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the end of a pregnancy before the fetus is viable, wether spontaneous or elective

answer

abortion

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closing of the cervix with a suture to prevent early dilation and spontaneous abortion

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cerclage

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complex disorder that may complicate abruption placentae; large blood clot forms behind the placenta consumes clotting factors which leave the rest of the mothers body deficient in the factors

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disseminated intravascular coagulation

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pregnancy-induced hypertension complicated by one or more seizures

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eclampsia

question

when maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes

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erythroblastosis fetalis

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an endocrine disorder that manifests during pregnancy

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gestational diabetes mellitus (GDM)

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polyhydramnios; an excess of amniotic fluid, leading to overdistention of the uterus. OFten seen in diabetc pregnant women even if there is no coexisting fetal anomaly

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hydramnios

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mechanical defect in the cervix, making it unable to remain closed throughout pregnancy and resulting in spontaneous abortion

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incompetent cervix

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process where fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may respond by making antibodies to destroy the Rh-positive erthrocytes

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isoimmunization

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abnormally large infant, or neonatal birth weight above the 90th percentile

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macrosomia

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may be used when Gestational Hypertension (GH) includes proteinuria; progresses to eclampsia when convulsions occur

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preeclampsia

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The human fetus, placenta and other such products of conception which occur with a miscarriage or theraputic abortion.

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products of conception (POC)

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substance that causes an adverse effect on the developing embryo or fetus

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teratogen

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May result in cerebral hemorrhage, abruptio placenta, fetal compromise, or death of the mother or fetus.

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An eclamptic seizure

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(formerly known as grand mal seizures) are a type of generalized seizure that affects the entire brain. Tonic-clonic seizures are the seizure type most commonly associated with epilepsy and seizures in general, though it is a misconception that they are the only type

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tonic-clonic seizures

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development of the fetus outside the uterus

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Ectopic Pregnancy

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May contribute to ectopic pregnancy

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use of an intrauterine device for contraception

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(If tube is not ruptured) what med. inhibits cell division in the embryo and allows it to be reasorbed

answer

methtrexate

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excessive nausea and vomiting during pregnancy

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Hyperemesis gravidarum

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failure of the cervix to remain closed until the fetus is mature enough to survivie outside the uterus

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Incompetent cervix

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spontaneous loss of a pregnancy before 20 weeks (often called miscarriage)

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Spontaneous abortion

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Nursing interventions with woman with hyperemesis gravidarum

answer

avoid food odors, I and O monitoring, frequent small amount food, taking fluids between meals

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vaginal bleeding without dilation of the cervix or passage of tissue

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Threatened abortion

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bleeding and cramping with passage of some tissue

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Incomplete abortion

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bleeding and cramping with cervical dilation but no passage of tissue

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Inevitable abortion

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passage of all products of conception

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Complete abortion

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retention of the dead fetus in the uterus

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Missed abortion

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two or more consecutive spontaneous abotions

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Recurrent abortion

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Intentional termination of pregnancy to preserve the health of the mother

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Therapeutic abortion

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intentional termination of pregnancy for reasons unrelated to health

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Elective abortion

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An ectopic pregnancy usually occurs in the

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follopian tube

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The purpose of the biophysical profile is to

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determine if the placenta is functioning well enough to support fetal life

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What fetal or neonatal problems should the nurse anticipate if a woman has persistent hyperemesis gravidarum

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smaller than expected birth weight

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this ultrasound scan measure teh amniotic fluid pockets in all four quandrants. 5 to 19cm is normal

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Amniotic Fluid volume

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fewer than three fetal kicks within an hour or cessation of fetal movement for 12 hours indicates the need for evaluation

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Kick Count

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determines the level of this fetal protein in the pregnant woman's serum

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Alpha-fetoprotein testing

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insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid

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Amniocentesis

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Abortion

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miscarriage

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Edema of the feet and legs is common during pregnancy, but edema above the waist suggest

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GH

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Hypertension during pregnancy is

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-Increase over baseline SBP 30 mmHg -Increase over baseline DBP 15 mmHg

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Hypertension during pregnancy Risk Factors

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First baby Obesity Maternal age over 40 or under 19 Multifetal pregnancy Family or personal history of PIH Chronic hypertension Chronic renal disease Diabetes mellitus

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Postpartum care of Pt's with GH

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Must be monitored at least 48 hours during postpartum time Mom is still at risk for seizures for 72 hours after the birth of the baby Antihypertensive drugs may adversely affect milk production for breastfeeding Diuretics reduce milk production and are not given to breastfeeding mothers

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What is the purpose of magnesium sulfate

answer

if given for hypertension, it reduces it. Also it is an anticonvulsant given to prevent seizures. It inhibits uterine contractions and most women receive it with oxytocin to strenghen labor contractions.

