Scott Gardner TCC Nursing Q3S05 Unit 3

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Describe chorionic villi sampling.: In order to obtain cells from the placenta surface, a thin catheter is inserted into the cervix and uterus and a sampling of cells is suctioned into the tube. Ultrasound is used to guide placement of the catheter.

Done after 14 weeks.

Indicated over 35Yo/Neural Tube Defects.
Describe amniocentesis.: A procedure in which a small sample of amniotic fluid is drawn out of the uterus through a needle inserted in the abdomen. The fluid is then analyzed to detect genetic abnormalities in the fetus or to determine the sex of the fetus.
Describe triple screen.: During the 16th to 18th week of pregnancy, expectant mothers typically are offered a blood test called the triple screen test or triple marker.

For the screening, a sample of blood is drawn from the mother to measure three basic things: the levels of hCG (human chorionic gonadotropin) and estriol, which are produced by the placenta, and the level of alpha-fetoprotein (AFP), which is produced by the fetus. The levels of these three substances in the blood can help doctors identify a fetus at risk for certain birth defects such as neural tube defects like spina bifida or chromosomal abnormalities like Down syndrome.
Describe Non Stress Test: A nonstress test is a safe, painless way to check on a baby's well-being before it is born. Two small monitors are placed on your abdomen and held in place using elastic belts. These are attached by cables to a larger machine, the electronic fetal monitor. One of these monitors records your contractions on some special paper, called a strip or tracing, while the other records your baby's heart rate. The test normally takes about 20 to 60 minutes. Occasionally, additional testing time is necessary. Your care givers will look at the baby's heart rate tracing to see how the baby is doing and to see if more testing is needed.
Describe Contraction Stress Test: Also called a stress test or an oxytocin challenge test, this test measures your baby's heart rate during uterine contractions in order to make sure that he can get the oxygen he needs from the placenta during labor. During contractions, the flow of blood and oxygen to the placenta temporarily slows. If your placenta is healthy it will have extra stores of blood ready to provide the baby with the oxygen he needs during contractions. So if everything is OK, your baby's heart will not slow down during or after a contraction. But if the placenta isn't functioning properly, your baby won't get enough oxygen and his heart rate will slow after a contraction. The contraction stress test isn't commonly done, but your practitioner may recommend it as you get close to your due date if you're having a high-risk pregnancy or if a non-stress test or biophysical profile indicates that your baby may not be getting enough oxygen.
What problems occur with moms with cardiovascular and respiratory disorders.: Increased intervascular volumes perinatal.
Normal heart can handle, diseased hearts hearts cannot.

Growing Fetus causes pressure.
Continue Asthma meds during labor and delivery.
1-4% have asthma. Some pregnancy meds can exacerbate the asthma.
What is PIH? When does it occur?: (PIH) Pregnancy Induced Hypertension
A complication of pregnancy marked by increasing blood pressure, proteinuria, and edema.

Happens in or after 20th week of gestation.
What is nursing role when working with a mom who has been physically abused?: Provide emotional support.
-Assess on each visit for possible abuse
-Provide support to assist bonding.
-Provide education that batting will continue post-partum and offer support to resources. Where to go, what to take with.
40-60%. Smoking and ETOH might be coping factors.
-Stress of pregnancy might strain relationship
-Man may be jelous of fetus or angry at unborn child or woman
-Might be consious or unconsioius attempt to end the pregnancy.
What are the effects on pregnancy of alcohol?: Metal Retardation
FAS
Fetal Growth Restriction
Altered Facis
Developmental problems.
What are the effects on pregnancy of cocaine?: Miscariage
Preterm Labor
SGA
Abruption of placenta
Still Birth
What are the effects on pregnancy of heroin?: Inerference with growth
PROM
Preterm Labor
Fetal Addiction
What are the effects on pregnancy of methamphetamine?: S/S similiar to cocain with less impact on mother or fetal health.
What are the signs and symptoms of amniotic fluid embolism?: -Similiar to empolism
-Increase in pressure.
-86% morbidity rate mom
-50% morbidity rate baby
-S/S Resp Distriss, DIC, Shock

Pulmonary vessels are blocked by hair, mecomium, vernix, skin cells.
What is uterine rupture?: NOT TESTED PER Rachelle on Friday Lecture.
Rare, but serious.

Might be from old C-Section Scar.

1500-2000 births.

Accidents or trauma, intense uterine contraction.

Complete or Incoplete.
What is shoulder dystocia: Rare.

