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91 Cards in this Set

  • Front
  • Back
What is the most common disorder of pregnancy?
hypertension disorders of pregnancy
What is the most common medical problem?
anemia
What is the 2nd leading cause of maternal death in the US?
pre-eclampsia
What is the only cure for pre-eclampsia?
removal of the placenta
What are the first three things to assess in a women with suspected pre-eclampsia?
-is she puffy?
-what is her BP?
-what is the TP in her urine?
What are the signs of mild pre-eclampsia?
-BP >140/90 but <160/110 on two separate occasions (6hr apart)
-proteinuria >300mg but <5g/24hr
What are the signs of severe pre-eclampsia?
-BP >160/110 on two separate occasions (6hr apart)
-proteinuria >5g/24hr
-oliguria <400ml/24hr
-thrombocytopenia
-HELLP syndrome
-pulmonary edema
-eclampsia
What are some symptoms of severe pre-eclampsia?
-HA ** (new onset)
-RUQ pain
-visual changes
What are the three indicators for magnesium sulfate?
-PTL
-neuroprotection
-severe pre-eclampsia
How do you dose magnesium sulfate?
-4g loading over 20 minutes
-1-2g per hour
What kind of nursing care are you giving a patient on magnesium sulfate?
this drug is dangerous and must have one to one care.
check all the following later:
1. DTR & clonus
2. RR
3. LOC
4. serum level (4-7mEq)
What is the antidote for magnesium sulfate?
CaGluconate 10% IVP immediately
How long after birth can a mother have an eclamptic seizure?
up to 42 days after birth
What is the HELLP syndrome?
-Hemolysis
-Elevated Liver Enzymes
-Low Platelet Count
What are the symptoms of HELLP?
-nausea
-vomiting
-malaise
-flu-like symptoms
-epigastric pain
If a patient has high blood pressure > 20 weeks what is it called?
pre-eclampsia
If a patient has high blood pressure <20 weeks what is it called?
chronic hypertension
What are the maternal risks with Pre-E/Eclampsia?HELLP?
-CNS (HA, hyperreflexia, seizures, stroke)
-pulmonary edema (3rd spacing: leaky capillaries)
-thrombocytopenia
-hematoma of liver
-acute tubular necrosis
-liver capsular swelling & rupture
What are the fetal/neonatal risks?
-preterm delivery
-fetal death/hypoxia from utero-placental insufficiency
-still birth
-fetal growth restriction
-placental abruption
-over sedation from maternal meds (mag)
What is the pre-eclampsia assessment
-BP q15mins
-FHR tracing
-hourly urine output
-urine protein
-urine specific gravity
-edema
-lab tests
-pulmonary edema (BS)
-DTR
-Clonus
-placenta abruption (tenderness, pain, uterine tightness)
-HA
-visual disturbances
-LOC
-epigastric pain
What medications are you giving to a patient coming in with severe pre-eclampsia?
-magnesium sulfate
-apresoline
-corticosteroids
What will we see with magnesium overdose?
1. no DTR
2. RR<10
3. change in LOC
4. respiratory arrest
5. clonus arrest
What are your nursing cares for a intrapartum management of eclampsia?
-emergency
-note time and length
-turn patient to side
-o2
-suction
-may need second loading dose of mag (4-6g IVP)
What is the most important thing to check for if a patient has a seizure during labor?
check to see if baby has delivered in the bed
What is the worst case scenario with HELLP syndrome?
DIC
If your patient is on mag AP how long after birth will she remain on mag?
24 hours after birth and mother cannot be left alone with baby while on mag
Most seizures occur when?
48 hours after birth
For PIH (pregnancy induced HTN) what labs are we going to go shopping for?
1. BUN (increase)
2. creatinine (increase)
3. liver enzymes (increase)
4. CBC (decrease)
5. 24 hour TP
6. uric acid (increase)
7. LDH (increase)
8. fibrinogen
9. fibrin split products
What will happen to BUN and creatinine typically during pregnancy?
lower
What is A1GDM?
diet controlled GDM
What is A2GDM?
insulin controlled GDM
Prior to pregnancy we want our patients in "tight control" with DM1 and DM2?
HgbA1c<6.5
What are the risk factors for GDM?
-previous GDM
-ethnicity (african american, hispanic, native american)
-family history
-BMI >25
-Age >25
-previous hx of macrosomia
-undiagnosed IUFD in the 3rd trimester
With patients who have prior DM1 or DM2 should we give them a glucocola test?
NO, we should not test them. We should just check their blood sugar.
When you test a patient with the glucola test, what is the normal value?
normal is <135mg/dL
if over 135 proceed to diagnostic testing
if over 180 pt is overly diabetic
How many 3 hour glucose test must be elevated to diagnosis GDM?
2 elevated values for GDM
What is the criteria to diagnose a patient with GDM who prior to pregnancy had DM1 and DM2?
test blood sugar 4x a day for one week and if 20% are abnormal then you are GDM.
What is definition of anemia during pregnancy?
<10g/dL pregnant
<12g/dL in non-pregnant

(11.5 at our altitude)
What can we give to treat IDA?
ferrous sulfate 325mg tid
add colace
teach bowel habits (fruit, water, fiber)
How does GDM effect fetal lung maturity?
hyperglycemia somehow competes at the cellular level for surfactant production and fetal lung maturity
What are the possible causes of bleeding in the first trimester?
-SAB*
-TAB
-Ectopic*
-Hematoma
-Infection
-Intercourse
-Implantation
-Exercise
What are the possible causes of bleeding in the second trimester?
