Problems Of Antepartum Nursing: Ircc

Front 1

Hyperdymanic state of pregnancy

Back 1

over active, over stimulation of body systems of the state of pregnancy

Front 2

Hypermetabolic

Back 2

thryoid is in overdrive, may have transient hyper thyroidism

Front 3

Diabetogenic

Back 3

more likely to have increased blood sugar due to progesterone

Front 4

hypervolemic

Back 4

huge increase in blood volume

Front 5

immunity changes in the pregnancy state

Back 5

decrease in immunity

Front 6

Pregestational risk factors

Back 6

Anemia-common in teens,substance abuse, heart or renal disease, HIV infection, <16 years or >35 years, low socioeconomic
multiparity >4,Wt <100 lbs or >200 lbs,smoking
pre-existing health problems: epilepsy, lupus, Tb hep B, Deabeties

Front 7

___ in 4 women identified as high risk.

Back 7

1

Front 8

Two goals for Healthy Prople 2010 related to pregnancy.

Back 8

Decrease the number of women with diabeties.
Decrease the number of eptopic pregnancys.

Front 9

4 most common pregestational problems

Back 9

substance abuse
HIV infection
anemia
diabeties mellitus

Front 10

Ketoacidosis

Back 10

when the blood sugar is high but the insulin is not available or does not work to bring the glucose into the tissues, the body's response is to break down it's own tissues, 1st fat than muscle, this is teratogenic to featus

Front 11

1st half of pregnancy of the diabetic mother

Back 11

increased insulin production and increased response to insulin

Front 12

2nd half of pregnancy

Back 12

increased insulin resistance and increased glucose tolerance, mother may need 2-3 times the insulin dosage (when already diabetic)

Front 13

featus uses glucose from maternal stores, this results in what?

Back 13

increased disruption in maternal carbohydrate metabolism

Front 14

increased maternal lypolysis and ketone production takes place in which common pregestational problem?

Back 14

diabetus mellitus

Front 15

what two medications can be sued to treat diabetes during pregnancy

Back 15

Insulin
Glyburide

Front 16

In maneging pregestational diabetes during pregnancy the need for insulin diminishes, true/false?

Back 16

true

Front 17

at what time in weeks during the pregnancy are all women screened for diabetes?

Back 17

24-48 weeks

Front 18

What kind of tests are doe to check for didabetes during pregnancy?

Back 18

Ususally a fasting blood sugar is done, post prendial check, and an hemoglobin A1c for the pregestational diabetic woman.

Front 19

What 2 kinds of insulin are used during pregnancy

Back 19

Lispro
Humalog

Front 20

When is the typical delivery done for the diabetic mother and what is it based on?

Back 20

around 39th week and based on BPP (biophysical profile)

Front 21

risks to mother and baby of a diabetic mother (12)

Back 21

macrosomia, LGA, premature rupture OM, PMD (premature dilevery), hypoglycemia, polycythemia, hyperbilirubinemia, congenital anomolies, IUGR, RDS, hydramnios, ketoacidosis, pre-ecclampsia, ecclampsia, increased risk of maternal retinopathies, vaginitis, UTI's

Front 22

in the diabetic mother, maternal ___ crosses the placenta.

Back 22

Glucose.

Front 23

___ does not cross the placenta in the diabetic mother.

Back 23

Insulin

Front 24

how does the fetus get macrosomic in the diabetic mother?

Back 24

high maternal glucose levels and high insulin levels to fetus result is large fetus

Front 25

after delivery of newborns of uncontrolled diabetic mothers, baby runs a high risk of___.

Back 25

hypoglycemia

Front 26

gestational diabetes occurs when?

Back 26

2nd and 3rd trimester
throught to result from HPL (human placental latogen)

Front 27

renal threshold for urine dip in the diabetic mother, how often is this done?

Back 27

180, done at each visit as a screening device

Front 28

in the diabetic mother a ___ hour test is done first and if results are ___ then a ___ hour test is done.

Back 28

1 hour
> or equal to 140
3 hour

Front 29

what is the key to women with gestational diabetes?

Back 29

nutritional counseling and good patient teaching!!!

Front 30

What kind of nutritional counseling should you give to your diabetic mother patient?

Back 30

Eliminate concentrated sweets and reducing high fat, exercise is still important, should be moderate exercise as not to raise maternal body temp too high, and if diet and exercise don't work then must go to medication

Front 31

pregnant diabetic patient needs a lot of teaching about:

Back 31

about diabetes
glucose testing
insulin administration
s/s hypo/hyperglycemia and treatment
more frequent office visits

Front 32

fetal survelance using___,___,___ will be ongoing during the high risk pregnancy.