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What observations are needed for a woman who is receiving magnesium sulfate as treatment for hypertension

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watch for hypotension

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Theraputic serum level of magnesium is

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4-8 mg/dL

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The nurse should alert the newborn nursery staff when magnesium sulfate has been admonistered during labor because

answer

if the newborn is treated with aminoglycosides(such as kanamycin (Kantrex) or neomycin), an interaction can occur and result in paralysis of the newborn.

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Administering magnesium sulfate (common protocols) (Only by RN)

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VS q 1 hr with Temp. q 4hrs Deep tendon reflexes q 1-4 hrs I&O q 1hr (may have indwelling cath for accuracy) Protein dip with q void Mag levels q 4 hrs

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Signs and symptoms of deterioration and is promptly reported when given magnesium sulfate

answer

Increasing BP Signs of CNS irritation: facial twitching, hyperactive DTRs Decreased urinary output Abnormal FHR Symptoms which commonly precede seizures: severe headache, visual disturbances, epigastric pain

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What signs or factors that should be recognizied as magnesium toxicity signs,and reported to charge nurse so calcium gluconate can be given

answer

Absent of deep tendon reflexes Respirations under 12 breaths/min Urine output 8 mg/dl

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What drug should be on hand if a woman is receiving magnesium sulfate

answer

calcium gluconate

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Rh blood incompatibility can only occur if the mother is Rh ___ and the fetus is Rh ___

answer

negative , positive

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The drug given to prevent Rh incompatibility is

answer

RhoGAM

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The preferred drug used to control the blood glucose during pregnancy is ___ because it ___

answer

insulin, does not cross the placenta

question

Why is glucose monitored by blood testing during pregnancy

answer

insulin requirements fluctuate

question

How do labor and the postpartum period change the demands on the heart

answer

each contraction temporarily shifts 300 to 500 ml of blood from the uterus and placenta to the woman's circulation, overloading the heart

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Three reasons why a pregnant woman needs increased iron

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increased blood volume, transfer to the fetus, a cushion against the blood loss expected at birth

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Iron foods

answer

meats, chicken, fish, liver, legumes

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Folic Acid foods

answer

green leafy vegetables, asparagus

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Vitamin C foods

answer

strawberries, cantalope

question

What foods are good to take with an iron supplement

answer

vitamin C, because it enhances the absorption of iron

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What foods or durgs should be avoided at the time an iron supplement is taken and why

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calcium or antacids, because it impairs absorption

question

no effective prevention or treatment

answer

Cytomegalovirus

question

immunize children to avoid infecting pregnant women, immunize nonimmune woman after birth

answer

Rubella

question

deliver infants by cesarean birth if the woman has genital lesions when labor begins

answer

Herpesvirus

question

give immune globulin immediately after birth followed by vaccine

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Hepatitis B

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Three ways an infant may be infected with human immunodeficiency virus

answer

transplacentally, through contact with infected maternal secretions at birth, through breast milk

question

If a woman has cardiac disease, the main risks tot he fetus are related to

answer

poor oxygenation

question

Toxoplasmosis

answer

wash hands and surface after handling raw meat, cook meat thoroughly, avoid cat litter

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Group B streptococcus

answer

treat culture positive woman and her infant with penicillin

question

Why is a pregnant woman more likely to have a urinary tract infection

answer

alters the self-cleaning action because pressure on urinary structures keeps the bladder from emptying completely

question

Three things the nurse can teach a woman about avoiding a urinary tract infection

answer

front to back direction, adequate fluid intake, reduce sexual intercoarse

question

General approaches tot he care of pregnant women related to bioterrorist attacks

answer

safe food and water supply, safe air, available vaccines

question

Manifestations of fetal alcohol syndrome

answer

growth restrictions, mental retardation and facial abnormalities

question

ACE inhibitors

answer

fetal kidney anbormalities, growth restircition and insufficient amniotic fluid

question

Cigarette smoking

answer

infant may be smaller than expected for gestation

question

Cocaine

answer

severe vasoconstriction may cause preterm labor, hypertension with reduced placental circulation and maternal stroke

