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112 Cards in this Set
- Front
- Back
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What are some causes of UTIs during pregnancy?
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• Decreased muscle tone of urethra
• Decreased baldder tone • Increased bladder capacity • Incomplete emptying • Elevated urine pH level and glycogen level |
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Why can a decreased muscle tone of urethra cause a UTI?
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These is reduced passage of urine through system causing some stasis- stasis leads to bacterial pooling/infection
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What is the common treatment for a lower UTI?
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abx-oral single/3 day/or 7 day doses
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What are the common abx to give for UTIs?
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Trimethoprimsulfamethoxazole
Fluoroquinolones fomycin tromethmine |
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If a UTI present, a ____ culture may also be needed.
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blood
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What complications can arise from a UTI?
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Preterm labor
Septicemia Restricted growth- low birth weight Preeclampsia HTN Maternal anemia |
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Anemia indicates...
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inadequate levels of hemoglobin (Hb) in the blood
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What are causes of maternal anemia?
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-Insufficient Hgb production r/t nutritional deficiency in iron or folic acid
-Hgb destruction in inherited disorders (sickle cell) -Baby needs high supply of iron so mother is deprived |
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What Hgb level is needed to diagnose maternal anemia?
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Hgb < 11g/dL in pregnant women
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What is the most common tyoe of anemia in pregnant women?
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iron deficiency anemia
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How does folic acid deficiency cause anemia?
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Folic Acid is needed for RNA and DNA synthesis and cellular replication- absence in F.A. causes immature RBCs to fail to divide- result is bigger and fewer RBCs
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How to treat iron deficiency anemia?
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Prenatal iron supplements daily
Iron rich diet |
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How much iron should women take during pregnancy?
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27mg daily
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What can a diet high in iron cause?
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constipation- can take stool softener
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What complications can maternal anemia cause?
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Infection
Fatigue Increased preeclampsia and postprandial hemorrhage Poorly tolerated minimal blood loss during labor Delayed healing Cardiac failure |
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What fetal complications can maternal anemia cause?
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Low birth weight
Prematurity Stll birth Neonate birth Neonate death Increased r/f iron deficiency during infancy |
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How to treat folic acid anemia?
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0.4 mg folate supplement daily and 1 mg folic acid supplement taken with iron
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What are fetal complications of folic acid anemia?
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Neural Tube defects (spina bifida)
Anencephaly Meningyolocele |
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What causes N/V during first trimester of pregnancy? (morning sickness)
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-Increasing levels of hCG (major cause- when levels subside so does N/V
-Hormones- rising estrogen -Metabolic, neurologic, psychosomatic factors |
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What should we teach mom about diet to decrease morning sickness?
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Eat dry crackers/toast before arising
Dry meals with fluids between meals Eat small meals q2-3 hrs Avoid greasy or highly seasoned foods Low fat protein and complex carbs Avoid trigger foods/odors |
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What to teach mom about getting out of bed if she is experiencing morning sickness?
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Get out of bed slowly (avoid Hypotension)
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What is pitocin used for antepartum?
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to induce or augment uterine contractions
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What is pitocin used for postpartum?
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to control postpartum bleeding or hemorrhage
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When is pitocin contraindicated?
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hypotension
hypertonicity cephalopelvic disproportion. |
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What are maternal s/e of pitocin?
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Nausea
vomiting uterine hypertonicity cardiac arrythmias |
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What are the most serious maternal s/e of pitocin?
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uterine rupture
water intoxication |
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What are fetal s/e of pitocin?
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Bradycardia
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What are the most serious fetal s/e of pitocin?
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hypoxia
permanent brain damage death |
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Pitocin can be administered after the cerevix has ______
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ripened
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When titrating pitocin, increase amount _____
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slowly
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When administering pitocin, ______ the infusion if hypertonicity or fetal compromise occurs
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stop
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What to teach pt about piton?
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purpose of the drug & rationale for frequent assessment
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What is Magnesium Sulfate mainly used for?
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preventing/treating seizures associated with preeclampsia, eclampsia, and preganancy induced hypertension
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What is a secondary use for Magnesium Sulfate
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Also been used as a tocolytic (Preventing the onset of labor) because it is a CNS and muscular depressant.
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Side effects of magnesium sulfate stem from...
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magnesium toxicity
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Maternal s/e of magnesium sulfate
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Headache
hyporeflexia weakness thirst flushing |
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Most serious Maternal s/e of magnesium sulfate
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Circulatory collapse
respiratory depression pulmonary edema |
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Fetal s/e of magnesium sulfate
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Heart rate changes
neonatal hypotonia respiratory depression |
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How is Mag Sulfate administered?
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IM or IV
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What to monitor for with mom and fetus while admin mag sulfate?
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Continuously monitor vitals of mom and fetus
(Watch for respiratory depression, drop in BP, increased PR interval, increased QRS complex) |
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What labs must be drawn frequently while pt is on mag sulfate?
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Serum Mg levels
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What diet should pt be on if they are on mag sulfate?
