Ectopic Pregnancy

ATI OB Antepartum Nursing Care Flashcards

Cards Return to Set Details Term Abstinence Definition 1. Natural-Family Planning Method2. Abstaining from having sexual intercourse eliminates the possibility of sperm entering a woman's vagina3. Instructions: Refrain from sexual intercourse; can be associated with saying "no" but can say "yes" to other gratifying sexual activities: affectionate touching, communication, holding hands, kissing, massage, oral/manual stimulation4. Advantages: most effective, abstinence during fertile period (rhythm method) can also be used but requires knowledge/awareness, can eliminate STDs if no genitalia contact5. Disadvantages: Requires self control6. Risks/possible complications/contraindications: no risk if complete abstinence Term Coitus Interruptus (Withdrawal) Definition 1. Natural-Family Planning Methods2. Man withdraws penis from vagina prior to ejaculation3. Instructions: be aware of fluids leaving the penis4. Advantages: Possible choice for monogamous couples with no other option (opposed to birth control because of religion)5. Disadvantages: Most ineffective method, no protection against STDs6. Risk/possible complications/contraindications: Depends on man's ability to control ejaculation (adolescent boys frequently do not have this), leakage of fluid that contains spermatozoa prior to ejaculation can be deposited in vagina, risk of pregnancy Term Calendar Method (Rhythm Method) Definition 1. Natural-Family Planning Method2. woman records her menstrual cycle by calculating fertile days based on assumption that ovulation occurs about 14 days before onset on next menstrual cycle.3. Instructions: accurately record the number of days in each cycle counting from first day of menses for 6 cycles, start of fertile period is longest cycle -18 (26 days-18 = 8th day), end of fertile period is longest cycle -11 days (30 days-11=19th day), avoid intercourse during that time (8th-19th day)4. Advantages: Most useful when combined with basal body temp or cervical mucus method, inexpensive5. Disadvantages: not a very reliable technique, requires accurate record keeping, requires compliance from both partners in regards to abstinence6. Risks/possible complications/contraindications: various factors can affect and change time of ovulation and cause unpredictable menstrual cycles, risk of pregnancy Term Basal Body Temp (BBT) Definition 1. Natural-Family Planning Method2. Temp will decrease prior to ovulation (can be used to facilitate conception or be used as a natural contraceptive)3. Instructions: woman is instructed to measure oral temp prior to getting out of bed each morning to monitor ovulation4. Advantages: inexpensive, convenient, no side effects5. Disadvantages: reliability can be influenced that can cause inaccurate interpretation (stress, fatigue, illness, alcohol, warmth or coolness of sleeping environment6. Risks/possible complications, contraindications: risk of pregnancy Term Billings Method (Cervical Mucus method) Definition 1. Natural-Family Planning Method2. Fertility awareness based on ovulation; after ovulation cervical mucus becomes thin and flexible. Ability for mucus to stretch between fingers is greatest during ovulation (spinnbarkeit sign)3. Instructions: engage in good hang hygiene before and after, begin examining last day of menstrual cycle, obtained from vaginal introitus, do not douche4. Advantages: woman can begin to recognize her mucus characteristics at ovulation and self-evaluation can be very accurate, self-evaluation can be diagnostically helpful in determining the start of ovulation while breastfeeding, planning pregnancy, and start of menopause5. Disadvantages: may be uncomfortable touching genitals and mucus 6. Risks/possible complications/contraindications: risk of pregnancy Term Condoms Definition 1. barrier method2. instructions: place condom on erect penis, leave empty space for sperm reservoir, following ejaculation hold rim and withdraw to prevent spillage, may be used in conjunction with spermicidal gel or cream3. Advantages: may be used to protect STDs 4. disadvantages: high rate of noncompliance, may reduce spontaneity of intercourse, penis must be erect to apply condom, if penis is withdrawn while still erect, can interfere with sexual intercourse6. Risks/possible complications/contraindications: condoms can rupture/leak, have a one-time usage, cannot only be used by people allergic to latex, only water-soluble lubes can be used Term Diaphragm and Spermicide Definition 1. barrier method2. dome-shaped cup with a flexible rim made of latex or rubber that fits snugly over the cervix with the spermicidal cream or gel placed into the dome and around the rim3. Instructions: female should be properly fitted, must be refitted every 2 years/15 lb weight change/full-term pregnancy/second-term abortion, requires proper insertion/removal with spermicidal jelly or cream on cervical side and around rim, in place 6 hrs post coitus, must spermicide reapplied each time, empty bladder prior to insertion4. Advantages: eliminates surgery and gives woman more control5. Disadvantages: inconvenient, interfere with spontaneity, require reapplication with spermicidal gel/cream/foam, requires prescription and visit to provider, must be inserted correctly6. Risks/possible complications/contraindications: not for those who have hx of TSS or frequent UTIs, increased risk of TSS, cannot be worn by those allergic to latex Term Combined oral contraceptives Definition 1. hormonal method2. contains estrogen (suppress ovulation) and progestin (thicken cervical mucus to block semen), also alters uterine decidua to prevent implantation3. Instructions: requires prescription and follow-up appt., med requires consistent and proper usage, observe for side effects (chest pain, SOB, leg pain from poss. clot, headache, eye problems, HTN). Miss a dose? Take missed pill ASAP, if 2 or 3 are missed, follow instructions and use alternate method.4. Advantages: highly effective, can alleviate dysmenorrhea by decreasing menstrual flow and menstrual cramps, reduce acne5. Disadvantages: no STD protection, can inc. risk of thromboses, breast tenderness, scant/missed menstruation, stroke, nausea, headaches, hormone-dependent cancers, teratongenic; exacerbates conditions affected by fluid retention (migraine, epilepsy, asthma, kidney, heart disease)6. Risks/possible complications/contraindications: not advised to take if hx of blood clots, cerebrovascular accident, cardiac problems, breast/estrogen cancers, pregnancy, or smoking if over 35; effectiveness can decrease if taking antibiotics and anticonvulsants Term Minipill Definition 1. Hormonal method2. Oral progestins that provide same action as combined oral contraceptives3. Instructions: take pill at same time daily to ensure effectiveness secondary to a low dose of progestin, cannot miss a pill, may need another form of birth control during 1st month4. Advantages: fewer side effects than combined, safe during breastfeeding5. Disadvantages: less effective in suppressing ovulation than combined, increases occurrences of ovarian cyst, no STD protection, frequent breakthrough/irregular vaginal bleeding and lowered libido, increases appetite6. Risks/possible complications/contraindications: antibiotics and anticonvulsants decrease effectiveness Term Emergency Oral Contraceptive