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10 Cards in this Set

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  • Back
What nursing implications exist regarding incompetent cervix?
Teaching - the woman must understand the importance of contacting her physician immediately of her membranes rupture or labor begins. The physician can remove the suture to prevent possible complications.
What is Hyperemesis?
Extremely rare condition characterized by excessive vomiting during pregnancy.
What factors may be associated with Hyperemesis?
Although the exact cause of hyperemesis is unclear, increased levels of hCG may play a role. Other variables include transient hyperthyroidism, hypofunction of the anterior pituitary gland and the adrenal cortex, abnormalities of the corpus luteum, Helicobacter pylori infection and psychologic factors.
What nursing treatment and patient education may be indicated for hyperemesis?
In severe cases hyperemesis begins with dehydration, which leads to fluid-electrolyte imbalance and alkalosis from loss of hydrochloric acid. Hypovolemia, hypotension, tachycardia, increased hematocrit and blood urea nitrogen(BUN), and decreased urine output can also occur. Initially the woman is NPO and IV fluids are given. Potassium chloride is given to prevent hypokalemia. Antiemetics can be given, if after 48 hours of NPO and the condition does not improve, TPN may be given.
Define Premature Rupture of Membranes )PROM):
Spontaneous rupture of the membranes prior to the onset of labor. PPROM (preterm premature rupture of membranes) is the rupture before 37 weeks gestation.
How is PROM diagnosed?
A sterile speculum examination is done to detect the presence of amniotic fluid in the vagina. If fluid is not obviously pooling, the diagnosis can be confirmed with nitrazine paper (which turns navy blue) and a microscopic examination (ferning test).
What risk does PROM pose to the mother?
Maternal risk is related to infection, specifically chorioamnionitis and endometritis. In addition, abruptio placentae occurs more frequently in women with PROM.
What risk does PROM pose to the fetus?
Risk of respiratory distress syndrome, fetal sepsis due to ascending pathogens, malpresentation, prolapse of the umbilical cord and increased perinatal morbidity and mortality.
How is PROM managed conservatively?
Management of PROM in the absence of infection and gestation of less than 37 weeks is usually conservative. The woman is hospitalized on bedrest. On admission a CBC, C-reactive protein and UA are obtained. Continuous fetal monitoring may be ordered at the beginning of treatment. Regular nonstress tests or biophysical profiles are used to monitor fetal well-being. Maternal VS are done q4 hours. Vaginal exams are avoided to decrease chance of infection. Although controversial, after initial treatment and observation, if leaking ceases, some women may be followed at home (they must have sufficient amniotic fluid, no infection and cervical dilation of less than 4cm).
When is PROM treated more aggressively?
Maternal corticosteroid administration to promote fetal lung maturity and prevent respiratory distress syndrome remains controversial because of possible adverse effects on the fetus and mother. Currently a single dose of betamethasone is recommended for women with PROM prior to 30 to 32 weeks gestation, if there is no intra-amniotic infection. Repeat courses of corticosteroids should not be routinely used.