Combo with "RH incompatibility" and 1 other
GDM INSULIN NEEDS
....
A woman has tested human immunodeficiency virus (HIV) positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?
"Even though my test is positive, my baby might not be affected."
A laboring client in the latent phase is experiencing uncoordinated, irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain?
"I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."
Which statement by a postpartal woman indicates that further teaching is not needed regarding thrombus formation?
"I'll put my support stockings on every morning before rising."
A woman who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is:
"You should come into the office and let the doctor check you."
The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area?
+3 edema
Early postpartum hemorrhage is defined as a blood loss greater than:
500 mL in the first 24 hours after vaginal delivery.
hich is true about newborns classified as small for gestational age (SGA)?
They are below the 10th percentile on gestational growth charts.
Which statement is true about large for gestational age (LGA) infants?
They are prone to hypoglycemia, polycythemia, and birth injuries.
Screening
1 hr 50g venous plasma glucose = or < 130 -140 indicates further testing
Which temperature indicates the presence of postpartum infection?
100.8° F on the second and third postpartum days
Iron Needs
1000 mg more iron 300-400 will be transferred to the fetus 500 mg for maternal 100 mg placenta 280 mg to replace 1mg of iron through feces, urine, sweat
A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
lacerations of the genital tract.
GDM
1st Trimester: Insulin need decreases Levels of hPL are low (Insulin antagonist) Energy demands of embryo are minimal N/V risk of hypoglycemia or insulin shock
GDM
Carbohydrate intolerance of variable severity with onset or 1st recognition during pregnancy 1) unidentified pre existing disease 2) Unmasking of compensated metabolic abnormality by added stress 3) direct consequence of the altered maternal metabolism stemming from changing hormone levels
Prevention
27 mg of iron supplement daily and eat iron rich diet Take Iron with Vitamin C to increase absorption
when is RhoGAM administered
28-29 weeks of gestation Rh- mother's for prophylactic protection
A postpartum client would be at increased risk for postpartum hemorrhage if she delivered a:
6.5-lb infant after a 2-hour labor.
Massive fetal-maternal hemorrhage
May require larger doese of immunoglobin
2. Anxiety r/t effects of hyperemesis on fetal well-being The client with hyperemesis gravidarum is anxious or even fearful about the effects of her condition on the fetus.
A client with hyperemesis gravidarum would most likely benefit from nursing care designed to address which nursing diagnosis? 1. Imbalanced nutrition: More than body requirements r/t pregnancy 2. Anxiety r/t effects of hyperemesis on fetal well-being 3. Anticipatory Grieving r/t inevitable pregnancy loss 4. Ineffective Coping r/t unwanted prengancy
1,5 I am so sorry. This must be difficult for you Would you like to speak with a hospital or counselor
A 34 year old client comes to the er with cramping and vaginal bleeding. She has missed 2 menstrual periods. Which statement by the nurse is appropriate when the client is diagnosed with an incomplete abortion? Select all that apply 1. "I am so sorry. This must be difficult for you." 2. "the doctor will clean out your womb with a D & C." 3. "Did you really want to be pregnant now?" 4. "You'll still be able to have children after this is over." 5. "Would you like to speak with a hospital chaplain or counselor?"
Send the client home to ambulate. A client with contractions 10-30 minutes apart and 1-2 cm cervical dilation, membranes intact, and a thick cervix is in the latent phase of early labor. Send the client home to ambulate. The client will be admitted only when she begins active labor. Beginning to hydrate the client with IV fluids is not appropriate; there is no dehydration status or preterm labor. Monitoring the client with pelvic checks every hour is not appropriate until active labor and progress has been made.
A G1P0 client at 39 weeks gestation arrives at the birthing center with irregular contractions ranging from 10-30 minutes apart. Assessment data reveals 1-2 cm cervical dilation, membranes intact, and a thick cervix. What would be the most appropriate nursing action at this time?
Five minutes apart for one hour. The nullipara client should come in when her contractions are five minutes apart for one hour. The multigravida client should come when contractions are three minutes apart for thirty minutes. Implementation; Physiological Integrity; Comprehension
A G1P0 client calls the hospital and asks the nurse, "I think I am having labor pains. When should I come to the hospital?" The nurse correctly replies that the client should come in when her contractions are:
Temperature 99.4°F and blood pressure 130/88 During the first stage of labor, normal blood pressure is 90-140/60-90, pulse 60-90, respirations 12-20/minute, and temperature <37.6°C (99.6°F). Analysis; Physiological Integrity; Analysis
A G3P0 client in active labor is admitted to the birthing center. Which data set should the nurse interpret as being within the normal range?
2. Absence of seizures Magnesium sulfate is a central nervous system depressant used to prevent seizure activity in the preeclamptic client.
