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85 Cards in this Set
- Front
- Back
Hyperdymanic state of pregnancy
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over active, over stimulation of body systems of the state of pregnancy
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Hypermetabolic
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thryoid is in overdrive, may have transient hyper thyroidism
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Diabetogenic
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more likely to have increased blood sugar due to progesterone
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hypervolemic
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huge increase in blood volume
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immunity changes in the pregnancy state
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decrease in immunity
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Pregestational risk factors
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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 |
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___ in 4 women identified as high risk.
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1
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Two goals for Healthy Prople 2010 related to pregnancy.
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Decrease the number of women with diabeties.
Decrease the number of eptopic pregnancys. |
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4 most common pregestational problems
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substance abuse
HIV infection anemia diabeties mellitus |
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Ketoacidosis
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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
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1st half of pregnancy of the diabetic mother
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increased insulin production and increased response to insulin
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2nd half of pregnancy
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increased insulin resistance and increased glucose tolerance, mother may need 2-3 times the insulin dosage (when already diabetic)
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featus uses glucose from maternal stores, this results in what?
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increased disruption in maternal carbohydrate metabolism
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increased maternal lypolysis and ketone production takes place in which common pregestational problem?
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diabetus mellitus
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what two medications can be sued to treat diabetes during pregnancy
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Insulin
Glyburide |
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In maneging pregestational diabetes during pregnancy the need for insulin diminishes, true/false?
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true
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at what time in weeks during the pregnancy are all women screened for diabetes?
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24-48 weeks
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What kind of tests are doe to check for didabetes during pregnancy?
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Ususally a fasting blood sugar is done, post prendial check, and an hemoglobin A1c for the pregestational diabetic woman.
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What 2 kinds of insulin are used during pregnancy
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Lispro
Humalog |
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When is the typical delivery done for the diabetic mother and what is it based on?
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around 39th week and based on BPP (biophysical profile)
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risks to mother and baby of a diabetic mother (12)
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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
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in the diabetic mother, maternal ___ crosses the placenta.
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Glucose.
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___ does not cross the placenta in the diabetic mother.
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Insulin
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how does the fetus get macrosomic in the diabetic mother?
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high maternal glucose levels and high insulin levels to fetus result is large fetus
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after delivery of newborns of uncontrolled diabetic mothers, baby runs a high risk of___.
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hypoglycemia
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gestational diabetes occurs when?
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2nd and 3rd trimester
throught to result from HPL (human placental latogen) |
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renal threshold for urine dip in the diabetic mother, how often is this done?
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180, done at each visit as a screening device
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in the diabetic mother a ___ hour test is done first and if results are ___ then a ___ hour test is done.
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1 hour
> or equal to 140 3 hour |
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what is the key to women with gestational diabetes?
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nutritional counseling and good patient teaching!!!
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What kind of nutritional counseling should you give to your diabetic mother patient?
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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
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pregnant diabetic patient needs a lot of teaching about:
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about diabetes
glucose testing insulin administration s/s hypo/hyperglycemia and treatment more frequent office visits |
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fetal survelance using___,___,___ will be ongoing during the high risk pregnancy.
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US, NST, CST
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women with GD are ar high risk to develop type 2 DM in ____ (esp if obese).
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5-10 years
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in the HIV pregnancy how does their disease progress?
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pregnancy does not accelerate the disease progress.
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THe drug known as ___ significantly reduces the risk of pre-natal ransmission to the fetus.
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ARV
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pregnant diabetic patient needs a lot of teaching about:
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about diabetes
glucose testing insulin administration s/s hypo/hyperglycemia and treatment more frequent office visits |
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fetal survelance using___,___,___ will be ongoing during the high risk pregnancy.
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US, NST, CST
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women with GD are ar high risk to develop type 2 DM in ____ (esp if obese).
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5-10 years
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in the HIV pregnancy how does their disease progress?
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pregnancy does not accelerate the disease progress.
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THe drug known as ___ significantly reduces the risk of pre-natal ransmission to the fetus.
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ARV
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what other drug after ARV is recommended during pregnancy go HIV?
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Zidovuine.
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Is breast feeding recomended for the HIV mom?
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NO!
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if the viral load is ___ than a c-section is done for HIV mom.
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< 1000
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Greatest risk to featus in women with pre-existing cardiac problems is___.
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Hyopxia
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SOB during pregnancy is normal or not?
