1550: NURS mgmt Preg & Preg@Risk-ch12&19

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  1. Antepartum Care:
    Preconceptual counseling: pp 365-366, box 12.2.

    Diabetes: what must be normal?

    What does macrosomia mean?
    Diabetes: A1c tests indicate whether you are diabetic or not. Two separate tests resulting in  >6.5% indicates diabetes.

    Macrosomia: large baby; >4.5 k grams
  2. Preconceptual counseling: pp 365-366, box 12.2.

    Folic acid deficiencies? Explain intervention.

    Hypothyroidism, what can it cause? Explain intervention.
    Folic acid: neurotube does not close (baby's back). Women should take prenatal vitamins to have sufficient folic acid. 

    Hypo: MR, developmental delays. Mother should increase thyroid hormone during prego.
  3. Preconceptual counseling: pp 365-366, box 12.2.

    Oral anticoags: if mother is on, what is given instead?

    Smoking complications & interventions?
    Oral anticoags: mother is given heparin if she must be on anticoag.

    Smoking: placenta detaches from uterine wall causing death of baby.
  4. Preconceptual counseling: pp 365-366, box 12.2.

    Drug use complications?

    Work Place Exposure of certain known teratogen substances.
    Mothers can transmit disease if they are using needles (e.g., HIV, HepB, etc.)

    Work place should contain booklet of info. regarding substances they may harm pregnant women.
  5. Initial visit: describe the initial visit process.
    • Detect problems, prevent, for mom/fetus.
    • Determine:
    • GPTPAL
    • EDB (nagel's rule) + 1y, - 3 mos, + 7d
    • Hx taking process 
    • Complete physical exam
  6. If mother is HIV Positive, what is the HIV therapeutic mgmt?
    Oral medications (oral anti retro viral) twice daily from 14 weeks until birth due to end of 1st trimester.

    IV admin. during labor.

    Oral syrup for NB in 1st 6 weeks of life.
  7. Explain what Rh factor is.

    How is it treated?
    Rh is a protein on the surface of RBCs. If you have the protein, you're Rh +. You're negative if your RBC does not have the protein.

    If the mother and baby have different results, (e.g., mom: neg; baby's father: pos)

    During delivery, if your baby is Rh+ and you're Rh-, and if the baby's blood enters your bloodstream, you may develop Ab for Rh+ RBCs.

    For the next baby, your body may attack the baby if it is Rh+, leading to life-threatening anemia.

    Treatment involves an injection of Rh immune globulin to inhibit the production of Rh Ab during pregnancy.
  8. Common Lab & Tests

    *(must know) Blood type & Rh, why? (Rh factor); 
    *What is Rhogam? When is it given to the baby and why?
    If mother is Rh -: no protein; mother is given Rhogam shot @ 28 weeks even if Rh is unknown.

    If baby is + (protein), body recognizes baby as different from self. Body makes memory of it and may cause attack of later pregnancy defining it as foreign.

    Rhogam (given if baby is +): injection that does not allow body to see baby's blood type so attack does not happen *must be given within 72 hrs.
  9. Common Lab & Tests

    Sexually Transmitted Infections (STI)
    Syphyllis, how is it treated?

    Gonorrhea/Chlamydia: what lab tests are done?

    Herpes I or II?
    What is Tx for herpes? @what # of wks?

    HPV test done by?
    Syph: ABS Ab test-Penicillin is treatment of choice.

    Gon/Chlam: urine or cervical culture.

    • Herpes I/II: blood or culture.
    • Tx: @36 wks: given acyclovir.

    HPV: Pap smear.
  10. Lab Values.

    What happens to the "plasma volume"? 

    RBCs? (increase/decrease)

    Hgb? (increase/decrease)
    Plasma increases by 50% so mothers can bleed 499 cc.

    RBC increases 20-30%.

    Hgb decreases but not a true decrease, it's a result of the dilation.
  11. Maternal Wt. Gain.

    How many lbs. should be gained?
    Norm wt?
    • Underwt: gain of 28-40 lbs.
    • Norm wt: gain of 25-35 lbs.
    • Overwt: gain of 11-20 lbs.
  12. When would you know the sex of the baby?

    (week #)
    @20 weeks.
  13. 24-28 week visit.

    What happens?
    • Wt. & BP
    • Urine testing: protein, glucose, ketones, nitrates.
    • Fundal ht: should measure appropriate wk.

    • Assess fetal activity, HR, cerv. exam.
    • Glucose screening for gest. diabetes (low risk)
    • RhoGam if mother is Rh -.
  14. 32-36 week visit.

    What happens?

    What happens @36 weeks if the Pt has genital herpes?

    Assess for..
    • Wt&BP: compare to baseline.
    • Urine Testing: protein, glucose, ketones, nitrates.
    • Fundal ht: should measure appropriate wk.

