Mom & Baby (Antepartum)

What complications are pregnant teenagers in danger of developing?

- Preeclampsia: risk factors are obesity and inadequate nutrient intake - IUGR: Intrauterine growth restriction- fetal distress during pregnancy - CPD: Cephalopelvic disproportion- large baby, caused largely by gestational diabetes - STI'S: sexually transmitted infections - Anemia: iron deficiency in the blood

State three nursing interventions associated with forceps delivery.

1. Empty bladder. 2. Auscultate FHR before, during, and after traction periods of the procedure. Observe for maternal lacerations and newborn cerebral/facial trauma.

When should the nurse expect to begin hearing fetal heart tones?

11 weeks gestation. Using a stethoscope, fetal heart tones may be heard between 17-20 weeks gestation.

How much weight should a pregnant woman gain?

25-35 lbs.

Which condition poses the greatest risk to a 32-year-old client who is 15 weeks pregnant and has a history of hypertension?

A history of hypertension predisposes the client for developing abruptio placentae.

When can a pregnant client first feel fetal movement?

A primigravid can usually detect fetal movement (quickening) between 18-20 weeks gestation.

Naegele's rule

Add 7 days to the first day of the last menstrual period and subtract 3 months from the month of the last menstrual period to calculate the clients EDD.

Which findings best support a suspicion of ectopic pregnancy?

Amenorrhea (absence of menstruation) and adnexal (a lump of tissue near the uterus, usually around the ovary or fallopian tube) fullness and tenderness.

Before anesthesia for a cesarean section, the mother may be given an antacid or a histamine receptor or histamine agonist. State the reasons for this medication.

Antacid buffers alkalize the stomach secretes. If aspiration occurs, less lung damage ensues. An antisecretory drug reduces gastric acid, reducing the risk of gastric aspiration.

When preparing a client for an amniocentesis, the nurse should...?

Ask the client to void. The nurse should ask the client who is more than 20 weeks pregnant to empty the bladder to reduce the risk of bladder perforation.

What is the priority nursing action after spontaneous or artificial rupture of membranes?

Assessment of FHR.

Placenta previa

Associated with painless vaginal bleeding that occures when the placenta or a portion of the placenta covers the cervical os.

List the symptoms of water intoxication you would see due to use of oxytocin acting like anti-diuretic hormone.

Asthenia (abnormal physical weakness or lack of energy), muscular irritability, or headaches.

When is cardiac disease in pregnancy most dangerous?

At peak plasma volume increase 28-32 weeks gestation and during Stage 2 of labor(strong and regular contractions every 1-3 minutes lasting 45-75 seconds).

During a nonstress test, when should the nurse push the control button to mark the strip for fetal movement?

At the beginning of each fetal movement.

A nurse uses Nitrazine paper to determine whether a pregnant client's membranes have ruptured. If the membranes have ruptured, the paper will turn which color?

Blue. It turns blue on contact with alkaline substances such as alkaline fluid. Normal vaginal discharge and urine are acidic and cause it to turn pink.

A client who is 16 weeks pregnant reports many mood swings. Which statement accurately describes estrogen and progesterone levels during this client's stage of pregnancy?

Both estrogen and progesterone levels are rising. Until the seventh month of pregnancy, estrogen and progesterone are secreted in progressively greater amounts. Between the seventh and ninth months, estrogen secretion continues to increase while progesterone secretion drops slightly. This increasing estrogen-progesterone ratio contributes to mood swings.

When is preterm labor able to be stopped (or arrested)?

Cervix is <4 cm dilated, <50% effacement, and membranes intact and not bulging out of the cervical os.

What interventions would the nurse initiate to reduce CNS irritability in the pre-eclamptic patient?

Darken room, limit visitors, maintain close 1:1 nurse/client ratio, place in private room, plan nursing interventions all together so the client is disturbed as little as possible.

What specific information would the nurse include when teaching about HPV detection and treatment?

Detection of dry, wartlike growths on vulva or rectum. Need for Pap smear in the prenatal period. Treatment with laser ablation. Associated with cervical cancer in the mother and respiratory papillomas in the neonate. Teach about vaccination for females 9 to 30 with Gardasil.

Coombs' test

Detects maternal antibodies against Rh-positive factor.

What contraceptive technique is recommended for diabetic women?

Diaphragm with spermicide. Avoid birth control pills that contain estrogen and IUD's, which are an infection risk.

What condition would the nurse suspect if a woman of childbearing age presents to the emergency room with bilateral or unilateral abdominal pain, with or without bleeding?

