Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Perfusion 7/23PN
Perfusion PN Program
| Question | Answer |
|---|---|
| Central perfusion | Entire body |
| Local or tissue perfusion | Extremity |
| Sickle cell anemia | C or sickle shaped cell |
| Sickle cell anemia is | Genetic that is recessive and almost exclusively in African Americans |
| Recessive gene | From mom and dad |
| Can Mediterranean decent have sickle cell anemia | Yes |
| Sickle cell anemia (more severe) | From BOTH parents Symptoms usually start at the last part of the first year of life Chronically anemic May have sickle cell crisis |
| S/S sickle cell anemia or crisis | Low RBC counts Pale Fatigued Jaundice Cardiomegaly Swelling fingers/toes |
| Sickle cells | Shape is difficult to pass through capillaries thus causing pain and obstructing blood flow |
| Sickle cell trait ( asymptomatic) | Blood contains hbg a and sickle hgb s Only inherited from ONE parent Hgb and RBC normal Patient then becomes carrier |
| Sickle cell crisis vasooclusive | Most painful due to obstruction of blood flow |
| Sickle cell crisis | Lasts 1-10 days Triggered by stressors Tissue hypoxia = severe pain Risk for stroke due to miccroemboli ( clumping of cells) Fever ( due to inflammatory/ infection response) Affected/ painful areas = abdomen, chest, joints, bones |
| Diagnosis of sickle cell | Sickledex ( tests only for sickle cell) Before birth ( chronic villi sampling, amniocentesis) No test to determine a crisis |
| Known sickle cell + pain = | Assumed crisis |
| Treatment sickle cell | No heat or ice No cure Blood transfusion ( temporary fix to increase hgb) Pain management ( IV, pca) Demoral for adults Morphine IV fluid |
| Can infection come from a sickle cell crisis? | Yes |
| Is demoral given to children? | Only adults as it increases risk for seizures in peds |
| Why is ice not applied to painful areas during a crisis? | Promotes sickling |
| Hydroxyurea | MOA: increases blood flow during crisis Only drug approved for sickle cell disease Increases RBC size Doesn't treat acute crisis, take as prescribed to reduce amount of crisis' |
| Teach patient with sickle cell | 4-6 L of fluid daily No smoking or drinking as these are triggers for crisis Genetic counseling |
| Shoulder dystocia | Head is delivered but shoulders become impacted above mother's symphysis pubis. |
| Nursing and treatment of shoulder dystocia | HOB back McRoberts maneuver Suprapubic pressure |
| McRoberts maneuver | Pull knees to head to open up pelvis. |
| Risk factors of shoulder dystocia | Fetal macrosomia, gestational or overt DM, history of shoulder dystocia in prior birth, prolonged 2nd stage of labor History of macrosomic infant, maternal obesity, multiparity, & postterm pregnancy |
| s/s of shoulder dystocia | Fetal head delivers but no shoulders Turtle sign ( out goes back in) No delivery with gentle traction |
| Zavenelli Maneuver | Turn baby face down manually then push back in and go for emergent c - section ( live baby normally DOES NOT come from this) |
| Uterine atony | Uterus unable to contract back down |
| Complications of shoulder dystocia | 4th degree tear ( vagina to anus) Anoxic brain injury due to hypoxia to fetus Uterine stony Postpartum hemmorage Fractured clavicle to drop arm down and deliver |
| Placenta previa | implantation of the placenta over the cervical opening or in the lower region of the uterus |
| Marginal previa | Within 2-3 cm of cervix |
| Partial previa | Partially covers cervix |
| Total previa | Entire cervix covered |
| Painless vaginal bleeding Can be profuse bleeding Soft, not tender abdomen Malpresentation of fetus | Placenta previa s/s |
| Previous previa Cocaine use Previous c section/ uterine surgery Increased maternal age | Placenta previa risk factors |
| Placenta taking up space where it normally wouldn't be | High risk for malpresentation in previa |
| Ultrasound is main tool to diagnose at 20 week ultrasound Typically resolves before delivery but the more placenta covering cervix = more likely not to move | Placenta previa dx |