Definition 1. Hormonal Method2. morning after pill that prevents fertilization from taking place3. Instructions: taken within 72 hrs of unprotected coitus, OTC anti-emetic recommended 1 hr prior to counteract S/E of nausea, no menstruation in 21 days-recommend pregnancy test, provide client with counseling about contraception and risky sexual behaviors, considered form of "emergency birth control"4. Advantages: not taken on regular basis, can be obtained w/put prescription if 17+5. Disadvantages: nausea, heavier than normal menstrual bleeding, lower abd pain, fatigue, headache; no long-term contraception, does not terminate est. pregnancy; no STD protection6. Risks/possible complications/contraindications: do not take if pregnant or undiagnosed abnormal vaginal bleeding, if menstruation does not start within 1 wk or normal time, might be pregnant Term Transdermal Contraceptive Patch Definition 1. Hormonal method2. contains norelgestromin (progesterone) and ethinyl estradiol delivered at cont. level thru subQ tissue3. Instructions: apply patch to dry skin overlying subQ tissue of buttock, abd, upper arm, or torso (excluding breast area); replace once a wk; applied same day a week for 3 wks, no application on 4th wk.4. Advantages: maintins consistent blood levels of hormone, avoids liver metabolism of med since not absorbed in GI tract, decreases risk of forgetting daily pill.5. Disadvantages: no STD protection, same side effects as oral contraceptives, skin rxn may occur6. Risks/possible complications/contraindications: same as oral contraceptives, avoid applying patch to skin rashes/lesions Term Injectable Progestins (Depo-Provera) Definition 1. Hormonal method2. IM injection given every 11-13 wks3. Instructions: start of injections should be during first 5 days of period and every 11-13 wks thereafter, advise to keep follow-up instructions, should maintain an adequate intake of calcium and vit. D4. Advantages: very effective and only requires 4 injections per year, does not impair lactation5. Disadvantages: can prolong amenorrhea, irregular/unpredictable bleeding or spotting, inc. risk of thromboembolism, dec. bone mineral density (loss of Ca), no STD protection, should only be used for more than 2 years if other methods are inadequate6. Risks/possible complications/contraindications: avoid massaging injection site which accelerates absorption Term Contraceptive Vaginal Ring (NuvaRing) Definition 1. hormonal method2. contains etonogestrel and ethinyl estradiol that is delivered at cont. levels vaginally3. instructions: insert ring vaginally, replace after 3 wks and new ring within 7 days, insertion on same day montly4. advantages: does not have to be fitted, dec. risk of forgetting to take pill5. disadvantages: no STD protection, same side effects as oral contraceptives, some report discomfort during intercourse6. risks/possible complications/contraindications: blood clots, HTN, stroke, Heart attack, vaginal irritation, inc. vaginal secretions, headache, weight gain, nausea Term Implantable Progestin Etonogestrel (Implanon) Definition 1. hormonal method2. requires minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on inner side of the upper aspect of the arm3. instructions: avoid trauma to area of implantation4. advantages: effective cont. contraception for 3 years, reversible, con be used by mothers who are breastfeeding 4 wks postpartum5. disadvantages: etonogestrel can cause irregular menstrual bleeding and does not protect against STDs, most common side effect is irregular and unpredictable menstruation, headache6. Risks/possible complications/contraindications: Increased risk of ectopic pregnancy if pregnancy occurs Term Intrauterine device (IUD) Definition 1. hormonal method2. chemically active t-shaped device that is inserted thru cervix and placed in uterus by primary care provider; releases chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization3. Instructions: device must be monitored monthly by client after period, ro assure presence of small string that hangs from device to rule out expulsion or migration4. Advantages: maintain effectiveness for 1-10 years, can be reversed, does not interfere with spontaneity, safe for breastfeeding mothers, 99% effective in preventing pregnancy5. disadvantages: can increase risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy; should report late or abnormal spotting or bleedings, abd pain/pain with intercours, abdnormal or foul smelling vaginal discharge, fever, chills, change in string length or missing; no STD protection6. Risks/possible complications/contraindications: not for women who have not had children or are not in monogamous relationship, may cause irregular menstrual bleeding, risk of bacterial vaginosis, uterine perforation, uterine expulsion, must be removed in event of pregnancy Term Essure Definition 1. transcervical sterialization2. insertion of small flexible agents thru vagina into cervix and fallopian tubes that results in scar tissue in tubes preventing conception; exam after 3 months to ensure tube blockage3. instructions: normal activities may be resumed by most clients within 1 day 4. advantages: quick procedure w/out general anesthesia, nonhormonal, 99.8% effective, rapid return to normal ADLs5. disadvantages: not reversible, not for postpartum client, delay in effectiveness of 3 months, changes in menstrual patterns6. risks/possible complications/contraindications: perforation can occur, unwanted pregnancy if have unprotected intercourse in first 3 months, inc. risk of ectopic pregnancy Term Female sterilization (bilateral tubal ligation salpingectomy) Definition 1. surgical method2. surgical procedure consisting of severance and/or burning or blocking of fallopian tubes3. procedure: cutting/burning/blocking of fallopian tubes to prevent the ovum from being fertilized by the sperm4. advantages: permanent, unaffected sexual function5. disadvantages: surgical procedure carrying risks related to anesthesia complications, infection, hemorrhage, or trauma; considered irreversible6. risks/possible complications/contraindication: risk of ectopic pregnancy if pregnancy occurs Term Male sterilization (Vasectomy) Definition 1. surgical method2. surgical procedure consisting of ligation and severance of the vas deferens3. procedure: cutting of vas deferens, not effective for 20 ejaculations or 1 wk to several months to allow all sperm to exit vas deferens. Complete male infertility4. Instruction: Scrotal support and moderate activity for a couple of days to reduce discomfort, sterility is delayed until all remaining sperm ejaculated (20 ejaculations), alternative form must be used until then, follow up appt. for sperm count5. Advantages: permanent, procedure is short, safe, simple; no impaired sexual function6. Disadvantages: requires surgery, considered irreversible7. risks/possible complications/contraindications: rare but may include bleeding, infection, and anesthesia rxn. Term Infertility Definition inability to conceive despite engaging in unprotected sexual intercourse for a period of at least 12 monthsCommon factors: decreased sperm prod., endometriosis, ovulation disorders, and tubal occlusions Term Infertility Assessments Definition 1. Age: older than 35 years2. Duration of infertility: more than 1 year of coitus w/out contraceptives3. Med hx: atypical secondary sexual characteristic such as abnormal body fat distribution or hair growth, which is indicative of an endocrine disorder4. Surgical hx: particularly, pelvic and abd. procedures5. obstetric hx: past episodes of spontaneous abortions6. gyno hx: abnormal uterine contours or any hx of disorders that may contribute to the formation of scar tissue that can cause blockage of ovum or sperm7. Sexual hx: intercourse freq., # partners across lifespan, any hx of STDs8. Occupational/environmental exposure risk assessment: exposure to hazardous teratogenic materials in the home or at a place of employment9. Weight: women under or overweight Term Infertility Procedures Definition 1. Semen collection2. Pelvic exam3. Ultrasonography4. Hysterosalpingography5. Hysteroscopy6. Laparoscopy Term Infertility Procedure: Semen collection Definition 1. Semen is sterilely collected then evaluated and analyzed2. 