Exam II: Pregnancy at Risk

surveillance

-urine check (protein, nitrates, leukocyte esterase) -renal function (creatinine clearance and protein) each trimester -eye exam 1st trimester -HbA1c q 4-6 weeks -ultrasound, AFP (to detect congenital anomalies), BPP, amniocentesis -NSTs weekly after 28 weeks

medications for cardiovascular disorders

-warfarin not recommended- crosses placenta and may have teratogenic effects -lovenox is the recommended alternative

rescue agents for asthma

*reduce acute bronchospasm -albuterol -ipratropium

screening tests for DM

-2 hour 75g glucose challenge test abnormal; >120 mg/dL then... -3 hour 75 g glucose tolerance test

nursing management in labor

-IV rate and insulin based on blood glucose levels as ordered -blood glucose q1-2 hours or more frequently if necessary -keep syringe with 50% dextrose solution at the bedside to treat profound hypoglycemia -many women are NPO and on clear liquids only

gestational diabetes: risk factors

-age >35 -overweight -being a person of color -congenital anomaly -fetal demise or stillbirth -baby >9 lbs -DM or HTN -family history of diabetes (1st degree relative) -polycystic ovary syndrome (PCOS) -multiple pregnancy (twins, triplets)

other considerations: tuberculosis

-avoid streptomycin (ototoxic) -continue breastfeeding during tx

maintenance agents (steroids) for asthma

-beclomethasone -salmeterol

infections

-cytomegalovirus -rubella -herpes simplex -hep B -varicella -parvovirus -toxoplasmosis -group beta strep (GBS) -HIV

asthma

-diaphragmatic elevation, decrease in lung capacity occur late in pregnancy -greatest risk of asthma attack 24-26 weeks -flare ups are rare during last 4 weeks of pregnancy and during labor -medications -rescue agents to reduce acute bronchospasm -maintenance agents (steroids)

other considerations: iron deficiency anemia

-different from physiologic anemia -dietary considerations

non-diabetic mom

-fasting 60-90 mg/dL -1 hr postprandial 100-200 mg/dL -2 hr postprandial 60-120 mg/dL

diabetic mom

-fasting <90 mg/dL -1 hr postprandial <153mg/dL -2 hr postprandial <153 mg/dL

3 hour 75 g glucose tolerance test abnormal values

-fasting >95 -1 hour >140 mg/dL -2 hours > 120 mg/dL -3 hours >95 mg/dL

GDM management

-first line: insulin -oral meds: glyburide and metformin

congenital and acquired heart disease: at risk for...

-growth restriction -preterm labor and birth -fetal and neonatal mortality

gestational diabetes mellitus: pathophysiology

-maternal glucose levels decrease because of fetal demand -human placental lactogen causes insulin resistance -pregnancy with DM -> pancreas can't keep up with insulin demand

management of cardiovascular disorders

-preconception counseling -risk assessment -more frequent prenatal visits -medications -risk for decompensation highest at 28-32 weeks and 48 hours postpartum

extremes of age for pregnant women

-pregnant adolescent -women over 35

diabetes mellitus: assessment

-screening: all women with risk factors are screened at the 1st prenatal visit -standard screening at week 24-28 for everyone

other considerations

-thalassemia -autoimmune disorders

gestational diabetes mellitus: risks to fetus

-umbilical cord prolapse (polyhydramnios) -congenital anomaly (hyperglycemia in first trimester) -macrosomnia -> birth trauma -hypoglycemia

what do you give for GBS

ampicillin in labor

HbA1c levels

<7% indicates good control >8% indicates poor control and warrants intervention

congenital and acquired heart disease: types

Class I: asymptomatic with no limitation of physical activity Class II: symptomatic with slight limitation during increased physical activity Class III: symptomatic with normal activity Class IV: symptomatic at rest or with any physical activity

sickle cell anemia: management

IV fluids and O2 during labor

what needs to be avoided with HIV

avoid breastfeeding

what should you avoid with a toxoplasmosis infection?

avoid cat feces

nursing management postpartum

blood glucose q 2-4 hours for first 48 hours

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class?

class III

sickle cell anemia: pathophysiology

abnormal hemoglobing causes the RBC to become sickle shaped

The nurse determines teaching was successful when a pregnant client identifies which factor as being most important in helping to reduce complications associated with diabetes during pregnancy?

degree of blood glucose control achieved during the pregnancy

pathophysiology of cardiovascular disorders

hemodynamic changes in pregnancy create challenges for the woman with cardiac disease

•After providing education to an obese patient with gestational diabetes, which of the following indicates the correct understanding?

i will plan to gain 11-20 lbs

gestational diabetes mellitus

insulin resistance with onset during pregnancy or first detected in pregnancy

A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best?

left lateral recumbent (prevents compression of the vena cava and hypotensive syndrome)

cardiovascular disorders

prevalence of cardiac disease increasing in pregnancy due to: -smoking -diabetes -obesity -AMA (advanced maternal age)

pregestational diabetes

type 1: absolute insulin deficiency (usually <30years) type 2: insulin resistance or deficiency

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? •"You'll probably have a cesarean birth to prevent exposing your newborn." •"Antibodies cross the placenta and provide immunity to the newborn." • "Wait until after the infant is born, and then something can be done." •"Antiretroviral medications are available to help reduce the risk of transmission."

•"You'll probably have a cesarean birth to prevent exposing your newborn." •"Antibodies cross the placenta and provide immunity to the newborn." • "Wait until after the infant is born, and then something can be done." •"Antiretroviral medications are available to help reduce the risk of transmission."

Which of the following clients is at risk for developing Gestational Diabetes Mellitus (select all that apply)? •A 36 year old woman •A woman with a second cousin who had gestational diabetes •An obese woman •A woman who previously had a stillbirth •An African American woman

•A 36 year old woman •A woman with a second cousin who had gestational diabetes •An obese woman •A woman who previously had a stillbirth •An African American woman •

which neonate is at highest risk for developing neonatal herpes following birth? •A newborn who was delivered by cesarean section to a mother with genital herpes •A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions •A newborn who was delivered by cesarean section following prolonged rupture of membranes to a herpes positive mother with no active lesions A newborn who was

•A newborn who was delivered by cesarean section to a mother with genital herpes •A newborn who was a vaginal delivery to a mother who had her initial outbreak during the third trimester of pregnancy and has active lesions •A newborn who was delivered by cesarean section following prolonged rupture of membranes to a herpes positive mother with no active lesions A newborn who was