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156 Cards in this Set
- Front
- Back
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PREECLAMPSIA
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10% OF ALL FIRST TIME PREG WOMEN AFFECTED BY THIS SYSTEMIC DISEASE CHARACTERIZED BY PERIPHERAL VASCULAR RESISTANCE AND ORGAN DAMAGE.
25% WITH CHRONIC HTN WILL GET PREECLAMPSIA. THIS IS A DISEASE F PREGNANCY FROM MILD TO SEVERE CHARACTERIZED BY PROTEINURUA AFTER 20TH GEST WK. CURE: DELIVERY. BUT WILL HAVE COMPLICATIONS UP TO 5 DAYS POST PARTUM. |
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PREECLAMPSIA MEDICAL MANAGEMENT
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ANTIHYPERTENSIVES:
HYDRALAZINE - VASODILATOR METHYLDOPA - WORKS ON CNS LABETOLOL - BETA BLOCKER ALL ABOVE ARE FIRST LINE DRUGS. NIFEDAPINE - CALCIUM CHANNEL BLOCKER. 2ND LINE DRUG. |
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PREECLAMPSIA
MEDICAL MANAGEMENT MONITOR MOM AND FETUS ______ DRUGS OF CHOICE ARE __________ GOAL IS ______ AND _______ ONLY CURE IS _____ DELIVERY INVOLVES ______ (DRUG) |
ONCE DX, WOMAN AND FETUS SHOULD BE MONITORED WEEKLY. ANTIHYPERTENSIVES ARE USED TO CONTROL BP. GOAL --> CONTROL BP AND SEIZURE PREVENTION.
ONLY CURE IS DELIVERY WITH SEVERE PREECLAMPSIA WHEN MATERNAL STATUS IS DETERIORATING. CARE IN DELIVERY INVOLVES MAG. DELIVERY CURES, BUT STILL @ RISK FOR COMPLICATIONS INCLUDING ECLAMPSIA UP TO 5 DAYS PP. |
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CHRONIC HTN
HTN BEFORE ______ GEST. WEEK PLACES WOMAN AT HIGH RISK FOR DEVELOPING _______ |
HTN BEFORE CONCEPTION OR BEFORE 20TH GEST WEEK. PLACES WOMAN AT INCREASED RISK FOR DEVELOPING PREECLAMPSIA.
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PREECLAMPSIA/ECLAMPSIA
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SYSTEMIC DISEASE WITH HTN ACCOMPANIED WITH PROTEINURIA AFTER 20TH GEST WEEK. ECLAMPSIA IS THE CONVULSIVE STAGE.
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PREECLAMPSIA SUPERIMPOSED ON CHRONIC HTN
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HYPERTENSIVE WOMEN WHO DEVELOP NEW ONSET PROTEINURIA, OR PROTEINURIA BEFORE 20TH WEEK GEST., OR SUDDEN UNCONTROLLED HTN.
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GEST HTN
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HIGH BP DETECTED FIRST TIME AFTER MID PREGNANCY WITHOUT PROTEINURIA. TYPICALLY DX POST PARTUM. NO CHANGE IN WOMAN. 5-6% OF ALL PREGNANCIES.
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RISKS FOR PREECLAMPTIC WOMEN
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CEREBRAL EDEM, HEMORRHAGE, STROKE, DIC, PULMONARY EDEMA, CHF, HEPATIC FAILURE, RENAL AND LIVER FAILURE, ABRUPTIO PLACENTA
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PREECLAMPSIA:
NEWBORN RISKS 1 2 3 4 5 |
PREMATURITY
DELIVERY MAY BE INDICATED PRETERM IUGR r/t DECREASED UTERPLACENTAL PERFUSION LOW BIRTH WEIGHT FETAL INTOLERANCE TO LABOR STILLBIRTH |
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THESE WILL PUT YOU AT RISK FOR DEVELOPING PREECLAMPSIA
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NULLIPARITY - number of times a woman has given birth
AGE < 19 OR > 35 OBESITY MULTIPLE GESTATION FAMILY HX OF PREECLAMPSIA PREEXISTING HTN OR RENAL DISEASE HX OF PREECLAMPSIA / ECLAMPSIA DM |
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PREECLAMPSIA:
ASSESSMENT FINDINGS |
CHANGE IN COAGULOPATHIES
LABS: INCREASED LIVER FUNCTION TESTS, DECREASED KIDNEY FUNCTION. DECREASED GFR = OLIGURIA (S/S OF SERIOUS KIDNEY DAMAGE) ELEVATED BP: HTN 140/90 OR GREATER PROTEINURIA OF 1+ OR > LOW PLATELET COUNT (BELOW 100,00) SEVERE PERSISTANT HA DECREASED ALBUMIN = EDEMA PULMONARY EDEMA RETINAL ARTERY SPASMS CAUSE CHANGE IN VISION / BLURRED OR DOUBLE SEIZURES |
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HTN
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140 OR >
--------------- 90 OR > 2ND LEADING CAUSE OF DEATH AND CONTRIBUTES TO NEONATAL MORTALITY AND MORBIDITY MOST COMMON PREGNANCY COMPLICATION . 6-8% OCCURENCE |
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PREECLAMPSIA
PATHOPHYSIOLOGY |
REDUCED ORGAN PERFUSION SECONDARY TO VASOSPASM AND ENDOTHELIAL ACTIVATION.