40% of couples who are infertile and unable to conceive is due to male infertility3. Preferred starting point in evaluating couple b/c costs less and is less invasive Term Infertility Procedure: Pelvic exam Definition 1. assesses for for uterine or vaginal anomalies.2. Nurse positions client and has equipment and supplies ready Term Infertility Procedure: Ultrasonography Definition 1. Transvaginal or abdominal ultrasound procedure performed to visualize female reproductive organs Term Infertility Procedure: Hysterosalpingography Definition 1. outpatient Radiological procedure where dye is used to assess patency of fallopian tubes.2. Nurse should obtain hx and allergies to iodine and seafood Term Infertility Procedure: Hysteroscopy Definition 1. Radiographic procedure where uterus is examined for signs of defect, distortion, or scar tissue that may impair successful impregnation Term Infertility Procedure: Laparoscopy Definition 1. Procedure where gas insufflation is used to observe internal organs2. May cause postprocedural pain3. General anesthesia is required Term Nursing interventions for Infertility Definition 1. Encourage couples to express and discuss their feelings2. Monitor for side effects associated with meds to treat female and male infertility3. advise the use of meds to treat female infertility may increase the risk of multiple births by more than 25%4. provide info regarding assisted reproductive therapies5. Make referrals to support groups Term Genetic Counseling Definition 1. Recommended if family hx of birth defects or if maternal age is 352. Identify clients who may need it and make referrals3. Prenatal assessment of genetic disorders can post potential risks to the fetus4. Provide and clarify information Term Nursing Intervention for Genetic Counseling Definition 1. Assist in construction of family med hx of several generations2. Provide emotional support3. Make referrals to support groups Term Presumptive signs of pregnancy Definition Changes that are experienced by the woman that make her think she may be pregnant. Changes may be subjective symptoms or objective signs.1. Amenorrhea2. Fatigue3. Nausea and vomiting4. Urinary frequency5. Breast changes (darkened areola, enlarged Montgomery's tubules)6. Quickening (slight fluttering movements of the fetus felt by a woman, usually betw. 16-20 wks)7. Uterine enlargement8. Linea nigra9. Chloasma (mask of pregnancy)10. Striae gravidarum Term Probable signs of pregnancy Definition Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus)1. Abdominal enlargement related to changes in uterine size, shape, and position2. cervical changes3. Hegar's sign (softening and compressibility of lower uterus)4. Chadwick's sign (deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area)5. Goodell's sign (softening of cervical tip)6. Ballottement (rebound of unengaged fetus)7. Braxton Hicks contractions (false contractions, painless, irregular, and usually relieved by walking)8. Positive pregnancy test9. Fetal outline felt by examiner Term Positive signs of pregnancy Definition Signs that can only be explained by pregnancy1. Fetal heart sounds2. Visualization of fetus by ultrasound3. Fetal movement palpated by an experienced examiner Term Verifying Possible Pregnancy Using Serum and Urine Pregnancy Testing Definition 1. Serum and urine tests provide an accurate assessment for the presence of human chorionic gonadotropin (hCG).2. hCG can be detected 6-11 days in serum and 26 days in urine after conception following implantation3. Prod. of hCG begins with implantation, peaks at about 60-70 days of gestation and then declines until about 80 days where it then gradually increases until term4. Higher levels of hCG may indicate multifetal, ectopic pregnancy or hydatidiform mole (gestational trophoblastic disease) or a genetic abnormality 5. Lower levels of hCG may suggest a miscarriage or ectopic pregnancy6. Some medications (anticonvulsants, diuretics, tranquilizers) can cause false-positive or false-negative pregnancy results7. Urine samples should be first-voided morning specimens Term Calculating Delivery Date Definition 1. Nagele's rule: take 1st day of woman's last menstrual cycle, subtract 3 months, and then add 7 days and 1 year2. McDonald's method: measure uterine fundal height in cm from the symphysis pubis to the top of the uterine fundus (betw. 18-30 wks). Age is equal to fundal height Term Gravidity Definition Number of pregnancies1. Nulligravida: never pregnant2. Primigravida: in 1st pregnancy3. Multigravida: 2+ pregnancies Term Parity Definition # pregnancies in which fetus or fetuses reach viability (20-24 wks); does not matter if fetus is born alive1. Nullipara: no viable pregnancy2. Primipara: completed 1 pregnancy to viability3. Multipara: 2+ pregnancies to viability Term GTPAL Definition GravityTerm Births (38+ wks)Preterm Births (20-37 wks)Abortions/Miscarriages (prior to viability)Living Children Term GPA Definition GravityPara (more than twenty weeksAbortion (less than 20 wks)If pregnant: (P+A)-1=GIf not pregnant P+A=G Term Physiological Status of Pregnant Client Definition Reproductive: uterus will inc. in size and change shape and position. Ovulation and menses ceaseCardiovascular: CO and blood volume increase (45-50% at term) to meet the greater metabolic needs. HR increasesRespiratory: maternal O2 needs increase. During last trimester, size of chest may enlarge, allowing for lung expansion as uterus pushes upward. Increased respiratory rate and decreased total lung capacityMusculoskeletal: body alterations and weight increase necessitate an adjustment in posture. Pelvic joints relaxGI: N/V may occur b/c of hormonal changes and/or increase of pressure in abd. cavity as stomach and intestines are displaced within abd. Constipation may occur due to increased transit time of food through GI system and thus, increased h2o absorption.Renal: filtration rate increases during pregnancy secondary to influence of pregnancy hormones and increase in blood volume and metabolic demands. Amt of urine produced remains the same. Urinary frequency is common during pregnancyEndocrine: placenta becomes an endocrine organ that produces large amts. of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins. Hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery. Term Body Image Changes Definition 1. Pregnant woman requires support from family as her body changes2. First trimester: physiological changes not very noticeable, many