Unit 7

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Unit 7
2012-05-11 12:34:07
Antepartum Complications

Antepartum Complications
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  1. How much weight gain is required during pregnancy for a normal weight woman
    2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy. (total of 25-35 lbs)
  2. What are some complications that could occur due to inadequate weight gain
    • preterm labor
    • LBW infants
    • increased risk of infant with IUGR
  3. A woman of normal weight should gain how much weight during the 1st trimester
    1-2.5 kg
  4. A woman of normal weight should gain how much weight during the 2nd and 3rd trimesters?
    .4 kg/week
  5. A woman of normal weight should gain how much weight throughout her whole pregnancy?
    11.5-16 kg
  6. What is the term for a person with DM that existed before pregnancy
  7. What is any degree of glucose intolerance with its onset or first recognition occuring during pregnancy
    Gestational DM
  8. what is excessive fetal growth; birth weight greater than 4000 to 4500 g
  9. what is excessive amniotic fluid, greater than 2000 mL
  10. What is the drug of choice in the prevention and treatment of convulsions caused by preeclampsia or eclampsia
    magnesium sulfate
  11. what is an antihypertensive agent of choice for the treatment of chronic hypertension during pregnancy
  12. what is the antimetabolite and folic acid antagonist that is used to destory rapidly dividing cells; it is used for the medical management of an unruptured ectopic pregnancy
  13. what are signs of preeclampsia
    • MAP at 108
    • U/A indicates protein level of 32 mg/dl
    • bicep and patellar reflexs are 2+
  14. what are signs of gestational HTN
    at 24 weeks of gestation rising from prepregnant baseline of 120/70 to 150/92. No other problematic signs including proteinuria
  15. What are signs of chronic HTN
    consistently high BP since before pregnant
  16. what are signs of eclampsia
    HTN, hyperactive DTR with clonus, proteinuria of 4+, convulsion
  17. What are signs of HELLP syndrome
    HTN, U/A protein content of 3+, platelets are 95,000 and elevated AST and ALT levels, N/V, and epigastric pain
  18. In pregnancy what hormones is insulin resistance caused by
    insulinase and cortisol
  19. Smoking during pregnancy has serious health risks including what
    • bleeding complications
    • miscarriage
    • stillbirth
    • prematurity
    • placenta previa
    • placental abruption
    • low birth weight
    • SIDS
  20. Maternal and neonatal risks associated with gestational diabetes mellitus are
    Maternal preeclampsia and fetal macrosomia.
  21. what is the term for a blood pressure elevation detected for the first time after mid pregnancy w/o proteinuria
    Gestational HTN (normal again at 6 weeks postpartum)
  22. What is gestational HTN with no signs of preeclampsia present at the time of birth and HTN resolves by 12 weeks after birth
    Transient HTN
  23. What is a pregnancy-specific syndrome that usually occurs after 20 weeks of gestation and is determined by gestational HTN plus proteinuria
  24. what is the occurrence of seizures in a woman with preeclampsia that can't be attributed to other causes
  25. What is HTN that is present and observable before pregnancy or that is diagnosed before week 20 of gestation
    chronic HTN
  26. How is severe preeclampsia classified
    • a systolic BP > 160
    • a diastolic BP > 110
    • proteinuria
    • cerebral disturbances
  27. What does HELLP stand for
    • Hemolysis (rupturing of RBCs)
    • Elevated Liver Enzymes
    • Low Platelets (platelet count must be less than 1000)
  28. What are some signs of MgSO4 toxicity
    • decreased DTRs
    • nausea
    • muscle weakness
    • slurred speech
  29. What are associated high risk factors for developing preeclampsia
    • primigravidity - new partner
    • multifetal pregnancy
    • obesity
    • before age 20 and after age 40
  30. If HELLP syndrome develops what are the increased risks?
    • Placental abruption
    • renal failure
    • Pulmonary edema
    • ruptured liver hematoma
    • DIC
    • fetal and maternal death
  31. How do you treat severe preeclampsia and HELLP
    with MgSO4
  32. What is chronic HTN associated with an increased incidence of
    • abruptio placentae
    • superimposed preeclampsia
    • fetal compromise in labor
  33. what are postpartum complications of HTN
    • pulmonary edema
    • renal failure
    • HTN encephalopathy
  34. More than half the neonatal deaths in US are caused by
    preterm births
  35. what is excessive vomiting accompanied by dehydration, electrolyte imbalance, ketosis, and acetonuria causing 5% weight loss
    Hyperemesis Gravidarum
  36. What is most bleeding due to in the first trimester
    most bleeding is a result of miscarriage, ectopic pregnancy, and hydatidiform mole
  37. what is bleeding in the 3rd trimester due to?
    placenta previa and abruptio placentae
  38. what do hemorrhagic disorders cause an increased risk for
    increased risk for hypovolemia, anemia, and infection
  39. What is a pregnancy that ends w/o medical or surgical method before 20 weeks of gestation or 500 g birth weight
    miscarriage or spontaneous abortion
  40. What are some signs and symptoms of severe preeclampsia
    • Decreased urinary output
    • irritability
    • Ankle clonus
    • epigastric pain
    • Platelet count of less than 100,000/mm3
    • visual problems
  41. What are signs and symptoms of preeclampsia
    • +1 proteinuria
    • transient headache
  42. What is a process that diminishes the diameter of blood vessels, which impedes blood flow to all organs and raises BP during pregnancy leading to degenerative aging of the placenta, fetal growth restriction, and placental abruption?