A client with preeclampsia is receiving magnesium sulfate and oxytocin (Pitocin) IV to induce labor at 38 weeks. The nurse determines the magnesium sulfate has been effective after noting which effect on the client? 1. Lowered blood pressure 2. Absence of seizures 3. Onset of sedation 4. Stools that are soft
Offer the mother a soft-boiled egg to eat. Offering the mother a soft-boiled egg to eat is the culturally sensitive nursing action appropriate for the postpartum Hmong client. Commenting on the daintiness of her baby girl and assisting the mother in bathing the baby is not a cultural preference. Warm foods are preferred by this culture at this time, so offering cold foods would not be appropriate. Implementation; Psychosocial Integrity; Application
A Hmong client has just given birth to a five-pound baby girl. What culturally sensitive nursing action is appropriate at this time?
1. Gestational trophoblastic disease The client has 3 risk factos of molar pregnancy: Japanese background, brownish "Prune juice" vaginal bleeding, and the severe N/V
A client at 4 weeks' gestation who has recently emigrated from Japan, comes to the prenatal clinic because she is having some dark brown vaginal spotting and is experiencing severe nausea and vomiting. The nurse interprets that these symptoms are compatible with which conditions? 1. Gestational trophoblastic disease 2. Hyperemesis gravidarum 3. Placenta previa 4. Pregnancy-induced psychosis
3. "I will need to see the doctor yearly for follow-up" The client requires frequent monitoring to rule out development of malignancy after experiencing trophoblastic gestational disease. Weekly hcG measurements are done until normal levels are recorded for 3 weeks.
A client is being discharged from the hospital after evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the client makes which statement? 1. "I am so sad that I lost this baby." 2. "I may need to have chemotherapy after this." 3. "I will need to see the doctor yearly for follow-up." 4. "I will use contraception for the next year
4. The client with ruptured membranes prior to the beginning of labor is at increased risk for ascending infection
A client is hospitalized on the antepartum unit with premature rupture of membranes at 37 weeks' gestation. Which routine physician prescription would the nurse question for this client. 1. Bedrest with the bathroom privileges 2. Diet as tolerated 3. External fetal monitor 4. VS q shift
4. That is a very positive plan. Could you tell me more about feeling like a weak person Indicating the client has a positive plan acknowledges the client's intent to cut down or substance abuse while seeking additional information about the client's self-concept
A client who admits to substance abuse during pregnancy tells the nurse, " I know I am just a really weak person, but I will try to cut down while I'm pregnant." Which response by the nurse would be most therapeutic? 1. I am concerned about you and your baby. What can I do to help you? 2. I don't believe that you are weak at all. You just need to say no to drugs. 3. I have heard that before. You need to get serious now or your baby will suffer. 4. That is a very positive plan. Could you tell me more about feeling like a weak person?
1. Go to the hospital to have cerclage removed so your cervix isn't injured and to all the birth to progress The Shirdkar cerclage is closure of the cervix with suture material to prevent preterm dilation. When labor ensues, the suture must be cut so the fetus can pass through the birth canal.
A client who had an incompetent cervix with a previous pregnancy had a Shirodkar cerclage procedure done at 18 weeks in the current pregnancy. The client calls the clinic at 37 weeks' gestation because of irregular contractions occurring every 5-7 minutes. Which response by the nurse is most appropriate? 1. "Go to the hospital to have the cerclage removed so your cervix isn't injured and to allow the birth to progress" 2. "Wait and come in when the contractions are closer and harder." 3. "You sound like you are worried about this baby It must be frightening for you." 4. "You will need to have a cesarean birth with the Shirodkar cerclage in place."
1. The client to using cocaine a few times weekly The risk for placental abruption is increased with cocaine abuse
A client who had no prenatal care presents to the labor and delivery unit with moderate vaginal bleeding and severe abd pain. Fundal height is 34 centimeters. contractions are every 1.5 mins, lasting 60 seconds and strong with increasing resting tone. The monitor shows consistent with risk for placental abruption? 1. The client to using cocaine a few times weekly 2. The client works part time in a near by department store 3. the client in human immunodeficiency virus (HIV)-positive 4. the client is of low income and has a 10th-grade education
A clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment finding indicates to the nurse that the client is at high risk for contracting HIV?
A client who has a hx of IV drug use.
3,5 It's important to take prenatal vitamins and iron as prescribed Adequate nutrition to prevent anemia and avoid excessive weight gain Rationale: Taking prenatal vitamin and iron will help prevent anemia as well as positively affect fetal growth and development. Anemia and excessive weight gain increase the cardiac' workload and should be avoided by clients with heart disease.
