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62 Cards in this Set
- Front
- Back
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High-risk pregnancy
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jeopardy to mother, fetus, or both condition due to preg or result of condition present b4 pregnancy higher morbidity and morality risk assessment with first antepartal visit; ongoing |
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Spontanenous Abortion
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2nd trimester more likely related to maternal conditions |
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nursing assessment : Spontaneous abortion
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cramping or contractions vital signs, pain level client's understanding |
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Assessment SA
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Assessment Spontaneousvaginal bleeding Passageof clots Passageof tissue through vagina Lowuterine cramping Contractions Hemorrhageand shock |
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Implementation SA
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Implementation Maintain bedrest Monitor vital signs Monitor cramping and bleeding Count perineal pads to evaluate blood loss Save expelled tissues and clots Provide IV fluids as prescribed to prevent shock Prepare client for dilatation and curettage as prescribed for incomplete abortion |
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Ectopic pregnancy
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obstruction to or slowing passage of ovum through tube to uterus Therapuetic management: drug- methotrexate, prostaglandins, misoprostol, and actingmycin. surgery if rupture RH immunoglobulin if woman is rh negative. |
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At what stage in pregnancy are ectopic pregnancies most likely to occur?
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Assessment
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Pain unilaterally, with cramping and tenderness Mass in the adnexa or cul-de-sac Nausea and vomiting Slight, dark vaginal bleeding Fever Tachycardia Leukocytosis Low hemoglobin and hematocrit, elevated erythrocyte sedimentation rate Profound shock if rupture occurs |
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Implementation
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Obtain assessment data rapidly Obtain vital signs Initiate measures to prevent shock Monitor bleeding Obtain blood for type and cross-match Prepare for the administration of methotrexate if prescribed, for masses smaller than 4 cm, to induce abortion and preserve the fallopian tube Prepare client for laparotomy and removal of pregnancy and tube, if necessary, or repair of tube Administer antibiotics and RhoGAM as prescribed Encourage follow-up care Encourage counseling for future pregnancies |
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Ectopic pregnancy
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Hallmark sign: abdominal pain with spotting within 6-8 weeks after missed menses contributing factors lab and dxg test: transvaginal ultrasound, serum beta hcg, additional testing to rule out other conditions. |
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Gestational trophoblastic disease GTD
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chroriocarcinoma- more severe exact cause unknown therapeutic management: immediate evacuation of uterine contents long term follow up and monitoring of serial hcg levels. |
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GTD continued
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nursing management : preop prep, emotional support, education: treatment, serial hcg monitoring, prophylactic chemo |
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cervical insufficiency
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vaginal bleeding at 18-28 weeks of gestation suspected when a woman has 3 consecutive spontaneous pregnancy losses during the second trimester therapeutic management : bed rest, pelvic rest, avoid heavy lifting cervical cerclage- tie rope around cervix |
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Placenta previa
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assessment : risk factors, vaginal bleeding *painless, bright red blood in 2nd or 3rd trimester, spontaneous cessation then reoccurrence. |
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placenta previa
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monitor vitals, fhr, fetal activity assess bleeding including amount and quality maintain bedrest; position client in LEFT LATERAL POSITION |
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placental abruption
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premature separation of the placenta-after 20 weeks gestation assessment: bleeding *DARK RED, pain knife-like , rigid/ tender abdomen implementation: fhr, v/s, maintain bedrest. |
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placental abruption
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obstetric emergency involving premature separation management dependent on gestational age, extend of hemmorage and maternal-fetal oxygenation perfusion, nst, bpp maintenance of maternal cardiovascular status labs-CBC, COAG STUDIES prompt delivery of fetus cesarean birth if fetus still alive, vaginal if demise to prevent uterine scarring. |
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hyperemesis gravidarum
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continuing past week 20 weightloss >5% of prepreg body weight, dehydration, metabolic acidosis, alkalosis, and hypokalemia |
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HG: Therapetic management
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hospitilzation with parenteral therapy labs - electrolytes, bun, cbc, liver enzymes |
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Chronic hypertension
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CH nursing management
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lifestyle changes (DASH diet); frequent antepartal visits; monitoring for abruptioplacentae, preeclampsia; daily rest periods; home BP monitoring; closemonitoring during labor and birth and postpartum follow-up |
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Gestational hypertension
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hypertension after 20 weeks without proteinuria; bp returns to normal postpartum |
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Mild preeclampsia
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bed rest, daily bp monitoring and fetal movement counts. hospitilzation; iv mag sulf during labor |
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severe preeclampsia
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hospitilzation; oxytocin and mag sulf; prep for birth |
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eclampsia |
vasospasm, hypoperfusion, endothelial injury. seizure management, mag sulf, antihypertensive agents; birth once seizures controlled |
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impatient management
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antihypertensive meds- hydralazine - apresoline, Procardia antidieuretic- furosemide I/o, quiet environment, kick counts eclampsia- delievery |
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HELLP
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na- similar to that for severe preeclampsia; lab test results nm: same as for severe preeclampsia |
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disseminated intravascular coagulation DIC |
preeclampsia risk factor s/s - change in mental status- confusion, oliguria, sob, decreased pulses, bleeding management ; treat the cause - deliver baby, herapin-low dose, blood components replacement |
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DIC
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Thisis a complex disorder of the blood charact by abnormal clotting leading toconsumption of clotting factors that results in abnormal bleeding. |
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DIC |
This can happen during pregnancy or after: normally a preg womans clotting factors increase significantly later in pregnancy as a protective mechanism for possible post-partum bleeding. Increased clotting factors predispose her to DIC. Possible triggers include: pre-eclampsia/eclampsia, abruptio placentae, retained fetus or retained placenta.