women anxiously wait for when pregnancy will be more noticeable.3. Rapid physical changes during 2nd trimester. Most obvious in abdomen and breast enlargement. Skin changes (stretch marks and hyperpigmentation of face-chloasma). May find herself losing balance and feeling back/leg discomfort and fatigue.4. All changes may lead to negative body image; may make statements of resentment towards pregnancy and express desires for it to be over. Term Expected Vital Signs Definition 1. BP remain in prepregnancy range during 1st trimester then decreases 5-10 mmHg during 2nd then after 20 wks back to prepregnancy baseline2. Position of woman affects her BP, supine may lower it because of the pressure on the vena cava3. Pulse increases 10-15/min around 20 wks and remains elevated4. Respirations increase by 1-2/min; attributed to elevation of diaphragm by as much as 4 cm and changes to chest wall to facilitate increased maternal O2 demands5. some SOB Term Supine Hypotensive Syndrome or Supine Vena Cava Syndrome Definition caused from when the mother is in supine and the weight of the baby on the vena cava causes a decline in BP.Signs/Symptoms: dizziness, lightheadedness, pale/clammy skin. Encourage maternal positioning: left-lateral side, semi-fowler's position Term Expected Physical Assessment Findings Definition 1. Fetal Heart Tones heard at normal baseline rate of 110-160/min with reassuring FHR acceleration noted, which indicates an intact fetal CNS2. Heart will change in size and shape with resulting cardiac hypertrophy to accommodate increased blood volume and increased cardiac output. 3. Altered heart sounds: more distinguishable splitting of S1 and S2 with S3 heard more easily heard following 20 wks. Murmurs may also be ausc. Heart size and shape will return to normal shortly after delivery.4. Uterine size changes from uterine weight of 50-1000g by 36 wks, top of uterus and fundus will reach xiphoid process; pregnant woman will experience SOB as uterus pushes against diaphragm5. Cervix becomes a purpleish-blue color that extends into vagina and labia. Known as Chadwick's wign. Markedly softens in consistency (Goodell's sign)6. Breasts increase in size and areolas darken b/c of hormones7. Chloasma: mask of pregnancy (pigmentation increases on face)8. Linea nigra: dark line of pigmentation from umbilicus extending to pubic area9. Striae gravidarum: stretch marks most notably found on abd. and thighs Term Nursing interventions for pregnant client Definition 1. offer encouragement in sharing feelings; create judgment free zone2. discuss expected physiological changes and postpartum timeline to return to prepregnancy state3. assist in goal making for self-care and newborn care postpartum4. if body image starts to have negative impact on pregnancy, refer to counseling5. provide edu. on expected physiological and psychological changes6. encourage client to keep all follow-up appts and contact immediately if any bleeding, leakage of fluid, or contractions at any point. Term Prenatal Care Overview Definition dramatically reduces infant and maternal morbidity and mortality rates by early detection and treatment of potential problems; majority of birth defects occur betw. 2-8 weeks of gestation Term Nursing Assessments in Prenatal care Definition 1. Reproductive and obstetrical hx (contraception use, gyno diagnoses, OB difficulties)2. Medical hx, including immune status (rubella, hep B)3. Family hx (i.e. genetic disorders)4. Any recent or current illnesses or infections5. Current meds, substance abuse, alcohol consumption. (be nonjudgmental!)6. Psychosocial hx7. Any hazardous environmental exposures, current work conditions8. Current exercise and diet habits9. Client's goals for birthing process as well as various birthing methods (Lamaze, pain control) Term Prenatal Care Definition Begins with initial assessmentIf uneventful pregnancy, have visit every month for 7 months, every 2 wks during 8th month, and every wk during last month Term Initial prenatal visit Definition Determine estimated date of delivery based on last menstrual period. Vaginal ultrasound may be done to establish estimated date of deliveryObtain medical and nursing hx: past med health, family hx, social supports, review of systems (for risk factors), past OB hxPhysical exam to include baseline weight, VS, pelvic exam. Empty bladder prior to examInitial lab work: blood type, Rh factor, HIV status, hep B, venereal disease research lab, rubella status, urinalysis, Papanicolaou test Term Ongoing prenatal visits Definition monitor weight, BP, urine for glucose/protein/leukocytes, edemamonitor fetal development1. FHR heard by doppler at 10-12 wks or ultrasound steth at 16-20 wks. Listen at midline right about symphysis pubis2. Measure fundal height after 12 wks, between 18-30 fundal height in cm = weeks of gestation. Empty bladder then measure from level of symphysis pubis to upper border of fundus3. Assess for fetal movement betw. 16-20 wks.Provide edu. for self care and ways to manage common discomforts (N/V, fatigue, backache, varicosites, heartburn, activity, sexuality)Pelvic exam to determine status of reproductive organs and birth canal to determine if baby will be able to pass thru.Assess for costovertebral angle tenderness, indicative of renal infection Term Routine Lab Test in Prenatal CareBlood type, Rh-factor, presence of irregular antibodies Definition Determines risk for maternal-fetal blood incompatibility (erythroblastosis fetalis) or neonatal hyperbilirubinemia. If mom is Rh-negative and not sensitized, indirect Coombs' test will be repeated at 24-28 wks Term Routine Lab Test in Prenatal CareCBC with differential, Hgb, Hct Definition Detects infection and anemia Term Routine Lab Test in Prenatal CareHgb electrophoresis Definition Identifies hemoglobinopathies (sickle cell anemia and thalassemia) Term Routine Lab Test in Prenatal CareUA with microscopic exam of pH, specific gravity, color, sediment, protein, glucose, albumin, RBCs, WBCs, casts, acetone, and human chorionic gonadotropin Definition Identifies diabetes mellitus, gestational HTN, renal disease, and infection Term Routine Lab Test in Prenatal CareOne-hour glucose tolerance Definition oral ingestion or IV admin of concentrated glucose with venous sample taken 1 hr later (no fasting necessary)identifies hematuria; done at initial visit for at-risk clients, and at 24-28 wks for all pregnant womenresult of >140 mg/dL requires follow up Term Routine Lab Test in Prenatal CareThree-hour glucose tolerance Definition Fasting overnight prior to oral ingestion or IV admin of concentrated glucose witha a venous sample taken 1, 2, 3 hours laterused in clients with elevated 1-hr glucose test as a screening tool for diabetes mellitus. Diagnosis of gestational diabetes requires two elevated blood-glucose readings Term Routine Lab Test in Prenatal CarePapanicolaou (PAP) test Definition Screens for cervical cancer, herpes simplex type 2, and/or human papillomavirus Term Routine Lab Test in Prenatal CareVaginal/Cervical culture Definition Detects streptococcus B-hemolytic, Group B (routinely obtained at 35-37 weeks), bacterial vaginosis, or STDs (gonorrhea and Chlamydia Term Routine Lab Test in Prenatal CareRubella Titer Definition Determines immunity to rubella Term Routine Lab Test in Prenatal CarePPD (TB screening), Definition Chest