Head is born, but the ant shoulder can not pass under pubic arch.

Big baby or small pelvis.

Manuvers can free the anterior shoulder. None identfied as best. McRoberts Manuver.
What is vacuum extraction and when is it indicated?: Vaccuum cap to fetal head. Similar to use of forceps. Vertex presentation, and rupture of membranes.

Cervix must be totally dialated. Bladder empty. Preseting part must be engaged.

CPD
What is low forceps-assisted birth, when is it indicated and what are the nursing considerations?: Application of forceps at 2+ station.
Never use forcepts to an unengaged preseting part.
Nurse get ordered forcepts. Two tablespoons around an egg and goes around the ears.

FHR will drop if cord is depressed. FHR is recorded before and after forcep use.
Assess for vaginal and cervical lascerations. Watch for bleeding.
Check for urine retention due to bladder damage.
Neonate assess for facial paulsy, bruising or hemotoma.
What is Pitocin and when is it used; what is the protocol for discontinuing its use?: Titrated to uterine contrations via IVPB.

To induce labor, to maintain labor or to promote involution and decrease bleeding after delivery.

Delivery begins with 0.2 - 2.0 microunits per minute. Increase to 40 mU/minute. Maintain dose when 40-90 sec contractions with 2-3 frequency. Dilation 1cm/h in active phase I.

Reasons to D/C:
-Uterine Hypersytimulation
-NRFHR
-Suspected Uterine Rupture
-Inadequate Uterine Response
What is Prostaglandin E and when is it used?: Usually given in a gel, insert or oral that ripens the cervix, causing dilation and stimulates contractions.

Can be used before induction.

Adverse Headache, N/V, diahrreah, fever, hypotension, tachy systol, hyperstim of uterus. Fetal passage of mecomium.
What is induction of labor?: Mechanical or chemical initation of uterine contractions before they start spontanously on their own.
What is trial of labor?: Observance of mom and fetus during spontainous labor for 4-6 hours to assess safety of vaginal birth.

If mom wishes to have a vag birth.
What is external cephalic version?: Turn from breech or shoulder to vertex.

Done after 37 weeks during labor. Ultrasound done before to look for cord, an amount of amniotic fluid, fetal age, anomolies, FST, and FHR montiroing, placentia previa.
What is postdate pregnancy and what are the dangers to mom and baby?: After 42 weeks.
Decreased Amnio fluid
Placenta says "Im Done"
What is precipitous labor?: Labor that lasts for 3 hours or less.

It can be a result of small babies, anitomical anomolies, or use of cocaine can promote this.

Can cause tears and bleeding.
What is dystocia; what are the causes?: Dysfunctional Labor

-Ineffective uterine contractions or pushing.
-Alterations in pelvic structure
-Fetal abnormal presentation or position.
-Big sizes or multiple fetus
-Materal position
-Psychologial attitutes of mother
What is premature rupture of membranes?: When the membranes break early before labor begins.
Bigest concerns
-Cord Prolaps
-Onset of labor if significantly preterm
-Infection.
How is premature rupture of membranes tested?: PROM
Rupture before onset of labor.
Sudden gush then continous leakae.
Is it urine or amnio? Urine Acid/Amnio Base.

Cord prolops with PROM is a danger and must be assessed immediately.

Onset of labor is significanly preterm.

Infection - chorioamnioitis.
What is the biggest concerns of premature rupture of membranes?: -Cord Prolapse
-Infection
-Onset of labor in significantly preterm labor.
What is the management for near term and preterm or premature rupture of membranes?: -Rule out cord prolaps.
-Do kick count
-Vaginal cultures
-No baths, douching, or Sex
-May be bedrest, put off as long as possible until fetus is viable and strong.
What are tocolytic drugs?: Capable of relieving uterine contraction by reducing the excitability of myometrial muscle. 2. Any agent that diminishes uterine contractions by reducing myometrial excitability.
What is Ritodrine and its adverse effects and nursing considerations?: Tocolytic therapy of preterm labor relaxes smooth muscles and broncho dialation.

Tachycardia, dysrythmias, tremors, headache, N/V, Hypokalemia, fetal tachycardia, and hypoxia. Hyperglycemia for mom.

Supervison, and do ECG before starting, start PO dose 30 minutes before D/Cing the IV therapy.
What is Terbutaline and its adverse effects and nursing considerations?: Tocolytic and relaxes smooth muscle. Stops labor and hypertonic contractions.

