Exam 6 Lecture 2

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Exam 6 Lecture 2
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2014-04-30 23:24:07
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Exam 6 Lecture 2
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  1. Hgb level to dx anemia
    <11g/dL
  2. What is the main concern when a prego is anemic?
    oxygen transportation to the mom and placenta/fetus
  3. What does low oxygenation cause?
    IUGR
  4. Most common form of anemic in pregos
    iron deficiency
  5. Foods to eat for iron deficient anemia
    • meat
    • fish
    • chicken
    • liver
    • green leafy vegetables
  6. S/S that mom is anemic
    • pallor
    • fatigue
    • lethargy
    • headache
    • inflammation of lips/tongue
    • pica
  7. When will a baby be affected by a mom's anemia?
    Only if she is severely anemic....then the baby will have anemia for the first year of life
  8. Therapeutic management of iron deficiency anemia
    • 200mg/day of iron should be consumed
    • take in pre natal vitamins

    If have problem with this will take Ferrous Sulfate 600/mg
  9. How do you take your iron supplements?
    with meals and with 500mg of vitamin C
  10. Folic acid deficiency causes
    megaloblastic anemia
  11. Amounts of folic acid needed.....
    0.4mg or 400mcg/day for all women of childbearing age

    Prego....take .6mg or 600mcg/day
  12. Fetal risks when a woman has megaloblastic anemia
    • spontaneous abortion
    • abruption
    • neural tube defects
  13. What is sickle cell anemia
    a genetic disorder inherited from both parents seen in blacks and mediterraneans

    it causes distorted shapes of erythrocytes causing them to clump together and make it difficult to move through small arteries and capillaries
  14. S/S of Sickle Cell anemia/crisis
    • pallor
    • signs of cardiac failure
    • pain in abdomen, chest, vertebrae, joints, or extremities
  15. Pregnant women with sickle cell disease are prone to getting....
    • **UTI's
    • bone infection
    • heart disease
  16. Risks to fetus when the mom has Sickle Cell Anemia
    • IUGR
    • prematurity
    • fetal death during crisis
  17. How can the baby die during a sickle crisis
    the placenta will have infarctions
  18. Nursing management of a woman who has sickle cell disease and is prego
    Keep her out of a crisis!!

    • keep hydrated
    • make sure she eats and meets metabolic needs
    • rests plenty
    • avoids infectious illness....and gets treatment immediately if she gets a fever
  19. Intrapartum care for a woman who has sickle cell disease to prevent a crisis
    • continuous O2
    • fluids to keep hydrated
    • conservation of energy
    • Admin of packed RBC's
  20. Why would a woman in labor who has sickle cell disease receive packed RBC's
    only given if Hgb is less than 8g/dL or Hct is less than 20%
  21. What stimulates sickling process
    • dehydration....vomiting/sweating
    • exertion....labor
    • acidosis....vomiting
  22. What type of an infection is toxoplasmosis
    protozoal
  23. How can a prego get toxoplasmosis?
    it is transmitted through organisms in raw or undercooked meat,

    or through contact with infected cat feces

    or across the placental barrier to the fetus if the expectant mom acquires an infection during pregnancy
  24. S/S of toxoplasmosis
    • may have none....
    • or
    • few days of fatigue
    • muscle pains
    • swollen glands
  25. If a fetus is exposed to toxoplasmosis what can happen
    abortion
  26. Congenital toxoplasmosis causes
    • low birth weight
    • enlarged liver and spleen
    • jaundice
    • anemia
    • chorioretinitis
    • neurologic damage....hydrocephaly, microcephaly, calcification within the cranium
  27. Nursing considerations regarding toxoplasmosis
    • Patient teaching to prevent!!!
    • cook meat/eggs thoroughly
    • avoid cat feces
    • don't touch eyes or mucous membranes after handling raw meat
    • always watch hands and counters that have come in contact with raw meat
  28. When is the worst time to be exposed to toxoplasmosis?
    When does exposure usually occur?
    1st trimester....20 weeks

    3rd trimester
  29. Group Beta Streptococcus
    gram + bacteria that is normal flora in vagina that will cause life threatening perinatal infections
  30. Effects of GBS on fetus/baby
    • pneumonia
    • sepsis
    • meningitis
  31. When is a woman tested for GBS?
    36-37 weeks
  32. Meds given to treat Toxoplasmosis
    • Spiramycin
    • Pyrimethamine
    • Sulfadiazine
  33. Treatment for GBS
    • Penicillin
    • IVPB during intrapartum
    • or
    • 3 doses q4h before delivery
  34. Alternatives to penicillin
    • cefazolin
    • clindamycin
    • vancymycin
    • erythromycin
  35. If mom is GBS positive what happens after baby is born?
    she/he is observed for 48 hours for signs of sepsis