screening after 20 wks with positive purified protein derivativeIdentifies exposure to TB Term Routine Lab Test in Prenatal CareHep B screen Definition Identifies carriers of hep B Term Routine Lab Test in Prenatal CareVenereal disease research lab Definition Syphilis screening mandated by law Term Routine Lab Test in Prenatal CareHIV Definition Detects HIV infections (recommended for all pregnancies) Term Routine Lab Test in Prenatal CareToxoplasmosis, other infections, rubella, cytomegalovirus, herpes virus (TORCH) screening when indicated Definition Screening for a group of infections capable of crossing the placenta and adversely affecting fetal development Term Materal serum alpha-fetoprotein (MSAFP) Definition Screening occurs betw. 15-22 wks Used to rule out Down's, neural tube defects Term Prenatal education: Health Promotion Definition Avoid all OTC meds, supplements, and prescription meds unless OB okays it.No alcohol (birth defects) or tobacco (low birth weight) or substance abuseEncourage flu vaccine, treating infections, obtaining genetic testing/counselingDetermine maternal exposure to hazardous materialsModerate exercise of 30 min (walking, swimming) daily; no hot tubs or saunas; drink 2-3 L of water/fluids daily Term Prenatal education: Preparation for Pregnancy and Birth Definition Provide anticipatory teaching regarding: physical/emotional changes and interventions to provide relief; danger signs/symptoms to report; various birthing optionsFirst trimester: physical/psychosocial changes, common discomforts and how to provide relief, lifestyle and STDs, possible complications and what to report, fetal growth and development, prenatal exercise, expected lab testingSecond Trimester: benefits of breastfeeding, common discomforts and relief measures, lifestyle, fetal movement, complications, childbirth prepThird trimester: childbirth prep (classes, breathing, pain management, signs/symptoms of preterm labor and labor, labor process, infant care, postpartum care), fetal movement/kick (less than 3/hr or none in 12 hr requires eval), diagnostic test for fetal well-being (nonstress test, biophysical profile, ultrasound, contraction stress test) Term Common discomforts of pregnancy Definition 1. N/V in first trimester; try crackers or toast before getting out of bed; avoid empty stomach, greasy/spicy/gas-forming foods2. Breast tenderness3. Urinary frequency: empty bladder frequently, decrease fluid intake before bedtime, use perineal pads, practice Kegals4. UTIs: decrease by encouraging client to wipe front to back, avoid bubble baths, wearing cotton underpants, avoid tight-fitting pants, and consume water; urinate pre/post sex, do not retain urine, notify provider if malodorous or contains blood/pus5. Fatigue during 1st and 3rd trimesters; engage in frequent rest periods6. Heartburn during 2nd and 3rd b/c of stomach displacement from uterus and slowing of digestion from hormones; eat small frequent meals, sit for 30 min post meal, OTC antacids, do not get too empty or full7. Constipation during 2nd and 3rd; drink plenty fluids, high fiber, exercise regularly8. Hemmorrhoids during 2nd and 3rd; warm sitz bath, witch hazel pads and topical ointments9. Backaches during 2nd-3rd; exercise regularly, perform pelvic tilt exercises, proper body mechanics10. SOB/dyspnea b/c diaphragm is elevated; maintain good posture, sleep with extra pillows and contact if symptoms worsen11. Leg cramps during 3rd b/c of compression of nerves and vessels by uterus; massage and apply heat 12. Varicose veins and lower extremity edema during 2nd-3rd; rest with legs elevated, avoid constricting clothing, wear support hose, do not cross legs, sleep in left lateral, change positions often, frequent walking13. Gingivitis, nasal stuffiness and epistaxis from elevated estrogen levels; gently brush teeth, use humidifier, use NS nose drops/spray14. Braxton Hicks contractions; change in position or walking may make them subside. 15. Supine hypotension (disc. earlier) Term Danger Signs during Pregnancy Definition 1. Gush of fluid from vagina prior to 37 wks2. Vaginal bleeding3. abd pain4. changes in fetal activity5. persistent vomiting6. severe headaches7. elevated temperature8. dysuria9. blurred vision10. edema of face/hands11. epigastric pain12. concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased thirst and urination, headache13. concurrent occurrence of clammy pale skin, weakness, tremors, irritability and lightheadedness Term Dick-Read Birthing Method Definition "Childbirth without fear", controlled breathing and conscious/progressive relaxation of different muscle groups throughout bodyinstructs a woman to relax during contractions and keep all muscles except uterus relaxed Term Lamaze Birthing Method Definition Mission is to promote a healthy, natural, and safe approach to pregnancy, childbirth and early parenting by advocating and working with health care providers, parents and professional childbirth educators Term Leboyer birthing method Definition method is "birth without violence", environmental variables imp. to ease transition of fetus into world. Water births are based on this methoddim lights, soft voices, warm birthing room Term Bradley Definition stresses partner's involvement as birthing coach.Emphasizes increasing self awareness and teaching woman to deal with stress of labor by tuning into her own body; encouraged to trust her body through the use of natural breathing, relaxation, nutrition, exercise, and edu. throughout pregnancy Term Recommended weight gain during pregnancy Definition 25-35 lbs total3-4 lbs during 1st 1 lb per wk during last 2 Term Nutrition plan of care for pregnant client Definition Outcome: consume recommended dietary allowances/nutrients during pregnancyInterventions: assess dietary journal on next visit, provide educational materials regarding nutritional benefits, weigh client and monitor for signs of inadequate weight gain, make referral if neededEvaluation: adequate weight gain? client compliant with nursing plan of care? Term Caloric Increases during pregnancy Definition 1. Increase of 340/day during 2nd trimester2. Increase of 452/day during 3rd trimester3. Breastfeeding = 330/day during first 6 mo., additional 400/day during second 6 mo. Term Protein and folic acid intake during pregnancy Definition Folic acid crucial in neurological development and prevention of neural tube defectsFoods high in folic acid = leafy vegetables, dried peans/beans, seeds, OJ, breads, cerals, other grains fortified with folic acid600 mcg of folic acid during pregnancy500 mcg of folic acid during lactation Term Iron intake during pregnancy Definition Supplements often given to facilitate increase of maternal RBC mass.Best absorbed betw. meals and when given with good source of vitamin C; milk/caffeine interfere with absorptionGood sources: beef liver, red meats, fish, poultry, dried peas/beans, fortified cereals/breadsMay cause constipations (give stool softener) Term Calcium intake during pregnancy Definition involved in bone and teeth formationGood sources: milk, calcium fortified soy milk, fortified OJ, legumes, dark green leafy vegetables1,000 mg/day for pregnant and nonpregnant over 191300 mg/day for those under 19 Term Fluids, caffeine, alcohol consumption during pregnancy Definition 2-3L of fluids daily: water, fruit juice, milk300 mg/day