Tachycaria and flushing, palpations, termors, headache, N/V, hypokalemia, ketonuria, altered glucose metabolsm, fetal tachy.

Not FDA approved for tocolytic.
what is Betamethasone?: A common drug used to help develop the baby's lungs when it appears the woman will deliver prematurely. Given by IM.
What is preterm labor?: Labor that begins between 20 and 37 weeks gestation.
When does preterm labor occur?: Before 37 weeks.
What are the medical and nursing management implications of preterm labor?: Education...Education...Education
What lifestyle changes are needed.
When to contact HCP.
What tocolytics are available.
What happens during the 3rd stage of labor? What is the nursing role.: It is the time between the birth of the baby and the expulsion of the placenta.
-Maintain cultural considerations.
-Check placental appearence and examine intactness so that no portion remains in the uterine cavity.
What is the circle of fire?: Painful, Red, Stretched Labia.
What is a perineal laceration?: When the head is so large that it causes the perineam to tear. It can be superficial or actually extend through the rectum.

If a tear is allowed to occur spontaneously, the perineal body, external anal sphincter (Stage 3), and rectal wall (4th degree).
What is included in nursing assessment during the 1st stage of labor and why is it done?: Assess general S/S of complications.
Vaginal exam for efacement and dilation done sterile.
Determine presentation, positoin.
What is Leopoldâ€™s maneuver; how can the nurse be of emotional support?: Helps identify number of fetuses
-Preseting parts
-Fetal Lie
-Attitude
Mom on her back, and hands pressed into abdomen.
What is nursing role/care of the newborn during the 2nd stage?: FHR, Apgar, Keep baby warm, get baby to breast.
Give protective clothing. Cord clamping, rub, dries, check for two arteries, 1 vein.

Swap and give to parents if stable. Critial for bonding.
What is an episiotomy?: Incision of the perineum at the end of the second stage of labor to avoid spontaneous laceration of the perineum and to facilitate delivery.
What are the different locations, potential problems and description by â€œdegreesâ€ of episiotomy?: Midline with the spine most common,

Mediolateral on the side when posterior extension is likeely. Morebloodloss, and greater to heal.
What is the nursing support for the second stage of labor- emotional and physical?: Encourage woman to listen to her body.
Suggest upright postion to promote descent.
Encourage bearing down, and being loud if needed.
Maternal movement and postion changes.
Discourage long breath holds.
Encourage slow gentle breaths to "blow away" the pain.
Use mirror to touch to see the emerging fetal head.
Coach relaxation of mouth, neck, and throut which will also relax the pelvic flood.
Warm compress to peri to promote relaxation.
When is emergency intervention/ delivery indicated?: NRFHR
Inadequate uterine relaxation.
Vaginal bleeding.
Infection
Prolapse of cord.
What is spontaneous rupture and artificial rupture of membranes?: Spontanous by mom on her own.

Artficial is by crochet hook by the HCP.
What nursing care/ teaching is done concerning rupturing of the membranes?: Observe the amount, color, odor, and if any mecomium is evident.
When is it important to reassess and what does the nurse do during a rupture of the membranes?: Assess color, odor, amount, mecomium.
What causes acceleration?: Normal and caused by fetal movement and uterine contractions.
What causes early deceleration?: Normal and caused by head compression. OK so long as not prolonged.
What causes later deceleration?: NON REASSURING
Utero-Placenal insufficincy and the placeta does not have adequate blood supply to support fetus during contraction.
What causes variable deceleration?: Umbilical cord compression. Can be normal, so long as not for long periods of time.
what is the duration of a contraction?: About 90 seconds.
Why do FHR monitoring?: To assure fetal well being. Can be internal or external.

Has been used since the 1970s and has helped prevent fetal compromise and neonate health after birth.
What is the difference between external and internal FHR monitoring?: External uses a device on the mothers abdomen.

Internal uses a probe placed on the presenting part. Membranes must be ruptured, and cervix sufficiently dilated.
What are tachycardia and bradycardia values in FHR montiroing?: Brady <110
Tachy >160
What does the term variability mean?: Irregular fluctations in the baseline of FHR of 2 cycles per minute or greater.
What does the term nonreassuring FHR mean?: A heartrate that gives cause for concern. Biggest concern is late deceleration which might indicate placental insufficiency. Early deceleration is reassuring because it could mean that the head is compressing .
What does the term acceleration and deceleration mean?: Acceleration is when the FHR gets faster with a contraction. This is reassuring.