| Previa treatment | Pregnant as long as possible for mom and baby safety Monitor placenta location Monitor fetus especially with any bleeding High risk for bleeding before, during, and after surgery Steroids for lung maturity ( typically high risk) |
| Why do you not want the placenta to deliver first? | Because then what is perfuming baby??? |
| Why does Previa cause high risk for infection | Vagina is not sterile |
| Educate mom that no stimulation or penetration while pregnant with previa because | Uterus contracts during orgasm thus causing bleeding |
| Tearing away from uterus | Placental abruption |
| Placental abruption | Abruptio placentae |
| placental abruption risk factors | Hypertension Cocaine use Prior history of abruption Folate deficiency |
| Abruption S/S | Dark, red bleeding Extreme pain in abdomen and low back Rigid abdomen, board like Enlarging uterus Constant contractions |
| Enlarging uterus indicates what in abruption | Distinction is due to leakage into uterus |
| Some bleeding may not come out of vagina because | Be concealed above above baby depends on placenta location |
| Abruption diagnosis | Decels of FHR Constant contractions Ultrasound helpful sometimes KB Test to determine if mom and baby bloods mixed |
| KB test | measure amt of fetal Hb transferred into the maternal bloodstream. Use on Rh neg woman w/ an Rh positive fetus --> determine dose of Rh Ig to prevent sensitization. (you don't want mom to make her own IgG's to it --> will transfer over in next preg |
| Abruption treatment | Some can be monitored if mom and baby ok Vitals Contractions Monitor for hemorrhage |
| Placental abruption | Bleeding above and out |
| Placental previa | Covering cervix |
| Hemorrhage in vaginal delivery | 500 mL or greater blood loss |
| Hemorrhage in C-section | 1000 mL of greater blood loss |
| Early hemorrhage | Within 24 hours postpartum |
| Late hemorrhage | 24 hours to 6 weeks postpartum |
| S/S hemorrhage | Tachycardia Bleeding (visible or not) Altered LOC Cool, clammy Low BP Fundus firm or boggy |
| Early postpartum hemorrhage | Uterine atony ( most common) Lacerations Placental abruption Hematoma in repro tract |
| Uterine atony | Bladder will take up room to the right, where uterus would be, pushed up Not contracting back to size No placenta to perfume, uterus doing nothing Amount of blood lost not apparent till mom stands Boggy uterus |
| Treatment uterine atony | Uterine massage Assess bladder Mag sulfate |
| Lacerations of repro tract | Increased blood volume causing engorged vasculature beds Usually suture to treat NPO till MD assess Evaluate for active bleeding |
| He's Tomas of reproductive tract | Blood collection within tissue Bulging blue or purple mass Unrelenting pain unrelieved by analgesics Ice packs and pain meds to these mamas Unusual lochia |
| Late postpartum hemorrhage | Retention of placental fragments Lochia returns back to red bleeding IV fluid Possible DNC |
| If nothing stops uterine atony what is next step | Hysterectomy |
| 1 gram of blood loss = | 1 mL of blood loss |
| hypovolemic shock | shock resulting from blood or fluid loss |
| Body's response to hypovolemic shock | Cool, clammy skin Tachycardia Tachypnea Body only perfuming essential organs Low BP |
| Treatment hypovolemic shock | Foley catheter to monitor output and kidney function Pitocin for uterus to contract down Blood transfusion O2 therapy Hemabate ( don't give to someone with asthma will cause severe attack) Methergine |
| Nursing care hypovolemic shock | Frequent vitals Blood loss Signs of anemia I&O Assess fundus Assess lochia O2 sat monitoring |
| Don't forget to provide support to family | Watching the wife go through this is difficult for the partner |
| QBL | Quantitative blood loss, blood loss often underestimated |
| AWHONN | Association of Women's Health, Obstetric and Neonatal Nurses , 53-94% of maternal hemorrhage related deaths could have been prevented with improved clinical response |
| HTN in pregnancy risk factors | Obesity Diabetes Family history of GH First pregnancy Chronic hypertension More than 10 years since last child was born |
