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30 Cards in this Set

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What are some pre-existing problems which may adversely affect pregnancy?
age, parity, blood type, socioeconomic status, psychologic health or preexsting chronic illesses.
How does excessive alcohol consumption affect a pregnant woman?
Chronic alcohol use can cause malnutrition, bone marrow suppression, increased incidence of infections and liver disease.
How does alcohol affect the fetus?
Effects incluce Fetal Alcohol Syndrome (FAS). Newborns may also suffer withdrawal. Breastfeeding is not contraindicated but it may intoxicate the infant and inhibit letdown.
What is the effect of cocaine use on a pregnant woman?
Prevents reuptake of dopamine and norepinephrine, which results in vasoconstriction, tachycardia and HTN. Increases incidence of spontaneous abortion, abruptio placentae, preterm birth and stillbirth. Symptoms include mood swings, appetite changes, and withdrawal symptoms such as deression, irritability, nausea, lack of motivation and psychomotor changes.
What effects does cocaine have on the fetus?
Increase risk of intrauterine frowth restriction (IUGR), small head circumfrance, cerebral infarctions, shorter body length, altered brain development, malformations of the GU tract and lowe agar scores. Cocaine also crosses into breastmilk.
What is the effect of Marijuana on a pregnant woman?
Risks are dose related, with an increase risk of intrauterine growth restriction and sudden infant death syndrome in infants born to heavy users.
What effects does Marijuana have on the fetus?
Marijuana is associated with impaired coordination, memory and critical-thinking ability.
What is the effect of Heroine on the pregnant woman?
Pregnany users are considered high risk because of the increased incidence of poor nutrition, iron deficiency anemia, and preeclampsia as well as higher incidence of STD's.
What effects does Heroine have on the fetus?
Increased risk for intrauterine growth restriction (IUGR), meconium aspiration and hypoxia.
What are symptoms of withdrawal from Heroine in the newborn?
Signs of withdrawal usually appear within 72 hours and may last for several days. The most significant postnatal problem is withdrawal. The Heroine addicted newborn frequently suffers respiratory stress, mainly meconium aspiration pneumonia and transient tachypnea
How does pregnancy affect diabetes?
During the first trimester the need for insulin decreases and during the second trimester it increases. N/V may lead to hypoglycemia, increased energy needs during labor may require increased insulin, usually an abrupt decrease in insulin requirements occurs after the passage of the placenta. All pregnant women should be screened for gestational diabetes toward the end of the second trimester.
How does diabetes adversely affect pregnancy?
The pregnant diabetic is at higher risk for perinaltal mortality and congenital anomalies. They are also at increased risk for monilial vaginitis, UTI, hydramnios, preeclampsia-eclampsia and hyperglycemia can lead to ketoacidosis.
How can diabetes affect the fetus?
Mom needs tight control - cannot take oral hypoglycemics. Increased risk for anomalies involving the heart, central nervous system and skeletal system. Infants can be LGA (large for gestational age). Excessive growth is called MACRSOMIA. Infants may display intrauterine growth restriction (IUGR), respiratory distress syndrome, polycythemia and hyperbilirubinemia.
What special monitoring of the pregnany diabetic is indicated?
Women with any risk factors should be screened earlier than the second timester for gestational diabetes. 1-2-3 hour fasting is done and levels are checked. If two or more values are equaled or exceed, gestational diabetes is diagnosed.
What special surveillance regarding gestational diabetes is important during labor?
Frequent maternal insulin requirements decrease dramatically during labor. Often two IV lines are used, one with D5 and one with saline solution. The IV insulin is discontinued with the completion of the third stage of labor.
What postpartum teaching of DM or GDM is indicated?
Antihyperglycemics are contraindicated during breastfeeding. Insulin requirements fall significantly after birth regardless of type of diabetes. Woman with GDM who did not require insulin therapy during pregnancy generall does not need it postpartum. The woman should be assessed 6 weeks postpartum. If levels are normal, she should be reassessed at a minimum of 3-year intervals.
What types of Anemia are associated with pregnancy?
Anemia indicates inadequate levels of hemoglobin in the blood. During pregnancy, anemia is defined as hemoglobin less than 10g/dL. Types of anemia include iron deficiency, sickle cell and folic acid anemia.
What is iron deficiency anemia?
Inadequate iron intake resulting in hemoglobin levels of less than 11g/dL. Most women are advised to take supplemental iron.
What is sickle cell anemia?
Autosomal disease in which normal adult hemoglobin is abnormally formed (sickling of RBC's).
How is sickle cell anemia treated?
Crisis is treated by rehydration with IV fluids, administration of oxygen, antibiotics and analgesics. The fetus is monitored throughout.
What nursing care needs may be associated with sickle cell crisis in labor?
Pregnancy may aggravate sickle cell anemia and bring vaso-occlusive crisis. Maternal mortality is rare but there is a significant risk of maternal infection. Maternal infection is treated promptly because dehydration and fever can trigger sickling and crisis. Oxygen, IV fluids, antiembolism socks and close fetal heart rate monitoring are all interventions.
What is folic acid deficiency?
In the absence of folic acid, immature RBC's fail to divide, become enlarged (megaloblastic), and are fewer in number. Increased folic acid metabolism during pregnancy and lactation can result in deficiency.
How is folic acid anemia deficiency treated?
Because the condition is difficult to diagnose, the best approach is prevention. All women who become pregnant shold take a multivitamin containing 400 mcg daily before conception and through at least the first trimester.
What foods are high in folic acid?
Fresh leafy green vegetables, red meat, fish, poultry and legumes but is easily destroyed by overcooking or cooking with large quantities of water.
What is the pathophysiology of AIDS in pregnancy?
HIV-1 which causes AIDS typically enters the body through blood, blood products, or other body fluids such as seme, vaginal fluid and breast milk. HIV affects specified T cells and decreases the body's immune response. Thus making the affected person succeptible to opportunistic infections such as pneumonia, candidiasis, tuberculosis and toxoplasmosis.
What drug is given to a pregnant client with HIV/AIDS?
Combination ARV therapy suppresses viral replication, helps preserve immune function and reduces the developent of resistance. ZIDOVUDINE (ZDV) is perhaps the best.
Why is Zidovudine the drug of choice? How is it given?
Best choice because is is effective in reducing perinatal transmission during early clinical trials, and indications to date suggest that it is relatively safe during pregnancy. Some wait until 12 weeks to start therapy because the fetus is most susceptible to teratogens during the first 10 weeks. It is available in tablets, syrup or injection. There is a three part prophylaxis - one tablet daily, IV form during labor until birth and oral for the infant starting 8-12 hours after birth.
What management of the client using ARV therapy is indicated?
Assessed regularly for absolute CD4+ lymphocyte count (200/mm or lower increases risk of infection), close fetal monitoring.
How is fetal well-being evaluated when a mother has HIV/AIDS?
Invasive procedures like fetal scalp monitoring, vaginal exam after ROM, vacuum assist should only be done after weighing the risks. C-section may be used to further decrease transmissin. Weekly NST are given at 32 weeks, serial ultrasounds to detect IUGR and biophysical profiles are indicated.
What teaching for the childbearing family is indicated regarding HIV/AIDS?
Prenatal counseling about the possible implication of HIV for the fetus as well as subsequent family planning.