Deceleartion is the slowing of the FHR with a contraction. Early is not a problem, but late is NONREASSURING and could mean placental problems, and hypoxia to the fetus.
When are local ansesthetics used?: For Peri tissues, commonly used for episiotomies and when pudendal block isn't feasible due to time or fetal head position.
What is pudendal block?: Useful for 2nd stage of labor, episiotomy and birth
-Doesn't relieve pain from uterine contractions but relieves pain in lower vagina, vulva and perinemu
-Pudendal nerve - transverses the sacrosiatic notch just medial to the tip of the ischial spine on each side.
What is the difference between spinal and epidural anesthesia?: Spinal is injected at 3rd 4th or 5th lumbar space and mixes with CSF. Can cause CSF leaks and headache for mom.

Epidural is block from T-12 to S-5. Needs an IV line and causes occassional dizziness, weakenss of LE, difficulty emptying bladder and shivering.
What are the side effects and level of anesthesia with Spinal and Epidural anesthesia?: Spinal causes headach.

Epidural causes dizziness, weakness in LE, difficulty emptying bladder, and shivering.
What is action of Stadol?: Mixed agonist-antagonsit analgesic.
Used for Labor.
What is action of Nubain?: Mixed agonist-antagonsit analgesic.
Used for Labor.

Also used for Postoperative pain from C-Section.
What are the names of common drugs used during labor?: |
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When are systemic drugs indicated in labor?: |
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what are nonpharmacological methods for pain management?: Childbirth Preparation Methods
-Dick Read
-Lamaze
-Bradley (Husband Coached)

Breathing
Acupressure/Heat&Cold/Therapeutic Touch/Hypnosis/Biofeedback/Aromatherapy
What are factors that influence pain?: Culture
Anxiety & Fear
Previous Experience (Difficult or Painful)
Childbirth Prep - Family Support
What are maternal adaptations to labor- cardiac, vital signs, lab, GI: Cardiac output increases:
10-15% in 1st Stage
30-50% in 2nd Stage
HR increases slightly in 1/2
WBC Increase
RR Increases
Temperature may be slightly elevated
+1 ProteinUria
Gastric Motility Increases
BGL Decrease
What is normal FHR; what happens to prepare the baby to breath?: Normal FHR is 110-160.

As the baby is delived through the vagina, it is pressed during contractions which helps to expell the fluid from its lungs and prepares the neonate to take its first breaths.
What are the seven cardinal movements during labor/delivery?: Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and External Rotation
Expulsion
What are the different phases of the first stage of labor?: Includes three sub-stages, latent, active, and transition phases. Lasts from the onset of regular uterine contractions to full dilation of the cervix. Exact onset difficult to establish. Longest of the three stages. No absolute values exist for normal length of this stage, can be from 1 hour to more than 20 hours in first time mothers.
Describe the first stage of labor.: Includes three sub-stages, latent, active, and transition phases. Lasts from the onset of regular uterine contractions to full dilation of the cervix. Exact onset difficult to establish. Longest of the three stages. No absolute values exist for normal length of this stage, can be from 1 hour to more than 20 hours in first time mothers.
Describe the second stage of labor.: Lasts from full dilation of the cervix to the birth of the fetus. Average times are from 20 minutes for a multiparous (Having borne more than one child ) woman, to 50 minutes for a nuliparous woman (A woman having never given birth). Times are approximate, and can be affected by things such as epidural analgesia. It continues so long as progress is moving forward, and the fetus is not in any distress
Describe the third stage of labor.: Lasts from the birth of the fetus until the placenta is expelled. This may be as short as 3 to 5 minutes, but an hour is considered within normal limits.
Describe the fourth stage of labor.: Lasts a more arbitrary time, but approximately 2 hours. It is the period of immediate recovery when the mothers system is returning to its normal homeostatic state. It is a key time to watch for complications that might exist, including hemorrhage.
What is the difference between true and false labor?: |
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Why should mom stay off her back during 3rd trimester and during labor/delivery?: The weight of the baby can depress the Vena Cava and cause hypoxia.
What is effacement?: In obstetrics, the thinning of the cervix as the internal os is slowly pulled up into the lower uterine segment.
What is dilation?: The amount that the cervix has opened in preparation for childbirth, dilation is measured in centimeters or, less accurately, in â€œfingers,â€ during an internal (manual, pelvic) exam. â€œFully dilatedâ€ means the mothers cervix is at 10 centimeters and ready to push the baby out.
What are the powers of labor? What is the difference between primary and secondary powers of labor?: Primary is when the body is conracting and moving the fetus into the birth position. Involuntary and responsible for efacement and dilation.