INCREASE IN BP R/T INCREASE IN PERIPHERAL RESISTANCE NO KNOWN ETIOLOGY WOMAN'S UTERUS DOES NO REMODEL ITSELF LIKE IT SHOULD. ARTERIES REMAIN THICK CAUSING DECREASED PLACENTAL PERFUSION. UTEROPLACENTAL PERFUSION CAN BE DECREASED 50% BEFORE ONSET OF S/S POOR ORGAN PERFUSION = INCREASED PERIPHERAL RESISTANCE = INCREASED BP = INCREASE IN FAT DEPOSITS ON LIVER = EPIGASTRIC PAIN = LIVER DAMAGE = HELLP SYNDROME = LOW GFR = OLIGURIA = PROTEINURIA COAGULATION SYSTEM IS ACTIVATED AND THROMBOCYTOPENIA OCCURS = CLOTTING CASCADE = PLATELET COUNT BELOW 100,000 |
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MILD PREECLAMPSIA
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SYSTOLIC BP 140-160
DIASTOLIC BP <100 PROTEINURIA-TRACE TO 1+ SERUM CREATININE - NORMAL |
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SEVERE PREECLAMPSIA
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SYSTOLIC - >160
DIASTOLIC 110 OR > PROTEINURIA - 2+ OR > HA VISUAL CHANGES UPPER ABD PAIN OLIGURIA SEIZURES - POSSIBLE ELEVATED SERUM CREATININE ELEVATED LIVER ENZYMES FETAL GROWTH RESTRICTION (R/T DECREASED BLOOD FLOW) POSSIBLE PULMONARY EDEMA |
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MAG
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CNS DEPRESSANT PROVEN TO DECREASE SEIZURE ACTIVITY WITHOUT LONG TERM EFFECTS TO WOMAN AND FETUS
TOCOLYTIC PREVENT PRETERM LABOR STOPS PT FROM CONTRACTING DECREASED BP SO PT WONT STROKE OUT ON YOU |
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MAG LOADING DOSE
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4-6g DILUTED IN 100 ML IVF OVER 15-20 MIN
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MAG RN ACTIONS
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PT WILL BE HOT.
AC NO BRIGHT LIGHTS EYE PATCHES NO VISITORS NO NOISE |
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MAG ASSESS FOR
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HA, VISUAL CHANGES, HYPOREFLEXIA, DTRs AND CLONUS, DOCUMENT DAILY WEIGHT, ASSESS FOR EDEMA, ASSESS FOR FLUID RETENTION
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MAG RN INTERVENTIONS
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ASSESS VS BEFORE ADMIN
VS Q 5-15 MIN WHEN LOADING THEN Q 30-60 MIN UNTIL PT STABILIZES ASSESS FOR DTRs Q 2H STRICT I&O ASSESS S/S OF TOXICITY |
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MAG S/S OF TOXICITY
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DECREASED REFLEXES=PENDING RESPIRATORY DEPRESSION
LESS THAN 14 BREATHS PER MINUTE OLIGURIA = OU < 30 ML/HR SOB OR RR < 24 CHEST PAIN EKG CHANGES ABSENCE OF PATELLAR DEEP TENDON REFLEXES DECREASED LOC CARDIAC DYSRYTHMIAS MAINTAIN SEIZURE PRECAUTIONS, KEEP RESUSCITATION EQUIPMENT BEDSIDE CONTINUOUS FHR MONITORING |
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MAG CONTINUOUS INFUSION
MAINTENANCE IS _____g/hr in ______mL IVF MEASURE SERUM LEVELS AT ____ TO ______ hr IV INFUSION SHOULD CONTINUE FOR ____hr POST DELIVERY |
2g/HR IN 100ML IVF FOR MAINTENANCE.
MEASURE SERUM LEVELS AT 4-6HR . IV INFUSION SHOULD CONTINUE FOR 24 H POST DELIVERY USE INFUSION PUMP TO MAINTAIN RATE |
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MAG PT WILL FEEL
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HOT
FLUSHED SEDATED |
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MAG ANTIDOTE
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CALCIUM GLUCONATE OR CALCIUM CHLORIDE
5-10mEq GIVEN IV SLOWLY OVER 5-10 MIN |
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MAG TOXICITY SUSPECTED
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STOP INFUSION
ADMIN ANTIDOTE PREVENT CARDIAC ARREST |
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WHICH OF THE FOLLOWING IS AN INDICATION TO TURN OFF MAG IN A WOMAN WITH PREECLAMPSIA?
BP 190/110 N/V EPIGASTRIC PAIN RESPIRATORY RATE 13 BREATHS PER MINUTE |
RESPIRATORY RATE OF 13 BPM
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THE GOAL OF MAG THERAPY IN TREATING PREECLAMPSIA IS TO
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PREVENT SEIZURES
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MAG EXPECTED SE
RESPIRATORY DISTRESS CAN OCCUR WITH LEVELS > ______ mg/ dL |
FLUSHING
DROWSINESS HA LETHARGY N/V RESPIRATORY DEPRESSION CAN OCCUR WITH SERUM LEVELS ABOVE 9mg/dL |
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MAG THERAPEUTIC LEVEL
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4-7mEq/ L
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ECLAMPSIA
TRIGGERED BY: |
CEREBRAL -
VASOSPASM HEMORRHAGE ISCHEMIA EDEMA |
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ECLAMPSIA WARNING SIGNS
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SEVERE AND PERSISTANT HA
EPIGASTRIC PAIN N/V HYPERREFLEXIA WITH CLONUS RESTLESSNESS |
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THESE WILL PUT YOU AT RISK FOR DEVELOPING PLACENTA PREVIA
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COCAINE
SMOKER HTN DM ENDOMETRIAL SCARRING: PREVIOUS PLACENTA PREVIA PRIOR C-SECTION ABORTION MULTIPARITY -(twins triplets...) IMPEDED ENDOMETRIAL VASCULARIZATION: ADVANCED MATERNAL AGE UTERINE ABNORMALITIES SUCH AS FIBROIDS, ENDOMETRITIS INCREASED PLACENTAL MASS: LARGE PLACENTA MULTIPLE GESTATION |
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WHAT IS PLACENTA PREVIA?