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Folic acid antagonists

answer

causes spontaneous abortion and other serious fetal anomalies

question

Heroin

answer

abstinence syndrome may develop in woman or infant if drug is stopped suddenly

question

Lithium

answer

associated with congenital heart disease and toxicity to fetal thyroid and kidneys

question

Tetracycline

answer

infant may have discolored teeth

question

Vitamin A preparations

answer

reliable birth control is needed for three months after treatment with this drug

question

Warfarin

answer

crosses placenta, possibly causing spontaneous abortion, growth restriction and central nervous system and faical defects

question

If a woman needs a potentially teratongenic therapeutic drug during pregnancy, how will the health care provider make a decision about what to prescribe

answer

drug is weighed against the potential for fetal harm it may cause and the fetal or maternal harm that may occur

question

Risks for a woman and her infant is she is a victim of abuse

answer

miscarriages, still births and low-birthweight

question

Common manifestations of battering

answer

bruises or laceration in various stages of healing

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Characteristic causes of high-risk pregnancies

answer

can relate to the pregnancy itself, can occur because the woman has a medical condition or injury that complicates the pregnancy, can result from environmental hazards that affect the mother or her fetus, can arise from maternal behaviros or lifestyles that have a negative effect on the mother or fetus

question

Assessment of Fetal healh

answer

done at any age, amniotic fluid index, biophsical profile

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Amniotic fluid index

answer

normal 5cm-19cm

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Danger signs in pregnancy

answer

suddne gush of lfuid from the vagina, vaginal bleeding abdominal pain, persistent vomiting, epigastric pain, edema of face and hands, severe, persistent headache, blurred vision or dizziness, chills with fever over 100.4, painful urination or reduced urine output

question

excessive nausea and vomiting, dehydration, reduced delivery of blood, oxygen and nutrietns to the fetus, can effect growth

answer

Hyperemesis gravidarum

question

Treatment of hyperemesis gravidarum

answer

correct dehydration and electrolyte or acid-base imbalance, antiemetic drugs may be prescribed, TPN may be required nad/or hospitalization

question

95% occur in fallopian tube, scarring or tubal deformity

answer

Ectopic Pregnancy

question

Scarring or tubal deformity may result from

answer

hormonal abnormalities, inflammation, infection, adhesions, congenital defects, endometriosis

question

Ectopic pregnancy manifestations

answer

lower abdominal pain, may have light vaginal bleeding, if tube ruptures may have sudden severe lower abdominal pain, signs of hypovolemic shock, shoulder pain

question

Ectopic pregnancy treatment

answer

pregnancy test, transvagiannl ultrasound, priority is to control bleeding, no action, treatment with methotrexate, surgery to remove pregnancy from the tube

question

Signs and Symptoms of Hypovolemic Shock

answer

changes in fetal heart rate, risking weak pulse, risking respiratory rate, shallow, irregular respirations, air hunger, falling blood pressure, decreased or absent urinary output, pale skin or pale mucous membranes, col, clomammy skin, faintlness, thirst

question

Bleeding disorders

answer

placenta previa, albruptio placentae

question

Abnormal implantation of placenta, bright bleeding occurs when cervix dilates, resulting in painless bleeding

answer

Placenta previa

question

Normal implantation of placenta, dark bleeding with pain and enlarging uterus suggest blood its accumulating within the cavity

answer

Albruptio placentae

question

Placenta previa risks

answer

infection, because of vaginal organisms, postpartum hemorrhage, because if lower segment of uterus was site of attachment, then there are frew muscle fibers so weaker contractions may occur

question

Abruptio placentae risks

answer

hypertension, cocaine or alcohol use, cigarette smoking and poor nutrition, blows to the abdomen, prior history of abruptio placentae, folate deficiency

question

Care of the pregnant woman with excessive bleeding

answer

document blood loss, closely monitor vs, including I and O, observe for pain, verify orders for blood typing and cross-match have been carried out, monitor intravenous infusion, prepare for surgery, if indicated, monitor fetal heart rate and contractions, monitor laboratory results, inclduing coagulation studies, administer oxygen by mask, prepare for newborn resuscitation

question

Less than a 5-cm (2-inch) stain on pad of blood (10mL)

answer

Scant

question

Less than a 10cm (4-inch) stain on pad (10-25 mL)

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Light

question

Less than a 15cm (6-inch) stain on pad (25-50 mL)

answer

Moderate

question

Larger than a 15cm stain or one pad saturated within 2 hours (50-80 mL)

answer

Large or heavy

question

Saturation of a perineal pad within 15 minutes

answer

Excessive

question

Hormones (estrogen and progesterone) an enzyme (insulinase) produced by the placenta, and increased prolactin levels have two effects:

answer

-increased resistance of cells to insulin - increased speed of insulin breakdown

question

Nursing Alert 1

answer

Most woen respond to changes by secreting extra insulin to maintain normal carbohydrate metabolism while still providing plenty of glucose for the fetus. If the woman cannot increase her insulin production, she will have periods of hyperglycemia (increased blood glucose levels) as glucose accumulates in the blood.

question

Gestational Diabetes Mellitus

answer

Glucose intolerance with onset during pregnancy. In true GDM, GLUCOSE USUALLY RETURNS TO NORMAL BY 6 weeks postpartum.