Secondary is the pushing action of the mother during a contractions, have no effect on dilation but only help with expulsion of the fetus.
Which pelvis shape is best for vag delivery?: Oval
What is engagement and station?: Station is represented by -5 / 0 / +5 of the ischial spines.

Engagement is when the largest transverse diamater of the presenting part has passed into the true pelvis.
What do the numbers mean in engagement and station?: |
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How is fetal position determined?: By palpating the fontanelles during a vaginal examination.
What position is the easiest to deliver?: LOA
Left Occipitoanterior
What are the components of a birth plan?: -Birth companions
-Clothing
-environmental modification
-Labor Activities
-Comfort and Relaxation methods
-Birth medical interentions
-Immediate Newborn Care Methods.
Who are the providers in a birth plan?: Medical Doctor
RN Midwife
Midwifes
Doula
What are some common settings for delivery?: -Hospital
-Birth Center
-Home

May be influienced by HCP preference, characteristics of the birthing unit, preferences of insurance.
What are the factors affecting delivery? (The 5 P's): -Passenger
-Passageway
-Powers
-Position of the Mother
-Psycologic response
What are the names and purpose of sutures and fontanels?: They help the skull to compress during birth so that the head can pass through a variety of different sized vaginal pelvis's.
What is Rh Incompatibility?: Suppression of immune response in nonsensitized women with Rh-Negative blood who receive Rh-Positive blood cells from the fetus.
What is Coombs test?: Test to determine Rn Factor.
What is RhoGAM: Rhogam: Rh0 immunoglobulin, also called anti-Rh or anti-D immunoglobulin is an injectable blood product used to protect an Rh-positive fetus from antibodies by its Rh-negative mother. The idea underlying Rhogam is if anti-Rh antibody is given soon after delivery, it blocks the sensitization of the mother and prevents Rh disease from occurring in the woman's next Rh-positive child. Rhogam was developed in the 1960s by Dr. Vincent J. Freda (1927-2003), professor of obstetrics and gynecology at Columbia University.
what is fetal attitude and what is â€œnormalâ€?: The degree of flexion.

-Complete is "Good Attitude"
-Moderate is "Military"
-Partial extension
-Complete extension may indicate neuro defects.
what is fetal lie?: Relationship of long axis (spine) of fetus to long axis (spine) of mom.

-Longitudinal (Vertical) 99% Cephalic or breech.
-Transverse (Horizontal) - Vaginal birth can not occur.
What is presentation?: The direction of the "Passenger"

Vertex (96%) Head First
Breech (3%) Buttocks first
Shoulder (1%) requires manipulation or c-section.

Can be affected by lie, attitude, and extension/flexion of fetal head.
What are the different types of presentations and factor determining presentation?: Occipital Head 96%
Breech Butt 03%
Shoulder 01%

Determined by Fetal Lie, Fetal Attitude, and Extension/Flexion of Head.
What is pregestational diabetes?: Pre Gestational DM is what we typically think of as Type 1 or Type 2 DM. Not induced by pregnancy.
What is gestational diabetes?: Diabetes of pregnancy woman that usually occurs in the 2nd and 3rd Tri-mester as a result of maternal ingestion of greater amounts of food which causes sustained levels of blood glucose in the mother.

Placental hormones such as cortisol and insulinase are insulin antagonists which cause additional rises in BGL.
What are TORCH infections and why do we get concerned?: The TORCH test, which is sometimes called the TORCH panel, belongs to a category of blood tests called infectious-disease antibody titer tests. This type of blood test measures the presence of antibodies (protein molecules produced by the human immune system in response to a specific disease agent) and their level of concentration in the blood. The name of the test comes from the initial letters of the five disease categories. The TORCH test measures the levels of an infant's antibodies against five groups of chronic infections â€“

Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, Herpes
What is Group B strep and why do we get concerned?: GBS is a bacteria that is different form Group A Strep which is found in the throat and mucous membranes. Group B Strep is found in the lower intestines, and the vagina of some women. Many people are â€œcolonizedâ€ with the disease but are asymptomatic. The infant is at a risk of being exposed to the virus once the membranes have ruptured, or even during a cesarean section delivery. If the mother is know to be GBS positive, IV antibiotics should be administered upon her admission to the hospital at the first signs of labor. This has been found to eliminate, or at least greatly reduce the incidence of transferring the potential for disease to the new born child.
What is DIC (clotting problem): Disseminated Intravascular Coagulopathy DIC is a situation of inappropriate coagulation within the blood vessels which leads to the consumption of clotting factors, thus resulting in the failure of the clotting mechanism at the site of bleeding. DIC begins with an event (possibly one of the above) that triggers widespread clotting with the formation of microthrombi throughout the circulation. The clotting factors are then used up. The DIC triggers fibrinolysis ( the breakdown of fibrin occurring as a response to the presence of clotted blood) and FDP production (Fibrin Degradation Products, the products of fibrinolysis). The FDPs reduce the efficiency of normal clotting.
What is vasa previa (unbilical cord problem)?: The presentation of the umbilical blood vessels in advance of the fetal head during labor.
What is an algorithm?: Like a Flow Chart, or Decision tree to help a provider make decisons about the care of a client. Can be used in many different health care disciplines.
What is nursing diagnosis for excessive bleeding; what is EOC?: |
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What is abruptio placentae; how does patient present?: Premature separation of the placenta
What is placenta previa; how does patient present?: A placenta that is implanted in the lower uterine segment near or over the internal cervical os.

May result from old scaring from induced pregnancy or previous c-section.

-70% have painless uterine bleeding.
-20% have vaginal bleeting with uterine activity.
-Vital Signs may be normal even with blood loss.
-ABD examination will show soft, relaxed, non tender uterus with normal tone.
Leopold's manuver may show fetus oblique or breech due to low placement in the os of the cervix.
What is hydatidiform mole; what are patient symptoms; what is management?: Is a Molar Pregnancy.
Complete occurs when a Sperm fertalizes an ovum without a necleus.
Incomplete is two sperm fertalize the same ovum.

It resluts in a "Bag of Grapes" and the fluid filled vessicles grow rapidly. So much so that mother may present with weight gain much higher than gestation would indicate. Also might have very high levels of hCG for the time. May present with vaginal bleeding and dark brown (Prune Juice) discharge or bright red.

Management
Will usually spontaniously abort, or may require D&C for removal.
Rhogam is usually given IM.
Where is the ovum usually implanted in an ectopic pregnancy?: -95% in the felopian tubes
-3/4% in the Abdominal cavity (Where viabliity is possible 5-25% of the time, but abnormalities almost always exist.
-1% each in the Ovary or Cervix
What are patient symptoms in an ectopic pregnancy?: -50-80% have vaginal bleeding
-Adnexal fullness
-Tenderness dull to colicly as uterine tube stretches.
-Referred Shoulder Pain from Diaphratic fullness
-Pain becomes more severe if tube ruptures.
How do the symptoms of eptopic pregnancy differ from miscarriage?: |
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What is incompetent cervix? What is medical and nursing management?: Passive and painless dilation of cervix during 2nd Trimester or early 3rd Trimester, without labor or contractions.

Management is collaborative.
MEDICAL MANAGEMENT includes a Cerclage which is a nonabsorbable ribbon used to close the OS of the uteris. It can be removed at 37 weeks or left in place for C-Section.
NURSING MANAGEMENT focuses post-op on contractions, ROM and infection. Discharge planning notes the importance of no intercourse, prolonged standing, or heavy lifting.

Tocolytics may be given to prevent contractions and further dilation of the cervix.
why are pregnant adolescents high risk: Poor Prenatal care, and possible poor nutrition.
For older moms, what are the risks for adverse outcomes?: |
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Why are multifetal pregnancie high risk? What is the nurses role in these pregnancies?: |
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What is hyperemesis gravidarum including etiology?: Persistent, continuous, severe, pregnancy-related nausea and vomiting, often accompanied by dry retching. Causes weight loss (5% or More), dehydration and electrolyte abnormalities. Ketosis, acetonuria.

Several reasons have been proposed, but none absolutely account for the sidorder.

Seen in 1% of Pregnancies. Might be from high levels of hCG or Estrogen.

Might be psychological from ambivalance towards pregnancy.
Who is at high risk for hyperemesis gravidarum and why do we worry?: Incidence is greatest in women <20 years, those who are obese, non-smokers, multi-fetal gestation, and molar pregnancies.

IV Therapy might be needed to correct the FVD.

Might need to be NPO until N/V have resolved.

Severe cases might need TPN.
What are the symptoms and medical management of hyperemesis gravidarum?: -Symptoms include sersistent vomiting.
-Decreased BP and Increased HR
-Poor Skin Turgor
-Lab Tests reveal electrolyte imbalance
What is nursing education for patient with gestational diabetes?: Once a dx of GDM is made the mother must begin tx ASAP and does not have time to adjust to tx regimne as another woman might.