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NPO
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What position to place mom in if she is on mag sulfate?
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Place in left lateral recumbent position
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What precautions to have on standby if pt is on mag sulfate?
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Have seizure precautions ready
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What other medication to have on standby if pt is on mag sulfate?
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calcium gluconate (Antidote)
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What is Betamethasone?
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A steroid used to prevent respiratory distress in newborns by accelerating pulmonary maturity.
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When and how is Betamethasone given?
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It is given IM once a day for 2 days and birth should be delayed for at least 24 hrs after completing the first round of treatment
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When is Betamethasone contraindicated?
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when birth cannot be delayed
there is an inadequate L/S ratio maternal infection diabetes gestational age greater than 34 weeks. |
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What are maternal s/e of Betamethasone?
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Increased risk for infection is possible
hyperglycemia pulmonary edema (especially when used with tocolytics) |
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What are fetal s/e of Betamethasone?
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Lower cortisol levels
hypoglycemia risk of neonatal sepsis |
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Where is Betamethasone administered?
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Administer deep into gluteal muscle (Not in deltoid) if given IM (or can be given IV)
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What is Ritodrine and what is it used for?
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A tocolytic beta agonist. It is used to treat pre-term labor
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Why is Ritodrine not used that much?
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because it has more adverse effects than terbutaline and has been discontinued by the manufacturer
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What is Terbutaline?
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A tocolytic beta agonist
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What is Terbutaline used for?
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used to control labor that is between 20 and 34 weeks gestation.
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When is Terbutaline contraindicated?
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before 20 weeks or in the case where a beta agonist might be dangerous to the mother.
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Terbutaline is a Beta 2 _______ (__________) and is counteracted by _____ ______
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agonist (stimulant)
beta blockers |
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What are maternal s/e of Terfbutaline?
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Tachycardia
palpitations arrythmias tremors |
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What are the most serious maternal s/e of Terfbutaline?
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Pulmonary edema,
cerebral and myocardial ischemia |
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What are fetal s/e of Terbutaline?
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Tachycardia
hypoglycemia (Can be serious) |
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What antidote to have ready nearby in case of Terbutaline overdose?
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A Beta Blocker
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When should Terbutaline be administered?
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as soon as preterm labor has been diagnosed
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What to monitor while pt is on Terbutaline?
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-Monitor maternal pulse rate, BP, fluid status
-Monitor fetal heart rate (decrease infusion rate if adverse effects appear) |
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What is important pt teaching for pts being given Terbutaline ?
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This drug buys time for other drugs to have an effect that might eliminate complications of the preterm newborn
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What is physiological jaundice?
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A harmless condition caused by accelerated destruction of fetal RBCs, impaired conjugation of bilirubin, and increased bilirubin reabsorption
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When does physiological jaundice occur?
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during transition from intrauterine to extrauterine life and appears after 24hrs of life
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Why does jaundice occur after birth?
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ilirubin is taken care of in utero by the placenta. After birth the amount of bilirubin is dependent on rate of hemolysis, bilirubin load and majority of liver and presence of albumin binding sites. ****So what happens is the inability of the liver to adequately bind bilirubin for excretion.***
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Physiologic jaundice is caused by the shorter ____ ___ of the fetal RBCs, slower uptake by the ________ and lack of ________ bacteria and hydration level.
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life span
liver intestinal |
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High levels of bilirubin is _________. Bilirubin crosses the blood brain and directly damages brain cells, and produce ___________ which refers to the depositing of bilirubin in the basal ganglia of the brain.
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neurotoxic
kernicterus |
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How does indomethacin cause hyperbilirubinemia?
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drug that causes a decrease in the binding affinity of bilirubin to albumin
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Why are premature babies more at risk for hyperbilirubinemia?
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premature infants have less albumin available for bilirubin to bind with
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What is the major worry about preterms with hyperbilirubinemia?
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we worry about these infants having high concentrations of unconjugated bilirubin and damage to the brain.
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Why are babies with high bilirubin levels encouraged to breastfeed or formula feed?
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higher intake of food leads to increased excretion of bilirubin (it is excreted in stool)
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Erythroblastosis fetalis and Hydrops fetalis
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hemolytic diseases of the newborn characterized by anemia, jaundice, hepatomegaly, splenomegaly, and generalized edema
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What causes Erythroblastosis fetalis and Hydrops fetalis?
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Caused by isoimmunization due to Rh incompatibility or ABO incompatibility
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Who is at increased risk for babies having hyperbilirubinemia?
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pregnant women who are Rh negative or who have blood type O (or both) → Possible Rh/ABO incompatibility
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What are 2 treatments for hyperbilirubinemia?
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Phototherapy and
exchange transfusion |
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Phototherapy
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-Highly effective in decreasing elevated bilirubin levels, particularly in cases of non-hemolytic hyperbilirubinemia
-The lights facilitate the excretion of unconjugated bilirubin by converting in into photobilirubin which are 2 isomers. |
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What are complications of phototherapy?