Back 32

US, NST, CST

Front 33

women with GD are ar high risk to develop type 2 DM in ____ (esp if obese).

Back 33

5-10 years

Front 34

in the HIV pregnancy how does their disease progress?

Back 34

pregnancy does not accelerate the disease progress.

Front 35

THe drug known as ___ significantly reduces the risk of pre-natal ransmission to the fetus.

Back 35

ARV

Front 36

pregnant diabetic patient needs a lot of teaching about:

Back 36

about diabetes
glucose testing
insulin administration
s/s hypo/hyperglycemia and treatment
more frequent office visits

Front 37

fetal survelance using___,___,___ will be ongoing during the high risk pregnancy.

Back 37

US, NST, CST

Front 38

women with GD are ar high risk to develop type 2 DM in ____ (esp if obese).

Back 38

5-10 years

Front 39

in the HIV pregnancy how does their disease progress?

Back 39

pregnancy does not accelerate the disease progress.

Front 40

THe drug known as ___ significantly reduces the risk of pre-natal ransmission to the fetus.

Back 40

ARV

Front 41

what other drug after ARV is recommended during pregnancy go HIV?

Back 41

Zidovuine.

Front 42

Is breast feeding recomended for the HIV mom?

Back 42

NO!

Front 43

if the viral load is ___ than a c-section is done for HIV mom.

Back 43

< 1000

Front 44

Greatest risk to featus in women with pre-existing cardiac problems is___.

Back 44

Hyopxia

Front 45

SOB during pregnancy is normal or not?

Back 45

no, this is not normal, only in last few weeks could this be normal

Front 46

What kind of symptoms would indicate an underlying cardiac problem?

Back 46

fatigue, chest pain, dyspnea,edema, cyanosis, arrythmias

Front 47

Peripartum cardio myopathy

Back 47

occurs in non-cardiac patients in the last month of pregnancy or in post partum period, symptoms are similar to CHF, conservation of energy is stressed, during L & D pts are monitored closely and tx provided prn

Front 48

_____ _____ through good prenatal care can prevent serious complications and decrease maternal and fetal mortality.

Back 48

Early detection

Front 49

Hyperemesis gravidarum

Back 49

pernicious vomiting, occurs in 4/1000 pregnancies, N/V beyond the 1st trimester, unknown etiology: could be elevated HCG/ estrogen, psycogenic causes, hydatform mole (dog tapeworm)

Front 50

complications of hyperemesis gravidarum (5)

Back 50

F & E imbalance, acid/base imbalance, hypokalemia-cardiac arrhythmias, hyopvolemia-decreased placental perfusion, inadequate nutrients to sustain fetal development

Front 51

Treatment for hyperemesis gravidarum

Back 51

pt needs to rest GI tract, needs IV rehydration of vitamins and electrolytes to be given in arms (not hand), vit B6/ pyridoxine, Reprivex (ginger + B6), benzodiazepine anti-emetics, seritonin antagonist, 5HT3/5HTP receptor blocker, zofran ondansetron (phenergan not used)cortosteroids, anti-hestimines, anti-refulx medications, TPN may be required for CHO, protein and fat

Front 52

nursing interventions for hyperemisis gravidarum

Back 52

provide emotional support, restful environment, remove unplasant environmental elements, NPO- gradually advance, small frequent feedings high in carbs, monitor I&O, urine quality, daily weight, skin torgor, calorie content, labs: Hct, BUN, lytes, minimum 1000 mL urine q24h, good oral hygine, monitor fetal hart tones-dehydration increases uterine instability

Front 53

Molar pregnancy/ Hydatiform Mole

Back 53

conception takes place but normal fetus does not develop, high levels of HCG which causes the bloated feeling and N/V, can be complete or partial

Front 54

Risk factors for molar pregnancy

Back 54

>40yrs, previous miscarriages or eptopic pregnancies, mexico, phillippines, southeast asia, (2% are cancerous)

Front 55

S/s of molar pregnancy

Back 55

abnormally high HGC levels, brownish vaginal discharge, abdominal pain, distention, hydropic vesicles may be passed, uterine enlargement may be greater than expected with pregnancy, hyperemesis, anemia

Front 56

how is the molar pregnancy diagnosed?

