Nur 113 Ch 21

Front 1

planned medical termination of a pregnancy

Back 1

elective abortion

Front 2

medical term for any interruption of a pregnancy before a fetus is viable (able to survive outside the uterus if born at that time).

Back 2

abortion

Front 3

Viable fetus

Back 3

usually defined as a fetus of more than 20 to 24 weeks of gestation or one that weighs at least 500 g. A fetus born before this point is considered a miscarriage or premature or immature birth

Front 4

the interruption occurs spontaneously, it is clearer to refer to it as a

Back 4

miscarriage.

Front 5

missed miscarriage, also commonly referred to as ,_____ ______ ______the fetus dies in utero but is not expelled

Back 5

early pregnancy failure, discovered at a prenatal examination when the fundal height is measured and no increase in size can be demonstrated or when previously heard fetal heart sounds cannot be heard.

Front 6

women who had three spontaneous miscarriages that occurred at the same gestational age were called .

Back 6

“habitual aborters

Front 7

what is the danger of an Incomplete miscarriage?

Back 7

maternal hemorrhage as long as part of the conceptus is retained in the uterus b/c the uterus cannot contract effectively under this condition.
-D&C will be performed by MD

Front 8

If the fetus was Rh positive and the woman is Rh negative, enough Rh-positive fetal blood may enter the maternal circulation to cause
____________.

Back 8

isoimmunization—the production of antibodies against Rh-positive blood. If the woman's next child should have Rh-positive blood, these antibodies would attempt to destroy the red blood cells of this infant during the months that infant is in utero

Front 9

After a miscarriage, b/c the blood type of the conceptus is unknown, all women with Rh-negative blood should receive _______ to prevent the buildup of antibodies in the event the conceptus was Rh positive

Back 9

Rh (D antigen) immune globulin (RhIG)

Front 10

it is important for any woman who begins to miscarry at home to bring any clots or tissue passed to the hospital with her. The presence of clear fluid-filled cysts changes the diagnosis from miscarriage to ?

Back 10

gestational trophoblastic disease

Front 11

This condition tends to occur most often in women who have a low protein intake, in women older than age 35 years, in women of Asian heritage, and in blood group A women who marry blood group O men

Back 11

gestational trophoblastic disease (hydatidiform mole)

Front 12

an abnormal proliferation & then degeneration of the trophoblastic villi . As the cells degenerate, they become filled w/ fluid & appear as clear fluid-filled, grape-sized vesicles. The embryo fails to develop beyond a primitive start. Abnormal trophoblast cells must be identified because they are assoc. w/ choriocarcinoma, a rapidly metastasizing malignancy

Back 12

Gestational trophoblastic disease

Front 13

, previously termed an incompetent cervix, refers to a cervix that dilates prematurely and therefore cannot hold a fetus until term. It occurs in about 1% of women. The dilatation is usually painless. Often the 1st sx is show (a pink-stained vaginal discharge) or increased pelvic pressure, which may be followed by rupture of the membranes & d/c of the amniotic fluid. Uterine contractions begin, & after a short labor the fetus is born. , this commonly occurs at approx wk 20 of preg, when the fetus is still too immature to survive

Back 13

Premature cervical dilatation

Front 14

After the loss of one child because of premature cervical dilatation, a surgical operation termed _______ _______ can be performed to prevent this from happening in a second pregnancy

Back 14

cervical cerclage

Front 15

, nylon sutures are placed horizontally and vertically across the cervix and pulled tight to reduce the cervical canal to a few millimeters in diameter

Back 15

McDonald procedure

Use w/ Premature cervical dilatation

Front 16

, sterile tape is threaded in a purse-string manner under the submucous layer of the cervix and sutured in place to achieve a closed cervix

Back 16

Shirodkar technique

Used w/ Premature cervical dilatation

Front 17

is a minor surgical procedure in which the opening to the uterus (the cervix) is stitched closed in order to prevent a miscarriage or premature birth

Back 17

cervical cerclage

-post-op: bedrest for a few days, (slight trendelenburg position) to decrease pressure on sutures

Front 18

is a condition of pregnancy in which the placenta is implanted abnormally in the uterus. It is the most common cause of painless bleeding in the third trimester of pregnancy

Back 18

Placenta previa

Front 19

is an acquired disorder of blood clotting in which the fibrinogen level falls to below effective limits. Early symptoms include easy bruising or bleeding from an intravenous site. Conditions such as premature separation of the placenta, pregnancy-induced hypertension, amniotic fluid embolism, placental retention, septic abortion, and retention of a dead fetus are all associated with its development

Back 19

DIC

Front 20

labor that occurs before the end of week 37 of gestation

Back 20

Preterm labor
Any woman having persistent uterine contractions (four every 20 minutes) should be considered to be in labor. A woman is documented as being in actual labor rather than having false labor contractions if she is having uterine contractions that cause cervical effacement over 80% or dilation over 1 cm

Front 21

rupture of fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks

Back 21

Preterm rupture of membranes
-The cause of preterm rupture is unknown, but it is associated with infection of the membranes

Front 22

a condition in which vasospasm occurs during pregnancy in both small and large arteries.

Back 22

Pregnancy-induced hypertension (PIH)

Front 23

*3 classic signs of PIH?

Back 23

Signs of hypertension, proteinuria, and edema develop.