max of caffeineNo alcohol consumption Term Risk factors to ensuring adequate nutrition during pregnancy Definition 1. adolescents who may have poor nutritional habits2. vegetarians who have low protein, Ca, Zn, Fe, vit. B123. N/V4. anemia5. Eating disorders: anorexia, bulmia6. Pica appetite disorder7. Excessive weight gain8. Financially unable to purchase/access food (recommend WIC) Term Dietary complications during pregnancy Definition 1. Nausea: eat dry crackers or toast; avoid alcohol/caffeine/fats/spices; avoid drinking fluids with meals2. constipation: increase fluid consumption and include extra fiber3. Maternal phenylketonuria (PKU): maternal genetic disease in which high levels of phenylaline pose danger to fetus. Resume PKU diet 3 mo. prior to pregnancy and throughout pregnancy; avoid fish/poultry/meat/eggs/nuts/dairy; monitor fetal blood levels to avoid complications such as mental retardation and behavioral probs. Term Lactating woman's nutritional plan Definition Instructions to:1. Increase caloric intake2. increase oral fluids3 increase protein intake4. avoid alcohol and caffeine5. avoid food substances that do not agree with newborn6. adhere to recommended, well-balanced diet7. take Ca supplements if needed Term Ultrasound Definition lasts approx. 20 min, consists of high-frequency sound waves to visualize internal organs/tissues by producing real time 3D image of fetus and maternal structuresAllows for early diagnosis of complications to decrease neonate and maternal morbidity Term External abdominal ultrasound Definition Noninvasive, painless, safe procedure after 1st trimester. Ultrasound transducer is moved over abdomen to obtain image. Term Internal transvaginal ultrasound Definition Invasive procedure where probe is inserted vaginally and allows for more accurate evaluation; does not require full bladderused in 3rd trimester in conjunction with abd. scan to evaluate for preterm laboresp. useful for obese and in 1st trimester to detect ectopic pregnancy, identify abnormalities, help est. gestational age Term Doppler ultrasound blood flow analysis Definition external ultrasound to non invasively study maternal-fetal blood flow by measuring velocity by which RBCs are traveling in uterine and fetal vesselsuseful in fetal intrauterine growth restriction (IUGR), identifying poor placental perfusion, as adjunct in pregnancies at risk because of HTN, diabetes mellitus, multiple fetuses, or preterm labor Term Indications for Ultrasound Definition Potential diagnosis for:1. confirming pregnancy2. confirming gestational age via biparietal diameter3. identifying multifetal pregnancy4. site of fetal implantation (uterine or ecotopic)5. assessing fetal growth and development6. assessing maternal structure7. confirming fetal viability or death8. ruling out or verifying fetal abnormalities9. locating site of placental abnormalities10. locating site of placental attachment11. determining amniotic fluid volume12. fetal movement observation (FHR, breathing, activity)13. placental grading (evaluating placental maturation)14. adjunct for other procedures (i.e. amniocentesis)Clinical presentation1. vaginal bleeding evaluation2. questionable fundal height in relationship to gestational wk3. reports decreased fetal movements4. preterm labor5. questionable rupture of membranes Term Nursing action in ultrasound Definition 1. Explain procedure and lack of risk2. Advise intake of 1-2 quarts of fluid to prepare3. assist into supine position with wedge under right hip to displace uterus4. apply gel to abd.5. allow her to empty bladder after procedure Term Nursing action for transvaginal ultrasound Definition 1. assist client into lithotomy position; probe is covered with protective device and lubricated2. during procedure position probe or tilt table to facilitate view3. inform client that she may feel some pressure4. point out some structures to client as it is performed Term Biophysical Profile Definition uses real-time ultrasound to visualize physical and physiological characteristics of fetus and biophysical responses to stimuliAssesses fetal well-being with 5 variables, 2 = normal and 0 = abnormal.1. Reactive FHR = 2, nonreactive = 02. Fetal breath movements (1 episode of 30 sec in 30 min) = 2, absent or less than 30 sec duration = 03. Gross body movements (at least 3 body or limb extensions with return to normal flexion in 30 min) = 2, slow extension and flexion, lack of flexion or absent movement = 04. Fetal tone (at least 1 episode of extension with return to flexion) = 2, slow extension and flexion, lack of flexion or absent movement = 05. Amniotic fluid volume (at least 1 pocket of fluid that measures at 1 cm in 2 perpendicular planes) = 2, pockets absent or less than 1 cm = 0Score of 8-10 = normal6 = equivocalPotential diagnosis: nonreactive stress test, suspected oligohydramnios or polyhydramnios, suspected fetal hypoxemia or hypoxiaClient presentation: premature rupture of membranes, maternal infection, decreased fetal movement, intrauterine growth restriction Term Nonstress Test (NST) Definition Most widely used technique for antepartum eval of fetal well-being during 3rd trimester; noninvasive technique that monitors response of FHR to fetal movementDoppler transducer (monitors FHR)and tocotransducer (monitor uterine contractions) attached externally to abd. to obtain paper tracing strips.Client pushes button ever time she feels a fetal movement, its recorded on paper tracingDisadvantages: high rate of false nonreactive results b/c of sleep cycles of fetus, fetal immaturity, maternal medications, chronic smoking Term Indications for use of nonstress test during pregnancy Definition Potential diagnosis for1. assessing intact fetal CNS during 3rd trimester2. ruling out risk of fetal death in clients who have diabetes mellitus (2x wk or after 28 wks)Client presentation1. decreased fetal movement2. intrauterine growth restriction3. postmaturity4. gestational diabetes mellitus5. pregnancy-induced HTN6. maternal chronic HTN7. Hx of previous fetal demise8. advanced maternal age9. sickle cell disease Term Interpretation of Findings of nonstress test Definition Reactive if FHR is normal baseline rate with moderate variability, accelerates to 15 beats/min for at least 15 seconds and occurs 2 or more times during a 20 min periodNonreactive NST indicates that FHR does not accelerate adequately with fetal movement and does not meet criteria after 40 min. CST or BBP is indicated Term Preparation of client for nonstress test Definition 1. Set client in reclining chair or in semi-fowler's, apply conduction gel, apply 2 belts to abd. and attach FHR and uterine contraction monitors2. client presses button each time fetus moves3. if fetus is not moving, vibroacoustic stimulation may be used to awaken Term Contraction Stress Test Definition Women lightly brushes palm across nipple for 2-3 min (causes pituitary gland to release endogenous oxytocin). stop stimulation when contraction starts. Repeated after 5 min rest periodStimulated contractions decrease placental blood flow and allows for analysis of FHR to determine how fetus will tolerate stress of labor. Pattern of three contractions within 10 min (each 40-60 sec)Avoid hyperstimulation of nipple should be avoided.If nipple stimulation fails; admin oxytocin (may cause contractions difficult to stop and thus causing