at least 600 mcg/day
Hemoglobinopathies, Sickle-cell anemia:
Usually do well in pregnancy, but increased UTI’s and may be iron deficient. Risk for thromboembolism: encourage fluids, use antiembolism stockings; bed rest if positive Homan’s sign
Hemoglobinopathies, Thalassemia:
Relatively common hereditary disorder, in which insufficient hemoglobin is produced to fill the RBCs. Major and minor varieties of the alpha and beta hemoglobin chains
Do a Hemoglobin electopheresis test if
MCV < 80
Unbalanced synthesis of Hgb leads to
premature RBC death, and resulting anemia (and bone deformity in major)
Women with thalassemia minor have a
mild, persistent anemia, but RBC level may be normal – no systemic problems, and pregnancy does not worsen the condition. Genetic counseling recommended if FOB also affected.
The most common respiratory problem affecting pregnancy: one-half will improve, one fourth will stay the same, one fourth will worsen is?
Asthma
Almost all asthma medications are what during pregnancy?
safe in pregnancy (prefer to avoid systemic steroids unless absolutely necessary). Continue medication during labor and postpartum
Why should asthmatic mothers avoid morphine and meperidine (Demerol) in labor?
they trigger histamine release
With SLE, women are advised to be in remission for at least how long?
6 months before attempting pregnancy. 50% will experience exacerbation in pregnancy
With SLE, there is an increased risk of?
of miscarriage, fetal loss, IUGR and prematurity; also preeclampsia, renal impairment and HELLP
With SLE medical therapy is?
kept to a minimum (may need ASA or prednisone)
With SLE what nursing intervention test is very important?
Monthly 24 hour urine for protein/Cr clearance
Effect of epilepsy on pregnancy is?
is unpredictable – up to 80% have no change in seizure activity
Seizure Disorder May complicate differential diagnosis of
eclampsia
With seizure disorder risk of vaginal bleeding is
doubled – three-fold increased risk of abruption
Potential fetal complications of anti-seizure meds include
cleft lip or palate; congenital heart disease; urogenital defects and neural tube defects – counseling needed on importance of taking anti-seizure meds
With seizure disorder, monitor neonates for
Vit. K deficiency and drug withdrawal
More common in pregnancy (enlarged uterus interferes with normal gallbladder drainage). Most often occurs in multips with a history of previous attacks is?
Cholecystitis
Symptoms of Cholecystitis:
fatty food intolerance, with colicky abdominal pain radiating to back or shoulder, N/V
With Cholecystitis, surgery should be postponed until
until postpartum if possible, but second trimester laproscopic cholecystectomy poses minimal risk to mother and fetus
HEALTH DEVIATIONS IN CHILDBEARING (OREM):
1. Seeking and securing appropriate medical assistance (Obtaining prenatal care, Recognizing signs and symptoms of complications) 2. Being aware of and attending to the effects and results of pathological conditions (Hyperemesis, Gestational diabetes, Anemia) 3. Effectively carrying out medically prescribed diagnostic and therapeutic measures (Modifying lifestyle (smoking, alcohol, caffeine, exercise), Bedrest, Maintaining blood sugar and diet records in GDM) 4. Being aware of and attending to or regulating the discomforting effects of medical care (Managing constipation).
Health Deviation SCR:Modifying the self-concept in accepting oneself as being in a particular state of health and in needing specific forms of health care
1. Modifying lifestyle 2. Participation in prenatal care 3. Accepting the physical and emotional changes of pregnancy 4. Accepting modifications of birth plan in the event of high risk pregnancy/delivery
Health Deviation SCR: Learning to live with effects of pathological conditions and states, and the effects of treatment measures, in a lifestyle that promotes continued personal development.
1. Adaptation to changes in work/career roles with complications of pregnancy 2. Seeking assistance from the lactation consultant for problems with breastfeeding in order to continue to breastfeed when returning to work
Developmental SCR:
"1. Maintenance of optimal intrauterine stages of life (Seeking prenatal care, Making dietary changes to improve nutritional needs, Compliance with medical regimens to treat or prevent complications (e.g., diabetes, pre-term labor) 2. Provision of care associated with the birthing process (Participation in childbirth education courses) 3. Provision for the establishment of attachment and bonding, mothering and parenting behaviors (Accepting the fact of high risk pregnancy, Seeking information and support groups for infant with special needs) 4. Maintenance of conditions that facilitate growth, development and maturation (For adolescent pregnancy, participation in education programs for teen mothers)