Ectopic pregnancy

What would a nurse need to consider when teaching a pregnant adolescent compared to a pregnant adult?

Establish trust and rapport before counseling and teaching begin. Adolescents do not respond to an authoritarian approach. Consider developmental tasks of identify and social and individual intimacy.

The goal for diabetic management in labor is euglycemia. What does this term mean?

Euglycemia: normal blood glucose, also known as normoglycemia. 60-100 mg/dL.

Biophysical profile (BPP)

Evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. Normal response receives 8-10 points indicating fetus has a low risk of deprivation and isn't in distress. Score of 6 or lower is at risk for asphyxia and premature birth. This score warrants investigation and repeated test.

What is the cause of preeclampsia?

Exact cause unknown. Suspected causes: improper functioning of placenta, high fat and poor nutrition, insufficient blood flow to the placenta, genetic risk factors, immune function disorders.

A client, now 37 weeks pregnant, calls the clinic because she is concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to the client's concerns, the nurse should take which action?

Explain that these are expected problems for the latter stages of pregnancy. This is caused by the growing uterus and pressure on the diaphragm.

When may a VBAC be considered by a woman with a previous cesarean section?

If a low uterine transverse incision was performed and can be documented AND if the original complication does not recur.

What are the major symptoms of preeclampsia?

Increased BP of 30 mmHg systolic and 15 mmHg diastolic over previous baseline; hyperreflexia; proteinuria (albuminuria); CNS disturbances; headache, visual disturbances; epigastric pain (felt in middle of upper abdomen).

What causes large variable decelerations in the fetal heart rate (FHR) after an amniotomy?

Indicates umbilical cord prolapse. This is an obstetrical emergency that requires immediate intervention to prevent fetal hypoxia.

What special actions would the nurse take during the intrapartum period when attempting to arrest preterm labor?

Intrapartum period: from the onset of labor to 3rd stage of labor (baby born and placenta delivered). Monitor the FHR continuously and limit drugs, which cross placental barriers to prevent fetal depression or further compromise.

Why is regular insulin used in labor?

It is short-acting, predictable, can be infused intravenously, and discontinued quickly if necessary.

What are the two most difficult time periods for control of blood sugars in the pregnant diabetic?

Late in the 3rd trimester and in the postpartum period when insulin needs drop sharply (the diabetogenic effects of pregnancy drop precipitously).

What instructions would the nurse give a woman with a threatened abortion?

Maintain strict bedrest for 24-48 hours. Avoid intercourse for 2 weeks.

What are the major goals in the care of pregnancy induced hypertension with eclampsia?

Maintenance of uteroplacental perfusion; prevention of seizures; prevention of complications such as HELLP syndrome, DIC, and abruption.

Name three maternal and three fetal complications related to gestational diabetes.

Maternal complications: hypoglycemia, hyperglycemia, ketoacidosis. Fetal: macrosomia, hypoglycemia at birth, fetal anomalies.

A client at 6-weeks' gestation comes to the emergency department, and a transvaginal ultrasound confirms ectopic pregnancy with the tube intact. The client will be treated medically. What medication will the nurse prepare to administer to this client?

Methotrexate. This type of pregnancy in which the fertilized ovum implants outside the uterine cavity, as the embryo enlarges, creates the potential for organ rupture. With early diagnosis, most women with ectopic pregnancy can be treated with an IM injection of methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo.

State three priority nursing actions when caring for a pre-eclamptic patient in the immediate postdelivery.

Monitor for signs of blood loss, continue to assess BP and deep tendon reflexes every 4 hours, and monitor for uterine atony.

What are the warning signs of preterm labor?

More than 5 contractions an hour, cramps, dull backache, pelvic pressure, change in vaginal discharge

Multiparas average cervical dilation per hour is ________in the active phase compared with ____________in a nullipara during the active phase.

Multiparas average cervical dilation is 1.5 cm/hr in the active phase compared with nullipara dilation of 1.2 cm/hr in the active phase.

When providing teaching to a pregnant client on her first prenatal visit, what topic should the nurse be sure to cover?

No matter how far the client's pregnancy has progressed the nurse should teach about danger signs during pregnancy so the client can identify and report them early, helping to avoid complications.

Does insulin cross the placental barrier? Does insulin cross the breast milk barrier?

No, therefore insulin-dependent women can breastfeed.

Can a woman with Type II diabetes or gestational diabetes take oral medications to reduce blood sugar during pregnancy?

Oral hypoglycemic medications are teratogenic (causes malformation to an embryo) to the fetus. Insulin should be used instead.

What postoperative complications would you monitor for following a cesarean section?