Educate client and family on the importance of sticking with diet plan. It might be beneficial to remind the client that GDM typically disappears when pregnancy is done.
How is gestational diabetes diagnosed; what is screening test; what happens if it is elevated?: Clients who are not high risk are not routinely tested for GDM.

Those at risk are Hispanic, Native, Asian and African American Women, obesity, Age >30 family hx of Type 2 DM.

Screen at 24-28 weeks with Glucola 50g Non Fasting load results in >140 mg/dL then followed by OGTT.
What is normal post prandial blood sugar?: <120
What are the glucose/metabolic changes that occur with the 1st Trimester of Pregnancy?: -Rising Levels of Estrogen & Progesterone
-Lower fasting glucose levels
What are the glucose/metabolic changes that occur with the 2nd Trimester of Pregnancy?: Diabetogenic effect
Decreased tolerance to glucose
Maternal insulin requirements double and begin to decline slightly by 36 weeks gestations.
What are the glucose/metabolic changes that occur with the 3rd Trimester of Pregnancy?: Diabetogenic effect
Decreased tolerance to glucose
Maternal insulin requirements double and begin to decline slightly by 36 weeks gestations.
What is the definition of spontaneous abortion?: It is also known as a Miscarriage and is a pregnancy that ends before 20 weeks gestation.

-10-15% of all pregnancies end in miscarriage.
-90% occur before 8 weeks.
-50% are a result of chromosomal abnormality.
-Can be missed abortion where there is fetal death but must clean with D&C
-Can be threatened which are treaded with supportive care and BR.
-May be related to endocrine imballance
How does the patient present (symptoms) of spontaneous abortion?: Depend on the duration of the pregnancy.

-May include Pain, Bleeding, uterine contractions or uterine pain.

-Usually before the 6th week may present as heavy menstral flow
-6-12 weeks is moderate blood loss and discomfort.
-After 12th week more sever pain like labor, because Fetus must be expelled.
What is the medical and nursing management of spontaneous abortion?: THREATENED - Bedrest, Sedation, avoid Stress and Orgasm
INEVITABLE/INCOMPLETE - Prompt termination is accomplished usually by D&C
MISSED - If spontanous evacuation does not occur D&C is performed. Keeping contents in the uterus for >5 weeks can result in DIC
SEPTIC - Immediate termination is accomplished and C&S Studies are done.
What is the discharge teaching of spontaneous abortion?: -Report any heavy, Profuse or Bright Red Bleeding
-Scant Discharge may exist for 1-2 Weeks
-No Tampons or Vaginal Intercourse until bleeding stops.
-If Abx are prescribed stress importance of completion compliance
-Understand and deal with loss and mood swings
-Postpone pregnancy for 2 months to allow body to heal.
What are the maternal and neonatal complications that can occur as a result of gestational diabetes?: MOM
-Increased Risk of perineal laceration, episotomy, and c-section.

BABY
-Macrosomia (Big Baby)
-Hypoglycemia, hypocalcemia, hyperbilirubinemia, thrombocytopenia, RDS
When is a mom with diabetes hospitalized?: -Any Period of Infection as it may lead to hyperglycemia and Diabetic Keto Acidosis.
-Not maintaining adequate BGL
-Worsening Hypertensive disorder
-Fetal Macrosomia
-Fetal Growth Restrictions

Big Babies often times result in the need for C-Section.
When is delivery indicated in a mom with gestational diabetes?: Delivery is indicated if:
-Poor Metabolic Control
-Worsening hypertensive disorder
-Fetal macrosomia
Failure to Progress
-Fetal Growth Restriction
What is HELLP syndrome; what are patient signs and symptoms?: An acronym derived from the first letters of the terms that describe the following laboratory findings: Hemolysis, Elevated Liver enzymes, and Low Platelet count.

Risk Factors include Older, Causasian, Multiparous women.

12% will have HELLP.
Signs and Symptoms are report of Malaise for Several Days. RUQ ABD Pain probably from hepatic ischemia. 65% have gastric pain. 1/2 have N/V.

Rental failure and coagulation.

72-96 hours after birth will usually resolve.
What is preeclampsia; what are risk factors for developing; pathophys/ changes?: Preclampsia is a pregnancy specific condition in which hypertension develops after 20 wks of gestation in a previously normtensive woman. Multi system disease characterized by hypertension and proteinuria.