1 OUT OF ______ DELIVERIES _______ ARE CONTRAINDICATED |
1/300 DELIVERIES
OCCURS WHEN PLACENTA ATTACHES TO LOWER UTERINE SEGMENT OF UTERUS, NEAR OR ON CERVICAL OS BLEEDING OCCURS R/T PLACENTAL SEPARATION FROM INTERNAL CERVICAL OS OR LOWER UTERINE SEGMENT AND THE INABILITY OF THE UTERUS TO CONTRACT AT VESSEL SITES VAG EXAMS ARE CONTRAINDICATED |
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PLACENTAL PREVIA CAUSES
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MATERNAL BLOOD LOSS WHICH RESULTS IN DECREASED OXYGEN CARRYING CAPACITY THAT DIRECTLY IMPACTS OXYGEN DELIVERY TO MATERNAL ORGANS
PLACENTAL BLOOD FLOW IS DECREASED = DECREASED OXYGEN TO FETUS |
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PLACENTA PREVIA PUT WOMEN AT RISK FOR:
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HEMORRHAGIC / HYPOVOLEMIC SHOCK R/T EXESSIVE BLOOD LOSS
UNRESOLVED BLEEDING AT TERM CAUSES EXANGUIATIONSIN IN 10 MIN ANEMIA POTENTIAL Rh SENSITIZATION AS Rh-neg WOMEN CAN BECOME SENSITIZED DURING ANY ANTEPARTUM BLEEDING EPISODE |
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PLACENTA PREVIA
NEWBORN RISKS |
placenta previa:
UTEROPLACENTAL BLOOD FLOW DISRUPTION CAUSES FETAL STATUS TO DECLINE FETAL COMPROMISE BLOOD LOSS, HYPOXIA, ANOXIA, DEATH, FETAL ANEMIA, NEONATAL MORBIDITY R/T PRETERM BIRTH |
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PLACENTA PREVIA ASSESSMENT FINDINGS
PAINLESS ________ FIRST BLEEDING EPISODE RARELY _________ BLEEDING OCCURS NEAR END OF _______ TRIMESTER OR INTO ________ TRIMESTER NO ________!! |
PAINLESS BLEEDING
BLEEDING NEAR END OF 2ND TRIMESTER OR 3RD TRIMESTER. FIRST BLEEDING EPISODE RARELY SERIOUS NO VAG EXAMS!!!! |
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PLACENTA PREVIA
ABSOLUTELY NO |
VAG EXAMS
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PLACENTA PREVIA EMERGENCY MEDICAL MANAGEMENT
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C SECTION WHEN MOM OR BABY IS COMPROMISED
C SEC PRETTY MUCH WITH ALL WOMEN BECAUSE PLACENTA IS AT OR NEAR CERVIX, AND CERVICAL DILATION CAUSES PLACENTAL HEMORRHAGE VAG DELIVERY MAY BE ATTEMPTED IS PLACENTA IS LOW LYING AND ONE CAN PROCEED WITH C SECTION IF NECESSARY BLOOD IS TRANSFUSED AS NEEDED IF WOMAN AND FETUS ARE STABLE AND BLEEDING STOPS, DC HOME WITH BEDREST, ANTENATAL SURVEILANCE, AND CLOSE PROXIMITY TO HOSPITAL |
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ABRUPTIO PLACENTA ASSESSMENT
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HYPOVOLEMIC SHOCK
HYPOTENSION OLIGURIA THREADY PULSE SHALLOW IRREGULAR BREATHS PALLOR ANXIETY POSSIBLE VAG BLEEDING SEVERE ABD PAIN UTERINE CONTRACTIONS UTERINE TENDERNESS RIGIDITY WHERE BLOOD IS HYPERTONUS, INCREASE UTERINE DISTENTION N/V DECREASED UO SHOCK S/S OCCUR WHEN 25-30% BLOOD LOSS HAS OCCURRED KB TEST IN MOM'S BLOOD BLOOD COULD SHOW FETAL BLOOD RBCs |
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WHAT IS ABRUPTIO PLACENTA?
CAN BE CAUSED BY WHAT DRUG? _______ |
CAN BE CAUSED BY COCAINE
SEPARATION OF PLACENTA FROM IMPLANT SITE AFTER 20WKS GEST AND BEFORE DELIVERY CAN BE PARTIAL OR TOTAL GRADES 1-3 BLEEDING INTO DECIDUA BASALIS CAUSES HEMORRHAGE AND PLACENTAL SEPARATION |
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ABRUPTIO PLACENTA:
FETAL ASSESSMENT FINDINGS _______ OR _________ CHANGE IN _______ LATE _______ DECREASED ____________ |
TACHYCARDIA OR BRADYCARDIA
CHANGE IN FHR LATE DECELERATIONS DECREASED BASELINE |
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ABRUPTIO PLACENTA ASSESSMENT FROM LECTURE
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FOR VAG BLEED, OBSERVE FOR DURATION
AMOUNT COLOR CHARACTERISTIC OF BLEED VS PAIN FHR EMOTIONAL RESPONSE |
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ABRUPTIO PLACENTA
CLASSIC S/S SEVERE AND SUDDEN ONSET OF ______ ______ UTERINE ______ AND _________ POSSIBLE ________ |
SEVERE AND SUDDEN ONSET ABD PAIN
UTERINE CONTRCTIONS UTERINE TENDERNESS POSSIBLE VAG BLEEDING IF BLOOD IS TRAPPED IN CENTER OF PLACENTA, NO BLEEDING SEEN. 10% OF ABRUPTIONS IS SEPARATION OCCURS AT EDGE OF PLACENTA, BLOOD WILL BE SEEN. |
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THESE WILL PUT YOU AT RISK FOR DEVELOPING ABRUPTIO PLACENTA
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COCAINE USE
PREVIOUS ABRUPTION HTN DISORDERS OF PREGNANCY ABD TRAUMA METH USE SMOKING PREMATURE MEMBRANE RUPTURE UTERINE ANOMALIES/FIBROIDS |
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A WOMAN WITH ABRUPTIO PLACENTA WILL HAVE THE FOLLOWING RISK FACTORS
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HEMORRHAGIC STROKE
DIC HYPOXIC ORGAN DAMAGE ESP KIDNEYS AND LIVER POST PARTUM HEMORRHAGE |
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ABRUPTIO PLACENTA
RISKS FOR THE BABY OBVIOUS - MOM IS IN SERIOUS CONDITION, BABY IS AT RISK FOR_________ MOM IS BLEEDING, BABY AT RISK FOR ________ ________ ________ INJURY FETAL _________ __________ |
BABY AT RISK FOR PRETERM BIRTH
HYPOXIA ANOXIA NUEROLOGICAL INJURY, FETAL DEATH IUGR 15% RATE OF NEONATAL DEATH |
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ABRUPTIO PLACENTA EMERGENCY MANAGEMENT
TYPE OF BIRTH_________ MONITOR MOM'S _______ ________ RESTORE ________ ________ MONITOR AND CORRECT _________ ________ |
C SECTION
MONITORING MATERNAL BLOOD STATUS RESTORING BLOOD LOSS MONITORING COAGULATION DEFECTS CORRECTING COAGULATION DEFECTS |
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ABRUPTIO PLACENTA:
IF MATERNAL STATUS IS STABLE AND FETUS IS IMMATURE... |
HOSPITALIZATION
CLOSE MONITORING OF FHR AND STATUS CORTICOSTEROIDS MAY BE GIVEN TO ACCELERATE FETAL LUNG MATURITY |
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ABRUPTIO PLACENTE NURSING ACTIONS
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MONITOR FOR VAG BLEEDING
ASSESS ABD PAIN PALPATE UTERUS FOR CONTRACTIONS, TENDERNESS, HYPERTONUS, INCREASED UTERINE DISTENTION MANAGE N/V ASSESS FOR DECREASED UO MONITOR MOM FOR DECREASED BP AND TACHYCARDIA MAINTAIN IV ACCESS WITH LARGE BORE NEEDLE FOR EMERGENCY BLOOD TRANSFUSIONS ADMIN 02 VIA FM @ 8-10L ASSESS FHR FOR BASELINE CHANGES MONITOR LAB FINDINGS AND CBC AND CLOTTING CASCADE PROVIDE EMOTIONAL SUPPORT PROVIDE INFORMATION TO MOTHER AND FAMILY REGARDING TX PLAN AND INFANT STATUS |
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DISTURBED SLEEP PATTERNS DURING PREGNANCY
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INSOMNIA LASTS THROUGHOUT PREGNANCY.
