Antepartal Risk

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Antepartal Risk
2014-10-06 11:17:47
Antepartal Risk

Antepartal Risk
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  1. Hypertensive Disorders in Pregnancy
    • Gestational HTN (Previously PIH)
    • Preeclampsia
    • Eclampsia (seizures)
    • Superimposed Preeclampsia
    • Chronic HTN (htn prior to pregnancy)
  2. Chronic HTN:
    • Preexisting but remains after pregnancy
    • May not be discovered until after
    • May be mistaken for gestational HTN
  3. Elevated BP after 20 weeks gestation accompanied by significant proteinuria signifies this....develops during last half of pregnancy in a woman who prev. had normal BP
    • Preeclampsia
    • (BP => 140/90, Urine dipstick of 1+ protein or .3g in 24 hours, Seizures post delivery, Edema)
  4. Clinical Manifestations of Preeclampsia
    • High BP after 20 weeks gestation
    • Proteinuria (dipstick of 1+ or .3g in 24 hours)
    • Edema (pulmonary and generalized...face swollen, 4lbs heavier)
    • Seizures post delivery (within 1st 24 hours)
    • Vascular Changes (eye exam)
    • Liver, renal, hepatic abnormalities
    • Low Platelets 
    • Hyperrelexia (DTRs)
  5. Incidence of Preeclampsia
    • 7%
    • (major cause of death)
  6. Risk factors of preeclampsia
    • 1st preg
    • <19 or >40 yrs old
    • Obesity
    • Family Hx
    • HTN or vascular disease
    • Chronic Renal Disease
    • DM
    • Periodontal Disease  
    • Multiple Gestation
    • Clotting Disorders (Antiphospholipid synd)
    • African American
    • Mother/Sister with preeclampsia
    • Father of baby with preeclamptic mother
    • Angiotensin gene T235
  7. Pathophysiology of Preeclampsia
    Lack of compensatory mechanism of normal pregnancy to increase volume and cardiac output

    No resistance to angiotensin 2; vasoconstrictor

    Vasoconstriction and vasospasm impede flow to major organs (PVR- peripheral vascular resistance)
  8. Preeclampsia affects what major body organs?
    • Renal
    • Hepatic
    • Cerebral
    • Pulmonary
    • Placenta
  9. Symptoms of Preeclampsia
    • Silent Killer- when symptoms arise, disease is advanced
    • Generalized Edema
    • H/A, drowsiness, confusion
    • Visual disturbances (double vision, spots)
    • Numbness, tingling of extremeties
    • Epigastric pain (ominous)
    • Oliguria
  10. Why are regular prenatal appointments important?
    To catch potential complications of preeclampsia epigastric pain
  11. SX of Mild Preeclampsia:
    • Cure > delivery!
    • BP 140-159/90-110
    • Blood levels WNL
    • 1+ proteinuria
    • Minimal Increase in Liver Enzymes (or no increase)
    • No severe HA
    • Normal feta growth
  12. Sx of Severe Preeclampsia
    • BP >160/>110
    • Elevated Serum Creatinine
    • Elevated Liver Enzymes
    • Decreased Platelets
    • Severe HA
    • Visual Disturbances
    • RUQ pain, nausea, vomiting
    • Pulmonary Edema
    • Reduced Amniotic Volume
    • IUGR
  13. Progression of preeclampsia to generalized seizures that cannot be attributable to other causes
    • Eclampsia
    • (Seizures may occur post partum!!!)
  14. When can seizures occur with eclampsia?
    During prenatal, intrapartum, or post partum periods
  15. Manifestation of a seizure with eclampsia
    Facial Twitching, body rigidity, tonic clonic motions about 1 min in length

    Uterine irritability (baby gets brady/tachy)


    Oliguria and Pulmonary Edema

    Cerebral Hemorrhage may occur
  16. HELLP Syndrome
    • Hemolysis
    • Elevated Liver Enzymes
    • Low Platelets
    • Severe preeclampsia or eclampsia may proceed to HELLP or it may develop without preeclampsia
  17. S/S of HELLP Syndrome
    • Liver Distention (avoid deep palpation)
    • Jaundice
    • Bleeding
    • Hypovolemic shock
    • RUQ pain/Lower right chest pain/mid epigastric pain
    • Delivery if >32 weeks!!!!
  18. Management of MILD preeclampsia
    can be managed at home if woman follows plan