Back 56

with transvaginal ultrasound, Hcg testing

Front 57

treatment of molar pregnancy

Back 57

D and C or Dand E, microscopic examination to check for incomplete # of chromosomes, serum Hcg and pelvic q2weeks X 3months, than q1 month for up to a year, advised not to concieve for 1 year to r/o metastasis

Front 58

possible causes of spontianious abortion

Back 58

fetal/placental abnormalities, chromosomal defects, faulty implantation, drugs/infection, endocrine/reproductive tract problems

Front 59

threatened abortion

Back 59

unexplained vaginal bleeding, cramping, may or may not have fetal demise

Front 60

treatment for threatned abortion

Back 60

limit activities, bedrest, nothing in vagin

Front 61

imminent or inevitable AB

Back 61

bleeding increases, Os dialates

Front 62

Complete AB

Back 62

all products of conception are expelled

Front 63

incomplete AB

Back 63

not all productus of conception are expelled, pt will need D&C

Front 64

TEST: Missed AB

Back 64

fetal demise in uteuro, may or may not abort spontaneously, may need induction of labor or D&C

Front 65

Septic AB

Back 65

Pt presents with uterine infection, elevated temp, malodorous bleeding, abdominal tenderness, often due to missed AB, serious condition

Front 66

REcurrent pregnancy loss may signal?

Back 66

Chromosomal or hormonal abnormality

Front 67

Nursing interventions for pt with AB

Back 67

emotional support, mother needs help through the greeving process 6-24 months, be a good listener, encourage family to verbalize, provide opportunity for aborted fetus, foot prints, photo, refer to support group, same post partum care, Rhogam

Front 68

Emotions which take place in the family of spontanious AB

Back 68

shock, disbelief, grief, sadness, anger, guilt, mourning, resolution, acceptance

Front 69

when 2 or more spontaneous ab's occur in the 2nd trimester this may be a result of____.

Back 69

Incompetent or dysfunctional cervix
cervix may be weak, torn, or absent sphincter muscle at cervical os

Front 70

Premature dialation is painful/painless?

Back 70

painless

Front 71

Treatment for incompetent or disfunctional cervix

Back 71

bedrest, possible cerclage, pelvic rest

Front 72

sugical suture around internal os, week 13-15, suture must be opened for delivery around 37 weeks

Back 72

cerclage, not 100% effective, mom must notify if SROM occurs

Front 73

Premature rupture of membranes

Back 73

many predisposing risk factors, see pg 6 notes, nitrozine paper is used to test for amniotic fluid, no digital examination

Front 74

treatment options for PROM

Back 74

trying to forstall labor, assess fetal welbing and gestational age, antibiotics, <37 weeks minimal options, >34 weeks, assess lung maturation, monitor for signs to help prevent premature labor, provide psychologic support

Front 75

pre-term labor is defined as?

Back 75

onset of labor 20-37 weeks

Front 76

some of the causes of pre-term labor

Back 76

DM, PIH (pregnancy induced hypertension), CV (cardio vascular disease?), placental problems, tramua, PROM

Front 77

effect to fetus in pre-term labor event

Back 77

maturational deficiencits, no body fat, respiratory distress, poor glucose and heat regulation

Front 78

Diagnosis for pre term labor

Back 78

cervial dialation >1cm, effacement=or >80%, greater than 4 contractions in 20 minutes or greater than 8 in one hour

Front 79

Toxcolytic Drugs- drugs that inhibit uterine contraction

Back 79

Procardia XL
Terbutaline-Brethine
Magnesium Sulfate (TEST!!!)

Front 80

How should magnesium sulfate be administered

Back 80

IV piggyback, check mom and baby, check MG levels, respiratory depression, slurred speech, decreased b/p (it is a CNS depressant)

Front 81

in braxton hicks "labor" the patient will experience

Back 81

greater than 4 cx /hr, new low back pain, spotting or bleeding, increase in vaginal discharge, pelvic pressure

Front 82

Treament for patient experiencing braxton hicks "labor" early contractions

Back 82

bedrest sidelying, adequate hydration, frequent voiding, avoid nipple stimulation and sexual activity

Front 83

Agglutination and hemolysis of the baby's RBC's is a result from

Back 83

Rh incompability

Front 84

Rh incompatbility results in what 3 pathologies?

Back 84

Hydrops Fetalis
Erythroblastosis Fetalis
Kernicterus

Front 85

_____ prevents maternal sentiization in the Rh negative mom.

Back 85

RhoGAM