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dehydration
nutrition deficits skin integrity deficits EYE DAMAGE thermal regulation problems |
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Exchange Transfusion
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used to treat anemia with RBCs that would soon be lysed, remove serum bilirubin and provide bilirubin-free albumin and increase the binding sites for bilirubin
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What are the concerns for exchange transfusions?
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potential for HIV and hepatitis
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Complications of untreated hyperbilirubinemia
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Kernicterus or Acute Bilirubin Encepalopathy (ABE)
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Kernicterus or Acute Bilirubin Encepalopathy (ABE)
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"yellow nucleus”; refers to the deposition of indirect or unconjugated bilirubin in the basal ganglia of the brain
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What are S/S of sepsis in newborns?
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Subtle behavioral changes “not doing well”
Temperature instability Feeding intolerance Hyperbilirubinemia Tachycardia, spells of apnea or bradycardia |
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What is an early sign of sepsis in a newborn?
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hypothermia
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What are late signs of sepsis in newborns?
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more than one episode of forceful vomiting,
refusal of two feedings in a row, lethargy, cyanosis with or without a feeding, and absence of breathing for longer than 15 seconds. |
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What does apnea have to do with infection?
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They go hand in hand! :)
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What infants have the highest mortality with infection?
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infants who are preterm and small for gestational age
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What cultures to take in infants when sepsis suspected?
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Culture many sites, spinal, suprapubic bladder aspirations, skin & orfaces.
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take cutures especially in infants whose moms had ____
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PROM
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What are common infections in neonates?
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bactermia or sepsis, UTI, meningitis or pneumonia
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Indications for the use of ______ include the presence of any condition that threatens the mother or fetus and that can be relieved by birth.
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forceps
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What are conditions that put mom at risk for needing forcep assist?
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Heart disease
Acute pulmonary edema or pulmonary compromise, Certain neurological conditions Intrapartal infection Prolonged second stage, or exhaustion |
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What are some fetal conditions that may indicate the need for forcep intervention?
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premature placental separation
Prolapsed umbilical cord Nonreassuring fetal status |
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What are Risk factors for a forceps or vacuum-assisted birth?
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Nulliparity
Maternal age > 35, maternal height < 4' 11" Excessive pregnancy wt gain Posterm baby Epidural anesthesia, Dystocia Infant presentation other than occipitoanterior Abnormal FHR tracing |
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Vacuum extraction
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an obstetric procedure used to assist the birth of a fetus by applying suction to the fetal head.The vacuum extractor is composed of a soft suction cup attached to a suction bottle (pump) by tubing. The pump is used to create negative pressure (suction)
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How does the physician or CNM use the vacuum for extraction?
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The physician or CNM then applies traction in coordination with uterine contractions. The fetal head should descend with each contraction until it emerges from the vagina
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What are risk factors for fetus if using Vacuum assist?
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cephalohematoma, brain injury, and fetal death.
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What is induction?
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stimulation of uterine contractions before the spontaneous onset of labor with or without ROM to accomplish labor
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What are ways (other than medication) to induce labor?
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Stripping of the membranes
Also other CAM methods- sexual intercourse, nipple stimulation, herbs, caster oil, acupuncture, etc. |
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Stripping of the membranes
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Physician or a Nurse Midwife usies a gloved finger- separates amniotic membranes that are lying against the lower uterine segment. This releases prostaglandins that stimulate uterine contractions. This is done before medical interventions.
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What hormone stimulates uterine contractions?
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prostaglandins
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What is o Oxytocin/ Pitocin used for?
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Used to induce labor and/or to enhance ineffective contractions
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How does Oxytocin/ Pitocin work to induce labor?
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Stimulates smooth muscle and blood vessels of the uterus causing excitability of the muscle cell, increasing the muscle contraction, and supporting the propagation of the contraction
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How is Oxytocin/ Pitocin administered?
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Mom is started on a 10000ml electrolyte bag (LRS usually) and Pitocin is added to an additional line of IV fluid and then piggybacked into the primary line
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What are possible maternal side effects of Oxytocin/ Pitocin?
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Abruptio placentae
Impaired uterine blood flow Rapid Labor and birth Uterine rupture Water intoxication |
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What happens to fetus if there is impaired uterine blood flow?
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Can lead to fetal hypoxia
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What are negative outcomes of rapid birth?
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can lead to lacerations or cervix, vagina or perineum, uterine atony, fetal trauma
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What are S/S of water intoxication?
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N/V, hypotension, tachycardia, cardiac arrhythmia
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Because Oxytocin/ Pitocin can cause Hypercontractility of uterus, what can the effect be on the fetus?
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Decreased O2 supply to fetus causing Irregularities or decrease in FHR
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How can the use of Oxytocin/ Pitocin cause Hyperbilirubinemia in the newborn?
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Birth trauma, bruising, lysed RBCs in the process
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What is the major s/e of Oxytocin/ Pitocin on mom?
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Hypotension
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