    Frequent rest periods in L lateral position for 1 1/2 hours per day (improves perfusion)

    BP home monitoring 2-4 times per day (same position, same arm)

    Daily weights

    Daily Urine Dipstick

    Diet-- protein and calories (no need to alter salt or fluid intake...not the cause of edema)
  19. Management of SEVERE Preeclampsia
    • Put in Hospital for a period of time:
    • Bed Rest- left lateral position
    • Quiet and dark atmosphere
    • Padded Side Rails
  20. Pharmacotherapy for Preeclampsia:
    • Antihypertensives (ACE inhib are contraindicated)
    •    -Hydralazine for vasodilation
    •    -Nifedipine (CC blocker)
    •    -Labetalol (BBlocker)

    • Seizure Prevention: Magnesium Sulfate IV with piggyback (4-6gm diluted in 100ml over 15-20 min...then 2 m per hour)
    •    -CNS depressant (check every 15 min for Mg toxicity), reduces vasoconstriction and helps fluid shift
  21. What is the major advantage to using Hydralazine for Preeclampsia
    Vasodilates and increases cardiac output and blood flow to the placenta
  22. Magnesium Sulfate (MgSO4) Side Effects and Toxicity:
    • Increased Serum Levels
    • Diminished Urine Output (watch for oliguria!!!)
    • Possible decreased variability of FHRs
    • Decreased DTRs
    • Thirst
    • Confusion
    • Decreased Ox Sat (<95%)
    • Decreased Resp Rate (<12)
  23. Key assessment concept regarding Magnesium Sulfate Administration
    Be a careful observer of what your patient came in with and what you are comparing her to now...some s/s will be similar to preeclampsia
  24. Nursing care related to MgSO4
    • Monitor BP and RR closely
    • DTRs per protocol (every 15 min)
    • Urinary Output q hour
    • Keep ANTIDOTE nearby!!! (Calcium Gluconate)
    • Have resuscitation equip available
    • Watch for impending seizures (HAs, DTRs 4+, RUQ pain, N+V)
    • Keep quiet, dark, minimal intrusion, dont startle, restrict visitors
  25. Antidote for MgSO4
    Calcium Gluconate
  26. What percentage of all pregnancies does diabetes occur?
    • 4-14%
    • (may be preexisting or induced by pregnancy)
  27. Effects of diabetes during pregnancy:
    • Early Pregnancy: insulin release is greater in response to glucose -> Hypoglycemia
    • Fat stores increase for later use by growing fetus

    • Later in Preg: insulin resistance occurs in mother so more glucose is available for baby
    • Hyperglycemia in mother may occur in response to insulin resistance, normally pancreas will compensate by producing more insulin, otherwise hyperglycemia worsens
  28. GDM puts mom at higher risk for developing:
    Type 2 DM later on
  29. Overall Concept behind larger babies with moms that have GDM:
    Mother's blood brings extra glucose to fetus

    Fetus Makes more insulin to handle extra glucose

    Extra Glucose gets stored as fat and fetus is larger than normal
  30. A mom that has Preexisting DM is at risk for:
    • Miscarriage
    • Preeclampsia
    • Fetal Abnormalities (neural tube and cardiac)
    • Ketoacidosis
    • UTIs
    • Polyhydramnios
    • Macrosomia (hyperglycemia results in increased fetal insulin production which increases growth)
    • Conversely, problems with vascular impairment result in decreased placental perfusion (Decreased O2 and glucose)
  31. Neonatal Complications from Preexisitng DM mothers:
    • Hypoglycemia (bc of accelerated insulin production)
    • Hypocalcemia
    • Hyperbiliruinemia (from hypoxia, excess erythrocytes)
    • Respiratory Distress Synd (accelerated insulin retards cortisol production and slows lung maturity)
  32. Preexisting DM management for mom/baby:
    • Goal= keep safe glucose levels in mother
    • Adherence to insulin therapy (frequent testing and dietary control)
    • Increased insulin usually required during 2 and 3 Trimester
    • Assess for organ damage (cardiac, eye- retinopathy, renal function)
  33. Predisposing Factors for GDM:
    • Overweight
    • HTN
    • Over age 25
    • Family Hx
    • Fasting Glu >140 or random >200
    • Hx of: LGA babies, Congenital anomalies, unexplained fetal death, gestational dm
  34. Screening for GDM (on everyone)
    Glucose Challenge Test (GCT)-- weeks 24-28