IMPLEMENT SLEEP HYGIENE MEASURES LIKE REGULAR BEDTIME, RELAXING ACTIVITIES BEFORE BEDTIME COMFORTABLE SLEEP ENVIRONMENT WITH BODY PILLOW, EXTRA PILLOWS, TEACH BREATHING EXERCISES AND RELAXATION TECHNIQUES, EFFLEURAGE IS A MASSAGE TECHNIQUE VERY LIGHT TOUCH WITH 2 FINGERS IN 2 REPETITIVE CIRCULAR PATTERNS OVER GRAVID OF ABD., WARM BATH, WARM BEVERAGE PRE BEDTIME. |
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CHOLELITHIASIS IN PREGNANCY
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GALLSTONES: PROGESTERONE INDUCED RELAXATION OF SMOOTH MUSCLE RESULTS IN DISTENTION OF GALL BLADDER AND SOWS EMPTYING OF BILE. BILE STASIS AD ELVATED CHOLESTEROL LEVELS CAUSE GALLSTONES. 8% OF ALL PREGOS WILL GET GALL STONES.
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CBC
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RBC INCREASED BY 30%
RBC VOLUME INCREASE BY 17-30% WBC INCREASSE Hg and Hct DECREASED R/T IRON DEF ANEMIA THAT MOTHER IS MOST LIKELY DEVELOPING DUE TO INCREASED NEED FOR IRON FROM THE FETUS INCREASED FIBRINOGEN AND INCREASED PLASMA FIBRIN = HYPERCOAGULATION. |
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BLOOD VOLUME DURING PREGNANCY
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BV INCREASES 40-50% OR BY 1500 ML
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GOOD WEIGHT GAIN DURING PREGNANCY
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25-35lbs
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PURPOSE OF PRECONCEPTION CARE IS
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TO IMPROVE PERINATAL OUTCOMES
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PRESUMPTIVE SIGNS OF PREGNANCY ARE PHYSIOLOGIC CHANGES FELT/PERCEIVED ONLY BY _______
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PHYSIOLOGIC CHANGES PERCIEVED BY WOMAN
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PHYSIOLOGIC CHANGES IN PREGNANCY
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ARE PROTECTIVE OF THE WOMAN AND FETUS
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INTIMATE PARTNER VIOLENCE
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CROSS ALL LEVELS AND NUMBER 1 COD
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RHOGAM WOULD BE ADMIN AT 28 WEEKS GEST TO WHICH WOMAN?
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BLOOD TYPE 0-
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BLOOD VOLUME INCREASES DURING PREGNANCY BY
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1500ML
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10 WEEKS GESTATION WITH N/V TELL HER TO
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EAT SMALL FREQUENT MEALS
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PRESUMPTIVE SIGNS OF PREGO
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PERCEIVED BY THE WOMAN HERSELF.
INCREASED URINATION INCREASED URINATION FREQUENCY AMENORRHEA, N/V, BREAST CHANGES, FATIGUE AND QUICKENING - movement of fetus in utero |
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HARMFUL EFFECTS OF SMOKING
nicotine causes _________ smoking causes _______ and _________ |
NICOTINE CAUSES REDUCED UTERINE BLOOD FLOW
SMOKING CAUSES LBW AND PREMATURITY PHYSIOLOGICAL EFFECTS OF SMOKING ARE A RESULT OF TRANSIENT INTRAUTERINE HYPOXEMIA. CIGARETTE SMOKE HAS MANY CHEMICALS LIKE NICOTINE AND CARBON MONOXIDE. THESE CAUSE ADVERSE PREGNANCY OUTCOMES LIKE LBW AND PREMATURITY. CARBON MONOXIDE BINDS TO HEMOGLOBIN REDUCING O2 CARRYING CAPACITY OF THE BLOOD. |
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HARMFUL EFFECTS OF SUBSTANCE ABUSE
ALCOHOL ________ AND _______ BIRTH DEFECTS _____% WILL DRINK WHILE PREGNANT MOST COMMON _____ __________ BORN A YEAR WITH FASD |
13% WILL DRINK WHILE PREGO.