Paralytic ileus (decreased intestinal movement), infection, thromboembolism, respiratory complications, and impaired maternal infant bonding.

What antibiotic does a pregnant woman receive for group B streptococcus chorioamniotits?

Penicillin G potassium IV.

What interventions can the nurse implement to maintain cardiac perfusion in a laboring cardiac client?

Position client in a semi or high-fowlers position, prevent Valsalva's maneuver's, position client in a supine position for regional anesthesia, avoid stirrups because of possible popliteal vein compression and decreased venous return.

List three conditions pregnant clients with diabetes are more prone to developing.

Preeclampsia, hydramnios, and infections.

What complications is the pregnant adolescent at risk for?

Preterm labor and births, low birthweight infants, iron-deficiency anemia, sexually transmitted infections, poor maternal weight gain, preeclampsia, poor eating habits, nutrition, and postpartum depression.

Describe discharge counseling for a woman who had a dilation and curettage for treatment of a hydatidiform mole (molar pregnancy).

Prevent pregnancy for at least one year. Return to clinic for monthly hCG levels for one year. Surgical post op care will include calling primary care provider if bright red vaginal bleeding occurs or if vaginal discharge has a foul odor of temperature spikes above 38 degrees C.

What is the major side effect of beta adrenergic tocolytic drugs such as terbutaline?

Tachycardia

List the symptoms of cardiac decompensation in a laboring client with cardiac disease.

Tachycardia, tachypnea, dry cough, rales in the bases of lungs, dyspnea (difficult or labored breathing), and orthopnea (shortness of breath).

I pregnant client who is 4 months pregnant asks about exercise. What type and quantity of exercise should the nurse advise?

Taking brisk walks is one of the easiest ways to exercise during pregnancy. The client should walk slowly for 10-15 mins per day and increase gradually to a comfortable speed and duration of 30-45 mins per day.

Preterm labor and sexual intercourse

The client should abstain unless using a condom because semen contains prostaglandins that stimulate uterine contractions.

Spotting in early pregnancy where the cervix remains closed. What should the nurse expect?

Threatened abortion. Spotting in the first trimester may indicate the pregnancy is in jeopardy. Bed rest and avoidance of stress are recommended. Abortion is usually inevitable if bleeding is accompanied by pain with dilation and effacement of the cervix. An inevitable abortion is associated with cervical dilation. An ectopic pregnancy is in the fallopian tubes, and a false positive pregnancy could reflect a missed abortion.

What is the purpose of administering magnesium sulfate? What is the main action? What is the antidote? What are three assessment findings indicating toxicity?

To prevent seizures by decreasing CNS irritability. The antidote for magnesium sulfate is calcium gluconate. S/s of toxicity: palpitations and variability in HR (AFib), changes in ECG (prolonged PR interval, widened QRS), loss of deep tendon reflexes and muscle weakness, and fluid-filled lungs.

What factors predispose a woman to preterm labor?

UTI, overdistension of uterus, diabetes, preeclampsia, cardiac disease, placenta previa, psychosocial factors (stress).

What is the common complication of oxytocin augmentation or induction of labor? List three actions the nurse would take if such a complication occurs.

Uterine tetany- extremely prolonged uterine contractions (life threatening to the fetus). Turn off Pitocin, turn the woman onto her side, administer O2 by mask

Identify plan of care and interventions for a patient with hyperemesis gravidarum.

Weigh daily, urine ketone checks 3x daily, progressive diet, check fetal heart rate every 8 hours, monitor for electrolyte imbalances.

When would the nurse hold the dose of magnesium sulfate and contact the physician?

When the client's respirations are <12/minute, when deep tendon reflexes are absent, or urinary output is <100cc/4hrs.

A nurse is caring for a client who is at 32 weeks of gestation and performs Leopold's maneuvers to confirm that the fetus is in the cephalic position. To identify fetal heart tones, identify where the nurse should place the Doppler transducer.

When the fetus is in the cephalic position (head down), fetal heart tones are best auscultated midway between the symphysis pubis and the umbilicus. When the fetus is in the breech position, fetal heart tones are best heard at or above the level of the umbilicus.

List three symptoms of abruptio placenta and three symptoms of placenta previa.

a. Abruptio placenta would include fetal distress, rigid boardlike abdomen, and pain; may have dark red bleeding or may be absent (occult). b. Placenta previa pain free, bright red vaginal bleeding, normal fetal heart rate, soft uterus.

Gentle counterpressure against the perineum during an emergency delivery prevents and .

maternal lacerations fetal cerebral trauma