Beruflich Dokumente
Kultur Dokumente
By Susan Sienkiewicz
Peer pressure Self-esteem Lack of role models Gain attention Media Poverty Rite of passage
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Maternal health:
CPD PIH
prematurity
resp complications cp cognitive deficits death
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anemia
nut deficits mortality
Risks fundal height # of sexual partners knowledge of infant care/needs family unit/support system baseline VS/weight
IMPLICATIONS OF DELAYED PREGNANCY Pre-existing conditions Preterm labor SGA/LBW IUGR PIH Abruption C-section Uterine fibroids PP hemorrhage Chromosomal abnormalities
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Inevitable
No false reassurance Check by U/S for complete vs. incomplete Analgesics for D&C RhoGAM
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Missed
Hospitalization Before 14 wks D&C + IV Pitocin After 14 wks Pitocin or Prostaglandins Wait 3 to 5 wks for spont Ab (93%) Monitor for DIC
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Bldg, cramping X 1-2 wks vaginal rest X 1 wk temp BID f/u in 2 wks
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Missed Period Abdominal Pain Vaginal Spotting Rupture Severe lower abd pain hCG levels No gestational sac on U/S
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MTX
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Vaginal bleeding anemia uterus size, cramps No FHTs N/V Early PIH
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1.
2.
3.
4. 5.
6.
7. 8. 9. 10.
Initial symptom is vaginal bleeding 2. Membranes rupture and cervix dilates 3. Some, not all, products of conception are expelled. 4. Treatment includes D&C 5. All products of conception passed 6. All unsensitized Rh neg women should receive RhoGAM 7. May be treated with bedrest 8. Retained dead fetus 9. May be complicated by DIC 10. Pregnancy may continue
A. B. C. D. E.
Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Missed abortion
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Bedrest
no sex act
report bldg
delivery
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(unless concealed)
U-act
hemorrhage
boardlike abd late decels s&s shock
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DIC
Placental Bleeding Thromboplastin release
Fundal Ht
Lab Data (H/H, coags) Emotional response
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S&S Pre-eclampsia
Rapid wt gain edema of hands & face proteinuria hyperreflexic DTRs H/A, visual disturbances epigastric pain
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Treatment of Pre-eclampsia
Mild: diastolic <
Bedrest protein diet document fetal activity weekly NST
100, trace to 1+ proteinuria, no H/A
Delivery
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Eclampsia
HELLP Syndrome
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Bedrest Meds
Delivery
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Prenatal:
wt, B/P, U/A, H/A, visual disturbances daily wt hourly u/o, dipstick urine Q4H VS, FHR LOC, DTRs, H/A clonus
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Hospitalized Ct:
Ca gluconate @ BS Mg levels IV MgSO4 (should be Y connected to another primary bag) D/C MgSO4 for RR < 12 or absent DTRs renal function (30 mL/hr)
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Incompetent Cervix
S&S
advanced cervical dilation low abd pressure
bloody show
urinary frequency Treatment cerclage
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S&S
Treatment
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Assessment
Teaching
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Postterm Pregnancy
S&S
Treatment
fetal surveillance
NST, CST, BPP Q wk mom monitors mvmt Pitocin (10-20U/L) @ 1-2 mU/min every 2060 min
Risks
Induction
fetal mortality cord compression mec asp LGA shoulder dystocia CS episiotomy/laceration depression
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Polyhydramnios
Oligohydramnios
S&S
Risks
Treatment
Treatment
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Hyperbilirubinemia
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Repeat frequently
Management of Rh Incompatibility
Prenatal per algorithm
Prevention
Postpartum
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Hyperemesis Gravidarum
S&S
Treatment
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3 GTT
hi carb diet X 2 days, then NPO after MN FBS, then drink 100g glucose,
1, 2, 3 BS
Gestational Diabetes is diagnosed with FBS > 105 or with 2 of the following BS results: 1 > 190, 2 > 165, 3 > 145
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Effects of Pre-Existing DM
Maternal
Fetal
Treatment of Pre-existing DM
Team approach Monitor glycosylated Hgb A Diet: 50% carb, 20% prot, 30% fat Insulin TID Hourly glucoses during labor NSTs weekly (starting at 28-30 wks)
Amnio ( lung maturity)
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Maternal Effects
Fetal Effects
