OB test 3

The nurse has just received the shift report. Which client should the nrsse assess first?

the 2-day postpartum client who has a blood pressure of 138/90 mm Hg

partial placenta previa (seperation)

internal os (The opening that leads to your uterus) is partially covered by the placenta

Preciptious labor

labor that lasts less than 3 hours from onset of contractions

macrosomia

large-bodied baby commonly seen in diabetic pregnancies

marginal separation of placenta

more severe than partial placenta previa

pregnancy danger sign: hyperemesis

naseau and vomitting (typically 1st trimester) that can lead to dehydration, weight loss, death if not treated

risk factors for placental abruption

-HTN -Cocaine -polyhydramnios -chorioamnionitis -PROM -smoking -small for gestational age prior pregnancy

general interventions for placental abruption

-administer blood transfusion (usually for over 500 mL blood loss) -establish IV access and give lactated ringers solution

risks for neonate large for gestational age

-birth injury -respiratory distress -hypoglycemia -polycythemia -perinatal asphyxia -congenital abnormaliites

lab tests run for placental abruption

-cbc -blood type and cross -creatine -liver function tests (if preeclamptic) -coagulation studies

priority assessments in women with preeclampsia

-continuous EFM -IV access with 18-20 gauge IV -monitor I's and O's (IV fluid input and urine output) -labs (baseline and ongoing) -

when should woman with preeclampsia notify her provider?

-decreased fetal movement -vision changes -increased swelling (rapid onset) -epigastric pain -severe headache

side effects of these steroids

-fetal heart rate changes (decreased variability) -maternal hyperglycemia

effects of placental abruption

-fetal o2 can become compromised -mother may become hemodynamically unstable

lab valus for DIC

-fibrinogen (decreased) -fibrin degradation products (increased) -D-dimer (elevated)

obesity risk factors for pregnant women

-gestational diabetes -preeclampsia -macrocosmic infant -preterm birth

signs of hypoglycemia

-hunger -shakiness -pallor -headache -coma /seizure -impaired judgement

risks for PROM

-infection -fetal malpresentation leading to cord prolapse or C section -placental abruption (due to infection) -preterm birth -cord compression

important assesments for preeclampsia

-maternal temp -pusle -blood pressure -respiratory rate -oxygen saturation -deep tendon reflexes

interventions for PROM

-monitor for signs of infection -prevent infection (start antibiotics) -tests for GBS and STI's -

risk factors for preeclampsia

-multifetal gestation -nulliparity (never given birth) -history of preeclampsia -chronic illness (renal, autoimmune) -IVF -Elevated blood lead level -pt themselves was small for gestational age -barrier methods of birth control -new male partner

class 3 placental abruption (15%)

-no to heavy bleeding -fetal distress -high risk for maternal shock -high risk for DIC

class 2 placental abruption (45%)

-no to moderate vaginal bleeding -possible tectonic contractions -DIC possible -possible maternal tachycardia -fetal distress

class 1 placental abruption (40%)

-none to mild vaginal bleeding -back/abdominal pain -uterine tenderness

macrosomia infants are more likely to cause

-prolonged labor -c section -assisted vaginal delivery

preeclampsia diagnosis criteria is high blood pressure in addition to one of these symptoms

-proteinurea greater than or equal to 0.3 g in 24 hr urine specimen or dipstick greater than or equal to 2+*** -protein / creatine ratio of 0.3 mg -platelet count less than 100,000 (Thrombocytopenia) -pulmonary edema -serum creatinine of 1.1 mg/dL or higher -new onset of headache not going away w use of analgesics -visual symptoms (blurry, flashing lights, scotama) -liver transimases twice the upper limit -new onset cerebral disturbances (seizures) -high blood pressure (systolic above 140 and diastolic above 90) on at least 2 occasions at least 4 hours apart

discharge risks for patient with PPROM

-pt's should monitor for signs of infection -elevated temp 24 hours after birth -soreness in uterus -increased vaginal bleeding -foul smelling discharge

macrosomia risks

-shoulder dystocia -fractures -c section -lacerations -tissue damage

If you see signs of magnesium sulfate toxicity in your patient, you should

-turn off infusion -notify provider and obtain order for stat mag level -administer the antidote

typical labs ordered in women with preeclampsia

-urine test -blood test -fetal ultrasound -biophysical profile or non stress test

interventions for monitoring hemodynamic stability

-watch HR and BP (hypotension and rapid hr are concerning) -maintain greater than 30 ml/hr output -weigh soiled bloody materials for blood loss -continuous FHM

symptoms of superimposed preeclampsia

-worseing / resistant hypertension -new onset of proteinurea or sudden increase -significant new end-organ dysfunction occuring after 20 weeks gestation

weight gain for obese women should be

11-20 lbs

Urine output should be at least ________ per 4 hours

120 mL

After the initial bolus has been administered, total IV fluids should be limited to ________ unless otherwise noted ; maintenance dose is _______

125; 1-3 / hr

weight gain for overweight women should be

15-25 lbs

if blood pressure is greater than _____ systolic and _____ diastolic thna confirmation within minutes is ok

160 ; 110

pregnancy danger sign : vaginal bleeding

1st trimester : miscarriage 2nd / 3rd trimester: low lying placenta (placenta privea,) detaching placenta (placental abruption), bloody show (breakdown of the mucus plug that seals off cervix)

magnesium sulfate will be given at least ________ postpartum

24

assessments should be done every _____ hours on woman with preeclampsia

4

magnesium sulfate loading dose

4-6 grams over 20 minutes

magnesium sulfate therapeutic range

4-7 mg/dL

Biophysical profile

A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction

While caring for a client in early labor with preterm premature rupture of membranes (PPROM), the nurse observes a foul odor. What actions would the nurse implement? Select all that apply.