    Blood drawn one our after ingestion of 50g oral glucose (if above 140, do 3 hour OGTT)
  35. Maternal and Neonatal Effects of GDM
    Less chance of abnormalities than preexisting DM

    Less Chance of Miscarriage

    Increased morbidity and mortality later in pregnancy due to macrosomia and hypoglycemia
  36. Gestational DM management:
    calories restricted for obese women (eliminate simple sugars)

    • Exercise: safe, graduated program
    • Monitor: Fasting <90 and 1hr Post Prandial 130-140
    • Insulin may be ordered based on results
    • Increased fetal surveillance (ultrasound, BPP, kick counts)
    • HbA1c- discuss implications
  37. Nursing care of woman with DM during preg:
    • Assessment of her knowledge, understanding, and attitude
    • Provide more information
    • Education re: diet, BG timing, danger signs
    • Instruction re: insulin administration (subcutaneous sites, angle of needle, aspiration, quick or slow, infusion pumps)
  38. "Food Coma" Hyperglycemia:
    • Fatigue
    • Flushed, Hot
    • Dry mouth
    • Thirsty
    • Frequent urination
    • Rapid, deep respirations
    • Drowsy/HA
    • Depressed Reflexes
  39. "The Shakes" Hypoglycemia:
    • Shaking
    • Sweaty
    • Cold, Clammy
    • Disoriented, Irritable
    • Hungry
    • Blurred Vision
  40. Adolescent Pregnancy
    Incidence of Adolescent pregnancy is declining

    Rate= 39.1 births per 1000 girls (15-19)

    US still remains the highest in all industrialized nations
  41. Teen Pregnancy in the Black adolescent has ______
  42. Associated Factors of Teen Pregnancy:
    • "I'm in love"
    • High Rate of sexual activity
    • Low use of contraceptives
    • Gaining or maintaining a love relationship
    • Limited understanding of vulnerability
    • Societal Controversy regarding sex education
  43. Psychosocial and Socioeconomic Implications of Teen Pregnancy
    Interruption in achieving normal tasks of adolescence 

    Decision making about the pregnancy

    Interruption of Education

    Potential for lifelong dependence on Welfare
  44. Maternal Health Implications of Teen Pregnancy
    • Higher Maternal Mortality
    • Increased Risk of Preeclampsia
    • Anemia and Nutritional Deficiencies-- lack of knowledge or being afraid to gain weight
    • High rate of STDs-- lead to preterm labor
    • Absent or late prenatal care-- they could be in denial or trying to hide their pregnancy
  45. Fetal and Neonatal Complications of teen pregnancy:
    • Higher newborn mortality rate
    • Higher rate of prematurity
    • Higher rate of low birth

    (notice s/s of complications too is priority)
  46. Complications of adolescent parenting behavior
    • Risk for negative parent-infant interactions
    • Poor understanding of growth and development
    • Relationship with father of baby- may or may not be in the picture...need for support from family and friends...psychosocial issues
  47. Nursing Assessment on Teen Pregnancy:
    • Complete Physical Exam
    • Knowledge of infant needs and care
    • Cognitive development (egocentrism, present-future orientation, abstract thinking)
    • Dx: Risk for Altered Health Mantenance
    • Assessment of family and support system (who will be there when baby comes, who takes them to their appointments, if she has a car, etc)