    Arteriolar vasospasm
  43. What is a lab dx for a variant of severe preeclampsia that involves hepatic dysfunction?
    HELLP syndrome
  44. What is a protein concentration of 30 mg/dl or more in at least 2 random urine specimens collected at least 6 hours apart
  45. What is a miscarriage that occurs before 12 weeks
    early miscarriage
  46. what is passive and painless dilation of the cervical os w/o laobr or contractions of the uterus; occurs in 2nd trimester or early in 3rd trimester; miscarriage or preterm birth may result
    Recurrent premature dilatoin of cervix (incompetent cervix)
  47. What is a disorder that arises from the placental trophoblast, it includes hydatiform mole, invasive mole, and choriocarcinoma
    Gestational trophoblastic disease
  48. what is a disorder that results when an egg w/o an active nucleus has been fertilized
    complete mole
  49. what is a disorder that results when 2 sperm fertilize an apparently normal ovum
    Partial mole
  50. What is an implantation of the placenta in the lower uterine segment near or over the internal cervical os
    placenta previa
  51. what is the implantation of the placenta in the lower uterine segment w/o reaching the os
    low lying placenta
  52. what is detachment of part or all of the placenta from its implantation site
    placental abruption
  53. what is the pathologic form of clotting that is diffuse and consumes large amts of clotting factors, cuasing widespread external or internal bleeding or both. It is an overactivation of the clotting cascade and the fibrinolytic system that results in the depletion of platelets and clotting factors
  54. How do you measure the BP of a woman with gestational HTN
    • Place woman in lateral position
    • allow woman to rest for 5 minutes before taking BP
    • use same arm for each BP measurement
    • Use proper sized cuff that covers at least 80% of upper arm
  55. What are the signs of severe preeclampsia
    • proteinuria of 2+ or greater
    • platelet level of less than 100,000
    • DTR 3+, ankle clouns present
    • BP of 160/110
  56. What do you implement when starting MgSO4 for a pt
    • prepare a loading dose of 4 to 6g of MgSO4 in 100ml of ater
    • prepare the maintenance solution by mising 40g of MgSO4 in 1000 ml of lactated ringer's solution
    • monitor mom and fetal signs and UCs every 15-30 min
    • expect maintenance dose to be 1-3g/hour
    • report respiratory rate of less than 12 breaths
    • recognize that urinary output should be at least 30 ml per hour
  57. EOC with administration of MgSO4 would be met if woman experiences
    no seizures
  58. If a woman is treated at home for mild preeclampsia what should she do
    • Weigh herself daily before breakfast, after voiding
    • place a dipstick into a clean-catch sample of urine to test for protein
    • Fluid intake should be 8-10 glasses
    • do gentle exercises such as hand and feet circles and gently tensing and relaxing arm and leg muscles
    • aviod excessively salty foods
    • modified bed rest with diversional activities
  59. what is the nursing dx for a woman with a ruptured ectopic pregnancy
    deficient fluid volume related to blood loss associated with rupture of the uterine tube
  60. After receiving methotrexate for an ectopic pregnancy what should the woman do?
    avoid alcohol until PCP tells her the treatment is complete
  61. A pregnant woman at 32 weeks comes to the ER b/c she has begun to experience bright red vaginal bleeding. She has no pain. what is it?
    placenta previa
  62. Immediate focus for care of a woman at 38 weeks diagnosed with marginal placenta previa and just given birth is what?
    preventing hemorrhage
  63. What kind of miscarriage is classified as slight spotting, mild cramping, no passage of tissue or cervical dilation
  64. what kind of miscarriage is classified as moderate bleeding, mild to severe cramping, no passage of tissue with cervical dilation
  65. what kind of miscarriage is classified as heavy profuse bleeding, severe cramping, passage of tissue and servical dilation with tissue in cervix
  66. what kind of misscarriage is classified as slight bleeding, mild cramping, passage of tissue and no cervical dilation
  67. What kind of miscarriage is classified as no spotting or bleeding, cramping, passage of tissue or cervical dilation (fetus has died but still in uterus)
  68. when is cerclage or suturing of the cervix done
    For recurrent, spontaneous abortion associated with premature dilation (incompetent) cervix
  69. when is a dilation and curettage performed
    for a inevitable, complete or incomplete abortion