week 4 application of knowledge OB

This test result can help predict if a patient will or will not go into labor within the next _______ days

7

Which of the following time periods best describes preterm labor? A.Labor that begins after 20 weeks' gestation and before 37 weeks' gestation B.Labor that begins after 15 weeks' gestation and before 37 weeks' gestation C.Labor that begins after 24 weeks' gestation and before 28 weeks' gestation D.Labor that begins after 28 weeks' gestation and before 40 weeks' gestation

A.Labor that begins after 20 weeks' gestation and before 37 weeks' gestation

What is the difference between Class A1 and Class A2 of White's Classification of Gestational Diabetes in Pregnancy?

A1 - diet controlled A2 - requires medication

Cynthia (G5 T1 P2 A1 L3) is a 41-year-old black female who presents to the clinic for prenatal care. Cynthia is approximately 14 weeks pregnant by LMP (last menstrual period). past medical history ·Hypertension (HTN) diagnoses 2 years ago after the birth of her last child. Currently not medicated: "I keep it in control with my diet." ·BMI of 41 past surgical hx none obstetric hx ·2005 First-trimester termination of pregnancy ·2009 Full-term vaginal delivery post induction of labor for preeclampsia, 3,400 g ·2011 Preterm normal spontaneous vaginal delivery (NSVD) at estimated gestational age (EGA) 31 weeks, reported spontaneous contractions, hospitalized with cervical change and delivered within 2 days ·2013 Preterm NSVD at EGA 35 5/7 weeks, reported spontaneous contractions with spontaneous rupture of membranes, hospitalized and delivered within 5 days social history ·Smoked one pack per day (PPD) prior to pregnancy, "cut down dramatically" to 1/4 PPD when learned of this pregnancy ·Denies alcohol or drug use ·Denies domestic violence/intimate partner violence ·Works as a nurse's aid at a local nursing home; worries because she heard facility is making cutbacks to the work force ·Recently separated from husband of 14 years ·Associate's degree family history ·Mother: Essential HTN, type 2 diabetes mellitus, obese · Father: Deceased at age 70 from myocardial infarction · Sister: History of preterm birth eval ·Height 66 inches, weight 253 pounds ·BP 136/80 HR 102 ·Uterine size 15 weeks consistent with LMP and singleton pregnancy ·+ fetal heart rate ·Urine dip: positive nitrites and leukocytes WHAT TISK FACTORS PLACE THIS PATIENT AT RISK FOR PRETERM LABOR

Age: >35 Ethnicity/race - black female HTN Smoking Stress - recently separated from husband works physical job - concerned about

A 30 week gestation, G3 P1, is admitted to the labor unit. The patient is contracting every 5 minutes and the contractions are lasting 40 seconds. Which of the comments by the patient would be most informative regarding the etiology of the patient's present condition? A."For the past day I have felt burning when I urinate." B."I have a daughter who is 2 years old." C."I jogged 1 ½ miles this morning." D."My miscarriage happened 1 year ago today."

Answer A: preterm labor is strongly associated with an infection, especially a UTI. Whenever an infection is present in the body, the body produces prostaglandins. Prostaglandins ripen the cervix and the number of oxytocin receptor sites on the uterine body increase and preterm labor can quickly develop.

Which of the following therapies will most likely be ordered for the patient who has been recently diagnosed with gestational diabetes? A.Oral hypoglycemic agents B.Diet control with exercise C.Regular insulin injections

Answer B - Most patients diagnosed with gestational diabetes can be managed with diet and exercise alone

Which of the following pregnant patients is at high risk for preterm premature rupture of the membranes (PPROM)? Select all that apply. A.31 weeks' gestation with prolapsed mitral valve. B.32 weeks' gestation with urinary tract infection. C.33 weeks' gestation with twins post-in vitro fertilization. D.34 weeks' gestation with gestational diabetes. E.35 weeks' gestation with deep vein thrombosis.

Answer B and C: Infection, especially a urinary tract infection, places the patient at risk for PPROM. Multiple gestations, either spontaneous or via in vitro fertilization, place the patient at risk for PPROM.

The nurse would anticipate preparing to administer which prescribed medication to a patient who is 30 weeks pregnant, reports low backache and abdominal cramps, and is suspected of having preterm labor? A.Mifepristone B.Methylergonovine C.Calcium gluconate D.Magnesium sulfate

D. Magnesium sulfate Other meds that may be given: Terbutaline Nifedipine Indomethacin 17P Betamethasone

Elena is a 32 year old Hispanic American pregnant patient who is 28 weeks' gestation. Elena's mother was recently diagnosed with Type 2 Diabetes. Elena's first pregnancy resulted in the birth of a 10lb 6oz newborn who is now 2 years old. What risk factors does this patient have that may put them at risk for GDM?

̶Hispanic American ̶Family history of type 2 DM ̶Older than 30 ̶Previous birth of an infant > 4000gm

Other than a cervical exam, what test can be performed to help determine if a patient is at risk for going into preterm labor?

FFN

Since the patient is 28 weeks' gestation, a 1 hour OGTT is ordered. The result is: ̶1 hour OGTT result - 154mg/dL what do you expect to happen next for this patient?

The patient will need a 3 hour GTT This is an elevated 1 hour GTT result. This patient needs a 3 hour GTT to confirm GDM

What is PPROM

̶Preterm Premature Rupture of Membranes - occurs before 37 weeks

A pregnant patient who is a G5 T0 P2 A2 L2 is in the post-anesthesia care unit after a cervical cerclage procedure. During the immediate postprocedure period, the nurse should carefully monitor for what complication?

̶Uterine contractions With the manipulation of the cervix at the time of cerclage, the patients may develop uterine contractions and subsequent pre term labor.

You are a nurse in a prenatal clinic and receive a phone call from a pregnant patient who is 29 weeks' gestation. The patient reports back discomfort all day despite trying position changes, hydration, Tylenol, and taking a warm bath. What should you tell this patient to do?

come to the clinic for further evaluation - Since this patient is 29 weeks' gestation and having back discomfort despite trying certain interventions they should come to the clinic for further evaluation in order to determine if this is PTL.

Since the patient is 28 weeks' gestation, a 1 hour OGTT is ordered. The result is: ̶1 hour OGTT result - 154mg/dL 3 hour GTT results for the patient: ̶FBG: 94 ̶1 hour: 192 ̶2 hour: 160 ̶3 hour: 149 what do these results tell you

the patient has GDM Results tell you that the patient has GDM because 2 or more values are elevated

What happens to glucose levels in the PP period?

̶Drastically decrease

What is the diagnosis of preterm labor based on?

•Gestational age •Uterine activity •Progressive cervical change

Should patients with GDM or pregestational diabetes be encouraged to breastfeed?

yes helps to keep glucose levels lower

When does a diabetogenic effect occur in pregnancy?

̶ 2nd and 3rd trimesters

how is PPROM diagnosed

̶Clinical suspicion ̶Patient history ̶Simple testing ̶Fern ̶Pool ̶Nitrazine ̶Biochemical marker tests ̶US