    • Assess for lightening, fetal activity, HR.
    • Pt Hx of genital herpes: acyclovir @36 wks.
    • Cervical exam
    • Group B strept vag/rectal culture
  15. Genital Herpes.

    What happens if the Pt has an outbreak?
    Outbreak: must have a c-section.
  16. Group Beta Strep (GBS)

    Why is it done & when should it be screened?

    What are the complications to the baby?

    What is given for Tx if (+)?

    What if the Pt has a UTI & tests + for the culture?
    Bacteria that can spread to the baby if fluids come into contact during birth or even months before labor.

    Testing is done via swabbing vagina cells betwen 35-37 wks.

    • Complications: 
    • Inflammation of the lungs, membranes and fluid surrounding the brain and spinal cord (meningitis)
    • Bacteremia
    • Life-threatening infection in the blood (Sepsis)

    • Tx:
    • If +, antibiotics given during L&D of vag birth, preterm, or late preterm.

    Tx of antibiotics is given even if Pt is not in labor for someone w/ UTI.
  17. 41-42 week 2x/week.

    What happens?

    Asses for..
    • Wt/BP: compare to baseline.
    • Urine testing: protein, glucose, ketones, nitraties.
    • Fundal ht: should measure appropriate wk.

    • Assess for: lightening, fetal activity, HR.
    • Cervical exam
    • Non-stress test.
    • Biophysical profile.
  18. At 20 weeks gestation (20 cm), where should the head be?
    @ the umbilicus
  19. At which weeks is 

    Chorionic Villi Sampling?


    Marker Screening Tests?
    Chorionic Villi Sampling: 10-12 wks

    Amniocentesis: 15-18 wks

    Marker Screening Tests: 15-22 wks; ideal is 16-18 wks
  20. Prenatal tests: Chorionic Villus Sampling (CVS)

    What is this test and why is it done?
    A small piece of tissue is taken from the mother's placenta which contains cells from the baby.

    It is done to detect certain birth defects.
  21. Prenatal tests: Chorionic Villus Sampling (CVS)

    What is the nursing management for CVS for both procedures?
    • 1) transabdominal: 
    • -have Pt drink water to fill bladder
    • -advise that a needle will be used to puncture the abdominal wall to collect samples and sent to the lab.

    • 2) transcervical:
    • -place speculum into vagina w/ guidance of ultrasound.
    • -vagina cleaned and catheter is inserted into cervix to receive small sample to be sent to the lab.
  22. Prenatal tests: Chorionic Villus Sampling (CVS)

    What are s/sx you should tell Pt to watch for after the procedure?

    What should be done after 48h?
    • fever,
    • cramping
    • vaginal bleeding

    After 48h, assess FHR and give RhoGam.
  23. Prenatal tests: Amniocentesis

    What is it and why is it done?

    When is it best to perform an "amniocentesis?"
    Puncture to obtain amniotic fluid in order to detect chromosomal abnormalities and metabolic defects in the fetus.

    *also is used to CONFIRM other screening tests that might indicate a fetal abnormality.

    Best performed during the 2nd trimester since earlier testing have been linked to miscarriages.
  24. Prenatal tests: Amniocentesis

    What is the nursing management after this procedure is done?

    What should you encourage?

    What s/sx should Pt report?
    • Give RhoGam.
    • Assess maternal VS and FHR q15 for 1h.
    • Observe puncture site for drainage.
    • Encourage rest.

    Report fever, leaking amniotic fluid, vaginal bleeding, or uterine contractions or any changes in fetal activity (increased or decreased) to the health care provider.
  25. Prenatal tests: Marker Screening Test.

    What is it done?

    What is the nursing management?
    It is done to screen for Down Syndrome and neural tube defects.

    • Explain the test and that it is for screening purposes only. 
    • Explain that an "amniocentesis" confirms the test.
  26. Teaching Guidelines 12.1 p. 388.

    What must you teach for:
    vena cava syndrome
    urinary frequency or incontinence
    leg cramps
    Braxton Hicks Contractions
    • vc synd:
    • urinary frequency/incontinence:
    • fatigue:
    • N/V:
    • backache: 
    • leg cramps:
    • varicosities:
    • hemorrhoids:
    • constipation:
    • heartburn/indigestion:
    • Braxton Hicks Contractions:
  27. Stations.

    Describe what happens and the importance of stations; what stage of labor is the mother in at this time?

    What does -3 and 0 mean?
    Helps indicate the progress of the second stage of labor (expulsion of fetus)

    • -3: Baby's head has not started its descent.
    • 0: Baby's head is mid of birth canal and engaged in pelvis.
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1550: NURS mgmt Preg & Preg@Risk-ch12&19
2015-04-03 21:25:14

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