A client with Class II heart disease is being seen for her first prenatal visit. Which of the following teaching points would the nurse stress for this client? (Select all that apply) 1. Avoid all OTC medications during pregnancy 2. Regular exercise will help increase cardiac capacity during pregnancy 3. It's important to take prenatal vitamins and iron as prescribed 4. The client's fetus will probably have a similar congenital heart defect 5. Adequate nutrition to prevent anemia and avoid excessive weight gain
50 One mL of blood weighs approximately 1 gram. Thus, 50 mL of blood would weigh approximately 50 grams
A client with a known placenta previa is admitted at 30 weeks' gestation with painless vaginal bleeding. The nurse weights the client's peri-pads to monitor blood loss. After noting an increased weight of 50 grams, the nurse would document that this equals approximately _____ mL blood loss
2. I will check my pulse and not take the medication if it is less than 60. Digoxin is a cardiac glycoside that increases cardiac output by increasing the strength of contraction of the myocardium and slowing the heart rate
A client with heart disease has been prescribed digoxin (Lanoxin) during her pregnancy. The nurse evaluates that client teaching has been effective when the client makes which statement. 1. "I will avoid eating foods high in potassium while taking this medication." 2. "I will check my pulse and not take the medication if it is less that 60." 3. "I will not take antibiotics at the same time as this medication." 4. "I will take this medication with a full glass of water before breakfast."
1. Drop significantly Rationale: The placenta produces human placental lactogen (hPL) and increased amounts of estrogen and progesterone. These hormones interfere with maternal glucose metabolism and require increased insulin production or supplementation
A client with type 1 diabetes mellitus gives birth. The postpartum nurse monitors blood glucose level carefully, expecting that the mother's insulin requirements in the first 24 hours after delivery will follow which trend? 1. Drop significantly 2. Gradually return to normal 3. Increase slightly 4. Stay the same as before delivery
A nurse in a maternity unit is reviewing the records of the clients on the unit. Which client would the nurse identify as being the greatest risk for developing disseminated intravascular coagulation?
A gravida II who has just been diagnosed with dead fetus syndrome.
Encourage slow shallow breaths. Encourage slow shallow breaths should be the initial action by the nurse for a laboring client who complains of symptoms of hyperventilation (hypocarbia). Slow, shallow breathing will help her build up her CO2 level to balance out her excessive oxygen levels. Implementing seizure precautions, administering oxygen, and notifying the physician or midwife are not appropriate nursing actions for hyperventilation. Implementation; Physiological Integrity; Application
A laboring client complains of numbness of nose, fingers, and toes, and spots before her eyes. What should be the initial action by the nurse?
Dehydration. Dehydration is indicated by a hematocrit of 49% resulting from hemoconcentration. Anemia and hemorrhage are indicated by low hemoglobin. Infection is indicated by a high white blood cell count. Analysis; Physiological Integrity; Analysis
A laboring client in the birthing center has a hematocrit of 49. The nurse should anticipate that this finding is related to:
Every 30 minutes The client is in the transition phase of the first stage of labor. The nurse should assess vital signs every 30 minutes. More frequent assessment of vital signs is appropriate during the second and third stages and following anesthesia. Assessment; Health Promotion and Maintenance; Analysis
A low-risk client's vaginal exam reveals that her cervix is dilated to 8 cm with 75% effacement. How frequently should the nurse assess this client's vital signs?
Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?
A multiparous woman at 39 weeks of gestation who is expecting twins
Vernix
A white, cheesy substance covering the fetus's skin to protect it from the amniotic fluid,, a greasy substance that protects the fetus in utero and can still be present at birth.
A home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of pre-eclampsia?
Proteinuria Hypertension Generalized edema
If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition?
D&C
Which intrapartal assessment should be avoided when caring for the woman with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome?
Abdominal palpation
Premature separation of normally implanted placenta away from uterine wall
Abruptio Placenta
Which assessment finding would convince the nurse to "hold" the next dose of magnesium sulfate?
Absence of deep tendon reflexes
What is most helpful in preventing premature birth?
Adequate prenatal care
Because of the premature infant's decreased immune functioning, what nursing diagnosis would the nurse include in a plan of care for a premature infant?
Risk for infection
Rapid reproduction of outermost developing layer of embryo; includes hydatiform mole, invasive mole and choriocarcionoma
Gestation trophoblastic disease
A disorder of carbohydrate metabolism caused by inability of maternal pancreas to produce additional insulin needed during pregnancy
Gestational Diabetes
Which clinical sign is not included in the classic symptoms of preeclampsia?
Glycosuria
Of all the signs seen in infants with respiratory distress syndrome, which sign is especially indicative of the syndrome?
Grunting
What condition would indicate concealed hemorrhage in an abruptio placentae?
