OB high risk and Hyperemesis

What defines a high-risk pregnancy?

A pregnancy where a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother and/or fetus.

List three factors that can contribute to a high-risk pregnancy.

Obesity, being younger than 18 or older than 35, and small stature.

What is cephalopelvic disproportion?

A condition where the baby's head is too large to fit through the mother's pelvis.

What is dystocia?

Difficult or abnormal labor.

What diagnostic procedure uses high-frequency sound waves to visualize the fetus?

Ultrasound.

At what gestational age can an ultrasound diagnose pregnancy?

As early as 6 weeks gestation.

What can be determined by measuring the biparietal diameter of the fetal skull?

Gestational age and potential intrauterine growth issues.

What does a lack of heartbeat and respiratory movement in an ultrasound indicate?

Fetal death.

What is amniocentesis?

The aspiration of amniotic fluid from the pregnant uterus for examination.

What is a nonstress test (NST)?

A test that measures fetal heart rate acceleration in response to fetal movement.

What does a (-) reactive NST indicate?

Fetal heart rate increases with fetal movement.

What does a (+) nonreactive NST indicate?

Fetal heart rate does not increase with fetal movement.

What is the purpose of a contraction stress test?

To assess placental reserves and fetal response to uterine contractions.

What does a (-) normal contraction stress test indicate?

No fetal heart rate decelerations present with uterine contractions.

What does a (+) abnormal contraction stress test indicate?

50% or more of contractions cause a late deceleration.

List two clinical indications for a contraction stress test.

Diabetes Mellitus and hypertension in pregnancy.

What is the significance of a history of previous stillbirth in pregnancy?

It is a clinical indication for monitoring in high-risk pregnancies.

What is the role of electronic fetal heart rate monitoring?

To monitor uterine contractions and fetal heart rate continuously or intermittently.

What conditions can ultrasound help diagnose in pregnancy?

Placenta previa, hydatidiform mole, and fetal anomalies.

What is the clinical use of amniocentesis at 14-16 weeks?

Chromosomal determination.

What are the risks associated with high-risk pregnancies?

Infections, hemorrhage, and lack of access to continued health care.

What can ultrasound reveal about the placenta?

Its presence, size, location, and potential issues like placenta previa.

What is Hyperemesis Gravidarum?

A condition characterized by severe nausea and vomiting during pregnancy, associated with intrauterine growth restriction.

What are common signs and symptoms of Hyperemesis Gravidarum?

Severe nausea and vomiting, elevated hematocrit, reduced serum levels of sodium, potassium, and chloride, polyneuritis, weight loss, and urine positive for ketones.

What is the initial nursing implication for a patient with Hyperemesis Gravidarum?

Women may need to be hospitalized for about 24 hours to monitor intake and output, blood chemistries, and to restore hydration.

What intravenous fluid is commonly administered for Hyperemesis Gravidarum?

3,000 ml of Ringer's Lactate with added vitamin B1.

What medication may be prescribed to control vomiting in Hyperemesis Gravidarum?

Metoclopramide (Reglan), which is classified as pregnancy class B.

What is Rh Incompatibility?

A condition that occurs when an Rh-negative mother carries an Rh-positive fetus, leading to the formation of maternal antibodies that can destroy fetal red blood cells.

What is Rhₒ (D) immune globulin (RHIG)?

A preparation of passive antibodies against the Rh factor administered to the mother at 28 weeks of pregnancy and again within 72 hours after delivery of an Rh-positive infant.

What are the nursing implications for managing Rh Incompatibility?

Instruct the client about Rh incompatibility, arrange for antibody titers at the first prenatal visit, and monitor titers every 2 weeks if elevated.

What is Pregnancy-Induced Hypertension (PIH)?

A systemic disorder affecting almost all organs during pregnancy, characterized by high blood pressure and potential complications for both mother and fetus.

What are the symptoms of PIH?

Symptoms include peripheral vascular spasm, increased blood pressure, decreased glomerular filtration rate, proteinuria, and edema.

What are the classifications of PIH?

Gestational Hypertension, Mild Preeclampsia, Severe Preeclampsia, and Eclampsia.

What defines Mild Preeclampsia?

Blood pressure of 140/90 mmHg with proteinuria of 1+ to 2+, weight gain more than 2 lb/week in the second trimester, and mild edema.

What defines Severe Preeclampsia?

Blood pressure of 160/110 mmHg, proteinuria of 3+ to 4+, oliguria, and symptoms such as cerebral disturbances and extensive peripheral edema.

What is Eclampsia?

A severe form of PIH characterized by blood pressure greater than 160/110 mmHg and tonic-clonic seizures.

What management steps are taken for Mild Preeclampsia?

Instruct follow-up visits every 2 weeks and inform the physician if symptoms worsen.

What are the management steps for Severe Preeclampsia?

Hospitalization, monitoring blood pressure, obtaining blood studies, and preparing for possible amniocentesis or induction of labor.

What dietary recommendations are given for clients with PIH?

A high-protein, moderate sodium diet is recommended.

What medication is administered to reduce blood pressure in PIH?

Hydralazine (Apresoline).

What is the purpose of magnesium sulfate in the management of Eclampsia?

To prevent seizures and manage hypertension.

What are the signs of impending seizure in Eclampsia?

Monitor for changes in consciousness and assess for signs of abruptio placenta.

What is the significance of obtaining cord blood samples after delivery in Rh Incompatibility?

To assess the baby's blood type and check for hemolysis.

What is the role of amniocentesis in Rh Incompatibility management?

To monitor fetal well-being and assess for potential complications.

What is the importance of monitoring urine output in patients receiving magnesium sulfate?

To ensure it is above 25 to 30 ml/hr to prevent toxicity.

What should be kept at the bedside during magnesium sulfate therapy?

A solution of 10 ml of 10% calcium gluconate as an antidote.

What is the first step in managing a patient with Eclampsia?

Monitor for signs of impending seizure and administer oxygen.

What is the expected outcome if the spectrophotometer reading of amniotic fluid is low?

The fetus is likely in no distress.

What does a high spectrophotometer reading indicate?

The fetus is in imminent danger, necessitating immediate delivery or intrauterine transfusion.