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

question
the end of a pregnancy before the fetus is viable, wether spontaneous or elective
answer
abortion
question
closing of the cervix with a suture to prevent early dilation and spontaneous abortion
answer
cerclage
question
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
answer
disseminated intravascular coagulation
question
pregnancy-induced hypertension complicated by one or more seizures
answer
eclampsia
question
when maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes
answer
erythroblastosis fetalis
question
an endocrine disorder that manifests during pregnancy
answer
gestational diabetes mellitus (GDM)
question
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
answer
hydramnios
question
mechanical defect in the cervix, making it unable to remain closed throughout pregnancy and resulting in spontaneous abortion
answer
incompetent cervix
question
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
answer
isoimmunization
question
abnormally large infant, or neonatal birth weight above the 90th percentile
answer
macrosomia
question
may be used when Gestational Hypertension (GH) includes proteinuria; progresses to eclampsia when convulsions occur
answer
preeclampsia
question
The human fetus, placenta and other such products of conception which occur with a miscarriage or theraputic abortion.
answer
products of conception (POC)
question
substance that causes an adverse effect on the developing embryo or fetus
answer
teratogen
question
May result in cerebral hemorrhage, abruptio placenta, fetal compromise, or death of the mother or fetus.
answer
An eclamptic seizure
question
(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
answer
tonic-clonic seizures
question
development of the fetus outside the uterus
answer
Ectopic Pregnancy
question
May contribute to ectopic pregnancy
answer
use of an intrauterine device for contraception
question
(If tube is not ruptured) what med. inhibits cell division in the embryo and allows it to be reasorbed
answer
methtrexate
question
excessive nausea and vomiting during pregnancy
answer
Hyperemesis gravidarum
question
failure of the cervix to remain closed until the fetus is mature enough to survivie outside the uterus
answer
Incompetent cervix
question
spontaneous loss of a pregnancy before 20 weeks (often called miscarriage)
answer
Spontaneous abortion
question
Nursing interventions with woman with hyperemesis gravidarum
answer
avoid food odors, I and O monitoring, frequent small amount food, taking fluids between meals
question
vaginal bleeding without dilation of the cervix or passage of tissue
answer
Threatened abortion
question
bleeding and cramping with passage of some tissue
answer
Incomplete abortion
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bleeding and cramping with cervical dilation but no passage of tissue
answer
Inevitable abortion
question
passage of all products of conception
answer
Complete abortion
question
retention of the dead fetus in the uterus
answer
Missed abortion
question
two or more consecutive spontaneous abotions
answer
Recurrent abortion
question
Intentional termination of pregnancy to preserve the health of the mother
answer
Therapeutic abortion
question
intentional termination of pregnancy for reasons unrelated to health
answer
Elective abortion
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An ectopic pregnancy usually occurs in the
answer
follopian tube
question
The purpose of the biophysical profile is to
answer
determine if the placenta is functioning well enough to support fetal life
question
What fetal or neonatal problems should the nurse anticipate if a woman has persistent hyperemesis gravidarum
answer
smaller than expected birth weight
question
this ultrasound scan measure teh amniotic fluid pockets in all four quandrants. 5 to 19cm is normal
answer
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
answer
Kick Count
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determines the level of this fetal protein in the pregnant woman's serum
answer
Alpha-fetoprotein testing
question
insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid
answer
Amniocentesis
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Abortion
answer
miscarriage
question
Edema of the feet and legs is common during pregnancy, but edema above the waist suggest
answer
GH
question
Hypertension during pregnancy is
answer
-Increase over baseline SBP 30 mmHg -Increase over baseline DBP 15 mmHg
question
Hypertension during pregnancy Risk Factors
answer
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
answer
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
question
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.
question
What observations are needed for a woman who is receiving magnesium sulfate as treatment for hypertension
answer
watch for hypotension
question
Theraputic serum level of magnesium is
answer
4-8 mg/dL
question
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.
