Objective A.txt

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Objective A.txt
2014-02-26 13:49:31
Maternal Objective

Maternal Objective A
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  1. DM 1
  2. Insulin needs increase
    after first trimester; increasing insulin resistance as pregnancy progresses
  3. Effects of DM
    early loss of fetus due to abnormal metabolic environment; tissue injury or hemorrhage, preeclampsia, infections, preterm birth, polyhydramnios
  4. Fetal complications with DM
    IUFD, congenital malformations, macrosomia, birth injuries, neonatal hypoglycemia
  5. What are you monitoring for?
    Preeclampsia, hemorrhage and infection
  6. Gestational DM
    GTT at 26-28 weeks for 1 hour; if 140 or higher, need 3 hour GTT
  7. Intrapartum GDM
    monitor BS levels, IV insulin infusion
  8. Postpartum GDM
    2 hour GTT 6-8 weeks after delivery
  9. What can hypo and hyperglycemia cause?
    Spontaneous abortions, congenital malformations, HTN, UTIs and ketoacidosis
  10. Why are labor and postpartum dangerous for woman with heart disease?
    Each contraction causes up to 500 ml of blood from uterus and placenta to central circulation; added blood volume increases abnormal heartÂ’s workload and can result in CHF
  11. Why is folic acid needed?
    DNA synthesis in fetus; lack is associated with neural tube defects; folic acid is often destroyed by cooking
  12. Women who are obese or have uncontrolled diabetes prior to conception are at greater risk for babies with
    CNS defects
  13. Most cases of anemia in pregnancy are
    iron deficiency
  14. Folate deficiency anemia is the most common cause of
    megaloblastic anemia
  15. What drugs should asthmatic moms avoid?
    Morphine and meperdine as they release histamies
  16. Seizures can lead to
    fetal hypoxia and death
  17. Anticonvulsant meds are teratogenic and can cause
    fetal hydantoin syndrome
  18. Fetal risks for women with SLE
    stillbirth, IUGR and preterm birth
  19. Complication of pregnancy with cocaine abuser
    placental abruption
  20. Atrial septal defect
    most common seen during pregnancy; RHF and arrhythmias; L to R
  21. Ventricular septal defect
    uncommon in pregnancy but if so, high risk for arrhythmias, HF and pulmonary HTN
  22. Patent Ductus arteriosus
    uncommon during pregnancy but if so, same as VSD as well as endocarditis and PE
  23. Coartication of the aorta
    vaginal birth preferred, antibiotics during labor
  24. Tetralogy of fallot
    R to L, antibiotics during labor, reduced oxygenation
  25. Mitral valve stenosis
    rheumatic heart disease; may cause PE, AFIB, RHF, PE, ineffective endocarditis, hemoptysis
  26. Treatment of mitral valve prolapse
    prevent tachy, cardioversion, anticoagulant, Na restriction
  27. MI
    Rare, attributed to DM, HTN, CAD, lipid and advancing age
  28. Anticoagulants
    lovenox better than heparin
  29. Care for pt with heart disease
    manage fluids, position mom on side with head/shoulders elevated, O2, vaginal birth, avoid abrupt positional changes
  30. Care for pt with cardiac issues post partum
    signs of infection, hemorrhage, thromboembolism, CHF, urine output
  31. HGB for anemia
    <11 in 1st and 3rd, <10.5 in 2nd
  32. Iron deficiency anemia
    preterm birth and low birth weight
  33. How much folic acid to give?
    4 mg q day
  34. Fetal hydantoin syndrome
    craniofacial abnormalities, limb reduction, growth restrictions, mental retardation, cardiac anomalies
  35. Generalized seizures can lead to
    fetal hypoxia and acidosis
  36. Maternal effects of seizures
    preterm labor, vaginal bleeding, abruption placentae, failure to progress, anemia
  37. IBS and pregnancy
    addition of fat soluble (ADEK) vitamins, folic acid and calcium; risk of preterm birth and lowbirth weight infants
  38. Smoking and pregnancy
    vasoconstrictions and decreased placental circulation; bleeding complications, miscarriage, stillbirth, preterm labor, placenta previa, placental abruption, low birth weight, SIDS, PROM, neuro problems, decreased maternal appetite
  39. Alcohol, marijuana
    cross from mother to baby through placenta
  40. Cocaine
    placental abruption, PTL and precipitous labor
  41. Fetal and cocaine
    irritable, poor feeing, hyperactive
  42. GBS treatment
    PCN in mother and baby, culture 35-37 weeks gestation
  43. HTN in pregnancy
    placental abruption, cerebral hemorrhage, hepatic or renal dysfunction, DIC, pulmonary edema, seizures
  44. Factors for preeclampsia
    primigravida, old or young mom, multifetal pregnancy, obesity, preexisting medical condition
  45. Intrapartum care for HTN in pregnancy
    bed rest with siderails up, dark environment, mag suf, antihypertensives
  46. Post partum care for HTN
    vitals, DTRs, LOC, unable to tolerate excessive blood loss
  47. Eclampsia
    headache, blurred vision, epigastric or RUQ pain, altered mental status, convulsions
  48. Nursing for eclampsia
    patent airway and safety, stabilize mom
  49. Post partum complications of HTN
    pulmonary edema, renal and heart failure, encephalopathy
  50. Antidote for mag sulfate
    calcium gluconate