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84 Cards in this Set
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when vomiting during pregnancy becomes excessive enough to cause electrolyte, metabolic, nutritional imbalances this condition is
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hyperemesis gravidarum or pernicious vomiting
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it is associated with
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wt loss, dehydration, acidosis, ketones
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mostly associated with
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higher levels of HCG
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it is one of the most common nutrition related discomforts
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hyperemesis
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more common among
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unmarried white women during first pregnancy
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what can become depleted
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potassium leading to cardiac arrythmias
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what should be assessed
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the frequency, amount and character of emesis
assess fetus status |
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medical tx is
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meeting nutritional needs - this might mean hospitalization and TPN
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the pt should be
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weighed daily, and good oral care should be done
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wt loss and ketones in urine suggest what
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that fat stroes and protein are being metabolized to meet energy needs
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pt teaching should include
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dietary consultation
education on disease assist with own treatment referrals to psych, dr, social worker |
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twins originate with one fertilized ovum, ethe embryonic disk divides, causing identical twins
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monozygotic
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twins are the result of two separate ova being fertilized at the same time. they have two separate placentas, and dont always look alike
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dizygotic
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gestational trophoblastic disease
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hydatidiform mole (molar pregnancy)
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there are two distinct types
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complete or partial
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women at high risk for the mole are
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those who have undergone ovulation stimulation with clomiphene, early teens, older than 40
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riks for a second mole is
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1 - 2 %
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usually the complete mole contains no
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no placenta, fetus, amniotic membranes or fluid
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in about 20% of cases the complete mole progression toward
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cancer occurs
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signs and symptoms are
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in early stages cannont be distinguished from normal pregnancy
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later stages signs and symptoms
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vaginal bleeding in about 95% of cases
vaginal discharge (v. dark, like prune juice) or bright red either scant or profuse |
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the uterus is usually
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larger than expected from menstrual dates
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other s/s
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n/v excess, anemia, abdominal cramps, uterine distention , preeclampsia
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passages of vesicles (grape like clusters) might appear att
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16 weeks of gestation
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diagnostic tests
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US, amniography and mesurement of chorionic gonadotropin level
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most cases the mole is discovered in
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abortion or threatened or in progress
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medical management
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most spontaneously abort,
suction curettage is good |
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what med. management should not be preformed
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inducing labor with oxytocic
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adminisrationo what with RH neg mother
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Rh D immune globulin
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use should not get pregnant for at least how long
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one year
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implantation occurs somewhere other than within the uterus
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ectopic pregnancy
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the most common site is the
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fallopian tube
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higher incidence in
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nonwhite older women
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most common cause is
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PID
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s/s are
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slight vaginal bleeding
hypovolemic shock sharp , localized one sided pain or pain referred to the shoulder |
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treatment is
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rapid surgery
salpingectomy |
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what is used for unruptured ectopic pregnancys
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single or multiple doses of methotrexate
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the termination of pregnancy before the age of viability
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abortion
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spontaneous abortions are referred to
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miscarriages
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most occur in the
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first trimester
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spontaneous abortions occurs from
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natural causes
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therapeutic is caused by
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elective abortion
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spontaneous abortions are caused by
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abnormal embryonic development, chromose defects, inhertibable disorders
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main symptoms is
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bleeding, which may or may not be associated with cramps and lower back pain
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they are classified as
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threatened - unexplained bleeding and cramps
inevitable - bleeding occurs and hte cervical os begins to dilate complete - all products of conception are expelled incomplete - some, but not all products are expelled missed - fetus dies and growth ceases but fetus remians in utero septic - malodorous bleeding, elevated temp, cramping habitual - recurrent spontaneous abortion in three or more consecutive pregnancies |
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medical management
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iv fluids
blood replacement d&c |
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pt teaching
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rest
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occurs when the placenta implants in the loer uterine segment
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placenta previa
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risk factors include
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previous c - sections - most important risk factor
multiple gestation close spaced pregnancies, previous placenta previa advanced maternal age |
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the main sign and symptoms is
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painless, bright red vaginal bleeding occuring after 20 weeks of gestation
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dx test for it is
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US
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tx of choice is
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c - section
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if pt is at home they should staty on
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bed rest, and have someone with them at all times
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nurse should teach the pt
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assess vaginal discharge or bleeding after urination or bowel movement, monitor fetal movements, assess uterine activity, omit from sex
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premature separation of hte normally implanted placenta from the uterine wall
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abruptio placentae
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it generally occurs in
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late pregnancy
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major symptoms are
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sudden severe pain accompanied by uterine rigidity
uterus may increase in size as a result of hemorrhage |
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dx tests most common one is
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h and H
US hormone studies |
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what should be avoided
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vaginal and rectal examinations
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tx is
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c section blood replacement
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this is a disease encountered during pregnancy characterized by increasing hypertension, albuminuria, and generalized edeema
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pregnancy induced hypertension
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most often seen in
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primigravidas, those younger than 20 - 25
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most common in women who are
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poor nutritional status, or lower socioeconomic groups
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the only known cure is
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termination of pregnancy
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complex hormonal and vascular changes occur with PIH
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increased BP, decreased placental perfusion, decreased renal perfusion, altered glomerular filtration rate, fluid and electrolyte imbalance
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classic signs of PIH in order of appearance are
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1. edema
2. hypertension 3. proteinuria |
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when do these signs occur
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usually after 20 weeks of pregnancy
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sings of mild preeclampsia are
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bp of 140/90
generalized edema (face, hands, ankles) wt increase of 3 lbs permonth in the second trimester urine testing shows 1+ to 2+ albumin urine output is less than 500 ml per 24 hours |
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symptoms of severe preeclampsia may occur
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suddenly
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symptoms are
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bp of 160/110
edem in the face, hands, sacral abdomen wt increases dramatically urine albumin shows 3 + 4 + urine output is less than 500 ml in 24 hours |
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the most severe form of PIH is
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eclampsia
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the most dramatic characterisitic is
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seizures with tonic and clonic generally followed by a coma that last minutes to hours
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also characterized by
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elevated BP, albuminuria, oliguria
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it is important to remember PIH can occur at any time after
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20 weeks and persist until 2 days after delivery
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what is the sx of hte precursors of convulsions
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HA, drowsy, mental confusion,
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sx such as epigastric pain or upset stomach indicate
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convulsions are iniment
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visual disturbances - blurred vision, double vision indicate
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arterial spasms - edema in the retina
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if the pt is hospitalized monitor
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deep tendon reflexes
urinary output FHR |
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dx tests are
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H & H
bun cbc clotting studies specific gravity for protein |
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bed rest is order in what position
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left lateral recumbent position
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what is given parenterally to prevent sezuires
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magnesuim sulfate
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what should you watch for
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HA, edema , blurred vision
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protection during convulsions include
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-remain with pt - press emergency bell
- attempt to lay on side when in the tonic phase - note time and sequence of convulsions - insert airway after convulsions, suction mouth and nose -o2 8-10 L - observe fetal monitor - call doctor, or have someone call the dr |
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diet should be
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high protein, vitamin, mineral intake
salt should not be below 4 - 6 g bed rest is vital and a quiet environment is vital |