    • hypothermia
    • respiratory distress
    • apnea
  36. If mom comes in to hospital in labor and hasn't been tested for GBS we will....
    treat her as if she is GBS positive and giver her penicillin IVPB
  37. When will a woman who is GBS positive not get the antibiotics?
    • if she is having a planned c section and isn't in labor or had a ROM
    • tested positive early in pregnancy, but is currently negative
  38. Intrapartum antibiotics are indicated for a GBS positive mom if:
    • previous infant had GBS
    • GBS + this prego
    • Unknown GBS status and delivery at 37 weeks or less of gestation
    • membrane rupture at 18 hrs or later
    • intrapartum temp at 100.4 or higher
  39. How does Rh Alloimmunization occur?
    Rh- mom and Rh+ dad=Rh+ fetus

    2nd prego with same parents....get Rh+ fetus, but antibodies developed during delivery of the first baby against the Rh+ blood type that will now attack the babies cells
  40. Result of Rh Incompatability
    • hemolysis of RBC's
    • increased billi....so kernicterus
    • increase in erythroblasts which cant carry O2

    born with jaundice and anemia
  41. What does RhoGam do?
    it will inhibit the production of Rh+ antigen so mom doesn't produce antibodies
  42. When is RhoGam given?
    • Rh- mom....
    • at 28 weeks gestation and within 72 hrs after birth if infant is Rh+
    • AND any time a procedure is done that there is the possibility of blood mixing
  43. Nursing management of Rh-
    • women are screened at 1st pre natal visit by indirect Coombs
    • if Rh-...dad is tested
    • Rhogam given at appropriate times
  44. Describe an ABO incompatability
    • mom is O
    • baby is A,B, or AB

    Direct Coombs will be done to see babies blood type and baby will be monitored closely for hyperbilirubinemia....and Kernicterus
  45. Oral hypoclycemis and pregnancy
    they have been known to be teratogenic causing fetal hyperinsulinemia and hypoglycemia....so have been avoided in pregnancy
  46. One oral hypoglycemic med that minimally crosses the placenta
    Glyburide
  47. When does the problem with insulin start in the pregnancy
    20 weeks....so are tested between 24-28 weeks cause will see an increase in insulin resistance
  48. Insulin and the 1st trimester
    decreased amount is needed
  49. Serious problems seen in women with diabetes
    • they can have n/v and cravings which can increase their risk for
    • ketoacidosis
    • hypoglycemia
    • insulin shock and coma
  50. Effects of diabetes on the pregnant woman
    • 4x greater risk for PIH
    • UTI...r/t glycosuria
    • Polyhydraminos...urinates lots in AF
    • PROM
    • Difficult labor...macrosomia
    • Ketoacidosis
    • nephropathy
    • retinopathy
    • increased BP
  51. What is the risk for a woman with diabetes who gets ketoacidosis
    increase in fetal death risk
  52. What is critical for patients that have diabetes prior to pregnancy?
    Pre Conception care and education
  53. Fetal and Neonatal risks to a baby of a diabetic mom
    • congenital anomalies
    • cardiomyopathy
    • perinatal death
    • large infant
    • birth injury to baby
    • IUGR
    • Polycythemia from hypoxia
    • hyperbilirubinemia
    • RDS
    • Hypoglycemia
  54. Congenital anomalies r/t hyperglycemia
    • sacral agenesis
    • small left colon syndrome
  55. Goal of a babys blood sugar after birth when mom is diabetic
    40+
  56. How can a baby of a diabetic mom be SGA
    lots of bouts of hypoglycemia
  57. How does RDS happen to a baby born to a diabetic mom?
    hyperinsulinemia will retard cortisol, which is necessary for surfactant production
  58. How is GDM dx
    screening at 24-28 weeks