MOST COMMON TERATOGEN PASSES TO FETUS EASILY BABY'S LIVER PROCESSES IT SLOWER, SO BABY ALCOHOL LEVELS REMAIN ELEVATED LONGER. PHYSICAL AND MENTAL BIRTH DEFECTS FETAL ALCOHOL SPECTRUM DISORDERS (FASD) DESCRIBES EFFECTS OF ALCOHOL EXPOSURE PRIOR TO BIRTH. 40,000 BABIES/YR BORN WITH FASD. |
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HARMFUL EFFECTS OF SUBSTANCE ABUSE:
ILLICIT DRUGS COCAINE AND HEROIN COCAINE CAUSES 2 THINGS |
5.2% WILL USE DRUGS
MJ COCAINE AMPHETAMINES HEROIN ECSTACY COCAINE CAUSES VASOCONSTRICTION THAT CAN IMPACT UTERUS AN PLACENTA CAUSING ABRUPTION OF PLACENTA OR PRETERM BIRTH HEROIN - METHADONE TX IS RECOMMENDED TO PREVENT STILLBIRTH |
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ILLICIT DRUGS CAN CAUSE THE FOLLOWING FOR THE BABY
6 THINGS |
STILLBIRTH
LBW PRETERM BIRTH IUGR NEONATAL WITHDRAW SYNDROME SIDS |
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ILLICT DRUG USE CAN CAUSE THE FOLLOWING FOR THE MOTHER
***DONT WORRY ABOUT THIS ONE SO MUCH*** |
PRETERM LABOR
PPROM POOR WT GAIN POOR NUTRITIONAL STATUS PLACENTAL ABNORMALITIES: PLACENTA PREVIA, ABRUPTIO PLACENTA |
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SYMPTOMS OF 1ST TRIMESTER
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FATIGUE
MORNING SICKNESS EAT SMALL FREQUENT MEALS LOW IN FAT AND EASY TO DIGEST TENDER SWOLLEN BREASTS INCREASED UO ESP AT NOC DIZZINESS HEARTBURN CONSTIPATION FOOD CRAVINGS FOOD AVERSIONS |
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IUGR
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A DECREASED RATE OF FETAL GROWTHE USUALLY DUE TO A DECREASE IN CELL PRODUCTION RELATED TO CHRONIC MALNUTRITION
2 TYPES: 1) SYMMETRIC AND ASYMETRIC WOMAN MAY LOOK OR MEASURE SMALL FOR GEST AGE |
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SYMMETRIC IUGR
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GENERALIZED PROPORTIONAL REDUCTION IN THE SIZE OF ALL STRUCTURES AND ORGANS EXCEPT FOR BRAIN AND HEART.
CAUSED BY TERATOGENS, CONGENITAL INFECTIONS, GENETIC PROBLEMS. |
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ASYMMETRIC IUGR
CAN BE CAUSED BY MATERNAL OR PLACENTAL CONDITIONS THAT IMPEDE BLOOD FLOW CAN BE CAUSED BY 3 THINGS. 2 ARE PLACENTA RELATED 1 IS MOTHER RELATED. |
DISPROPORTIONAL REDUCTION IN ORGANS AND STRUCTURES.
CAUSED BY MATERNAL OR PLACENTAL CONDITIONS THAT OCCUR LATER IN PREGNANCY AND IMPEDE PLACENTAL BLOOD FLOW. CAN BE CAUSED BY PREECLAMPSIA, PLACENTAL INFARCTS, SEVERE MATERNAL MALNUTRITION |
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NAEGELE'S RULE
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STANDARD FORMULA FOR DETERMINING EDD BASED ON LMP.
FIRST DAY OF LAST MENSTRUAL PERIOD -3 MONTHS + 7 DAYS LMP APRIL 27 - 3 MONTHS ------------------------- JANUARY 27 + 7 DAYS ------------------------ FEB 3 |
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2 FACTORS INFLUENCE NAEGELE'S RULE
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REGULARITY OF WOMAN'S MENSES
LENGTH OF WOMANS MENSES |
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MOST WOMEN GIVE BIRTH WITHIN THE TIME PERIOD OF
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3 WEEKS BEFORE TO 2 WEEKS AFTER EDD
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WINDOW FOR TERM GEST IS
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5 WEEKS FROM 37 WEEKS TO 42 WEEKS GEST.
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NORMAL 3RD TRIMESTER FINDINGS
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NORMAL GROWTH AND DEVELOPMENT OF FETUS
BACK PAIN BIG BOOBS REALLY TIRED BRAXTON HICKS CONTRACTIONS DISCHARGE FREQUENT URINATION HEARTBURN CONSTIPATION SOB VARICOSE VEINS/SPIDER VEINS HEMORRHOIDS |
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39 WEEK PRIMIGRAVIDA
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FIRST TIME PREGNANCY
IS CONSIDERED FULL TERM |
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NUTRITIONAL COUNSELING FOR HIGH PRIORITY PATIENTS
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EAT FRESH FRUITS, VEGGIES, LEAN PROTEIN, LOW FAT DAIRY, WHOLE GRAINS, SMALL AMOUNTS OF HEALTHY FATS.
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3RD TRIMESTER
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FOCUSED ASSESSMENT INCLUDES ALL ASPECTS OF 2ND TRIMESTER AND A PELVIC EXAM TO ID CERVICAL CHANGES.
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3RD TRIMESTER ASSESSMENT OF FETAL WELL-BEING
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AUSCULTATION OF FHR
RECORD WOMAN'S ASSESSMENT OF KICK COUNTS LEOPOLDS TO DETERMINE FETAL POSITION GROUP B STREP SCREENING 1 HR GLUCOSE TEST AT 24-28 WEEKS CBC |
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3RD TRIMESTER FETAL GROWTH
____ TO ___ INCHES LOING ___ TO _____ LBS HAS _____ FAT HAS ESTABLISHED _____ AND _____ CYCLES |
17-20" LONG
6-8 LBS SUB Q FAT ESTABLISHED SLEEP AND ACTIVITY CYCLES |
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UNDERWEIGHT
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BMI < 19.8 28-40 LB
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PERFECT WEGITH
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BMI 19.8- 26 25-35 LBS WEIGHT GAIN
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OVER WEIGHT
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BMI 26.1 - 29 15-25 LB WEIGHT GAIN
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OBESE
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BMI > 29 GREATER THAN 15 LB WEIGHT GAIN
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PRENATAL NUTRITIONAL RECOMMENDATIONS
FRUITS |
2 CUPS
AVOID RAW UNPASTEURIZED JUICES |
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PRENATAL NUTRITIONAL RECOMMENDATIONS
VEGGIES |
2 1/2 CUPS
3 CUPS DURING 2ND AND 3RD TRIMESTERS VEGGIES THAT ARE DARK AND HAVE RICH COLORS ARE MORE NUTRITIOUS AVOID RAW SPROUTS |
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PRENATAL NUTRITIONAL RECOMMENDATIONS
LOW FAT/NON FAT DAIRY PRODUCTS |
3 SERVINGS
1 1/2 OZ OF CHEESE, 1 CUP MILK OR YOGURT AVOID RAW AND UNPASTUERIZED PRODUCTS AVOID SOFT CHEESES |
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PRENATAL NUTRITIONAL RECOMMENDATIONS
MEATS POULTRY FISH, EGGS, DRY BEANS NUTS |
3 (2 OZ) SERVINGS
SELECT LEAN AND LOW FAT SOURCES LIMIT FISH AND SHELLFISH TO 12 OZ / WEEK AND AVOID LARE FISH WITH HIGH MERCURY CONTENT (SWORDFISH, TILEFISH, SHARK, KING MACERAL) REHEAT LEFTOVERS AND READY TO EAT FOODS MAY REHEAT OR AVOID DELI MEATS |
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VEGANS/ VEGITARIANS
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MONITOR MICRO NUTRIENTS LIKE B12, CALCIUM, IRON, ZINC, CALORIES
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PRENATAL NUTRITIONAL RECOMMENDATIONS
GRAINS |
6 (1 OZ) SERVINGS
7 OZ SECOND TRIMESTER 8 OZ 3RD SELECT WHOLE GRAIN PRODUCTS FOR AT LEAST 1/2 OF THE SERVINGS |
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HIGH VIT C FOODS
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ORANGES
OJ KIWI BROCCOLI PAPAYA GRAPEFRUIT TOMATOES CELERY SPINACH PINEAPPLE CRANBERRIES RASBERRIES STRAWBERRIES |
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YOU ARE PREGNANT. CONGRATULATIONS?