preterm labor) Term Indications for use of contraction stress test Definition Potential diagnoses1. high risk pregnancies (gestational diabetes mellitus, postterm pregnancy)2. non-reactive stress testClient presentation1. Decreased fetal movement2. Intrauterine growth restriction3. Postmaturity4. Gestational diabetes mellitus5. Pregnancy induced HTN6. maternal chronic HTN7. hx of previous fetal demise8. adv. maternal age9. sickle-cell disease Term Interpretation of contraction stress test findings Definition Normal: negative CST- 3 uterine contractions and no late decelerations of FHR in 20 minAbnormal: Positive CST- persistent and consistent late decelerations on more than half of the contactions-uteroplacental insufficiency-cord compression-fetal head compressionMight induce labor or perform C-section Term Nursing Actions for contraction stress test Definition 1. Prep client by obtaining FHR, fetal movement, and contractions for 10-20 min; explain procedure and obtain consent; complete assessment2. initiate nipple stimulations and halt when contractions start; monitor and provide adequate rest periods to avoid hyperstimulation3. initiate IV admin if nipple stimulation fails4. If hyperstimulation occurs: monitor for contractions lasting longer than 90 seconds and/or more freq. than 2 min; provide tocolytics; maintain bed rest; observe client for 30min afterward Term Amniocentesis Definition Aspiration of amniotic fluid for analysis by inserting needle transabdominally into client's uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining position of fetus.May be done after 14 wks gestation Term Indications for Amniocentesis Definition 1. maternal age >35 years2. previous birth with chromosomal anomaly3. parent who is carrier of chromosomal anomaly4. family hx of neural tube defects5. prenatal diagnosis of genetic disorder or congenital anomaly of fetus6. alpha fetoprotein level for fetal abnormalities7. lung maturity assessment8. fetal hemolytic disease diagnosis9. meconium in the amniotic fluid Term Interpretation of Findings of amniocentesisAlpha-fetoprotein (AFP) Definition Can be measured in amniotic fluid betw. 16-18 wks to assess for neural tube defects in fetus or chromosomal disordersHigh levels = neural tubes defects such as anencephaly, spina bifida, omphalocele, normal multifetal pregnancyLow level: chromosomal disorders (Down's), gestational trophoblastic disease Term Interpretation of findings of amniocentesisFetal Lung Maturity Definition performed if less than 37 wks, in event of rupture of membranes, for preterm labor, complication indicating C-section birthDetermine if fetus will encounter resp. distress upon birthIf underdeveloped, more time in utero with admin of glucocorticoids to promote maturityLecithin/sphingomyelin (L/S) ratio- 2:1 indicates maturityPresence of phosphatidyglycerol (PG)- absence is assoc. with resp. distress Term Procedure for amniocentesis Definition Preprocedure: explain procedure/obtain consent, empty bladderIntraprocedure: assist into supine with wedge under right hip, drape only exposing abd.; prepare for ultrasound, obtain baseline VS and FHR; cleans with antiseptic solu.; edu. to keep breathing even if feeling pressurePostprocedure: monitor VS, FHR, uterine contractions throughout and 30 min post; rest for 30 min; admin Rho(D) immune globulin (RhoGAM) if Rh negative; edu. to rest and drink fluids and report any complications Term Complications of amniocentesis Definition 1. Amniotic fluid emboli2. Maternal or fetal hemorrhage3. Fetomaternal hemorrhage with Rg isoimmunization4. Maternal or fetal infection5. inadvertent fetal damage or anomalies involving limbs6. Fetal death7. Inadvertent maternal intestinal or bladder damage8. miscarriage or preterm labor9. premature rupture of membranes10. leakage of amniotic fluid Term Percutaneous umbilical blood sampling Definition Most common method of sampling fetal blood transfusion; obtain fetal blood by passing a fine gauge fiber optic scope into amniotic sac; needle is adv. into umbilical cord under ultrasound guidance and blood is aspirated from umbilical veinBlood studies from cordocentesis:1. Kleihauer-Betke: ensures blood is from fetus2. CBC count with differential3. Indirect Coombs' test for Rh antibodies4. Karyotyping (visualization of chromosomes)5. Blood typing Term Indications for percutaneous umbilical blood sampling Definition 1. Diagnosing prenatal blood and chromosomal disorders2. karyotyping or malformed fetuses3. detecting fetal infection4. determining acid base balance status of fetuses with IUGR Term Interpretation of findings for Percutaneous umbilical blood sampling, client edu., complications Definition Evaluate for isoimmune fetal hemolytic anemia and asses need for fetal blood transfusionProvide med admin as prescribed; educate and provide supportComplications: cord laceration, preterm labor, amnionitis Term Chorionic villus sampling (CVS) Definition assessment of portion of developing placenta is aspirated through a thin sterile catheter or syringe through the abd or intravaginally thru cervix under ultrasound guidance and analyzedFirst trimester alternative to amniocentesis at 10-12 wks and rapid results for chromosome studies in 24-48 hr Term Chorionic villus samplingIndications, Education, Complications Definition For women at risk of giving birth to neonate with genetic chromosomal abnormalityProvide support, instruct to drink fluids to fill bladderComplications: spontaneous abortion, risk for fetal limb loss, miscarriage, chorioamnionitis and rupture of membranes (weight benefits against increased risk!!) Term Quad Marker screening Definition Blood test done betw. 15-20 wks that determines probability of fetal birth defects (not an actual diagnosis). More reliable findings than alpha-fetoproteinScreens for presence of:1. hCG: hormone produced by placenta (human chorionic gonadotropin)2. AFP: protein produced by fetus (alpha-fetoprotein)3. Estriol: protein produced by fetus and placenta4. Inhibin A: protein produced by ovaries and placenta Term Indications and Findings for Quad Marker screening Definition Indications: 15-20 wks, at risk for giving birth to neonate with genetic chromosomal abnormalityLow levels of AFP: at risk for Down'sHigh levels of AFP: risk for neural tube defectsHigh levels of hCG/inhubin-A: risk for Down'sLow levels of estriol: risk for Down's Term Maternal Serum AFP, indications, findings, actions Definition Screening tool to detect neural tube defects; for all clients 16-18 wksHigh levels: Neural tube defect or open abd. defectLow levels: Down's syndromeAbnormal findings: referred to quad marker screening, genetic counseling, ultrasound, amniocentesisActions: discuss testing, draw blood sample, offer support Term Causes of bleeding in the first trimester and its signs/symptoms Definition Spontaneous Abortion: vaginal bleeding, uterine cramping, partial or complete expulsion of products of conceptionEctopic pregnancy: abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding Term Causes of bleeding in the second trimester and its signs/symptoms Definition Gestational trophoblastic disease: uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding Term Causes of bleeding in the third trimester and its sign/symptoms Definition Placenta previa: painless vaginal bleedingAbruptio placenta: vaginal bleeding, sharp