    *be able to evaluate maturity; many teens don't think bad things will happen to THEM so they have risky behaviors
  48. Nursing Interventions of Teen Pregnancy
    • Encourage ongoing prenatal care
    • Health education and counseling 
    • Infant care teaching
    • Long-term plans
    • Returning to school
    • Provide appropriate referrals
  49. Advanced Maternal Age put mother at risk for:
    • Preexisting health problems (hypertension, IDDM, Uterine Fibroids)
    • Complications of pregnancy
    • Genetic-increased risk of chromosomal abnormality at age 40
    • Preeclampsia, preterm labor, multiple gestation, gestational diabetes
  50. Later Pregnancy Implications compared to Teen Pregnancy:
    • Psychosocially Mature
    • Usually wanted and planned pregnancy
    • Financially Secure
    • Less Energy
    • May lack peer support from other parents
  51. Complications of Older Pregnancy
    Increased risk of chromosomal abnormalities (age 40 >) -- 1 in 100 risk for trisomy 21

    • Preeclampsia
    • Preterm labor
    • Multiple gesdtation (naturally and with fertility treatments)
    • Gestational diabetes
    • Dysfunctional labor (c-sections increase)
  52. Approximately _________ are exposed to one or more drugs during pregnancy.
    1 in 10

    (fetus receives any substance taken in by mother...drinking, snorting, injection...fetus cannot metabolize drugs which gives lasting effects to fetus)
  53. Most commonly abused substance during pregnancy
    Tobacco- (nicotine, carbon monoxide, cyanide)
  54. Fetal Risks of Tobacco:
    Prematurity, low-birth weight, developmental delays
  55. Maternal Risks for Tobacco Abuse during pregnancy:
    Spontaneous Abortion, Preterm Labor, Anemias
  56. Most serious condition caused by alcohol consumption during pregnancy
    Fetal Alcohol Syndrome
  57. Leading cause of intellectual disabilities in babies
    Alcohol Abuse
  58. 3 Clinical Features of Fetal Alcohol Syndrome
    Mental Retardation, Prenatal and Postnatal growth restrictions, Facial Anomalies (microcephaly, short palpebral fissures, flat midface, thin upper lip, IUGR-- intrauterine growth restriction, CNS impairment)
  59. Effects of Cocaine during Pregnancy:
    -Powerful short acting CNS stimulant

    Maternal: Stimulates contractions (leads to abortions, preterm labor, abruptio placenta, still birth)

    Fetal Effects: tachycardia, decreased variability, IUGR, fetal overactivity

    Neonatal Effects: marked irritability, difficult to console
  60. Overall effect of Narcotics (Opiods) during pregnancy: (Heroine, Meth, Demerol)
    CNS Depressant-- mental dullness, drowsiness, stupor
  61. Fetal Effects from Narcotic use during pregnancy (Heroine, Meth, Demerol)
    • Intermittent Hypoxia
    • Prematurity
    • Low Birth Weight
    • IUGR

    Neonatal Abstinence Syndrome: withdrawal, neurological and gastrointestinal issues, happens within 1st 24 hours
  62. Treatment of Substance Abuse during pregnancy:
    • Rehabilitation Treatment
    • Methadone Treatment (heroin addiction)
    • Outpatient Treatment
    • Support Groups
  63. Heart disease affects about _____ of pregnancy
  64. types of Congenital Heart disease
    • Septal Defects (acyanotic L-R shunt, cyanotic- R-L shunt)
    • ASD-- atrial septal defect
    • VSD-- ventricular septal defect
    • PDA-- patent ductus arteriosis
  65. Acquired Cardiac Disease
    Mitral Stenosis (beta blockers, calcium channel blockers)

    Mitral Valve prolapse (most common- benign)
  66. Prophylactic antibiotics during labor for MVP
    ampicillin, gentamycin

    (if allergic to penicillin, Vanco and Gentamicin
  67. Rare heart condition in pregnancy that appears in the last few weeks or last month to 5 weeks postpartum
    Peripartum and Postpartum Cardiomyopathy
  68. Risk Factors of Peripartum and Postpartum Cardiomyopathy
    Age greater than 35 years, Preeclampsia, Multiple gestation, African descent
  69. A pt with peripartum and postpartum cardiomyopathy will show s/s of :
    Cardiac Decompensation (CHF)
  70. Assessment for S/S of CHF during pregnancy:
    Rales, Cough, Dyspnea upon exertion, heart murmurs, syncope