question
Administering magnesium sulfate (common protocols) (Only by RN)
answer
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
question
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
question
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
question
What drug should be on hand if a woman is receiving magnesium sulfate
answer
calcium gluconate
question
Rh blood incompatibility can only occur if the mother is Rh ___ and the fetus is Rh ___
answer
negative , positive
question
The drug given to prevent Rh incompatibility is
answer
RhoGAM
question
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
question
Three reasons why a pregnant woman needs increased iron
answer
increased blood volume, transfer to the fetus, a cushion against the blood loss expected at birth
question
Iron foods
answer
meats, chicken, fish, liver, legumes
question
Folic Acid foods
answer
green leafy vegetables, asparagus
question
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
question
What foods or durgs should be avoided at the time an iron supplement is taken and why
answer
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
answer
Hepatitis B
question
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
question
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
question
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
question
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
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Assessment of Fetal healh
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done at any age, amniotic fluid index, biophsical profile
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Amniotic fluid index
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normal 5cm-19cm
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Danger signs in pregnancy
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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
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excessive nausea and vomiting, dehydration, reduced delivery of blood, oxygen and nutrietns to the fetus, can effect growth
answer
Hyperemesis gravidarum
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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
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95% occur in fallopian tube, scarring or tubal deformity
answer
Ectopic Pregnancy
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Scarring or tubal deformity may result from
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hormonal abnormalities, inflammation, infection, adhesions, congenital defects, endometriosis
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Ectopic pregnancy manifestations
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lower abdominal pain, may have light vaginal bleeding, if tube ruptures may have sudden severe lower abdominal pain, signs of hypovolemic shock, shoulder pain
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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
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Signs and Symptoms of Hypovolemic Shock
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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
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Bleeding disorders
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placenta previa, albruptio placentae
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Abnormal implantation of placenta, bright bleeding occurs when cervix dilates, resulting in painless bleeding
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Placenta previa
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Normal implantation of placenta, dark bleeding with pain and enlarging uterus suggest blood its accumulating within the cavity
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Albruptio placentae
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Placenta previa risks
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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
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Abruptio placentae risks
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hypertension, cocaine or alcohol use, cigarette smoking and poor nutrition, blows to the abdomen, prior history of abruptio placentae, folate deficiency
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Care of the pregnant woman with excessive bleeding
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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
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Less than a 5-cm (2-inch) stain on pad of blood (10mL)
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Scant
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Less than a 10cm (4-inch) stain on pad (10-25 mL)
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Light
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Less than a 15cm (6-inch) stain on pad (25-50 mL)
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Moderate
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Larger than a 15cm stain or one pad saturated within 2 hours (50-80 mL)
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Large or heavy
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Saturation of a perineal pad within 15 minutes
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Excessive
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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
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Nursing Alert 1
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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.
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Gestational Diabetes Mellitus
answer
Glucose intolerance with onset during pregnancy. In true GDM, GLUCOSE USUALLY RETURNS TO NORMAL BY 6 weeks postpartum.
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Nursing Alert 2
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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.
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Nursing Alert 3
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GDM resolves promptly after birth, when the insulin-antagonistic effects of pregnancy cease.
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Nursing Alert 4
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The priority of care is to limit physical activity to decrease the demands made on the heart.
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Nursing Alert 5
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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.
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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
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Nursing Alert 6
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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
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When a woman of childbearing age is immunized she should not get pregnant for at least 1 month after the immunization.
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Nursing Alert 8
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There is no effective treatment for CMV infection.
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Nursing Alert 9
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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
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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.
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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
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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.
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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
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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"
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Nursing Alert 16
answer
A blood pressure of 140/90 mm Hg or above is considered to constitute hypertension in pregnancy.
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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.
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question
the end of a pregnancy before the fetus is viable, wether spontaneous or elective
answer
abortion
question
closing of the cervix with a suture to prevent early dilation and spontaneous abortion
answer
cerclage
question
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
answer
disseminated intravascular coagulation
question
pregnancy-induced hypertension complicated by one or more seizures
answer
eclampsia
question
when maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes
answer
erythroblastosis fetalis
question
an endocrine disorder that manifests during pregnancy
answer
gestational diabetes mellitus (GDM)
question
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
answer
hydramnios
question
mechanical defect in the cervix, making it unable to remain closed throughout pregnancy and resulting in spontaneous abortion
answer
incompetent cervix
question
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
answer
isoimmunization
question
abnormally large infant, or neonatal birth weight above the 90th percentile
answer
macrosomia
question
may be used when Gestational Hypertension (GH) includes proteinuria; progresses to eclampsia when convulsions occur
answer
preeclampsia
question
The human fetus, placenta and other such products of conception which occur with a miscarriage or theraputic abortion.