BEHIND THIS CARD ARE _____ SIGNS AND SYMPTOMS RELATED TO BEING PREGNANT. |
OBJECTIVE S/S OF PREGNANCY THAT CAN BE ATTRIBUTED TO FETUS
AUSCULTATION OF FETAL HEART BY 10-12 WEEKS OBSERVATION AND PALPATION OF FETAL MOVEMENT BY EXAMINER SONOGRAPHIC VISUALIZATION OF FETUS CARDIAC MOVEMENT NOTED AROUND WEEK 4-8 VIA SONOGRAPHIC VISUALIZATION |
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NUTRITION
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FRESH FRUITS
VEGGIES LEAN PROTEIN LOW FAT/NON FAT DAIRY NO SOFT CHEESES WHOLE GRAINS SMALL AMOUNTS OF HEALTHY FATS |
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PRENATAL VIT
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FOLIC ACID
CALCIUM MAG VIT D IRON |
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PRESUMPTIVE SIGNS OF PREGNANCY
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SUBJECTIVE SIGNS LIKE PHYSIOLOGIC CHANGES PERCEIVED BY THE WOMAN HERSELF
AMENORRHEA - NO PERIOD N/V FROM WEEK 2 TO 12 BIG TENDER TINGLING BOOBS INCREASED BREAST VASCULARITY FATIGUE INCREASED UO QUICKENING |
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FUNDAL HEGHTS
MID PREGNANCY |
FUNDUS REACHES UMBILICUS
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UTERUS BEFORE PREGO
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SMALL PEAR
3" BY 2" BY 1" |
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DRINK
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8-10 GLASSES H20 / DAY
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RECOMMENDED WEIGHT GAIN LESS THAN ____ LBS DURING 1ST TRIMESTER
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5 LBS
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FUNDAL HEIGHTS
END OF PREGNANCY / 36 WEEKS |
FUNDUS REACHES XIPHOID PROCESS
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FUNDAL HEIGHT
2ND TRIMESTER (WEEKS 18-30 / 2ND AND 3RD TRIMESTERS) |
FUNDAL HEIGHT SHOULD EQUAL WEEKS OF GESTATION (IN CENTIMETER, GIVE OR TAKE 2CM)
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FUNDAL HEIGHTS
20-22 WEEKS |
UMBILICUS
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FUNDAL HEIGHTS
16 WEEKS |
HALFWAY BETWEEN SYMPHYSIS PUBIS AND UMBILICUS
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28 WEEK PRENATAL VISIT
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FIRST TRIMESTER
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28 WEEK PRENATAL VISIT
INITIAL VISIT: RISK ASSESSMENT |
AGE, GRAVIDA/PARA, ADDRESS, RACE/ETHNICITY, RELIGION, MARITAL/ FAMILY STATUS, OCCUPATION, EDUCATION
USED TO DETERMINE RISKS BASED ON SOCIODEMOGRAPHIC CHARACTERISTICS |
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28 WEEKS INITIAL VISIT
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HEALTH AND RISK ASSESSMENT
PREGO HX COMPLETE PHYSICAL AND PELVIC EXAM EDD WILL BE DETERMINED NUTRITION ASSESSMENT WITH 24HR DIET RECALL PSYCHOSOCIAL ASSESSMENT ASSESSMENT FOR PARTNER VIOLENCE |
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28 WEEKS INITIAL VISIT PROCEDURE/ LABS
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WBC
CBC RH BLOOD TYPE ANTIBODY SCREEN Hg, Hct PLATELET COUNT RPR, VDRL - SYPHILIS HIV / HEP B SCREEN GENETIC COUNSELING BASED ON FAMILY HX RUBELLA TITER PPD UA URINE CULTURE SENSITIVITY PAP SMEAR GONORRHEA AND CHLAMYDIA CULTURES ULTRASOUND INTRAVAGINAL |
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28 WEEKS PRENATAL VISIT (STUDY GUIDE)
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HX AND PHYSICAL ASSESSMENT
CHART REVIEW, INTERVAL HX, FOCUSED PHYSICAL ASSESSMENT, VS, GLUCOSE DIPSTICK, ALBUMINM KETONES, WEIGHT, FUNDAL HEIGHT, FHR, FETAL MOVEMENT, LEOPOLDS, EDEMA STERILE VAG EXAM / PELVIC EXAM NUTRITIONAL FOLLOW UP RHOGAM GIVEN FIRST AT 28 WEEKS TO RH - WOMEN 1 HR GLUCOSE TEST (24-28 WEEKS) TEST FOR GRAM + STREP AND PREPARE FOR POSSIBLE TX |
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ASSESSING FOR DOMESTIC VIOLENCE
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ACTUAL OR THREATENED VIOLENCE
HOMICIDE IS THE KILLER! HOMICIDE COMMITTED BY PARTNER ASSESS FOR: WITHIN LAST YR HAVE YOU BEEN HIT, SLAPPED, KICKED OR HURT? SINCE YOU HAVE BECOME PREGO? WITHIN LAST YR HAS SOMEONE RAPED YOU? |
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SUPINE HYPOTENSION
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HYPOTENSIVE CONDITION THAT OCCURS WHEN MID TO LATE PREGO WOMAN LIES ON HER BACK. UTERUS COMPRESSES INFERIOR VENA CAVA CAUSING DECREASE IN CO AND BP CAUSING DIZZY ANS FAINTNESS. TEACH WOMAN TO LIE ON HER SIDE AND RISE SLOWLY.