Hard, boardlike abdomen
Vaccinations
Hep B Flu Pneumoccocal
Anticoagulant to use during pregnancy
Heparin Does not cross placenta
Treatment
Antiretroviral therapy should be recommended to all infected pregnant women (HAART) 3 drugs, should include ZDV ( Retrovir and Ziveridine) After 1st trimester and no later than 28 weeks BABY: 6 wk regimen of oral zidovidine Perinatal tests @ 14-21 days 1-2 months 4-6 months and some within 48 hrs of birth
What activity guidelines should be included when teaching a client about home care for preterm labor?
Any activity could increase the risk of recurrence of labor contractions.
yellow staining of basal ganglia and brain from deposit of excessive unbound bilirubin, associated with a poor outcome
Kericterus
A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action?
Assess the fundus for firmness.
Which nursing measure would be appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth?
Assist the client in performing leg exercises every 2 hours.
Gestational Diabetes
Know Definition, Risks, Insulin needs, Screenings and Treatment
GDM
Labor: May require more insulin to balance IV Glucose After delivery: Insulin requirements decrease abruptly with loss of placenta (hPL)
Monilial vaginitis and UTI
Because of glycosuria or untreated can lead to pyelonephritis
What order should the nurse expect for a client admitted with a threatened abortion?
Bed rest
To prevent respiratory distress syndrome in the newborn when delivered prematurely. 12 mg IM q 12 X2, or 12 mg now and in 24 hr
Betamethasone (Celestone)
HIV transmission
Blood, Semen, Vaginal fluid, breast milk
DKA risks
Can occur more rapidly in pregnant because of hyperketonemia with starvation acceleration increasing postprandial glucose because of lower gastric motility and contrainsulin of HPL
Fetal Neonate Risks
CNS Hydrocephalus meningomyelocele Ancephaly Sacral agenesis (only occurs in diabetes)
Procedure of looping a suture around cervix to keep it securely closed during pregnancy, used to treat incompetent cervix
Cerlclage
Inflammation and infection in fetal membranes and amniotic fluid
Chorioamniontitis
Heart Disease by Class
Class 1 - no limitation of physical activity Class II- Slight Limitations, comfortable at rest but physical activity causes s/sx of fatigue, dyspnea, palpitations, angina pain Class III- Marked limitation Class IV- Inability to perform activities without experiencing distress and even at rest have s/sx Class I and II usually have a normal pregnancy Class III and IV are @ risk
Heart Disease
Classes, IMplications, Anticoag
A pregnant woman with premature rupture of membranes is at higher risk for postpartum infection. Which assessment data indicate a potential infection?
Cloudy amniotic fluid with strong odor
For which of the infectious diseases can a woman be immunized?
Rubella
In a sensitized pregnancy
Combination of Coombs test, amniocentesis, and ultrasound and she is to follow the developing fetus for evidence of distress or fetal hydrops
Retinopathy
Control BGL Photocoagulation Refer to opthamalogist
Lab test to identify antibodies on RBC'S; a direct Coombs' test determines if there are maternal anti-Rh antibodies in fetal cord blood, while an indirect Coombs' identifies anti-Rh antibodies in mother's blood
Coombs' test
What data would alert the nurse that the neonate is postmature?
Cracked, peeling skin
What is a characteristic of the postterm infant who weighs 7 lb, 12 oz?
Lack of subcutaneous fat
Preterm labor contractions Pregnancy induced hypertension (PIH) Calcium channel blocker antihypertensive (smooth muscle relaxant and also anti-hypertensive)
Nicardipine (Cardene)
Which factor is most important in diminishing maternal/fetal/neonatal complications in the pregnant woman with diabetes?
Degree of glycemic control before and during the pregnancy
Why is adequate hydration important when uterine activity occurs before pregnancy is at term?
Dehydration stimulates secretion from the posterior pituitary.
What is the most common time of maternal/fetal blood mixing
Delivery after an evening that meanwhile fetal cells in her maternal circulation program should be given.
What is the only known cure for preeclampsia?
Delivery of the fetus
What routine nursing assessment is contraindicated in the client admitted with suspected placenta previa?
Determining cervical dilation and effacement
Maternal risks continued...
Dystocia (difficult labor) caused by fetopelvic disproportion if macrosomia exists
What other current events allow for maternal/fetal blood mixing
Ectopic pregnancy, spontaneous or therapeutic abortion, CVS, amniocentesis, or trauma
Destruction of fetal RBCs by maternal anti-Rh antibodies cause production of many immature RBCs (erythroblasts) in fetus
Erythroblastosis fetalis
A pregnant client in the last trimester has been admitted to the hospital with a dx of severe pre-eclampsia. A nurse monitors for complications associated with the dx and assesses the client for:
Evidence of bleeding, such as in gums, petechiae, and purpura.
Hyperinsulinism and Hyperglycemia leads neonate to..
Excessive growth and macorsomia (deposits of fat)
Should a postpartum complication such as hemorrhage occur, the nursing staff will spring into action to ensure that client safety needs are met. This level of activity is very reassuring to both the new mother and her family members as they can see that the client is receiving the best of care.