answer
products of conception (POC)
question
substance that causes an adverse effect on the developing embryo or fetus
answer
teratogen
question
May result in cerebral hemorrhage, abruptio placenta, fetal compromise, or death of the mother or fetus.
answer
An eclamptic seizure
question
(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
answer
tonic-clonic seizures
question
development of the fetus outside the uterus
answer
Ectopic Pregnancy
question
May contribute to ectopic pregnancy
answer
use of an intrauterine device for contraception
question
(If tube is not ruptured) what med. inhibits cell division in the embryo and allows it to be reasorbed
answer
methtrexate
question
excessive nausea and vomiting during pregnancy
answer
Hyperemesis gravidarum
question
failure of the cervix to remain closed until the fetus is mature enough to survivie outside the uterus
answer
Incompetent cervix
question
spontaneous loss of a pregnancy before 20 weeks (often called miscarriage)
answer
Spontaneous abortion
question
Nursing interventions with woman with hyperemesis gravidarum
answer
avoid food odors, I and O monitoring, frequent small amount food, taking fluids between meals
question
vaginal bleeding without dilation of the cervix or passage of tissue
answer
Threatened abortion
question
bleeding and cramping with passage of some tissue
answer
Incomplete abortion
question
bleeding and cramping with cervical dilation but no passage of tissue
answer
Inevitable abortion
question
passage of all products of conception
answer
Complete abortion
question
retention of the dead fetus in the uterus
answer
Missed abortion
question
two or more consecutive spontaneous abotions
answer
Recurrent abortion
question
Intentional termination of pregnancy to preserve the health of the mother
answer
Therapeutic abortion
question
intentional termination of pregnancy for reasons unrelated to health
answer
Elective abortion
question
An ectopic pregnancy usually occurs in the
answer
follopian tube
question
The purpose of the biophysical profile is to
answer
determine if the placenta is functioning well enough to support fetal life
question
What fetal or neonatal problems should the nurse anticipate if a woman has persistent hyperemesis gravidarum
answer
smaller than expected birth weight
question
this ultrasound scan measure teh amniotic fluid pockets in all four quandrants. 5 to 19cm is normal
answer
Amniotic Fluid volume
question
fewer than three fetal kicks within an hour or cessation of fetal movement for 12 hours indicates the need for evaluation
answer
Kick Count
question
determines the level of this fetal protein in the pregnant woman's serum
answer
Alpha-fetoprotein testing
question
insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid
answer
Amniocentesis
question
Abortion
answer
miscarriage
question
Edema of the feet and legs is common during pregnancy, but edema above the waist suggest
answer
GH
question
Hypertension during pregnancy is
answer
-Increase over baseline SBP 30 mmHg -Increase over baseline DBP 15 mmHg
question
Hypertension during pregnancy Risk Factors
answer
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
question
Postpartum care of Pt's with GH
answer
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
question
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.
question
What observations are needed for a woman who is receiving magnesium sulfate as treatment for hypertension
answer
watch for hypotension
question
Theraputic serum level of magnesium is
answer
4-8 mg/dL
question
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.
question
Administering magnesium sulfate (common protocols) (Only by RN)
answer
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
question
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
question
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
question
What drug should be on hand if a woman is receiving magnesium sulfate
answer
calcium gluconate
question
Rh blood incompatibility can only occur if the mother is Rh ___ and the fetus is Rh ___
answer
negative , positive
question
The drug given to prevent Rh incompatibility is
answer
RhoGAM
question
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
question
Three reasons why a pregnant woman needs increased iron
answer
increased blood volume, transfer to the fetus, a cushion against the blood loss expected at birth
question
Iron foods
answer
meats, chicken, fish, liver, legumes
question
Folic Acid foods
answer
green leafy vegetables, asparagus
question
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
question
What foods or durgs should be avoided at the time an iron supplement is taken and why
answer
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
answer
Hepatitis B
question
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
question
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
question
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
question
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
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Assessment of Fetal healh
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done at any age, amniotic fluid index, biophsical profile
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Amniotic fluid index
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normal 5cm-19cm
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Danger signs in pregnancy
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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
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excessive nausea and vomiting, dehydration, reduced delivery of blood, oxygen and nutrietns to the fetus, can effect growth
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Hyperemesis gravidarum
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Treatment of hyperemesis gravidarum
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correct dehydration and electrolyte or acid-base imbalance, antiemetic drugs may be prescribed, TPN may be required nad/or hospitalization
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95% occur in fallopian tube, scarring or tubal deformity
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Ectopic Pregnancy
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Scarring or tubal deformity may result from
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hormonal abnormalities, inflammation, infection, adhesions, congenital defects, endometriosis
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Ectopic pregnancy manifestations
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lower abdominal pain, may have light vaginal bleeding, if tube ruptures may have sudden severe lower abdominal pain, signs of hypovolemic shock, shoulder pain
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Ectopic pregnancy treatment
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pregnancy test, transvagiannl ultrasound, priority is to control bleeding, no action, treatment with methotrexate, surgery to remove pregnancy from the tube
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Signs and Symptoms of Hypovolemic Shock
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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
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Bleeding disorders
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placenta previa, albruptio placentae
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Abnormal implantation of placenta, bright bleeding occurs when cervix dilates, resulting in painless bleeding
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Placenta previa