-Late SAB
-Late TAB
-GTD* (gestational trophoblastic disease)
-PTL
-Previa
-Abruption
-Trauma
-Incompetent cervix*
Is bleeding in the first trimester common?
yes
What is the most important for the nurse to do with a SAB?
provide anticipatory guidance. provide comfort
What is the implantation of a conceptus in a site other than the endometrial lining of the uterus?
ectopic pregnancy
How do we treat an ectopic pregnancy?
needs medical or surgical treatment to remove
Where is the most common location for an ectopic pregnancy?
ampullar tubal
What are the most common (early) signs and symptoms of eptopic pregnancy?
-misses menses
-bleeding/spotting or brownish discharge
-lower quadrant abdominal or rectal pain
-positive hCG test
What happens with hCG during normal pregnancy, eptopic and miscarriage?
-normal: hCG doubles throughout the entire pregnancy
-eptopic: hCG stays about the same
-miscarriage: hCG decreases
What is a pathologic proliferation of trophoblastic cells?
gestational trophoblastic disease (GTD)
A patient with GTD must have the following for follow up?
-beta hCG for a year
-chest x-ray monthly for a year
-good birth control
When a woman has GTD and it is removed what is she at risk for?
PPH
What is painless dilation of the cervix without contractions because of a structural or functional defect of the cervix before 16-18 weeks gestation?
incompetent cervix
What is it when a suture is placed in the cervix to prevent preterm cervical dilation and pregnancy loss?
cerclage
What are the nursing duties when performing a cerclage?
-epidural vs general anesthesia
-OR, sterile environment
-mersilene suture
-exposure for MD (retractors)
-observation for PTL after placement (bleeding, contractions, ROM)
-IV & I&O
What does TORCH stand for?
-Toxoplasmosis
-O: Other pathogens
-R: Rubella virus
-C: Cytomegalovirus
-H: Herpes
What can TORCH cause?
congenital anomalies
What are methods of infection of TORCH?
-transplacental
-vertical
-direct contact
How is HIV transmitted to the fetus?
transplacental
What should we NOT do with an HIV positive mother?
-avoid FSE
-scalp pH
-forceps
-vacuum extraction
What are the catastrophic effects to a fetus during the first trimester with a mother who is positive for Rubella?
-blindness
-deafness
-cataracts
-heart defects
What is the most common viral cause of intrauterine infection?
cytomegalovirus
What virus belongs to the herpes family?
CMV
What is the prophylaxis treatment for HSV?
at 35-36 weeks offer prophylactic anti-viral medication, if they have had 2-3 outbreaks during pregnancy. zovirax (acyclovir) 500mg bid
What are the four T's for PPH?
-tone (uterine tone)
-tissue (retained products)
-trauma (lacerations and hematomas)
-thrombo-embolic diseases
What are the PPH medications?
-prostaglandin F2 alpha
-hemabate 250mcg IM
-methergine 0.2mg IM
-pitocin 10u/1ml IM or 30u/1ml in 500ml NS
-cytotec 100mcg tablet x 10 rectally
What is the most common cause of PP infection
endometritis
What is mastitis typically caused from?
normal body flora (staph aureus)
What are the signs and symptoms for mastitis?
-high fever
-breast tenderness
-redness over clogged and infected lobule
-RED & HOT
What are PP "blues"?
last 2-3 days after birth (can be quite dramatic)
What is the most common PP modd change?
PP blues
What are the signs and symptoms of PP blues?
-fatigue
-uncertainty
-frustration
-hormonal fluctuations
-unrealistic expectations
-lack of sleep and support
What is the treatment for PP blues?
-rest
-support
-reassurance
What could possibly be the cause of PP depression?
-hormones
-chemical imbalance
-genetic predisposition
-lack of sleep
What is the treatment for PP depression?
-ask
-support groups
-anti-depressant safe to use with BF
-help at home
-reassurance is not alone
What does a woman have if there is euphoria with hallucinations before depressive symptoms and severe mood swings?
postpartum psychosis
What is the treatment with postpartum psychosis?
-hospitalization with baby but never left alone
-antipsychotic medications
-therapy
A mother with pre existing cardiomyopathy will have what 6 months after delivery?
profound presentation of cardiac decompensation up to 6 months after delivery
What is the TSB for normal physiologic jaundice?
4-6mg/dL
When should normal physiologic jaundice start and end?
it should not happen within first 24 hours and it should end within 7 days
When does pathologic jaundice take place?
within first 24 hours
What is the TSB for pathologic jaundice?
greater than or equal to 0.2mg/dL/hr
What is the number one risk for respiratory distress syndrome in neonates?
prematurity
When does BF jaundice take place?
after 4th day and peaks into 2-3 weeks
What does a baby in respiratory distress look like?
-grunting #1
-nasal flaring
-tachycardia
-tachypnea
What is the most common pathogen responsible for sepsis in a neonate?
group B strep
What are the signs and symptoms of NEC?
-gastric residuals >30% of previous feeding
-abdominal distension
-blood in stool
What is apnea in the preterm defined as?
cessation of breath x 20 sec during which the neonate exhibits bradycardia, cyanosis, hypotonia & acidosis
What can we do for the best developmental care of the preterm?
-nest (positioning)
-contain procedures
-observe for clues the preterm is ready for socialization (watches you, sucks on feeding tube)
What is the most common cause of death in ventilated neonates?
intraventricular hemorrhage
How much folic acid should you take if you are pregnant?
400mcg daily