False, On the contrary, the unusual activity of the hospital staff may make the mother and her family very anxious.
"You should come into the office and let the doctor check you."
Fetal heart rate, maternal pulse, and blood pressure
Preterm labor contractions PIH 10 mg SL (MR q 20 minX3) Calcium Channel Blocker (smooth muscle relaxant and also anti-hypertensive)
Nifedipine (Adalat, Procardia)
Macrosomia can lead to
Fractured clavicle or brachial plexus injuries due to shoulder dystocia
What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?
Fundal height measurement of 18 cm
Fetal Neonatal Risks (GDM)
Heart Septal Defects Coarctations of aorta Transposition of great vessels (most common)
Which insulin is best to use and why?
Human insulin, because it is least likely to have allergic response Lispro- Better glucose control (4 dose approach) take BEFORE q meal and NPH or Lente at bedtime
A woman is admitted with vaginal bleeding at approximately 10 weeks of gestation. Her fundal height is 13 cm. What potential problem should be investigated?
Hydatidiform mole
Moderate to severe hypertension from PIH 5-10 mg IV q20 min Antihypertensive
Hydralazine (Apresoline)
Maternal Risks for GDM
Hydramnios Result: Excessive urination of fetus (dysuria) Preeclamsia/Eclampisa
Generalized fetal edema caused by destruction of fetal RBCs by maternal anti-Rh antibodies
Hydrops fetalis
Fetal Risks- Liver
Hyperbilirubinemia- Inability of immature liver enzymes to metabolize the increased bilirubin resulting from polycythemia
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
Hypoglycemia
A nurse implements a teaching plan for a pregnant client who is newly dx with a gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching?
I should avoid exercise because of the negative effects on insulin production.
A nurse providing instructions to a maternity client with a hx of cardiac disease regarding appropriate dietary measures. Which statement if made by the client, indicates and understanding of the information provided by the nurse?
I should drink adequate fluids and increase my intake of high fiber foods.
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instructions?
I will maintain strict bed rest throughout the remainder of the pregnancy.
The nurse assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that teaching is needed if the client makes which statement?
I will need to increase my insulin dosage during the first 3 mos. of pregnancy.
Fetal Risks GDM
IUGR because of vascular changes and decreasing placental perfusion
In what situation would a dilation and curettage (D&C) be indicated?
Incomplete abortion at 10 weeks
Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?
Incomplete uterine relaxation
Which measure may prevent mastitis in the breastfeeding mother?
Initiating early and frequent feedings
Risks of HIV
Intrapartal or postpartal hemorrhage postpartum infection poor wound healing GI tract infections
Preterm labor (used less often for this purpose)--Decreases the intensity and frequency of uterine contractions. Preeclampsia (PIH)- to prevent seizures Drip (MgSO4) 1-4 gm/hr
Magnesium Sulfate
Anemia
Is the most common complication of pregnancy
A pregnant client reports to the health care clinic, complaining of loss of appetite, weight loss and fatigue. After an assessment of the client tuberculosis is suspected. A sputum culture obtained and identifies Mycobacterium tuberculosis is suspected. A sputum culture obtained and identifies Mycobacterium tuberculosis. The nurse provides instructions to the client regarding therapeutic management of the TB and the nurse tells the client:
Isoniazid plus rifmapin will be required for 9 mos.
Which technique is least effective for the woman with persistent occiput posterior position?
Lie supine and relax.
The mother-baby nurse must be able to recognize what sign of thrombophlebitis?
Local tenderness, heat, and swelling
excessively large body and high birth weight, as in infants of diabetic mothers who experience high glucose levels in utero
Macrosomia
Risks of Anemia
May be asymptomatic More suspectible to infection Tire easily Increased chance of preeclampsia and postpartum hemorrhage Healing of episiotomy or incision may be delayed Hgb less than 6g/dl could lead to heart failure
What form of heart disease in women of childbearing years usually has a benign effect on pregnancy?
Mitral valve prolapse
What instructions should be included in the discharge teaching plan to assist the client in recognizing early signs of complications?
Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.
Know prevention and treatment
Of iron deficiency anemia
Sacral Agenesis
Only occurs in diabetes Sacrum and lumbar spine fail to develop and lower extremities develop incompletely
Risk
Perinatal mortality and congenital anomalies Reduce risk by tight metabolic control >95 mg/dl + 2 hr post-prandial > 120mg/dl
Abnormal implantation of placenta low in uterus near or covering cervical os.
Placenta previa
A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action?
Plan for retesting during the third trimester.
Fetal Risks GDM Hematology
Polycythemia- Diminished ability to glycosylated hemoglobin in maternal blood to release O2
Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth?
Postpartum blues
What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord?