    1 hr glucose challenge without fasting...if >=140 then 3 hr GTT done

    if 2 out of the 4 values are + = GDM
  59. Values for 3 hr GTT
    • Fasting 95
    • 1 hr 180
    • 2 hr 155
    • 3 hr 140
  60. What makes a woman at risk for GDM
    • maternal age >30
    • pre prego weight >20% above ideal
    • family hx
    • prior birth of infant >4000 grams
    • hx of GDM
    • prior stillborn
    • prior birth of infant with congenital anomalies
  61. Therapeutic Management and Nursing considerations for a diabetic mom
    • DIET and exercise
    • Glyburide or insulin
    • 24 hour urine test to monitor renal fxn
    • know s/s of hyper/hypoglycemia
    • fetal surveillance
  62. When does a diabetic check her blood sugar?
    before she eats and 2 hours after
  63. With a diabetic mom when will the biophysical profile be done?
    34 weeks
  64. Normal cardiovascular changes during pregnancy
    • Increased:
    • HR
    • Stroke Volume
    • CO
    • Total blood volume
  65. Describe total blood volume increase
    • starts in 1st trimester
    • plateaus after 30 weeks
    • total increase is +40%
  66. Cardiovascular compensation to increased CO during pregnancy
    • ventricular dilation and hypertrophy
    • tachycardia
  67. S/S of cardiac decompensation
    • **Activity intolerance
    • cough
    • dyspnea
    • edema
    • palpitations
    • rales/crackles
  68. 4 Functional classifications of heart disease
    • 1 no limitation of activity
    • 2¬†SOB with mild activity
    • 3 severe SOB with mild activity
    • 4 SOB at rest
  69. Nursing management for a person with Class I and II heart disease
    • limit physical activity so s/s don't occur
    • avoid excessive weight gain
    • increase iron and protein in diet
    • decrease sodium in diet
    • prevent anemia to decrease workload of heart
    • prevent infection
    • careful assessment for CHF, pulmonary edema or cardiac arrythmias
  70. Nursing considerations for a person with Class III and IV heart disease
    • additional interventions include:
    • watch I&O
    • raise HOB
    • give O2 and monitor with pulse ox
    • heparin/lovenox-anti coagulants
    • digoxin, calcium channel blockers as antirrhythmics
    • Diuretics to control CHF
  71. What will you see in a baby born to a mom with heart disease
    • decreased weight
    • and risk for premature labor and delivery
  72. Intrapartum management of a woman with heart disease
    • strict IV fluid admin
    • Diuretics, Digoxin
    • VS
    • Lung/heart sounds
    • side lying with raised HOB
    • O2
    • Sedation in early labor to reduce discomfort
    • Quiet environment
    • Vaginal delivery recommended
    • Assisted delivery with forceps/vacuum
    • Encourage open glottal pushing during 2nd stage
  73. For a woman with heart problems how will her delivery be special
    • labor down
    • breath through pushes (open glottal)
    • vacuum/forceps
  74. Postpartum management of a woman with heart problems
    • increased risk for hemorrhage and cardiac arrest
    • admin O2
    • strict I&O
  75. Result of infant being exposed to Cytomegalovirus (Herpes virus)
    will pass it on to fetus if mom gets it while prego

    • causes:
    • deafness
    • seizures
    • MR
    • blindness
    • dental abnormalities
    • SGA
  76. When will you see the results of CMV on the newborn?
    may not see it for months-years
  77. When is the fetus/infant at most risk for getting exposed to Rubella
    • if mom gets prego within 3 months of vaccination
    • mom is exposed to during 1st trimester of prego
  78. Problems seen in infants exposed to Rubella
    • spontaneous abortion
    • IUGR/SGA
    • deaf
    • microcephaly
    • MR
    • cataracts
    • Cardiac defects
    • *Lack of limbs
  79. Education to provide to pregnant women
    stay away from all people with rashes....cuz of Rubella
  80. Risks to a pregnant woman when exposed to varicella zoster
    • PTL
    • encephalitis
    • pneumonia
  81. Risks to fetus/neonates who is exposed to varicella zoster
    especially during 13-20 weeks gestation

    • limb hypoplasia
    • cutaneous scars
    • choriorentinitis
    • cataracts
    • microcephaly
    • IUGR
  82. If a prego is not immune to varicella zoster, when should she be given the vaccine?
    post partum period
  83. How is the Herpes Virus passed from the mom to the infant?
    • happens after ROM
    • during birth and direct contact with genital secretions
  84. Effects of herpes virus on fetus/neonate
    • increased risk of spontaneous abortion
    • PTL
    • IUGR
    • 60% mortality rate
    • **Surviving infants will have sever neurologic complications
  85. Birth and a mom with herpes
    • no active lesion=vaginal birth
    • active lesion=c section
  86. How is Hep B transmitted?
    • blood
    • saliva
    • vaginal secretions
    • semen
    • breast milk
    • crosses placental barrier
  87. Fetal/Neonatal  S/S of Hep B in mom during pregnancy
    • PTL
    • low birth weight
    • neonatal death
    • increased risk to become chronic carriers
  88. Therapeutic management and nursing considerations for Hep B
    Hep B immunization is given to all infants

    HBig is given to babys only if mom has hep B

    IF she has Hep B....baby will bet both vaccines
  89. Check this prior to giving any injections
    Mom's Hep B status

    If mom has Hep B all infants must be bathed prior to receiving any and all injections
  90. What is contraindicated for the mom with Hep B?
    breast feeding
  91. S/S that a baby has been exposed to HIV
    • asymptomatic at birth
    • 20-40% develop disease
    • enlarged liver, spleen, lymph
    • failure to thrive
    • persistent thrush
    • extensive seborrheic dermatitis
    • rapid progression....death within 5 years
  92. It is contraindicated for a mom that is HIV positive to
    breast feed
  93. If a baby is born to a HIV positive mom....
    it will go on ZDV at birth for 6 weeks then will be tested to see if HIV positive
  94. How can mag toxicity be reversed?
    by slow admin of calcium gluconate

    1g calcium gluconate at 1 mL/min

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