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no, this is not normal, only in last few weeks could this be normal
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What kind of symptoms would indicate an underlying cardiac problem?
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fatigue, chest pain, dyspnea,edema, cyanosis, arrythmias
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Peripartum cardio myopathy
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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
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_____ _____ through good prenatal care can prevent serious complications and decrease maternal and fetal mortality.
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Early detection
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Hyperemesis gravidarum
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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)
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complications of hyperemesis gravidarum (5)
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F & E imbalance, acid/base imbalance, hypokalemia-cardiac arrhythmias, hyopvolemia-decreased placental perfusion, inadequate nutrients to sustain fetal development
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Treatment for hyperemesis gravidarum
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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
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nursing interventions for hyperemisis gravidarum
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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
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Molar pregnancy/ Hydatiform Mole
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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
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Risk factors for molar pregnancy
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>40yrs, previous miscarriages or eptopic pregnancies, mexico, phillippines, southeast asia, (2% are cancerous)
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S/s of molar pregnancy
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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
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how is the molar pregnancy diagnosed?
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with transvaginal ultrasound, Hcg testing
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treatment of molar pregnancy
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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
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possible causes of spontianious abortion
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fetal/placental abnormalities, chromosomal defects, faulty implantation, drugs/infection, endocrine/reproductive tract problems
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threatened abortion
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unexplained vaginal bleeding, cramping, may or may not have fetal demise
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treatment for threatned abortion
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limit activities, bedrest, nothing in vagin
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imminent or inevitable AB
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bleeding increases, Os dialates
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Complete AB
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all products of conception are expelled
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incomplete AB
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not all productus of conception are expelled, pt will need D&C
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TEST: Missed AB
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fetal demise in uteuro, may or may not abort spontaneously, may need induction of labor or D&C
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Septic AB
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Pt presents with uterine infection, elevated temp, malodorous bleeding, abdominal tenderness, often due to missed AB, serious condition
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REcurrent pregnancy loss may signal?
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Chromosomal or hormonal abnormality
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Nursing interventions for pt with AB
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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
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Emotions which take place in the family of spontanious AB
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shock, disbelief, grief, sadness, anger, guilt, mourning, resolution, acceptance
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when 2 or more spontaneous ab's occur in the 2nd trimester this may be a result of____.
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Incompetent or dysfunctional cervix
cervix may be weak, torn, or absent sphincter muscle at cervical os |
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Premature dialation is painful/painless?
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painless
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Treatment for incompetent or disfunctional cervix
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bedrest, possible cerclage, pelvic rest
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sugical suture around internal os, week 13-15, suture must be opened for delivery around 37 weeks
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cerclage, not 100% effective, mom must notify if SROM occurs
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Premature rupture of membranes
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many predisposing risk factors, see pg 6 notes, nitrozine paper is used to test for amniotic fluid, no digital examination
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treatment options for PROM
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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
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pre-term labor is defined as?
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onset of labor 20-37 weeks
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some of the causes of pre-term labor
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DM, PIH (pregnancy induced hypertension), CV (cardio vascular disease?), placental problems, tramua, PROM
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effect to fetus in pre-term labor event
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maturational deficiencits, no body fat, respiratory distress, poor glucose and heat regulation
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Diagnosis for pre term labor
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cervial dialation >1cm, effacement=or >80%, greater than 4 contractions in 20 minutes or greater than 8 in one hour
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Toxcolytic Drugs- drugs that inhibit uterine contraction
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Procardia XL
Terbutaline-Brethine Magnesium Sulfate (TEST!!!) |
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How should magnesium sulfate be administered
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IV piggyback, check mom and baby, check MG levels, respiratory depression, slurred speech, decreased b/p (it is a CNS depressant)
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in braxton hicks "labor" the patient will experience
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greater than 4 cx /hr, new low back pain, spotting or bleeding, increase in vaginal discharge, pelvic pressure
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Treament for patient experiencing braxton hicks "labor" early contractions
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bedrest sidelying, adequate hydration, frequent voiding, avoid nipple stimulation and sexual activity
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Agglutination and hemolysis of the baby's RBC's is a result from
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Rh incompability
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Rh incompatbility results in what 3 pathologies?
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Hydrops Fetalis
Erythroblastosis Fetalis Kernicterus |
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_____ prevents maternal sentiization in the Rh negative mom.
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RhoGAM
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