question

Nursing Alert 2

answer

Most oral hypoglycemic agents have not been used during pregnancy in the past because they can cross the placenta, possibly resulting in fetal birth defects or neonatal hypoglycemia.

question

Nursing Alert 3

answer

GDM resolves promptly after birth, when the insulin-antagonistic effects of pregnancy cease.

question

Nursing Alert 4

answer

The priority of care is to limit physical activity to decrease the demands made on the heart.

question

Nursing Alert 5

answer

Typically, insulin dosage may have to be reduced to avoid hypoglycemia in the firs trimester, when nausea decreases appetite and physical activity may be reduced.

question

TORCH

answer

Used to describe infections that can be devastating for the fetus or newborn. T = Toxoplasmosis O = Other infections R = Rubella C = Cytomeganlovirus H = Herpes

question

Nursing Alert 6

answer

An infant born to a mother with an active viral infection, such as rubella or varicella, must be placed on airborne and contact isolation.

question

Nursing Alert 7

answer

When a woman of childbearing age is immunized she should not get pregnant for at least 1 month after the immunization.

question

Nursing Alert 8

answer

There is no effective treatment for CMV infection.

question

Nursing Alert 9

answer

All women should be screened for hep B during the course of prenatal care, and the screening should be repeated during the 3rd trimester for women in high risk groups. Infants born to women who are positive for hepatits b should recieve a single dose of hep b immune globulin (for temporary immunity right after birth) followed by bep b vaccine (for long term immunity).

question

Nursing Alert 10

answer

Immunization during pregnancy is not contraindicated. If possible, injections should be delayed until after the infant's first bath, so that blood and other potentially infectious secretions are removed to avoid introducing them under the skin.

question

Tertogen

answer

a substance that causes an adverse effect on the developing embryo or fetus

question

The four main teratogens of concern during pregnancy are?

answer

Drugs, chemicals, infectious agents, and radiation.

question

Physical trauma

answer

usually blunt trauma(falls or blows to the body) but may be penetrating trauma (knife or gunshot wounds)

question

Nursing Alert 11

answer

Women abused during pregnancy are more likely to have miscarriages, stillbirths, and low-birth-weight babies. They often enter prenatal care late, if at all. The risk of homicide escalates during pregnancy.

question

Nursing Alert 12

answer

Abuse during pregnancy, as at other times, may take many forms. It is not always physical abuse, may women are abused emotionally. Emotional abuse makes leaving the relationship especially difficult, because it lowers the woman's self-esteem and isolates her from sources of help. The time of greatest danger to the abused woman occurs when she leaves her abuser.

question

Manifestations of Battering:

answer

In addition to having late or erratic prenatal care, the battered woman may have burises or lacerations in various stages of healing. The woman tends to minimize injury or forget its severity.

question

Effects of a high risk pregnancy on the family:

answer

Disruption of usual roles Financial difficulties Delayed attachment to the infant Loss of expected birth experience

question

Which drug is sometimes given to women with gestational hypertension to prevent seizures?

answer

Magnesium Sulfate

question

Which symptom Distinguishes abruptio placentae from placenta previa?

answer

Pain

question

TORCH is an acronym used to describe?

answer

Infections that can be devastating for the fetus or newborn.

question

Nursing Alert 13

answer

Rh incompatibility between the woman and fetus can occur only if the woman is Rh negative and the fetus is Rh positive.

question

Nursing Alert 14

answer

The primary management to prevent the manufacture of anti- Rh antibodies is by giving Rh0(D) Immune globulin(RhoGAM) to the Rh- negative woman at 28 weeks of gestation and within 72 hours after birth of an Rh-positive infant or abortion.

question

What reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate?

answer

Calcium gluconate

question

Nursing Alert 15

answer

Sudden excessive weight gain is the first sign of fluid retention. Visible edema follows the weight gain. Edema of the feet and legs is common during pregnancy, but edema above the waist suggests GH. The woman may notice facial swellin or may stop wearing rings because they are hard to remove. Edema is severe if a depression remains after the tissue is compressed briefly with the finger "pitting edema"

question

Nursing Alert 16

answer

A blood pressure of 140/90 mm Hg or above is considered to constitute hypertension in pregnancy.

question

Nursing Alert 17

answer

Chronic hypertension is considered moderate if the systolic reading is between 140 and 160 mm Hg ad the diastolic reading is below 110 mm Hg. However, an increase over baseline blood pressure of 30 mm Hg or more systolic and 15 mm Hg diastolic will place the woman in a high risk category, therefore a woman with a baseline blood pressure that is normally low, such as 90/60 mm Hg may be at risk for GH if her blood pressure rises to 120/80 mm Hg especially if proteinuria occurs. Blood pressure normally decreases during the first two trimesters.

Chapter 5 Nursing Care of Women with Complications during Pregnancy – Flashcards

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