    Ongoing cardiac consultation

    Monitor Weight Gain

    Prevent Anemia and Infection
  71. Intrapartum/Postpartum management
    Antibiotic treatment for Mitral valve prolapse

    Careful fluid management, lung assessment

    Oxygen therapy, sedation, early epidural cardiac monitor

    Very careful assessment 24-48 hours postpartum
  72. Reduction of O2 carrying capacity, below normal of the RBC number, quantity of hemoglobin or volume of packed red cells in blood
  73. Hgb levels of Anemia
    <11.0 (in 2nd tri)
  74. Hct levels of Anemia
  75. s/s of Iron Deficiency Anemia
    fatigue, pallor, lethargy, h/a, pica
  76. Treatment of Anemia in pregnancy
    • Oral Iron Ferrus Sulfate 1-3 times daily
    • (Give with 500 mg of ascorbic acid)
  77. Coenzyme in DNA synthesis, essential for cell duplication
    Folic Acid
  78. Folic acid deficiency is associated with
    Neural Tube Defects
  79. S/S of folic acid def
    Pallor, Lethargy, Fatigue
  80. Women of childbearing age require _____ mcg of folic acid every day, in pregnancy ___ mcg daily
    400; 600
  81. Food sources with folic acid
    • Dark, green leafy veggies
    • Citrus Fruits
    • Eggs
    • Legumes
    • Whole Grains
  82. Iron is better absorbed with _____
    Vitamin C (take with orange juice)
  83. Autosomal recessive genetic disorder gene hemoglobin "S"... abnormal shape causes cells to clump together and obstruct vessels
    Sickle Cell Anemia
  84. S/S of sickle cell anemia
    Fever, Pain in abdomen, Joints, and Extremeties
  85. Expectant mothers that have sickle cell anemia are predisposed to:
    Pylenoephritis, Bone Infection, Heart Disease
  86. Mothers with Sickle Cell are at risk for:
    Preeclampsia, IUGR, Prematurity IUFD
  87. Nursing Care for Sickle Cell pts
    • Biweekly physician visits
    • Frequent Fetal Surveillance (biophysical profile, US, serum Fe, total iron-binding, surveillance for infection)
    • Self Care Measures (good hydration, nutrition, folic acid, good hygiene)
  88. Hereditary disorder, abnormal synthesis of alpha or beta chains of hemoglobin
  89. Types of Thalassemia
    Beta Thalassemia Heterozygous form (MORE common!)

    Beta Thalassemia Homozygous form (hepto-splenomegaly, bone deformities, cardiovascular complications)
  90. Infections common during Pregnancy

