maternal exam3

4 p’s of pregnancy (questions)

used drugs/alcohol during pregnancy?

problems w/ drugs or alcohol in past?

does partner have problems w/ drugs/alcohol

are parents addicts/alcoholics?

maternal use of tobacco or marijuana is linked to

maternal asthma and low birth weight and possible preterm labor

high cocaine use can lead to

higher risk of placental eruption

if hiv+ woman is left untreated then there is

25% risk of transmission in first year of life

if hiv+ woman is treated then there is

1% risk of transmission in first year of life

antiretroviral medication schedule

given to mom throughout pregnancy and l&d

given to actual newborn for 4-6 months of life

toxoplasmosis edu

associated w/cat litter

avoid cat litter

hiv edu

give art in pregnancy & to newborn

wear gloves for newborn care

bathe newborn immediately

no breastfeeding

gbs edu

administer penicillin/ampicillin during delivery

gonorrhea edu

give im ceftriazone to mom during pregnancy

give erythromycin baby after delivery

chlymidia edu

give mom po azithromyciin during pregnancy

give baby erythromycin after delivery

trichomoniasis tx

presents as yellow/green discharge w/ odor, itching, dysuria

tx w/ metronidazole after 1st trimester

rubella edu

immunization during pregnancy is contraindicated

non-immune patients should avoid potention exposure and large crowds

give rubella vaccine post partum and avoid pregnancy for 3 months after

cytomegalovirus edu

droplet transmission

common in children: hand hygiene

no tx = prevention is important

herpes simplex edu

transmission from direct contact w/oral or genital lesions

c section required if active lesions

anemia lab value

< 11g/dl

type 1 dm

no insulin to allow sugar into cells

type 2 dm

cells are insulin resistant

1st half of pregnancy (altered glucose metabolism)

increased insulin production + tissue response

building up maternal glucose stores

2nd half of pregnancy (altered glucose metabolism)

mom becomes resistant to insulin to allow glucose to grow fetus

diabetes can develop or worsen d/t

hormones

gestational diabetes

carb intolerance + insulin resistance associated w/ pregnancy

cardinal signs of diabetes

polyuria

polydipsia

wt loss

polyphagia

glucosuria

maternal risks w/ gdm

hydramnios

preeclampsia

ketoacidosis

dystocia

increased susceptibility

high glucose can do what to fetal growth

macrosomia

hypoglycemia after delivery

mother’s hyperglycemia = lots of insulin in baby

results in blood sugar drop in baby since there is no more high glucose

fetal risks w/ gdm

rds

polycythemia

hyperbilirubinemia

hypocalcemia

rds

increased fetal insulin levels = decreased enzymes for surfactant

polycythemia

more rbcs to compensate for low o2 intake = clotting

hyperbilirubinemia

high rbc and clotting = high bilirubin = stressed liver

hypocalcemia s&s

tetany + irritability

gdm risk factors

first degree relative hx of dm / hx of pcos

prior macrosomic, malformed, stillborn infant

obesity

htn

glycosuria

when to do prenatal screening

@ 24 to 28 wks

2 step approach (1st step)

1 hr glucose tolerance test (50g load)

levels > 130-140 = 3 hr test

2 step approach (2nd step)

3 hr glucose tolerance test (100g load)

check levels @

fasting (≥95)

1 hr (≥180)

2 hr (≥155)

3 hr (≥140)

gdm dx if 2 or more levels equal or exceeded

1 step approach

overnight fast w/ 75g load

fasting (≥ 92)

1 hr (≥180)

2 hr (≥153)

gdm dx if = or exceeded

3 p’s

polyuria

polydipsia

polyphasia

s&s of hyperglycemia

3 p’s, rapid breathing, acetone, oliguria, anuria

s&s of hypoglycemia

sweating, disorientation, shakiness, pallor, blurred vision

why to monitor fetal wellbeing thru kick

easy way to determine any fetal stress

ultrasound

@ 18 wks to check fetal growth (iugr vs macrosomia) + gest age

afp

quad screen 16 to 20 wks to detect ntds

fetal activity monitoring

28 wks

nst

32 wks (if non reactive do cst)

biophysical profile contains

fhr accels

fetal breathing

fetal movements

fetal muscle tone

amniotic fluid volume

scores 0 or 2 pts for each

spontaneously abortion / miscarriage

termination of pregnancy anytime before 20 wks

placenta previa

placental placement over or near cervical

ectopic pregnancy

implant outside the uterine cavity

abruptio placentae

premature seperation of placenta

hyperemesis gravidarum

intractable n/v in first half of pregnancy w/ 5 percent pregnancy loss

hyperemesis gravidarum nursing care goals

anti emetics

restore electrolyte balance

maintain adequate nutrition

acupuncture, ginger, lozenges, hypnosis

preterm prom

20 and 37 wks

what to assess for a prom pt

fetus status and check for infection

preterm labor

between 20 and 37 wks gestation

preterm labor contractions

4 contx in 20 min or 8 contx in 60 min

preterm labor srom cervical change

effacement ≥ 80 percent

dilation ≥ 2 cm

before 20 wks of gestation w/ no proteinuria is

chronic htn

before 20 wks of gestation w/ increased proteinura, development of increasing blood pressures

preeclampsia superimposed on chronic htn

after 20 wks gestation w/ proteinuria

preeclampsia

after 20 wks gestation w/no proteinuria

gestational htn

cure for eclampsia

birth of baby

hellp

hemolysis

elevated liver enzymes

low platelets

when does hellp syndrome occur

usually < 36 wks, possibly appear postpartum

complications of hellp

renal failure

pulm. edema

ruptured liver hematoma

disseminated intravasc. coagulation

placenta abruption

iugr, asphyxia, fetal death

tx for hellp

removal of cause > delivery

rh gamma immunoglobulin

prevents antibody formation

rh isoimmunization

rh– mom carries rh+ baby and makes rh+ antibodies which attacks the next rh+ baby

early identification for rh isoimmunization

rh/abo dras @ 1st prenatal visit to measure # of rh+ antibodies

indirect coombs drawn if rh neg

indirect vs direct coombs

direct: from the baby

indirect: mother

antenatal prophylaxis (rhogam)

given @ 28 wks

provides protection for about 12 wks

postpartal rhogam is

mom is rh- and non sensitized + baby is rh+

given within 72 hrs of delivery

transvaginal ultrasound

done w/ empty bladder

identify cervical incompetence prior

typically 1st choice

transabdominal ultrasound

done w/ full bladder

drink 1-1. quarts (drinking 2 hrs)

positive pregnancy test confirms

the presence of beta hcg hormone in the bloodstream

beta hcg amount

doubles every 2 days in the first 10 days of pregnancy

2 levels drawn

48 hrs apart is a great test of viability

when would a quantitative beta hcg be ordered

spontan. abortion

bleeding

how to calculate amniotic fluid index

divide abdoment in four quadrents using umbilicus as center

measure deepest vertical pocket in each pocket

calculate 4 measurements

≤ 5 afi = further assessment or intervention

normal afi

5-24 cm