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30 to 35 cal/kg/day (3 meals, 2 snacks) Insulin FBS, post-prandial BS Q week NST, BPP Q week glycosylated Hgb A Amnio ( lung maturity)
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Glucose monitoring insulin administration type, onset, peak, duration, times, sites, injection technique diet s/s hypoglycemia tremors, pallor, cold/clammy skin give milk & crackers or glucagon inj s/s hyperglycemia fatigue, flushed skin, thirst, dry mouth, check glu, call MD for insulin order
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PPCM: Manifestations
dyspnea edema, wt gain chest pain palpitations jug vein distention enlarged heart spont ab, PTL
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Meds Sidelying, HOB Monitor VS, FHR, heart pressures (Swan-Ganz) Strict I/O Assess lungs
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Maternal Effects
Fetal Effects
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Maternal effects
Fetal effects
Treatment PO or IV Steroids
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AIDS
Maternal Effects
Fetal Effects
Treatment: ZDV (zidovudine) during PG, L&D ZDV to neonate for 6 wks
Asymptomatic at birth Candidal diaper rash thrush diarrhea recurrent bacterial infections FTT dev delay
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Which of the following socioeconomic factors contributes to the high incidence of adolescent pregnancy in the US?
A. B. C. D.
lack of adequate birth control poverty lack of information on safe sex availability of public assistance for unmarried mothers
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Which genetic screening test for chromosomal abnormalities provides an older expectant couple with information within the first trimester? A. B. C. D. Chorionic villus sampling (CVS) Amniocentesis Genetic karyotyping Ultrasonography
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When caring for a woman with mild preeclampsia, the nurse would be concerned with which finding?
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The nurse is preparing to infuse magnesium sulfate to treat preeclampsia. In implementing this order the nurse understands the need to: a. Prepare a solution of 20 g MgSO4 in 100cc D5W b. Monitor maternal VS, FHR and uterine contractions every hour c. Expect the maintenance dose to be approximately 4g/hr d. Discontinue the infusion and report a respiratory rate of < 12 breaths/minute
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The primary expected outcome for care associated with the administration of MgSO4 would be met if the woman:
a. Exhibits a decrease in both systolic and diastolic blood pressure b. Experiences no seizures c. States that she feels more relaxed and calm d. Urinates more frequently, resulting in a decrease in pathologic edema
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A primigravida at 10 weeks gestation reports slight vaginal spotting without passage of tissue and mild uterine cramping. When examined, no cervical dilation is noted. The nurse caring for this woman should:
a. Anticipate that the woman will be sent home and placed on bedrest with instructions to avoid stress or orgasm b. Prepare the woman for a dilatation and curettage c. Notify a grief counselor to assist the woman with the imminent loss of her fetus d. Tell the woman that the doctor most likely will perform a cerclage to help maintain the pregnancy
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CASE STUDY I
A G3P2 woman, at 38 wks gestation, arrives at the obstetric unit with c/o painless vaginal bleeding. 1. 2. 3. 4. What is the nursing priority at this time? What assessments are necessary? What is the most likely etiology of the bleeding? What is the expected treatment for Anne?
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CASE STUDY II
A G1P0 woman, at 35 wks gestation, is visiting the midwife for a routine prenatal visit. On assessment, the nurse finds that she has gained 8 lbs in the past month. 1. 2. 3. What is the significance (if any) of this weight gain? What other assessments should the nurse make at this time? What is the required treatment for this client?
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A 22 y.o. G1P0 who has a history of IDDM X 6 yrs and whose LMP was 12 wks ago arrives at the prenatal clinic.
1. 2. 3. 4. 5. How will this clients diabetes be affected by her pregnancy? What changes will she most likely have to make to adjust to her pregnancy? What routine assessments will be made at each prenatal visit? What tests will be required as the pregnancy progresses? What fetal effects occur with pre-existing diabetes?
6.
7. 8.
MATH PROBLEM
For induction, Pitocin is ordered 10 Units in 500 mL to start at 2 mU/min and increase by 1 mU/min every 20 minutes until effective contractions are achieved. At what rate will the nurse start the IV? By how much will the rate be increased every 20 minutes?
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THE END
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