Assess maternal temperature. Evaluate for uterine tenderness. Assess fetal heart rate. Contact the health care provider.

A client in labor and delivery has just been diagnosed with preeclampsia. Which signs and symptoms should the nurse prioritize when assessing this client? Select all that apply.

BP 140/90 mm Hg edema of face headache

The nurse is orientating in the Labor and Delivery unit and asks her preceptor how to differentiate a client with preeclampsia from one with eclampsia. Which symptoms would the preceptor describe to the new nurse as indicative of severe preeclampsia? Select all that apply.

Blood pressure above 160/110 mm Hg Nondependent edema Hyperactive deep tendon reflexes

fetal heart rate categories

Category 1-Reassuring. May or may not have accelerations 120-160 bpm ; no late or variable decelerations Category 2- non-reassuring / Indeterminate. Warrants further observation. -requires extra monitoring...yellow lights Category 3-Abnormal. Immediate and prompt intervention required; have 20 minutes to fix this before delivering baby via vaginal or c-section; bradycardia, absent variability, recurrent late / variable decelerations

complete separation with heavy vaginal bleeding

placenta completely detaches from uterine lining wall; heavy vaginal bleeding ensues

complete separation with concealed hemorrhage

placenta is completely detached; blood is retained behind the placenta and does not communicate with the cervix.

A woman at 34 weeks' gestation experiences abdominal trauma. What pregnancy complication is a result of abdominal trauma?

placental abruption (abruption placentae)

Nurse should continue to do __________ assessments postpartum in addition to typical postpartum assessment

preeclampsia

pregnancy danger sign: epigastric pain

preeclampsia

pregnancy danger sign: severe headache

preeclampsia

pregnancy danger sign: uterine contractions , abdominal pain, pelvic pressure

preterm labor

A client comes to labor and delivery after experiencing a gush of fluid while getting out of bed. The nurse assesses the client and writes the above notes. Based on this assessment, the client has which condition?

preterm premature rupture of membranes (PPROM)

PROM

preterm rupture of membranes; before 37 weeks and mother is not in labor

The nurse is reviewing the history of a new cleint who is pregnant. Which findings should the nurse prioritize in the care plan to monitor the client for possible postpartum hemorrhage? Select all that apply.

previous history of postpartum hemorrhage, current diagnosis of low-lying placenta, Polyhydramnios in current pregnancy

Reactive non-stress test

recording of a minimum of 2 FHR accelerations (15bpm for at least 15 sec per episode) w/ fetal movement w/in a 20 min period

patients may ________ after delivery

seize

Ecclampsia

seizure during pregnancy (transport patient on left side)

preeclamspia is considered ______________ when it occurs in a women with chronic hypertension

superimposed

Subgaleal Hemotoma

swelling that does cross the suture line but is rare

caput succedaneum

swelling under the skin of the scalp that does cross the suture lines

calcium gluconate should be given via

IV

Class 0 placental abruption

No symptoms, diagnosis made postpartum with inspection of placenta

What is often given to combat Naseau from magnesium sulfate?

Ondansetron ( Zofran ) is a medication used to prevent nausea

pregnancy danger sign: fluid leakage from vagina

PROM infection (w odor, itching, irritation) normal to have increase milky discharge during pregnancy

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropri

Stop the infusion immediately.

pregnancy danger sign: dysuria

UTI, can cause pregnancy complications

What are the 5 signs of placental separation?

Vaginal bleeding, although there might not be any. Abdominal pain. Back pain. Uterine tenderness or rigidity. Uterine contractions, often coming one right after another.

Disseminated Intravascular Coagulation (DIC)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues; catastrophic bleeding can occur

preeclampsia

abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache

administer ___________ to reduce the risk of respiratory distress in premature infant

antenatal steroids ; betamethasone or dexamethasone women 23-34 weeks

preeclampsia treatment

antihypertensives IV magnesium sulfate (to prevent seizure) Corticosteroids to promote development of your baby's lungs before delivery

A client at 24 weeks' gestation develops preterm premature rupture of membranes (PPROM). How will the nurse best reply when the client asks why steroid injections are prescribed?

"It is used to help your baby's lungs mature."

magnesium toxicity signs

bradypenea , bradycardia, slurred speech, muscle weakness, lethargy, hyporeflexia ( deep tendon reflexes absent or under 2)

pregnancy danger sign: fever

infection; pregnant women usually 0.4-0.6 hotter than usual

may take several weeks for _________ to return to baseline

blood pressure and other symptoms

what is the antidote for magnesium sulfate toxicity?

calcium gluconate

cephalahematoma

collections of blood between the skull and periosteum and does NOT cross the cranial suture line

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth?

cord compression

Preeclampsia cure

delivery of baby; until then symptoms must be managed

decreased platelets could cause issue with mom who wants _________

epidural

The nurse is assessing a client for HELLP syndrome. Which signs and symptoms will the nurse prioritize to determine if the client has HELLP syndrome? Select all that apply.

epigastric pain upper right quadrant pain hyperbilirubinemia

__________ is important during pregnancy

exercise

Common side effects of magnesium sulfate

flushing, nausea, headache, generalized muscle weakness, and diplopia (double vision)

HELPP syndrome

hemolysis, elevated liver enzymes, low platelets ; happens with severe preeclampsia