Front 24

Blood pressure 140/90 or systolic pressure elevated 30 mm Hg or diastolic pressure elevated 15 mm Hg above prepregnancy level; no proteinuria or edema; blood pressure returns to normal after birth

Back 24

Gestational hypertension

Front 25

Blood pressure 140/90 or systolic pressure elevated 30 mm Hg or diastolic pressure elevated 15 mm Hg above prepregnancy level; proteinuria of 1-2+ on a random sample; weight gain over 2 lb per wk in second trimester and 1 lb per wk in third trimester; mild edema in upper extremities or face

Back 25

Mild pre-eclampsia

Front 26

Blood pressure of 160/110; proteinuria 3-4+ on a random sample and 5 g on a 24-hour sample; oliguria (500 mL or less in 24 hours or altered renal function tests; elevated serum creatinine more than 1.2 mg/dL); cerebral or visual disturbances (headache, blurred vision); pulmonary or cardiac involvement; extensive peripheral edema; hepatic dysfunction; thrombocytopenia; epigastric pain

Back 26

Severe pre-eclampsia

Front 27

Seizure or coma accompanied by signs and symptoms of pre-eclampsia

Back 27

Eclampsia

Front 28

edema that has progressed to the upper extremities or the face is _______.
This accumulating edema will reduce their urine output to approximately 400 to 600 mL per 24 hours.

Back 28

Abnormal
Women report upper extremity edema as “my rings are so tight I can't get them off ” and facial edema as “when I wake in the morning, my eyes are swollen shut” or “I can't talk until I walk around awhile.”

Front 29

a continued motion of the foot

Back 29

ankle clonus

Front 30

To elicit ankle clonus:

Back 30

dorsiflex the woman's foot three times in rapid succession. As you take your hand away, observe the foot. If no further motion is present, no ankle clonus is present. If the foot continues to move involuntarily, clonus is present

Front 31

The nursing diagnoses used with PIH .

Back 31

-Ineffective tissue perfusion related to vasoconstriction of blood vessels
-Deficient fluid volume related to fluid loss to subcutaneous tissue
-Risk for fetal injury related to reduced placental perfusion secondary to vasospasm
Social isolation related to prescribed bed rest

Front 32

MILD PIH Intervention:
best method of aiding increased evacuation of sodium and encouraging diuresis.

Back 32

Bed Rest:
Rest should always be in a lateral recumbent position to avoid uterine pressure on the vena cava and prevent supine hypotension syndrome.

Front 33

MILD PIH Intervention:
take a mild antiplatelet agent:

Back 33

take low-dose aspirin (50-150 mg) as excessive salicylic levels can cause maternal bleeding at the time of birth.

Front 34

MILD PIH Intervention:
Don't restrict Na+, why?

Back 34

stringent sodium restriction may activate the renin-angiotensin-aldosterone system and result in increased blood pressure, compounding the problem.

Front 35

the drug of choice to prevent eclampsia

Back 35

magnesium sulfate

Front 36

Assess ______ and _____ before admin drugs to prevent eclampsia (hypotensive drug such as hydralazine (Apresoline), labetalol (Normodyne), or nifedipine)

Back 36

Pulse and B/P
-can cause maternal
tachycardia and act to lower b/p
-diastolic pressure should not be lowered below 80 to 90 mmHg

Front 37

Muscle relaxant; prevents seizures
-a central nervous system depressant
-halts premature labor

Back 37

Magnesium sulfate
Pregnancy risk category B

Front 38

Dosage for Mg Sulfate:

Back 38

Initially, 2-6 g IV administered in a 250-mL solution over a 20-minute period, followed by individually calculated IV infusion at a rate to maintain designated serum levels
Therapeutic range: 5.0-8.0 mg/100 mL
Patellar reflex disappears: 8-10 mg/100 mL
Respiratory depression occurs: 15-20 mg/100 mL
Cardiac conduction defects occur: More than 20 mg/100 mL

Front 39

Side Effects for Mg Sulfate:

Back 39

Flushing, thirst; with toxicity, absence of deep tendon reflexes, respiratory depression, cardiac arrhythmias, cardiac arrest, and decreased urine output

Front 40

Nursing Implications w/ Mg Sulfate?

Back 40

Infuse loading dose slowly over 15-30 min.
Always administer as a piggyback infusion
Assess respiratory rate, urine output, deep tendon reflexes, and clonus every hour.
Urine output should be over 30 mL/hour and respiratory rate over 12/min.
Observe for CNS depression (LOC) and hypotonia in infant at birth and calcium deficit in the mother.

Front 41

A long-term effect of magnesium sulfate therapy is

Back 41

osteoporosis

Front 42

HELLP syndrome

Back 42

is a variation of PIH named for the common symptoms that occur: hemolysis that leads to anemia, elevated liver enzymes that lead to epigastric pain, and low platelets that lead to abnormal bleeding/clotting and petechia

Front 43

Usually the amniotic fluid volume during pregnancy is 500 to 1000 mL at term. Excess fluid more than 2000 mL or an amniotic fluid index above 24 cm is considered

Back 43

hydramnios

Front 44

A term pregnancy is 38 to 42 weeks long. A pregnancy that exceeds these limits is prolonged :

Back 44

(post term pregnancy, postmature, or postdate). The infant of such a pregnancy is considered postmature, or dysmature

Front 45

(false pregnancy), nausea and vomiting, amenorrhea, and enlargement of the abdomen occur in either a nonpregnant woman or a man

Back 45

pseudocyesis

Front 46

an aborticient that causes sloughing of the implantation site,

Back 46

. Mifepristone