Presenting part at a station of -3
What nursing action is especially important for the SGA newborn?
Prevent hypoglycemia by early and frequent feedings.
Which factor is known to increase the risk of gestational diabetes mellitus?
Previous birth of large infant
Other Risk factors of getting GDM
Prior hx of GDM, LGA, marked obesity, diagnosis of polycystistic ovarian syndrome, family hx of Type 2
What data on a client's health history would place her at risk for an ectopic pregnancy?
Recurrent pelvic infections
As Pregnancy Progresses (GDM)
Renal threshold for glucose decreases Risk of ketoacidosis (can occur in lower serum glucose levels than in non pregnant women) Vascular disease can progress HTN can occur Leads to nephropathy and retinopathy
Which nursing action must be initiated first when evidence of prolapsed cord is found?
Reposition the mother with her hips higher than her head.
Fetal Risks GDM Respiratory
Respiratory Distress syndrome because of higher levels of fetal insulijn
What action should be initiated to limit hypovolemic shock when uterine inversion occurs?
Restore circulating blood volume by increasing the intravenous infusion rate.
In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?
Retinopathy of prematurity (ROP)
What is the most common problem of mismatched blood
Rh factor
Routinely give Rho Gam 300mg
Rh negative ,nonimmunized women at 28 weeks of gestation and within 72 hours of delivering an Rh positive infant.
GDM
Second Trimester: Insulin requirements begin to increase Placental maturation and production of hPL double or quadruple
Which instructions are most important to include in a teaching plan for a client in early pregnancy who has class I heart disease?
She must report any chest discomfort or productive cough.
CBF Study Guide Questions
Study Guide Questions...
Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem?
Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.
A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will probably be prescribed for at-home continuation of the tocolytic effect?
Terbutaline
Preterm labor 0.25 mg Sq q 1-3 hr units/1000 cc IV drip Tocolytic /Bronchodialator
Terbutaline (Brethine)
3. A primigravida in early labor who needs to be helped to the bathroom The registered nurse is responsible for client assessments and for client teaching. Helping the client to the bathroom is within the practice abilities of a CNA.
The charge nurse in the L&D unit has become overwhelmed with admissions and births. For which client can the charge nurse best delegate the needed care to a trusted certified nursing assistant (CNA) who is currently going to school to become a nurse? 1. A client in false labor, who needs teaching about true versus false labor signs 2. A client with preeclampsia who needs evaluation for reflexes and clonus 3. A primigravida in early labor who needs to be helped to the bathroom 4. An obese laboring client who needs to have her fetal monitor adjusted.
A home care nurse visits a pregnant client who has a dx of mild pre-eclampsia. Which assessment finding indicates a worsening of the pre-eclampsia and the need to notify the physician?
The client complains of a headache and blurred vision.
What will the nurse note when assessing an infant with asymmetric intrauterine growth restriction?
The head seems large compared with the rest of the body.
After delivery the baby is to be Rh+
The mother received RhoGAM again to protect subsequent pregnancies. When RhoGAM is given and helps to prevent development of these antibodies to the infant's blood in 99% of the cases
A nurse evaluates the ability of a Hep B positive mother to provide safe bottle-feeding to her infant during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the infant?
The mother washes and dry's her hands before and after self-care of the perineum and asks for a pair of gloves before feeding.
1. Abruptio placenta A sinusoidal fetal heart rhythm is associated with fetal anemia, which may be associated with an abruption
The nurse anticipates that which complication of pregnancy would be most consistent with development of a sinusoidal fetal heart rate pattern labor? 1. Abruptio placenta 2. Chorioamnionitis 3. Preeclampsia 4. Prolasped cord
Dilated pupils and increased blood pressure Dilated pupils, along with increased blood pressure, pulse, and respiration rate, indicate pain. Muscles would be tense. Analysis; Physiological Integrity; Analysis
The nurse is caring for a client in the transitional stage of labor. What objective data would indicate that the client is having pain?
G3P2 with intact membranes and 4 cm dilation The client that is G3P2 with intact membranes and 4 cm dilation should be encouraged to ambulate. If membranes are ruptured and the presenting part is not engaged, there is risk of prolapsed cord. A multigravida at 8 or 9 cm should labor in bed or a chair. Implementation; Physiological Integrity; Application
The nurse is caring for four clients in the birthing center. Which client should the nurse encourage to ambulate?
A client who is happy and talkative A client who is happy and talkative is demonstrating responses commonly seen during the latent phase. Increased fatigue, restlessness, and anxiety are commonly seen during the active phase. Increased irritability and feeling out of control are responses commonly seen during transition. Birth occurs at the end of the second stage of labor. Assessment; Health Promotion and Maintenance; Application
The nurse is caring for four laboring clients at Stage 1 of labor. Which client is demonstrating responses commonly seen during the latent phase?
