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What is a triple screen? When is it administered? (AFP- Alpha-fetoprotein); HGC; and unconjugated estriol levels- over age 35 at the 15th week of pregnancy
Why do we do a triple screen? drawn on blood serum; detect open spinal cord or chromosomal defect may occur. if positive in 16th week- amniocentesis will be scheduled
What are the three complications most likely to occur over age 40? Pre-term or post-term birth; PIH, or cesearean as a woman's circulatory system is not what it used to be; not as elastic
Name some reasons women over 40 develop PIH? possibly r/t blood vessel inelasticity or bc hypertension occurs more in nulliparas than multiparas.
Name the best intervention for women with PIH? Rest for a good portion of the day.
Women over 40 lose elasticity and cervical dilation may not occur as spontaneously as for younger women. What is a good method to determine if this is occuring? Graph/Chart labor progress and encourage a woman to verbalize her feelings about labor progression to allow for reassurance and to prompt any necessary interventions.
Besides cervial dilation, what else are we looking for complications with in terms of elasticity and labor complications? Interventions? loss of elasticity for the uterus and resulting higher risk for postpartum hemorrhage and perineal-anal tears. Close observation and assessment of lochial flow.
What areas of planning do you need to consider when working with phys/cogn. challenged moms-to-be? transportation, pregnancy counseling, support persons, health, work, recreation and self esteem
What do we need to especially consider when a develop. challen. woman wants to conceive? Urge her to come for preconceptual care- need to evaluate meds for safe pregnancy
What is a major concern of phys. or cogn. challenged pregnant women? What are we assessing? Safety. Assess emergency contact persons, suppliers of transportation, mobility, elimination, and autonomic responses as well as meds.
In terms of mobility and the disabled women in wheelchairs- what do we need to make sure they do and why? press with their hands against the armrests and lift their buttocks up off the wheelchair seat for 5 seconds/hr to prevent pressure ulcer formation on the buttocks and posterior thighs.
to prevent limitations on the venous return from the lower extremities for wheelchair bound pregs what can we have them do? for at least 1 hr morning and afternoon decrease the sharp bend at the knees. this will promote venous return and help prevent varicosities and thrombi formation- adjust the footrests
In terms of self esteem, what do we want disabled pregs to feel with changes to their mobility? her reduction in independence allows for a safe pregnancy as she is preventing potential falls
Why is elimination a concern for disabled pregs? If mobility is a challenge, they may not use the bathroom as much or consume appropriate volumes of liquids. Encourage a high fluid intake and frequent voiding to prevent UTIs. Also consider those who catherize themselves.
Define autonomic reflexia. An exaggerated autonomic response to stimuli in women with a high spinal cord injury (cervical or high thoracic)caused either distended bladder, + uterine size, contractios or breastfeeding.
What are symptoms of autonomic reflexia? without upper motor neuron control: severe hypertension (300/160mmHG), throbbing headache, skin flushing, profuse sweating above level of spinal lesion, nausea, bradycardia can occur also.
Why do we have to act immediately if we notice s/s of autonomic reflexia? immediately protect against cva or intraocular damage- eleveate her head to reduce cerebral pressure and locate the irritating stimulus. may need antihypertensive
If a disabled woman cannot be examined in a lithotomy position, what position can you put her in. dorsal recumbent
If a woman in a wheelchair relies on a support person for a hot meal cooked on a stove, what do you need to consider? How to inform her of nutritious foods that can be prepared cold.
What are special considerations for women in labor who are disabled? can they feel the contractions? (if not palpate the abdomen continually for initial signs) can they push? (if not, cesarean or forceps birth) they may have to deliver in a sims or dorsal recumbent position.
In labor, what are two risks with ruptured membranes? intrauterine infection and prolapse of the umbilical cord. after 24 hours after the rupture and labor has not started, induced labor will be initiated to help reduce these risks
What are four integrated concepts for a successful labor: passage, passenger, powers, psychological outlook
What is another name for the anterior fontanelle? the bregma
What is a vertex? the space between the two fontanelles
Created by: Bettiesailor