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GRAVIDA
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# OF TIMES A WOMAN HAS BEEN PREGO INCLUDING CURRENT PREGNANCY
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PARA
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ANY BIRTH THAT OCCURED AFTER 20 WEEKS GEST.
REGARDLESS DEAD OR ALIVE WITHOUT REGARD TO # OF FETUSES (TWINS IS 1 BIRTH, 1 PARA) |
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ABORTION
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PREGNANCY THAT ENDED BEFORE 20 WEEKS GEST WHETHER NATURAL OR MEDICAL
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NULLIGRAVIDA
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WOMAN WHO HAS NEVER GIVEN BIRTH
OR NEVER BEEN PREGNANT |
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PRIMIGRAVIDA
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WOMAN WHO IS PREGNANT FOR FIRST TIME
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MULTIGRAVIDA
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NOT PREGNANT FOR FIRST TIME. THIS IS AT LEAST HER SECOND BIRTH
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IPV SCREENING
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ACTUAL OR THREATENED VIOLENCE
PSYCHOLOGICAL EMOTIONAL PHYSICAL SEXUAL 16% OR 1/6 WOMEN REPORT ABUSE DURING PREGNANCY |
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IPV SCREENING
3 TOOLS |
WHEN IS THE LAST TIME U WERE HIT SLAPPED OR HURT OR KICKED?
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ABCDE'S
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ALONE
BELIEF CONFIDENTIALITY DOCUMENTATION EDUCATION SAFETY |
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ATTACHMENT
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New born family attachment
An important goal during the fourth stage Promoted by allowing early contact with newborn Encouragement of eye contact and touch Allowing time to hold the newborn Positive material bonding behaviors include making eye contact Touching and talking to baby And other positive behaviors such as smiling and cuddling the newborn This is the best time to institute breastfeeding The newborn may remain in labor and deleivery room with the family for all of the immediate recovery period. |
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terbutaline
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DECREASES THE RISK OF PRETERM BIRTH BY PROLONGING PREGNANCY
DELAYS DELIVERY FOR 3 DAYS GIVEN IV OR SQ MAX DOSE 0.08mg/min MAX DOSE SQ 0.25 mg Q3-4hrs |
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TERBUTALINE
MATERNAL SE |
TACHYCARDIA
CARDIAC ARRYTHMIA MYOCARDIAL ISCHEMIA PULMONARY EDEMA INCREASED MATERNAL GLUCOSE AND HYPOKALEMIA |
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TERBUTALINE RN CONSIDERATIONS
MONITOR _____ AND _____ MONITOR ____ FOR FLUID OVERLOAD WATCH FOR ___________ ________ HOLD MEDICATION IF MOM'S HR > ______ WATCH MOM'S ______ AND _____ (COMMON SIDE EFFECT OF THIS MEDICATION) |
MONITOR FHR, UCs,
MONITOR I&O FOR FLUID OVERLOAD WATCH FOR PULMONARY EDEMA MONITOR MOM'S HR AND HOLD IF HR > 120 WATCH MOM'S GLUCOSE AND POTASSIUM LEVELS |
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TERBUTALINE IS A _________
CONTRAINDICATED FOR MOM'S WITH _______ DISEASE |
BETA ADRENERGIC AGONIST THAT SUPPRESSES UTERINE ACTIVITY
CONTRAINDICATED FOR MOM'S WITH CARDIAC DISEASE |
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BETA AGONIST TOCOLYTICS
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TERBUTALINE AND RITODRINE
SAME EVERYTHING BOTH ARE THE SAME IF YOU KNOW ONE YOU KNOW BOTH |
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GEST DM
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ANY DEGREE OF GLUCOSE INTOLERANCE WITH ONSET OF PREGO. APPLIES WHETHER GDM IS CONTROLLED WITH DIET AND EXERCISE OR INSULIN AS WELL
7% OF PREGNANCIES GET GDM 200,000 / YR |
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WHY DO SOME WOMEN GET GDM?
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PREGNANCY IS A CONDITION CHARACTERIZED BY PROGRESSIVE INSULIN RESISTANCE THAT BEGINS MID PREGO AND PROGRESSES THROUGHOUT PREGO.
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2 MAIN CONTRIBUTORS TO GDM / INSULIN RESISTANCE
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INCREASED MATERNAL FAT/ADIPOSITY
INSULIN DESENSITIZING HORMONES MADE BY PLACENTA |
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GDM : PLACENTA
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PLACENTA PRODUCES HCS, CORTISOL, ESTROGEN, AND PROGESTERONE.