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Blood incompatibility
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ABO incompatibility- type O mothers and fetus with type a or b - less severe then rh incompat |
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RH incompatability
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exposure of Rh-negative mother to rh positive fetal blood; sensitization; antibody production; risk factors increases with each subsequent pregnancy and fetus with rh positive blood |
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Nursing management and assessment
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rhogam at 28/29 weeks |
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polyhydraminos
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tm- close monitoring; removal of fluid, indomenthacin- decreases fluid by decrease fetal urinary output |
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polyhydraminos - na
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risk factors, fundal height, abdominal discomfort, difficulty palpating fetal parts or obtaining fhr |
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polyhydraminos- nm |
high risk for cord prolapse with spontaneous rupture of membranes! |
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oligohydraminos
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tm- serial monitoring; amniofusion and birth for fetal compromise na- risk factors, fluid leaking from vagina nm- continuous fetal surveillance; assistance with amniofusion, comfort measures, position changes increased risk for variable decels |
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Multiple Gestation
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tm- serial ultrasounds, close monitoring during labor, operative delievery common |
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multiple gestation |
nm- education and support antepartally; labor management with perinatal team on standby; postpartum assessment for possible hemmorage |
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Premature rupture of membranes
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PPROM- less than 37 weeks Treatment- dependent on gestational age, no unsterile digital cervical exams until woman is in active labor; expectant management if fetal lungs immature. |
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Diabetes Mellitus
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impaired fasting glucose and impaired glucose tolerance gestational diabetes- diet controlled or meds classification- pregestational diabetes. gestational diabetes- diet controlled and meds |
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DM- TM
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preconception counseling 1hr fasting glucose, 3 hr if fail blood glucose control - hba1c - >7% glycemic control nm- hypoglycemic agents, close maternal and fetal surveillance management during labor and birth. |
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Iron Deficiency anemia
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usually due to inadequate dietary intake tm- eliminate symptoms, correct defic, replenish iron stores na- fatigue, weakness, malaise, anorexia, suscteptible to infections - frequent colds!, pale mucus membranes, tachycardia, pallor Abnormal lab results- low hg, low hct, low serum iron, microcytic and hypochromic cells, and low serum ferritin. |
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cytomegalovirus
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Cytomegalovirus(CMV) Produces flu-like ormononucleosis-like symptoms in the mother Transmitted throughthe respiratory or sexual route Organism crosses theplacenta, or the fetus may be infected through birth canal May cause fetaldeath, retardation, heart defects, deafness No effectivetreatment available Rubella: Organismtransmitted across placenta, Extremely teratogenic in the first trimester, Causes congenital defects of the eyes, heart, ears, and brain Women with low titersshould be vaccinated at least 2 months before becoming pregnant, or following adelivery |
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Rubella
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Measles
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Herpes
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Genital Herpes Affects the externalgenitalia, vagina, and cervix, Causes draining, painful vesicles, Virus islethal to the fetus if inoculated during vaginal delivery, Delivery of thefetus is usually by cesarean section if active lesions are present Maintain precautionsduring vaginal exam, Maintain isolation procedures during hospitalization ifthe disease is active Infant and mother maybe separated during the active period, or other special precautionary measuresmay be used to avoid transmission to neonate |
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HEP B
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Hepatitis B (serumhepatitis) is the only form of hepatitis known to affect the newborn. Theredoes not appear to be any increased risk of birth defects in infants ofinfected mothers, but an infected mother is very likely to pass the infectionon to her newborn due to exposure to maternal blood and feces. These infectedinfants have a 25 percent chance of dying of liver-related diseases such aschronic hepatitis, cirrhosis, and liver cancer. Protect newborn scalpintegrity Implementation(cont’d): Suction newborn immediately after birth, Cut cord with new sterilescissors not the scissors used on the perineum, Bathe newborn prior to invasiveprocedures, Clean and dry face and eyes before instilling eye prophylaxis |