2. Glycosylated hemoglobin (HbA1C) test provides an indication of what glucose levels have been over the last 4-8 weeks because glucose attaches to the RBC and remains there for the residual life of the RBC.
The nurse is especially interested in the results of which laboratory test that provides the nurse with the best information about ongoing control of type 1 diabetes mellitus in a pregnant adolescent? 1. Fasting blood glucose 2. Glycolylated hemoglobin (HbA1C) 3. Oral glucose tolerance test (OGTT) 4. Post prandial glucose
Which maternal condition always necessitates delivery by cesarean section?
Total placenta previa
3. Elisa Testing The infant of an HIV-positive mother will test positive on an ELISA test for human immunodeficiency virus because the maternal antibodies cross the placenta during pregnancy
The nurse would question an order for which lab test, which is inappropriate to test the current condition of the newborn whose mother is HIV-positive? 1. Bilirubin Level 2. Blood glucose test 3. ELISA testing 4. Hematocrit
A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?
The woman must make arrangements to stay somewhere other than her home until the children are no longer contagious.
If antibodies develop
They will at that subsequent Rh incompatible influence mentioned to severe fetal anemia and death
What data would alert the nurse caring for an SGA infant that additional calories may be needed?
Three successive temperature measurements were 97° F, 96° F, and 97° F.
A primary concern as pregnancy progresses
To control circulating glucose levels
Know HIV
Treatment, Transmission routes, Risks
100 gm 3 hr test
Unrestricted diet at 150 gms of carbs per day for 3 days Decreased to 100 gms in the am after overnight fast Measured: @ 1, 2, and 3 hrs Should remain seated and no smoking Met or exceeded Fasting: 95 mg/dl 1hr: 180 mg/dl 2 hr: 155 mg/dl 3 hr: 140 mg/dl
A nurse in a maternity unit is providing emotional support to a client and her husband who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicated a component of the normal grievance process?
We want to attend a support group.
A still born infant was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the infant. Which statement by the nurse would further assist the family in their initial period of grief?
What can I do for you?
3. She recognizes the need for caring interventions Pregnancy presents an ideal time for nurses to reach out to substance-abusing clients in a caring way since the client herself recognizes that she and her baby will benefit from prental care
What would be an appropriate interpretation by the nurse when a substance abusing pregnant woman presents herself for prenatal care? 1. She is ready to stop abusing illegal substances 2. She must be reported to the authorities 3. She recognizes the need for caring interventions 4. She will lack appropriate parenting skills.
what is Rh sensitization
When the infant's blood type is not identical to the mother's blood type and antibody developing significant
2. Monitor vital signs The client with a suspected ectopic pregnancy may be at risk for the development of hypovelmic shock. Assessment is the first step of the nursing process and airway, breathing, and circulation are the priorities
Which nursing action would take priority when caring for a woman with a suspected ectopic pregnancy? 1. Administer oxygen 2. Monitor vital signs 3. Obtain surgical consent 4. Provide emotional support
A nurse providing instructions to a pregnant client with HIV infection regarding care to the newborn infant after delivery. The client asks the nurse about the feeding options that are available. The best response by the nurse is:
You will need to bottle feed the newborn infant.
A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should:
administer calcium gluconate.
The visiting nurse must be aware that women who have had a postpartum hemorrhage are subject to a variety of complications after discharge from the hospital. These include:
anemia, exhaustion, failure to attach to her infant, postpartum infection.
A woman with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is:
anticonvulsant.
The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode is to:
assess fetal heart rate (FHR) and maternal vital signs.
A 17-year-old primigravida has gained 4 lb since her last prenatal visit. Her blood pressure is 140/92 mm Hg. The most important nursing action is to:
assess weight gain, location of edema, and urine for protein.
Rho gam also is to be adminstered
at aminiocentesis and other instances of potential uterine bleeding
Antiinfective prophylaxis is indicated for the pregnant woman with a history of mitral valve stenosis related to rheumatic heart disease because the woman is at risk of developing:
bacterial endocarditis.
In caring for the postterm infant, thermoregulation can be a concern, especially in the infant who also has a:
blood glucose of 25 mg/dL.
Routine prenatal blood work should include
blood type , Rh factor, or Coombs test for antibodies
Birth for the nulliparous woman with a fetus in a breech presentation is usually by:
cesarean delivery.
The fetus in a breech presentation is often born by cesarean delivery because:
compression of the umbilical cord is more likely.
The nurse should suspect uterine rupture if:
contractions abruptly stop during labor.
The nurse understands that a laboratory finding indicative of DIC is:
decreased fibrinogen.
When the pregnant diabetic experiences hypoglycemia while hospitalized, the nurse should have the client:
eat 6 saltine crackers.
To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant diabetic will need to alter her diet by:
eating her meals and snacks on a fixed schedule.