RISK FACTORS
Inadequate Protein/Ca/Na/Mg/Vit A/Vit E
Mom <19 or >40
Familial Hx
Twins
DM
Obesity
Rh Incompatability
What is difference between mild and severe preeclampsia (signs and symptoms)?: Mild Preclampsia
BP 140/90
MAP >105mm Hg
0.3 Protein Uria
No Headache or Vision Problems
Probable Normal Reflexes

Severe Preclampsia
BP 160/110
MAP >105mm Hg
Protein Uria >5g/L
Severe Headache /Blurred Vision/Photophobia
Hyperflexia
What is eclampsia; how is it treated; when do symptoms resolve?: A severe hypertensive disorder of pregnancy characterized by convulsions and coma, occurring between 20 weeks' gestation and the end of the first postpartum week.

Found in 0.5-2% of All Pregnancies
S/S Convultions/HTN/Proteinuria/hyperflexia

Requires Immediate Care
What is nursing care for a patient with eclampsia?: -Keep Airway Patent
-Turn womon on side to prevent vomitus aspirations
-Administer O2 as ordered
-Administer MgSO4 or other antihypertensive as ordered
-Prepare for IV Access with large bore needle
-Call for Assistance
-Protect with padded siderails
-Observe and Record Convulstion Activity
In a woman with eclampsia what are the indications for delivery (under what conditions will the patient be induced or require C-section)?: The more serious the condition of the woman, the greater is the need to proceed to the birth either with induction or c-section.

If fetal lungs are immature, and birth can be delayed for 48Hours, Bethamethasone may be given.

The "Cure" for Exlampsia is delivery of the fetus, so this is usually done ASAP if the fetus is vaible.
What is the nurses role for managing mild preclampsia. What is patient management of mild preeclampsia?: The Nurses most important Role is Prevention. Advocacy and Education.
-Keep BP Stable
-See that Urine Protein is <500mg in 24/h
-No Subjective Complaints.

Home Management
-Bedrest in Lateral Recumbant Position
-Diet High in Protein with some Salt for maintenance of blood flow and placental profusion.
What is the medical and nursing management of severe preeclampsia?: Recognize the client is critically ill.
-Administration of MgSO4 prophylaxis for seizures
-Antihypertensive if DBP>110
-Tx of Hypoglycemia if BG<40
NURSING
-Daily Weights
-Foley Cath
-Vaginal and ABD examination fetal size, activty and position.
-Urin tonicity
-Electronic Monitoring
-Bedrest
What medications are used for hypertension in pregnancy?: |
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For what problem is Magnesium Sulfate indicated and how does it work?: -Started to decrease incidence of seizures.
-Increases uterine blood flow to protect the fetus.
-Increases prostacyclines to prevent uterine vasoconstriction.
-It is NEVER Given IM.
What is toxic level of Magnesium Sulfate? What patient signs and symptoms of toxicity; what is included in nursing management?: Toxic Levels are >9.6 mg/dL

RR <12/min
Urin <30ml/hr
Hypoflexia, Absence of DTR
^Edema and Proteinurea
Fetal Tachy or Brady Cardia
v in Maternal Pulse or BP
What is DIC?: Disseminated intravascular coagulation (DIC) is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of haemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly meningococcal sepsis) and acute promyelocytic leukemia.
What is a Totolytic?: Medications used to suppress premature labor (toco refers to contractions, and lytic to removal).
They are nearly always given in midpregnancy, when delivery would result in an extremely premature infant.
Various types of agents are used, with varying success and side-effects.
* Ritodrine
* Fenoterol
* Nifedipine
* Atosiban
How is ectopic pregnancy diagnosed?: Usually with ultrasound.
What medical interventions usually happen with an ectopic pregnancy?: -Rhogam is given if needed.
-Methotrexate given to destroy cells and stop them from further growth.
Name Three Nursing Dx related to Placenta Previa.: I-Decreased cardiac output R/T Bleeding S/T Placentia previa.

II-Risk for Fetal Injury R/T decreased uterine/placental profusion S/T Bleeding

III-Riks for Infection R/T Anemia/Bleeding S/T placenta previa.
Describe some steps in GDM Antepartum Care.: -Diet
-Exercise
-BGM
-Insulin Therapy
-Possible Fetal Surveillance
What medications are given for preeclampsia?: Methyldopa - Management of mod-severe HTN
Hydralazine - Management of mod-severe HTN.

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Number of cards 152