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HP B - Implementation
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Breastfeeding contrainidicated... Immune globulin andvaccine are given to all HBsAg-positive newborns within 2 to 12 hours ofdelivery, at least before 24 hours and not more than 7 days after birth Inform mother thatHBV vaccine will be administered to the neonate, with the first dose givenbefore the infant leaves the hospital; the second dose at 1 month; and thethird dose at 6 months If the mother isidentified positive more than 1 month after delivery, her HBsAg-negative infantshould be treated |
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Varicella zoster virus
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Varicella zostervirus (VZV), a member of the herpesvirus family, is the virus that causes bothvaricella (chickenpox) and herpes zoster (shingles). Maternal infection ispreventable by preconception vaccination. |
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Parvovirus b19
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Parvovirus B19: also known as fifthdisease (referring to its “fifth place” in a list of common childhoodinfections). Approximately 50% to 65% of women of reproductive age havedeveloped immunity to parvovirus |
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Group B strep
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) is a naturallyoccurring bacterium found in 10% to 35% of healthy adults. Women who testpositive for the GBS bacteria are considered carriers. Carrier status istransient and doesn't indicate illness Although GBS israrely serious in adults, it can be life-threatening to newborns. GBS is themost common cause of sepsis and meningitis in newborns and is a frequent causeof newborn pneumonia-all pregnant women should be screened for GBS at 35 to 37weeks' gestation-Penicillin G is the treatment of choice -usually administeredintravenously at least 4 hours before birth |
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Toxoplasmosis
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Toxoplasmosis(Protozoa): Transmitted through raw meat or handling cat litter of infectedcats, Produces symptoms of acute flu-like infection in mother, Organism passesthrough placenta, Spontaneous abortion is likely to occur early in pregnancy |
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Vulnerable populations
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adolscents pregnant woman over age 35 woman who are positive for hiv women who abuse substances |
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adolescent pregnancy
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double in us than any where else . |
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Woman over age 35
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lab and dgn studies; testing for baseline; amniocentesis; quadruple blood test screen nm- promotion of healthy pregnancy, education early and regular prenatal teaching; continued surveillance. |
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woman who are hiv positive
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tm- oral antiretroviral drugs twice daily from 14 weeks until birth; iv admin during labor; oral syrup for newborn in 1st 6 weeks of life; decision for birthing method na- history and physical exam; hiv antibody testing for stis |
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Pregnant woman with substance abuse
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Effects of common substances alcohol: FAS; FASD caffeine; nicotine cocaine opiates and narcotics: neonatal abstinence syndrome marijuana sedatives meth |
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Dystocia
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problem with powers: hypertonic uterine dysfunction, hypotonic urterine dysfxn, precipitous labor problems with passenger: occiput posterior position, breech, multifetal, macrosomia, structural abnormalities probs w passageway: pelvic contraction, obstructions in maternal birth canal probs w psyche- psychological distress |
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preterm labor
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one of the most common obstetric complications tm- risk prediction, tocolytic drugs: mag sulf, terbutaline, indomethacin, nifedipine corticosteroids antibiotic prophylaxis for woman with gbs |
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preterm labor meds
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relaxes uterine muscles to stop irritability and contractions, to arrest uterine contractions for preterm labor - off label use |
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preterm meds
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relaxes smooth muscles to calm uterus, inhibits uterine activity to arrest preterm labor |
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MEDS preterm |
nifedipine- Procardia- blocks calcium movement into muscle cells, inhibits uterine activity to arrest preterm labor betamethasone - celestone- fetal lung maturity by stimulating surfactant production, prevents or reduces rds and intraventricular hemmorage in preterm neonate less then 34 wks |