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Normal implantation of placenta, dark bleeding with pain and enlarging uterus suggest blood its accumulating within the cavity
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Albruptio placentae
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Placenta previa risks
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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
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Abruptio placentae risks
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hypertension, cocaine or alcohol use, cigarette smoking and poor nutrition, blows to the abdomen, prior history of abruptio placentae, folate deficiency
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Care of the pregnant woman with excessive bleeding
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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
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Less than a 5-cm (2-inch) stain on pad of blood (10mL)
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Scant
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Less than a 10cm (4-inch) stain on pad (10-25 mL)
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Light
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Less than a 15cm (6-inch) stain on pad (25-50 mL)
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Moderate
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Larger than a 15cm stain or one pad saturated within 2 hours (50-80 mL)
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Large or heavy
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Saturation of a perineal pad within 15 minutes
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Excessive
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Hormones (estrogen and progesterone) an enzyme (insulinase) produced by the placenta, and increased prolactin levels have two effects:
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-increased resistance of cells to insulin - increased speed of insulin breakdown
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Nursing Alert 1
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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.
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Gestational Diabetes Mellitus
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Glucose intolerance with onset during pregnancy. In true GDM, GLUCOSE USUALLY RETURNS TO NORMAL BY 6 weeks postpartum.
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Nursing Alert 2
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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.
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Nursing Alert 3
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GDM resolves promptly after birth, when the insulin-antagonistic effects of pregnancy cease.
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Nursing Alert 4
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The priority of care is to limit physical activity to decrease the demands made on the heart.
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Nursing Alert 5
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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.
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TORCH
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Used to describe infections that can be devastating for the fetus or newborn. T = Toxoplasmosis O = Other infections R = Rubella C = Cytomeganlovirus H = Herpes
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Nursing Alert 6
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An infant born to a mother with an active viral infection, such as rubella or varicella, must be placed on airborne and contact isolation.
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Nursing Alert 7
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When a woman of childbearing age is immunized she should not get pregnant for at least 1 month after the immunization.
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Nursing Alert 8
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There is no effective treatment for CMV infection.
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Nursing Alert 9
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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).
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Nursing Alert 10
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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.
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Tertogen
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a substance that causes an adverse effect on the developing embryo or fetus
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The four main teratogens of concern during pregnancy are?
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Drugs, chemicals, infectious agents, and radiation.
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Physical trauma
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usually blunt trauma(falls or blows to the body) but may be penetrating trauma (knife or gunshot wounds)
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Nursing Alert 11
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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.
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Nursing Alert 12
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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.
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Manifestations of Battering:
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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.
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Effects of a high risk pregnancy on the family:
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Disruption of usual roles Financial difficulties Delayed attachment to the infant Loss of expected birth experience
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Which drug is sometimes given to women with gestational hypertension to prevent seizures?
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Magnesium Sulfate
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Which symptom Distinguishes abruptio placentae from placenta previa?
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Pain
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TORCH is an acronym used to describe?
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Infections that can be devastating for the fetus or newborn.
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Nursing Alert 13
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Rh incompatibility between the woman and fetus can occur only if the woman is Rh negative and the fetus is Rh positive.
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Nursing Alert 14
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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.
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What reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate?
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Calcium gluconate
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Nursing Alert 15
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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"
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Nursing Alert 16
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A blood pressure of 140/90 mm Hg or above is considered to constitute hypertension in pregnancy.
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Nursing Alert 17
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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.