1230 Unit 2 Part 1
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| Take care of mother and baby from pregancy through after the birth (for chronic conditions). | Perinatologist
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| Risk factors for the pregnant woman | chronic medical conditions; acute infections
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| Women with chronic medical conditions- | sometimes normal changes of pregnancy can alleviate or intensify symptoms of their illness.
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| Chronic disease in which glucose metabolism is impaired by lack of insulin in the body or by ineffective insulin utilization; when poorly controlled, it can adversely effect the pregancy outcomes | Diabetes Mellitus
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| DM complicates approximately __________ of pregnancies; ___________ should be involved in the care of the pregnant woman with DM. | 3% - 10%; specialists
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| DM where there is a higher incidence of spontaneous abortion; more likely to have C-section because of size of baby; high risk for congenital anomalies and/or stillbirth | Type 1 DM
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| Mother with Type 1 DM is at higher risk for: | hypertensive disorders; polyhydramnios (excess levels of amniotic fluid); preterm delivery; shoulder dystocia in the infant (shoulder delivered 1st)
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| Underlying pathophysiology is insulin resistance; mother will have increased risk for developing Type 2 DM after pregnancy; diabetogenic effect of pregnancy | Gestational DM
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| Screening for gestational DM is done at approximately: | 24-28 weeks gestation
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| Treatment for gestational DM: | pre-pregnant care (with diabetes); monitoring and maintaining glycemic control; insulin therapy; oral hypoglycemic agents; diet therapy; excercise; fetal surveillance; determining timing of delivery
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| S/S of cardiovascular disease very depending on underlying cause of heart disease. Earliest warning sign of cardiac decompensation is: | persistent rales (wet crackles) in the bases of the lungs
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| Treatment of cardiavascular disease during pregnancy: | activity levels - don't over-do it; stress management; diet and medications; management during labor and pospartum period (will do cesarean if condition is bad enough); protect herself from infection; precautions to avoid clot formations
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| pg. 352 - Classifications of Heard Disease |
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| Most important nursing action with pregnant client with cardiovascular disease: | monitor for and teach the woman to recognize signs of cardiac decompensation (HR dropping, BP dropping, etc.)
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| Immediately report any fever, increased bleeding, and any signs of decompensation | in the postpartum period of a woman with cardiovascular disease.
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| Pregnant women with cardiovascular disease should do this when traveling: | move around often; get up and walk every hour or so; avoid long trips if possible
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| S/S of this diesease in the pregnant woman are tachycardia, tachypnea, dyspnea, pale skin, low BP, heart nurmur, HA, fatigue, weakness, and dizziness | Iron-deficiency anemia
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| ingestion of non-food substances such as clay and laundry starch | Pica
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| frequent chewing or sucking on ice | pagophagia
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| Pica and pagophagia are both associated with: | iron-deficiency anemia
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| Hemoglobin levels less than ____________ define anemia during pregnancy. | 10 g/dL
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| Treatment of anemia during pregnancy: | iron supplement (take with OJ to increase absorption). Iron will cause constipation (increase fluid intake).
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| Women with sickle cell anemia rarely experience symptoms of the disease during pregnancy because: | their blood volume is increased and less sickled.
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| A woman with sickle-cell anemia is still at risk for a crisis ___________. She may experience recurrent bouts of pain in the: | any time during pregnancy; joints, bones, chest and abdomen
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| Treatment for sickle cell crisis: | oxygen, fluids, rest
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| What medication for cardiovascular disease cannot be taken during pregnancy? | Coumadin (it crosses the placenta and increases chance for anomalies)
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| Clinical manifestation of asthma: | shortness of breath and anxiousness
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| Treatment for pregnant woman with athsma: | management of acute exacerbation; inhalers; labor and birth management (oxygen, breathing); will have to alter medication management (steroids can cross placenta); smoking cessation
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| Current recommendations for the woman with epilepsy who is pregnant are to: | stay on the drug that most effectively controls her seizures
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| constant seizures | status epilepticus
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| nursing care with epliepsy: | teach importance of carefully following her treatment regimen and of diet high in folic acid (and taking supplement); provide emotional support during testing for fetal anomalies.
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| Women with disease need to do this before becoming pregnant: | contact their doctor
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| TORCH | Toxoplasmosis; Others (Hep B, Syphilus, Varicella, Herpes Zoster); Rubella (German Measles); Cytomegalovirus (CMV); Herpes Simplex Virus
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| Many of the TORCH infections do not have effective treatment regimens, so __________ is the focus of interventions. | prevention
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| TORCH screen will test for | latent (old) infections
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| Many STI's are reportable diseased tracked by the: | CDC
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| Most common (reportable) STI in the U.S. Left untreated, increases the risk of contracting HIV/AIDS | Chlamydia
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| Second prevalent in the US; resistant to antibiotics; can leave woman infertile or susceptible to ectopic pregnancy because of scarring in the reproductive tract | Gonorrhea
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| Most common viral STI in the U.S.; has tendency to incrase in size during pregnancy; neonatal infection can result in life-threatening laryngeal papillomas | Human papillomovirus
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| STI associated with adverse pregnancy outcomes; pt will have discharge/odor | Trichomoniasis
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| Two main gols of treatment for the pregnant woman infected with HIV: | prevent progression of the disease in the woman; prevent perinatal transmission of the virus to the fetus (C-section, no breastfeeding)
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| If a woman is HIV positive, the baby will be: | positive or negative (depends on delivery). An HIV positive mother does increase the chance of the baby having it, but it doesn't mean the baby automatically has it.)