HCS STIM PANCREAS TO SECRETE INSULIN IN THE FETUS AND REDUCES UPTAKE OF GLUCOSE IN THE MOM. AS PLACENTA GETS BIGGER, HCS IS MORE EFFICIENT AND CAUSES A PROGRESSIVE INSULIN RESISTANT STATE. |
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ROUTINE SCREENING FOR GDM DURING WEEKS ___ TO ____
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24 TO 28
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1 HR NON FASTING ORAL GLUCOSE TOLERANCE TEST +
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130 OR 140
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+ ORAL GLUCOSE TEST
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DO A 3 HR GLUCOSE TOLERANCE TEST TESTING EACH HR AFTER WOMAN HAS INGESTED 100 GRAMS OF GLUCOSE
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GDM RISKS FOR WOMAN
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HYPOGLYCEMIA AND DKA
DEVELOPMENT OF NON GESTATIONAL DIABETES |
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GDM RISKS FOR THE BABY
HYPO ______ ______ AND ________ ________ IS THE MOST COMMON MORBIDITY MACROSOMIA PLACES BABY AT RISK FOR ______ ________ INJURY AT RISK FOR ________ AND _______ AT RISK FOR ___________ DISTRESS SYNDROME CONGENITAL DEFECTS (5) CONGENITAL DEFECTS ARE ONLY FOR BABIES WHOSE MOMS HAD DM BEFORE PREGNANCY. NOT FOR GESTATIONAL DM. |
HYPO MAG, HYPO CALCEMIA AND HYPO GLYCEMIA A FEW HOURS AFTER BIRTH
MACROSOMIA IS THE MOST COMMON MORBIDITY MACROSOMIA PLACES BABY AT RISK FOR BIRTH INJURY -BRACHIAL PLEXUS INJURY IUGR AND ASPHYXIA RESPIRATORY DISTRESS SYNDROME POLYCYTHEMIA HYPERBILIRUBINEMIA PREMATURITY CONGENITAL DEFECTS (HEART, SKELETAL, NEUROLOGICAL, GU, GI) CARDIOMYOPATHY STILL BIRTH |
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MORE ON GDM
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WOMEN WITH DEFICIENT INSULIN SECRETORY CAPACITY DEVELOP GDM. MOTHER'S INSULIN DOES NOT CROSS PLACENTA. BABY IS EXPOSED TO MOTHER'S HYPERGLYCEMIA. BABY'S PANCREAS WORKS OVERTIME TO MAKE INSULIN
MORE INSULIN IN BABY MAKES BABY GROW HUGE (MACROSOMIA) |
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PREGO WOMEN KEEP YO DAMN HbA1C
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below 6%
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GDM RN ACTIONS
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TEST GLUCOSE 4X DAY
1 FASTING AND 3 TWO HR POSTRANDIAL CHECKS A DAY SUGGESTED GLUCOSE CONTROL FASTING < 95 BEFORE MEALS OR > 140 AT 1 HR AFTER MEALS AND LESS THAN 120 AT 2 HR AFTER MEAL TEACH TO MONITOR KETONURIA Q AM TEACH S/S OF DKA, HYPO AND HYPERGLYCEMIA |
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GDM LECTURE
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NO CHEWING GUM OR ANYTHING WHEN GETTING TESTED
BLURRED VISION COMMON PROBLEM AND INCREASES STROKE RISK FOR MOM WEIGH WITHOUT SHOES AND ASSESS FEET |
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BIG BABIES
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MACROSOMIC BABIES
USUALLY > 4000 GRAMS USUALLY HAVE DM BY 2 OR 3 YRS OLD GIVE D10/SUGAR WATER IF HYPOGLYCEMIC AT BIRTH MAY HAVE CONGENITAL ANOMALIES LIKE HIGH DROPS AND ENLARGED HEART |
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PIH LABS
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ELEVATED SERUM CREATININE 72 mg/dL
Hct LEVELS < 35 LOW PLATELET COUNT 100,000 OR < ELEVATED LIVER ENZYMES (AST > 41) |
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GDM MEDS
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DIET
EXERCISE INSULIN (40% OF THE TIME) |
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CARDIOVASCULAR DISEASE
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DURING PREGO CAN BE CATEGORIZE AS CONGENITAL, ACQUIRED, RHEUMATIC, OR ISCHEMIC
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CARDIAC DISEASE
RISKS FOR THE BABY |
IF MOM'S CIRCULATION IS IMPAIRED - IUGR
FETAL HYPOXIA = CNS DAMAGE DEATH |
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CLASS II CARDIAC DISEASE
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SLIGHT LIMITATION IN PHYSICAL ACTIVITY
ASYMPTOMATIC MATERNAL MORTALITY IS < 1% PLASMA VOLUME INCREASES BY 40-50% WHEN PREGO CO INCREASES BY 40-50% BY TERM HR INCREASE BY 20-30% AND STROKE VOLUME INCREASE BY 11-32% ALL THESE CAN EXACERBATE CARDIAC DISEASE |
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PT ASSESSMENT
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DETERMINE EDD
PRESUMPTIVE AND PROBABLE SIGNS OF PREGNANCY POSITIVE SIGNS OF PREGNANCY HYPEREMESIS GRAVIDARUM - FREQUENCY, AMOUNT, CHARACTER OF VOMIT I&O, SKIN TURGOR, MEMBRANES, PSYCHOSOCIAL ASSESSMENT, FETAL STATUS |
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Rh STUFF
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IF MOM IS Rh (-), NEED TO KNOW DAD'S Rh. IF DAD IS ALSO Rh (-) NO Rh PROBLEM WILL OCCUR. IF DAD IS Rh (+) PROBLEM CAN OCCUR. NEED TO ASSESS MOM FOR ANYTHING IN HER HX THAT MAY HAVE CAUSED SENSITIZATION
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AFP SCREENING
alpha fetoprotein WHEN IS MOM'S BLOOD DRAWN? WHEN IS AFP PRODUCED IN GESTATION? WHAT DOES AFP SCREEN FOR? (4 THINGS) WHAT DOES A LOW AFP LEVEL MEAN? |
AFP is produced early in gestation. mom's blood is drawn between 16 and 18 wks. AFP screens for developmental defects like NTD's (neuro tube), anencephaly, omphalocele, gastroschisis. a low level of AFP is a red flag for down syndrome and requires further testing.
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AMNIOCENTESIS
USUALLY DONE FOR GENETIC TESTING BETWEEN ____ AND ___ WEEKS GESTATION. ASSESSES 3 THINGS |
assesses lung maturity, hemolytic disease, intrauterine infection. ultrasonography is used to guide needle. usually done for genetic testing between 14-20 wks. less than 1% fetal loss rate if done after 15 weeks gest. increases to 2% - 5% if done when baby is < 15 wks gest.
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KICK COUNT
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mothers assessment of fetal well-being based on movement. Used to see if baby is getting enough oxygen. to be done once a da for 2 hrs. mom should sit and place both hands on belly to feel movement. 10 kicks in 2 hrs is good.
not 10 kicks?? drink OJ or eat a snack, try again. Call Dr if no change. usually first indicator that something is wrong with baby. |
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QUAD SCREEN
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triple screen or quad screen at 15-20 wks gest screens for neural tube defects and trisomy 21. NOT DIAGNOSTIC. if (+) NEED AMNIOCENTESIS TO DX AND VERIFY.
triple marker screen AFP, hCG, estriol, AND inhibin A (to make it a QUAD) all used to increase detection for trisomy 21. 80% efficient. =) |
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LOW MATERNAL SERUM ALPHA FETOPROTEIN (MSAFP) AND UNCONJUGATED ESTRIOL =
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abnormality
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hCG and inhibin A levels are twice as high when ______ is present
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trisomy 21
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low estriol =
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NTD's (neural tube defects)
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L/S RATIO RESULTS
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lecithin and sphingomyelin are 2 phospholipids that are detected in amniotic fluid.
the ratio between the 2 provide info on surfactant levels. L/S > 2:1 in a NON DIABETIC WOMAN = lungs are mature! =) L/S ratio 3:1 in DIABETIC WOMAN = lungs are mature |