Methergine (an oxytocic drug) increases the blood pressure. The nurse should question the order to administer Methergine to the woman with a history of:
eclampsia.
Abnormally placed pregnancy outside uterus
ectopic pregnancy
An infant girl is preterm and on a respirator with intravenous lines and much equipment around her when her parents come to visit for the first time. It is important for the nurse to:
encourage the parents to touch her.
An important independent nursing action to promote normal progress in labor is:
encouraging urination about every 1 to 2 hours.
The client who is being treated for endometritis is placed in Fowler's position because it:facilitates drainage of lochia.
facilitates drainage of lochia.
The nurse has been caring for a primiparous client who is suspected of carrying a macrosomic infant. Pushing appears to have been effective so far; however, as soon as the head is born, it retracts against the perineum much like a turtle's head drawing into its shell. In evaluating the labor progress so far, the nurse is aware that this is normal with large infants and extra pushing efforts by the mother may be necessary.
false, This is often referred to as the "turtle sign" and is an indication of shoulder dystocia.
Rh incompatibility can occur if the woman is Rh negative and her:
fetus is Rh positive.
Nursing measures that help prevent postpartum urinary tract infection include:
forcing fluids to at least 3000 mL/day.
In comparison with the term infant, the preterm infant has:
greater surface area in proportion to weight.
The nurse is in the process of assessing the comfort level of her postpartum client. Excess bleeding is not obvious; however, the new mother complains of deep, severe pelvic pain. The registered nurse (RN) has noted both skin and vital sign changes. This client may have formed a ____________________.
hematoma
A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that:
hemorrhage is the major concern.
While caring for the postterm infant, the nurse recognizes that the elevated hematocrit level most likely results from:
hypoxia in utero.
The nurse knows that a measure for preventing late postpartum hemorrhage is to:
inspect the placenta after delivery.
When teaching the pregnant woman with class II heart disease, the nurse should:
instruct her to avoid strenuous activity.
The preterm infant who should receive gavage feedings instead of a bottle is the one who:
is unable to coordinate sucking and swallowing.
The most important reason to protect the preterm infant from cold stress is that:
it could make respiratory distress syndrome worse.
Decreased surfactant production in the preterm lung is a problem because surfactant:
keeps the alveoli open during expiration.
Maternal Hgb
lower than 11 g/dl Serum Ferritin levels lower than 12 mg/dl
A placenta previa in which the placental edge just reaches the internal os is called:
marginal
An abortion in which the fetus dies but is retained in the uterus is called:
missed abortion.
A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurse's priority action should be to:
notify the physician promptly.
A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000 g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should:
notify the physician.
The neonatal intensive care unit (NICU) environment should:
nurture both the infant and the parents to optimize neonatal outcomes.
If the nurse suspects a uterine infection in the postpartum client, she should assess the:
odor of the lochia.
The nurse should expect medical intervention for subinvolution to include:
oral methylergonovine maleate (Methergine) for 48 hours.
The NICU nurse begins her shift by assessing one of the preterm infants assigned to her care. The infant's color is pale, his O2 saturation has decreased, and he is grimacing. This infant is displaying common signs of ____________________.
pain
After a birth complicated by a shoulder dystocia, the infant's Apgar scores were 7 at 1 minute and 9 at 5 minutes. The infant is now crying vigorously. The nurse in the birthing room should:palpate the infant's clavicles.
palpate the infant's clavicles.
Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a client has early signs of ectopic pregnancy should be observing her for symptoms such as:
pelvic pain, abdominal pain, vaginal spotting or light bleeding, missed period.
Glucose metabolism is profoundly affected during pregnancy because:
placental hormones are antagonistic to insulin, resulting in insulin resistance.
A white blood cell (WBC) count of 28,000 cells/mm3 on the morning of the first postpartum day indicates:
possible infection.
The primary symptom present in abruptio placentae that distinguishes it from placenta previa is:
presence of abdominal pain.
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early preterm infants, they may receive care that is much like that of a full-term baby. The mother-baby or nursery nurse knows that these babies are at increased risk for:
problems with thermoregulation, hyperbilirubinemia, sepsis
To maintain optimal thermoregulation for the premature infant, the nurse should:
put an undershirt on the infant in the incubator.
A 28-year-old primigravida is admitted to the antepartum unit with a diagnosis of hyperemesis gravidarum. Nursing care is based on the knowledge that:
she should be assessed for signs of dehydration and starvation.
A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that:
the organisms that cause mastitis are not passed to the milk.
Spontaneous termination of a pregnancy is considered to be an abortion if:
the pregnancy is less than 20 weeks.
Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin:
varies depending on the stage of gestation.
Non Stress Tests (HIV)
weekly at 32 weeks, serial ultrasound for IUGR
A client with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate:
worsening disease and impending convulsion.