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| Nursing care for pregnant woman with HIV: | assure confidentiality; ensure she understands risks to her sexual partners; explore her understanding of the treatment regimen
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| Nursing diagnosis for pregnant woman with HIV will involve: | teaching
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| Encourage mothers to be __________ about STI's. | honest
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| Cycle of violence: | when a woman goes back to her partner over and over even though they are abusive.
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| Getting hit in the stomach (abused) can cause: | pre-term labor
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| Interventions for the victim of IPV (Intimate Partner Violence) are directed toward: | safety assessment and planning
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| The decision of whether a woman should leave an abusive relationship must be made exclusively by: | the woman
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| Nursing care for IPV: | assist RN to assess for abuse; document the woman's responses to questions about IPV; carefully respond with supportive statments; document your assessment objectively; be knowledgeable about local resources
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| Many pregnant teens seek: | late prenatal care; may be fearful of disclosing her pregnancy; parents of girl may be mad or upset; girl has right to decide what happens with her child
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| Best treatment for teenage pregnancy: | prevention
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| Nursing care for teenage pregnancy: | caring for developmental needs; caring for physical needs; adequate nutrution is essential; caring for emotional and psychological needs; be knowledgeable about community resources for the pregnant teen.
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| Nursing care for an older pregnant woman: | approach her with an open mind; may feel they have "too much" medical information and feel overwhelmed
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| disorder of early pregnancy; characterized by severe nausea and vomiting; results in weight loss, nutritional deficiencies, and/or electrolyte and acid/base imbalance; most often appears between 8-12 weeks gestation; resolves by week 20 | hyperemisis gravidarum
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| exact cause of hyperemisis gravidarum is: | unknown
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| Risk of hyperemisis gravidarum is increased with: | a multiple gestation; molar pregnancy; history of hyperemesis gravidarum; stress and psychological factors can contribute
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| Clinical features of hyperemisis gravidarum: | syptoms of dehydration; postural hypotension; elevated hematocrit
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| Pts with hyperemisis gravidarum will have: | persistent nausea and vomiting, often with complete inability to retain food and fluids during the 1st 20 weeks; may need IV fluids; significant weight loss; dehydration; acid/base electrolyte imbalances; decreased potassium (causing cardiac dysrhythmia)
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| may be added for pt with hyperemisis gravidarum; many of which are in pregnancy Category C; usually more effective when given on a regular, around-the-clock schedule vs. PRN; given by parenteral injection or rectal suppository | antiemetics
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| Emergency treatment for hyperemisis gravidarum | correcting fluid, electrolyte, and acid/base imbalances; NPO for 24 hours until vomiting stops; Pyridoxine (Vit B6) with or without doxylamine is the recommended first-line therapy; antiemetics may be added; once clear liquid diet; thiamine supplements
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| Nursing care after vomiting has stopped | promote intake; mouth care before and after meals; observe family dynamics
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| Can occur at any time during pregnancy | bleeding disorders
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| Early pregnancy can be caused by: | ectopic pregnancy and spontaneous abortions; molar pregnancy
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| Mid-pregnancy bleeding can be caused by: | cervical insufficiency
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| Late-pregancy bleeding can be caused by: | placenta previa and abruptio placenta
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| Pregnancy that occurs outside of the uterus; leading cause of pregnancy-related death in the first trimester; can be caused by any condition or surgical procedure that can injur a fallopian tube | ectopic pregnancy
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| Clinical manifestations of ectopic pregnancy: | symptoms usually appear 4-8 weeks after LMP; most common sympton - pelvic pain and/or vaginal spotting; late signs include shoulder pin and hypovolemic shock (associated with tubal rupture); diagnosis not always immediately apparent
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| Tests done to confirm ectopic pregnancy: | serum or urine pregnancy test; transvaginal ultrasound; culdocentesis; laparoscopy
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| treatment of ectopic pregnancy: | depends on condition of the woman; shock requires emergency treatment; may need blood expanders or transfusion; labaraoscopic surgery is the most common; salpingectomy; IM injection of methotrexate; Rh-non-sensitized women require RhoGam
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| Nursing care for ectopic pregnancy: | VS; monitor vaginal bleeding; rport heavy bleeding or signs of shock; assist to prepare for surgery; once stable, emotional issues become the focus; instruct woman regarding danger signs after discharge
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| most common complication of pregnancy; occurs les than 20 weeks of gestation or fetal size of less than 350-500 grams; common name is miscarriage; usually happens during the first trimester | spontaneous abortion
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| Factors that increase risk of spontaneous abortion: | advanced maternal age; history of previous spontaneous abortion; smoking, alcohol and substance abuse; increasing gravidity; uterine defects and tumors; active maternal infection; chronic maternal health factors (DM, renal disease, etc.)
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| Three overall categories of causation of spontaneous abortion: | fetal (usually genetic), maternal (multiple factors), environmental (poor nutrition, exposure to chemicals, etc.)
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| occurs before 12 weeks; usually fetal cause | early abortion
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| occurs between 12 and 20 weeks; usually maternal cause | late abortion
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| Typical symptoms of spontaneous abortion: | cramping and spotting or frank bleeding; hCG levels will be drawn; transvaginal ultrasound
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| Conservative treatment if there is a: | threatened abortion
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| inevitable, incomplete, complete, and missed abortion treatment: | prostaglandin misoprostol (Cytotec) given by mouth; vacuum aspiration or dilation and curettage (D&C) are the most common surgical methods used to clear the uterus; after uterine evacuation-IV oxytocin (Pitocin), oral methylergonovine maleate (Methergine)
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| nursing care after spontaneous abortion: | assess vital signs, amount and appearance of vaginal bleeding, and pain level; report falling BP or rising pulse; save all expelled tissue; provide analgesics as ordered; grief reactions to be expected; accept and support woman's emotions
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