    • T- toxoplasmosis
    • O- other (gonorrhea, syphilis, varicella, hep B, HIV, parvovirus)
    • R- rubella
    • C- cytomegalovirus (CMV)
    • H- herpes simplex virus (HSV infection)
  91. If mom has open lesions from HSV, she will deliver
    by C Section
  92. If mom is infected with Hep B (transmitted by blood, saliva, vag secretions, semen, breast milk), the baby will receive
    HBIG (prophylaxis) and Hep B vaccine series
  93. If mom has varicell, she is given ____ to reduce effects on feturs, congenital varicella syndrome...infants exposed 5 days prior to birth and 48 hours after birth are given this too
  94. What percentage of pregnancies end in still birth with mothers that have not been treated for syphilis
  95. Prenatal screenings for STDs are done
    at initial prenatal exam and at 28 weeks (if high risk)
  96. Recommendations to reduce HIV transmission to infant:
    • Oral ZDV therapy beginning after 14 weeks to 34 weeks gestation
    • IV therapy starting 3 hours before delivery
    • Delivery at 38 wks gestation
    • Breastfeeding is Contraindicated!!! (teach to pump and dump)
  97. Treatment for UTIs during pregnancy
    ampicillin, gentamicin, cefazolin (ancef)
  98. All pregnant women must be screened for ____
    Genitourinary Infections (UTIs)
  99. S/S of pyelonephritis (usually due to E Coli)
    • Temp of 102.2
    • Flank Pain
    • N/V
  100. Treatment for pyelonephritis
    may need hospitalization and IV therapy
  101. Things to teach regarding UTIs
    • S/S of UTIs
    • Fluids 3000ml / day
    • Good Hygiene
  102. Hemorrhage conditions of early pregnancy
    • Abortion: loss of pregnancy before 20 weeks or weighing less than 500gms
    •    Spontaneous Abortion
    •    Threatened Abortion
    •    Missed Abortion
    • Disseminated Intravascular Coagulation
  103. Most first tri abortions are due to:
    Fetal or chromosomal abnormalities, congenital anomalies
  104. Some causes of abortions:
    Maternal infections, anatomic disorders of cervix and uterus, ectopic pregnancy
  105. Approximately _____ of pregnancies are lose spontaneously
  106. Vaginal bleeding may be accompanied by uterine cramping, persistent back ache, feelings of pelvic pressure
    Threatened Abortion
  107. Membranes rupture and Cervix Dilates:
    Inevitable Abortion
  108. Some but not all contents of conception are expelled:
    Incomplete Abortion
  109. If a pt has a + preg test but there is no fetal activity, it is considered _____
    Missed Abortion (mom's body should have had spontaneous abortion, but didn't)
  110. Interventions for Threatened Abortion:
    Ultra Sound, Beta hCG levels, Progesterone levels, Pelvic rest, Count perineal pads/color, quantity of blood and tissue, Odor
  111. Interventions of an Inevitable Abortion
    D&C (dilation and vacuum curettage)
  112. Interventions of Incomplete Abortion:
  113. Interventions for missed abortion:
    D&C, Ultra Sound, hCG levels, Monitor for infection
  114. Interventions for Complete Abortion:
    • Advise to rest, watch for additional bleeding and infection, pelvic rest
    • Ultra Sound, HCG levels, Monitor for infection, DIC
    • NO SEX, NO TAMPONS (tell pt to come back in a week to do lab values in office)
  115. Recurrent Spontaneous Abortions could be due to
    chromosomal abnormalities, structural or hormonal, or immunological

    Incompetant cervix
  116. If pt comes in with incompetent cervix what is the next action on their visit:
    Cerclage (suture placed around cervix, 11-15 weeks and removed at 37 weeks)
  117. Follow Up after a Cerclage:
    Bedrest, Pelvic Rest, Teach for S/S of labor, Bleeding, Tocolytic (Terbutaline) -> stops contractions
  118. Infusion of thromboplastin into bloodstream (uses up clotting factors) ex: abruptio placenta, prolonged retention of dead fetus (IUFD)
    Disseminated Intravascular Coagulation
  119. Conditions of disseminated intravascular coagulation are characterized by:
    Endothelial Damage (Severe Preeclampsia, HELLP)
  120. Lab values in Disseminated Intravascular Coagulation:
    • DECREASED fibrinogen and platelets
    • LONGER prothrombin time and activated partial thromboplastin time (PT and aPTT)
    • INCREASED fibrin degradation products
  121. Treatment/Nursing Interventions for Disseminated Intravascular Coagulation (DIC)
    Correct the cause

    Blood Replacement Products: Whole blood, packed red cells, cryoprecipitate

    Assess bleeding from any body orifices, IV sites, nosebleeds, unexplained bruising
  122. Implantation of fertilized ovum outside of uterine cavity (98% in fallopian tube)
    Ectopic Pregnancy
  123. Risk factors of Ectopic Pregnancy
    History of Pelvic Infection


    Previous surgery (failed tubal ligation)
  124. "Classic Symptoms" of an ectopic pregnancy
    • Missed Menstrual Period
    • Abdominal pain
    • Vaginal spotting
    • Positive Pregnancy Test
  125. Dx of Ectopic Pregnancy is done by:
    Transvaginal ultrasound, HCG level (present but lower than normal)
  126. Ectopic Sites of an ectopic pregnancy
    • Ampular
    • Fimbrial
    • Isthmic
    • Interstitial
  127. Treatment/Nursing Interventions for an Ectopic pregnancy:
    Medical Management (methotrexate, linear salpingostomy, salipingectromy if tube is damaged) Rhogam if RH negative!!!