| Gestational hypertension (GH) | This disorder begins after the 20th week of pregnancy where BP s elevated at 140/90 mm Hg or greater recorded at least twice, 4-6 hours apart within a 1 week period goes away after 6-12 weeks postpartum |
| preeclampsia | a complication of pregnancy characterized by hypertension, edema, and proteinuria |
| Eclampsia | Exact as preeclampsia but with seizure involvement |
| Chronic HTN in pregnancy | Preexisting Prior to 20 weeks gestation Last beyond 12 weeks postpartum LOL - beta blockers |
| Chronic HTN with superimposed preeclampsia | worse prognosis than chronic alone HTN or preEclampsia alone -new onset of proteinuria after 20 wks -sudden increase up to 160/110 BP -severe preEclampsia symptoms |
| Gestational HTN | >140/>90 first documented after 20 weeks without proteinuria Cause unknown Increased risk for developing ch on if HTN later in life BP to normal within 12 weeks postpartum |
| Preeclampsia | High BP affecting other organs Proteinuria Can occur PP After 20 weeks gestation can occur Greater than 140/90 Deliver the baby on a mom:baby safe ratio |
| Preeclampsia with severe features | Must have one of the following in addition to above BP ≥160 systolic or ≥110 diastolic on 2 occasions 6 hours apart Proteinuria ≥ 5 grams (5,000 mg) Cerebral or visual changes Epigastric /right upper quadrant pain, Fetal growth restriction Severe he |
| 1.preeclampsia 2.preeclampsia w severe features 3. Eclampsia | Better to worse |
| Ecclampsia | Preeclampsia that progresses to seizure Can occur antiparticle, postpartum, or intrapartum Deliver fetus (emergency c section) Toxemia is what is used to be referred to |
| Eclamptic Seizure | Cerebral hemmorhage Abruption Death of mom or fetus |
| Difference in CNS | Is ecclampsia vs preeclampsia |
| Chronic HTN with superimposed preeclampsia | Acute condition on top of chronic illness |
| Treatment with mom | Lab tests as liver gets affected Urine dips ( urine protein creatinine ratio) 30 min-hr fastest way BP 10-15 minutes |
| Vision changes in preeclampsia are due to what | Cerebral edema |
| Treatment chronic HTN with superimposed preeclampsia | Mag sulfate ( mom will feel like she has flu receiving this) Lebatolol ( treats acutely) Hydralazine (teats acutely) Baby is used to high bp perfusion so fetal distress due to low perfusion when bp drops |
| Nursing management chronic HTN with superimposed preeclampsia | Vitals Fetal monitoring Position O2 IV fluid |
| Complications chronic HTN with superimposed preeclampsia | Preterm delivery common Preeclampsia Intrauterine growth restriction Placental abruption |
| HELLP syndrome | hemolysis, elevated liver enzymes, low platelets |
| HELLP | Less than 100,000 platelets (thrombocytopenia) |
| HELLP S/s | RUQ pain ( due to liver location) Malaise ( don't feel good) N/V RUQ pain ( due to liver location) Malaise ( don't feel good) N/V |
| Hemolysis | the rupture or destruction of red blood cells. |
| HELLP TREATMENT | I&O Mag sulfate Fetal delivery Monitor bleeding |
| DIC | disseminated intravascular coagulation |
| HELLP can progress to | DIC |
| DIC is | Always secondary to another issue and clotting/bleeding issue simultaneously |
| DIC treatment | Blood products Can bleed from ANYWHERE Maternal and fetal mortality rates higher |
| Rh incompatibility | If mother is Rh- and baby is Rh+, than mother may develop antibodies against the infant's blood |
| Have or do not have | Rh factor |
| Maternal and fetal blood are close but do not | Mix |
| Rhogham administration | When rh neg mom crosses to rh positive baby given at 28 weeks and 72 hours after birth to prevent future fetus from being fought against by antibodies |
| Congenital heart disease | Most common birth defect |
| Cyanotic heart disease | Coarction of the aorta |
| Risk factors CHD | Rubella during pregnancy Alcoholism Parent with CHD |
| Effects CHD | Exercise difficulty Murmur Delayed development Eating is exercise for these kids |
| Acyanotic heart disease | left to right shunt most common |
| Tetralogy of fallot | a congenital malformation of the heart involving four distinct defects |
Created by:
TutorDavis17
Popular Nursing sets