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1230 Unit 2 Part 2

painless cervical dilation with bulging of fetal membranes and parts through the external os in the second trimester; pregnancy loss is frequently inevitable cervical insufficiency
standard treatment for cervical insufficiency; performed between 14 and 26 weeks gestation cervical cerclage (stitch the cervix)
hydatidiform mole or molar pregancy (benign), and gestational trophoblastic neoplasia (malignant) gestational trophoblastic disease
two types of molar pregnancies; both involve errors in chromosomal duplicationd uring fertilization; some features of a malignancy partial and complete
risk factors of molar pregnancy: history of previous gestational trophoblastic disease; extremees of age; young women in early teens and older women near the end of reproductive lives are at highest risk
clinical manifestations of molar pregnancy most common signe - vaginal bleeding; hCG level is usually higher than expected for gestational age; transvaginal ultrasound to confirm
treatment of molar pregnancy evacuation of the uterus; continued follow-up care for 1 year (may develop cancer)
nursing care for molar pregnancy woman at risk for several complications; monitor frequently for vag bleeding; check condition of uterine fundus; administer oxytocin as ordered; DIC (no clotting from any vessels); trophoblastic embolus or pulmonary edema secondary to fluid overload
condition in which the placenta is implanted close to or covers the cervical os; exact cause is not known placenta previa
things that increase risk for placenta previa history of elective abortions, multiparity (multiple deliveries), advanced maternal age (older than 35), previous cesarean birth or uterine incisions, maternal smoking, prior placenta previa
Placenta previa is classified according to the degree to which the placenta covers the cervix. total (rarely resolves - completely covers cervix); partial (sometimes resolves); marginal (sometimes resolves)
clinical manifestations of placenta previa painless, bright red bleeding (1st episode usually between 27 and 32 weeks gestation); transvaginal ultrasound
Total placenta previa is associated with: atypical fetal presentations (breech or transverse)
treatment for placenta previa imediate cesarean deliver is a life-saving measure for the woman and the baby (if massive bleeding occurs); Kleihauer-Betke test; RhoGam; NSTs
A ____________ delivery is necessary in all cases of total placenta previa. cesarean
nursing care for placenta previa careful observation; IV access at all times; assess for signs of shock (from bleeding); LISTEN TO FETAL HEART RATE AT LEASE EVERY 4 HOURS)
Postpartum care for placenta previa normal postpartum care; assess for signs of infection and mehorrhage (pad count)
prematue separation of a normally implated placenta; cause is unknown abruptio placentae
risk factors for abruptio placentae elevated blood pressure; preeclampsia and pre-existing chronic hypertension; advanced maternal age (>35); multiparity; history of cesarean delivery; trauma; smoking; alcohol; cocaine; preterm premature rupture of membranes
abruptio placentea classified by: whether bleeding is concealed (more dangerous) or apparent; whether degree of abruption is partial or complete
maternal complications with abruptio placentea: hemorrhagic shock, DIC, uterine rupture, renal failure, death
fetal complications with abruptio placentea relate to the degree of placental separation and maturity of fetus; hypoxia, anemia, growth retardation, death
clinical manifestations of abruptio placentea abdomen will harden and not release; based on s/s of patient; pain has sudden onset and is constant; ultrasound
treatment of abruptio placentea vaginal delivery is preferred for small abruptions
nursing care for abruptio placentea careful monitoring; watch for signs of shock; continuous EFM; prepare for emergency cesarean if ordered; monitor for postpartum hemorrhage and condinue to observe for signs of DIC after the birth
abrutpio placentea assessment though OB history; acut bleeding episode; obtain fetal heart rate and apply the EFM; evaluate the woman's pain
second leading cuase of maternal morbidity and mortality; not only dangerous for the woman, but also puts the fetus at risk hypertensive disorders in pregnancy (gestational HTN, preeclampsia/eclampsia; chronic HTN; preeclampsia superimposed on chronic HTN)
term used to describe elevated blood pressure (>140/90) that develops for the first time during pregnancy; can be transient or chronic gestational hypertension
serious condition in which the blood pressure rises to 140/90 or higher accompanied by proteinuria; may develop into eclampsia; may have presence of seizure activity or coma; exposure to trophoblastic tissue appears to be the triggering factor preeclampsia
tests for preeclampsia there are no diagnostic tests available
more likely to develop preeclampsia and are 2-3 times more likely to die from it or eclampsia African-American women
Primary problem underlying development of preeclampsia is generalized : vasospasm
categorized as mild or sever, seizures are tonic-clonic and only rarely progress to status epilepticus; edema is significant if it is nondependent or if it involves the face and hands preeclampsia
severe form of preeclampsia; greatly increases the mortality associated with preeclampsia HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets)
treatment of preeclampsia primary goal - to deliver baby and restore the woman to a healthy state; preventing maternal seizures; magnesium sulfate (ther. level is 4-8 mg/dL)
When giving magnesium sulfate, monitor the reflexes and respiratory rate of the woman receiving it at frequent intervals; high risk for antepartum complications 24-48 hours after deliver; antidote for magnesium sulfate: Calcium gluconate
nursing care for HELLP frequent monitoring of woman of fetus; auscultate lungs evry 2 hours; weigh woman daily; report HA, visual changes, epigastric pain; assess deep tendon reflexes; implement seizure precautions; woman on bed rest; adequate nutrition; phychosocial needs; NST
high blood pressure present before the woman becomes pregnant chronic hypertension
chronic hypertension and experiencing proteinuria preeclampsia superimposed on chronic hypertension
treatment and nursing care with preeclampsia superimposed with chronic hypertension prenatal visits at more frequent intervals; fetal surveillance is an area of intense focus; methyldopa (Aldomet) is the drug of choice for maintenance therapy
refers to a pregnacy in which the woman is carrying more than one fetus multiple gestation
twins are at risk for: twin-to-twin transfusion syndrom (TTTS); conjoined; experience growth restriction; be born prematurely
woman's risk with multifetal pregnancy postpartum hemorrhage; increases fetal nutrient demands; maternal anemia
nursing care with multifetal pregnancy increased emphasis on woman's diet, multivitamin and iron supplements, rest; teach symptoms of preterm labor; perform fetal movement counts daily after 32 weeks gestation
incompatibilities between the woman's blood and the fetus' blood can cause problems for the fetus - the two types are: Rh imcompatibility and ABO incompatibility
Rh incompatibility isoimmunization; fetus develops hemolytic anemia; anti-D immunoglobulin (RhoGam); woman will have no symptoms; fetus may be severely affected (miscarriage); treatment is RhoGam
To give RhoGam, woman must be: Rh negative; must not have anti-D antibodies; infant must be Rh-positive; direct Coomb's test must be weakly reactie or negative
ABO incompatibility another cause of hemolytic disease of newborn; most frequently arises when the woman's blood type is O and the baby's is A, B, or AB; much less severe form than Rh incompatibility; fetus rarely requires exchange transfusion
Created by: akgalyean