    Nursing Care: Prevention/early recognition of hypovolemic shock, pain control, psychological support

    Monitor for S/S of tubal rupture (pelvic, should, neck pain); dizziness/faintness; increased bleeding;
  128. Medical management for Ectopic Pregnancy:
    Methotrexate, Linear Salpingostomy, Salpingectomy if tube is damaged
  129. When trophoblast cells develop abnormally (1 in every 1000-1500 pregnancies); Placental tissue develops, but not fetal...fluid filled villi form grapelike clusters that grow rapidly
    Hydatiform Mole (trophoblastic disease)
  130. Hydatiform mole

    Trophoblastic cells reproduce rapidle- placenta develops, but not fetal
  131. S/S of Hydatiform Mole (trophoblastic disease)
    Abnormally large uterine size for gestational age, large sac with vessicles- no fetal activity

    • Higher HCG levels
    • Excessive N/V
    • Dark Brown Bleeding
    • Early preeclampsia prior to 24 weeks
  132. Management/Nursing Interventions of Hydatiform Mole:
    • Evacuation of Uterus (D&C)
    • Continuous monitoring of woman for 1 year for metastatic disease (increased risk of choriocarcinoma)
    • Beta-hCG levels every 2 weeks until not present
    • Pregnancy must be avoided for 1 year (oral contraceptives suggested BP method)
  133. Pregnancy must be avoided for ____ after hydostatic mole...therefore, _______ are suggested and highly important
    1 year; oral contraceptives
  134. Persistent uncontrollable vomiting that begins in early weeks of pregnancy and may continue throughout pregnancy
    Hyperemesis Gravidarum
  135. Etiology of Hyperemesis Gravidarum
    Multifactorial, high HCG levels, estrogen, hyperthyroidism, possibly genetic, psychological disorders
  136. Hyperemesis Gravidarum is associated with ____ or more of prepregnancy weight loss, dehydration, acidosis from starvation
  137. Pts with hyperemesis gravidarum will have what abnormal lab values:
    • Increased Ketones
    • Hypokalemia
    • Vitamin K deficiency
  138. Management of Hyperemesis Gravidarum
    Careful monitoring of fluid (I&O) and electrolytes, hematocrit, hemoglobin, sodium, chloride, potassium, and creatinine

    IV therapy, Hyperalimentation if necessary

    Slow return to solid foods; small frequent feedings of low-fat, easily digestible foods

    Home care: vitamin supplements, Vit B6 pyridoxine, ginger

    Provide Emotional support

    Drug Therapy (Phenergan, Ranitidine, Ondansetron, Methlyprednisone)
  139. Drug Therapy for Hyperemesis Graviderum
    • Promethazine (Phenergan)
    • Ranitidine (Zantac)
    • Ondansetron (Zofran)
    • Methylprednisolone (severe cases only bc category C drug)
  140. RH (Rhesus) factor incompatibility is present when:
    • Mother is Rh-NEG 
    • Fetus is Rh-POS
  141. Rhogam is given at ____ and within ____ after delivery
    • 28 weeks;  72 hours
    • *give them a card saying they've had the shot!
  142. Rh Incompatibility occurs in ____ of population (lower in African and Asian Populations)
  143. Causes of Trauma during pregnancy:
    Accidents, Assault, Suicide
  144. Most common cause of blunt trauma in pregnancy
    MVAs (motor vehicle accidents)
  145. Nursing Management for Trauma during pregnancy:
    Focus on the mother, THEN the fetus

    Place wedge under one side of mother (tips the uterus)

    • VS, urine output, fetal HR, CTX pattern
    • S/S of abruptio placenta
    • Kleihauer-Betke (KB test)-shows mixing of blood