Foundations of Maternal Newborn Nursing
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| Preeclampsia | Hypertensive disorder of pregnancy. Characterized by HTN & proteinuria
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| Eclampsia | HTN of pregnancy accompanied by seizures
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| The most common cause of spontaneous abortion | severe congenital abnormalities
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| Three Causes of Hemorrhage: during first half of pregnancy | Abortion, Ectopic pregnancy, Gestational trophoblastic disease
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| Inevitable Abortion | cannot be stopped when membranes rupture, cervix dilates
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| Threatened Abortion | 1st sign- vaginal bleeding
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| Vacuum curettage | to clean out uterus (if natural process is ineffective or incomplete)
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| D&C | for more advanced pregnancy or excessive bleeding (IV sedation or analgesic)
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| What is an Incomplete Abortion? | some, but not all products of conception are expelled from uterus
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| Incomplete Abortion | Initial treatment is cardiovascular stabilization
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| What is a complete abortion? | All products of conception are expelled from uterus
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| Manifestations of Complete Abortion | Uterine contractions and bleeding subside and cervix closes.
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| What is a Missed Abortion? | fetus dies during 1st half of pregnancy but is retained in uterus.
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| What is a serological test? | any of several laboratory procedures carried out on a sample of blood serum, the clear liquid that separates from the blood when it is allowed to clot.
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| What is the purpose of a serological test? | Detect serum antibodies or antibody-like substances that appear specifically in association with certain diseases.
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| When is a vaginal culture indicated? | it is used to check for overgrowth of yeast or other bacteria
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| How do you treat Pelvic Inflammatory Disease(PID)? | Acute PID is often treated with IV administration of broad-spectrum antibiotics. The IV antibiotics can be changed to oral treatment after 48 hours.
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| pregnancy-induced hypertension | Increased blood pressure; systolic increase of 30mmHg, diastolic increase of 15mmHg over the baseline pressure for the individual woman on two assessments at least 6-hr apart, Occurs mostly in the last trimester
Proteinuria, Edema
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| Preeclampsia | systolic BP >= 140mmHg or diastolic BP >= 90mmHg that develops after 20wks gestation and is accompanied by proteinuria
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| Gestational hypertension | Systolic BP >=140mmHg or diastolic BP >=90mmHg that develops after 20 wks gestation but without significant proteinuria
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| Chronic Hypertension | Systolic BP >=140mmHg or diastolic BP >=90mmHg that was known to exist before pregnancy or develops before 20 wks gestation (also if HTN doesn't resolve during postpartum period)
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| preeclampsia should be suspected if the woman has a sudden increase in _____. | proteinuria from her baseline levels, a sudden increase in BP when it had been previously well controlled, development of thrombocytopenia or abnormal elevations of liver enzymes (AST or ALT).
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| In normal pregnancy vascular volume and cardiac output _____ significantly. | increase
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| Blood pressure ___ rise in normal pregnancy. | does't
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| Vasospasm ______ the diameter of the blood vessels which results in endothelial cell damage. | decreases
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| _________ also results in impeded blood flow and elevated BP. As a result, circulation to all body organs including kidneys, liver, brain and placenta is ______. | Vasoconstriction, decreased
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| Additional risks associated with preeclampsia and eclampsia | Pulmonary edema, circulatory or renal failure, intracranial hemorrhage
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| The only cure for eclampsia | The only cure is to deliver the baby
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| If mother has preeclampsia or eclampsia and the fetus is <34 wks, | steroids will be given to accelerate fetal lung maturity and an attempt to delay birth for 48hrs
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| Care is given with administering anti-hypertensive meds for the woman on magnesium sulfate to avoid _______. | hypotension
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| Most common med given to pregnant women to prevent seizures | Magnesium Sulfate
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| Disseminated Intravascular Coagulation(DIC) | “Life-threatening” defect in coagulation.
Inappropriate coagulation in microcirculation
Tiny clots form in tiny blood vessels, blocking blood flow to organs, causing ischemia
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| Three Causes of Hemorrhage: during first half of pregnancy | Abortion
Ectopic pregnancy
Gestational trophoblastic disease
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| Threatened abortion | 1st sign: vaginal bleeding
May be accompanied by cramps, back pain
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| Inevitable Abortion | cannot be stopped when membranes rupture, cervix dilates (this is the difference between a threatened and inevitable abortion)
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| Manifestations of Inevitable Abortion | Ruptured membranes, Dilated cervix, Uterine Contractions, Active bleeding
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| Therapeutic Management of Inevitable Abortion | Vacuum curettage – to clean out uterus (if natural process is ineffective or incomplete)
D&C – for more advanced pregnancy or excessive bleeding (IV sedation or analgesic)
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| Incomplete Abortion manifestations | Active uterine bleeding, Severe abdominal cramping
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| Complete abortion theraputic management | Rest, Watch for further bleeding, pain, or fever, Teaching—no sex until follow-up with doctor
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| Missed abortion can only be diagnosed by | Ultrasound examination confirms fetal death
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| Recurrent Abortions | three or more spontaneous abortions
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| Diseases that cause DIC fall into 3 categories | Infusion of thromboplastin into the circulation, which consumes or “uses up” clotting factors such as fibrinogen & platelets. Conditions characterized by endothelial damage. Non-Specific effects of diseases, Maternal sepsis, Amniotic fluid embolism
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| Priority treatment for DIC is to correct the cause. | correct the cause.
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| DIC may be diagnosed if you ____ | Observe for bleeding from unexpected sites
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| If coagulation are severely abnormal—epidural is _______. | contraindicated
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| Ectopic Pregnancy | implantation of fertilized ovum in an area outside uterine cavity.
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| Ectopic pregnancy aka “disaster of reproduction” | Significant cause of maternal death from hemorrhage
Reduces chance of subsequent pregnancy because of damage to Fallopian tube
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| Clinical Manifestations or “Classic Signs” of ectopic pregnancy | Missed menstrual period
Abdominal pain
Vaginal “spotting”
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| Urine output below 30ml/hr may indicate _____. | renal failure
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| ____ _____may precede respiratory depression and indicate mag toxicity. | Absent reflexes
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| Methotrexate is used to | inhibit cell division (ectopic pregnancy)
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