abd. pain and tender rigid uterusVasa previa: fetal vessel cross over the cervix abrupt bright red vaginal bleeding following rupture of membranes Term Other causes of bleeding Definition Incompetent cervix: painless bleeding with cervical dilation leading to fetal expulsionPreterm Labor: Pink-stained vaginal discharge, uterine contraction becoming regular, cervical dilation and effacement Term Spontaneous Abortion Definition When pregnancy is terminated before 20 wks (fetal viability) or fetal weight is less than 500gTypes of abortions are classified according to symptoms and weather the products of conception are partially or completely retained or expulsedTypes: threatened, inevitable, incomplete, complete, missed Term Risk factors of spontaneous abortion Definition 1. chromosomal abnormalities (account for 50%)2. Maternal illness, such as insulin dependent diabetes mellitus3. Adv. maternal age4. Premature cervical dilation5. chronic maternal infections6. maternal malnutrition7. trauma or injury8. anomalies in fetus or placenta9. substance abuse Term Assessment of spontaneous abortion Definition Signs/Symptoms: backache, rupture of membranes, dilation of cervix, fever, abd. tenderness, hypotension, tachycardiaLab tests: Hgb and Hct if considerable blood loss, clotting factors monitored for disseminated intravascular coagulopathy (DIC), WBC for suspected infection, serum hCG levels to confirm pregnancyDiagnostic Procedures:1. Ultrasound to determine presence of viable or dead fetus or partial or complete products of conception within uterine cavity2. exam of cervix to determine open or closed3. dilation and curettage (D hemorrhage into uterus cavity occurs and vaginal bleeding results5. Approx 20% of complete moles progress toward a choriocarcinoma Term Partial mole Definition 1. Genetic material is derived both maternally and paternally2. A normal ovum is fertilized by two sperm or one sperm in which meiosis or chromosome reduction and division did not occur3. Partial mole often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood. No congenital anomalies are present4. Approx 6% of partial moles progress toward choriocarcinoma Term Risk Factors of Gestational Trophoblastic Disease Definition 1. low protein intake2. under 18 years of age3. older than 35 years of age Term Subjective and Objective Data of Gestational Trophoblastic Disease Definition Subjective1. Vaginal bleeding at approx 16 wk2. Excessive vomiting (hyperemesis gravidarum) due to elevated hCG levelsObjective Data1. Rapid uterine growth larger than expected for duration of pregnancy due to over-proliferation of trophoblastic cells2. Bleeding is often dark brown resembling prune juice, or bright red that is either scant or profuse and continues for a few days or intermittently for a few wks3. Bleeding accompanied by discharge from clear fluid-filled vessels4. Symptoms of pregnancy-induced HTN (PIH), including HTN, edema, proteinuria that occur prior to 20 wk (PIH is after 20 wk) Term Lab Tests and diagnostic procedures of Gestational Trophoblastic Disease Definition Labs1. UA for proteinuria (serial hCG immunoassays for pregnancy are strongly positive) and secondary hCG is produced by overgrowing trophoblastic cells2. Analysis of serum hCG every 1-2 wks until levels are normal; every 2-4 wks for 6 months; every 2 months for 1 yr.Diagnostic procedures1. ultrasound will reveal dense growth with characteristic vesicles but no fetus in utero2. suction curettage is done to aspirate and evacuate the mole3. Following mole evacuation, client should undergo a baseline pelvic exam and ultrasound scan of abd. in addition to frequent follow-up pelvic exams Term Nursing care and meds for gestational trophoblastic disease Definition Nursing care1. measure fundal height2. assess vaginal bleeding and discharge3. assess GI status and appetite4. assess client's extremities and face for edema5. admin chemo for choriocarcinoma in event of abnormal rising hCG titer, enlarging uterus, findings of malignant cellsMeds1. Admin RhoGAM to client who is Rh-negative Term Discharge instructions and edu. and outcomes for gestational trophoblastic disease Definition 1. Advise client to bring any clots or tissue passed to provider for exam.2. Provide edu. about disease and emotional support regarding loss of anticipated pregnancy3. use reliable contraception for 12 months because pregnancy would make it impossible to monitor the decline in hCG levels4. Instruct client of imp. of follow up b/c of inc. risk of choriocarcinoma5. no psychological or physiological signs or symptoms of complications Term Placenta Previa Definition Occurs when placenta abnormally implants in lower segment of uterus near or over cervical os instead of attaching to fundus. Abnormal implantation results in bleeding during 3rd trimester of pregnancy as cervix begins to dilate and efface Term Types of Placenta Previa Definition 1. Complete or total: when cervical os is completely covered by placental attachment2. Incomplete or partial: when cervical os is only partially covered by placental attachment3. Marginal or low-lying: when placenta is attached to uterine segment but does not reach the cervical os Term Risk factors for placenta previa Definition 1. previous placenta previa2. Uterine scarring (previous c-section, curettage, endometritis)3. Maternal age >354. multifetal gestation5. multiple gestations or closely spaced pregnancies Term Subjective and Objective Data, Lab tests and Diagnostic procedures for placenta previa Definition Subjective: painless, bright red vaginal bleeding that increases as cervix dilatesObjective1. soft, relaxed, nontender uterus with normal tone2. fundal height that is greater than expected3. fetus in breech, oblique, or transverse position4. palpable placenta5. VS that are usual and WNL6. decreasing urinary outputLab Tests1. Hgb and Hct for blood loss assessment2. CBC3. ABO blood typing and Rh-factor4. Coagulation profile5. Kleihauer-Betke test (used to detect fetal blood in maternal circulation)Diagnostic Procedures1. transabdominal or transvaginal ultrasound for placement of placenta2. fetal monitoring for fetal well-being assessment Term Nursing care, meds, discharge instructions and edu for placenta previa Definition Nursing care1. assess client for bleeding, leakage, contractions2. assess fundal height3. perform leopold maneuvers (fetal position and presentation)4. refrain from performing vaginal exams (may exacerbate bleeding)5. Admin IV fluids to client as prescribed6. have O2 equip available in case of fetal distressMeds: corticosteroids such as betamethasone (celestrone) are prescribed for fetal lung maturation if delivery of fetus is anticipated (C-section)Discharge Instruc.1. bed rest2. nothing inserted vaginally3. blood replacement as prescribedEdu.1. pregnancy maintained without any maternal or fetal compromise Term Abruptio placenta Definition Premature separation of the placenta from the uterus, which can be a partial or complete detachment; separation occurs after 20 wks, usually in 3rd trimesterSignificant maternal and fetal morbidity and mortality; leading cause of maternal deathCoagulation defect (disseminated intravascular coagulopathy) often assoc. with moderate to severe abruption Term Risk factors for abruptio placenta Definition 1. Maternal hypotension2. blunt external abd. trauma (motor-vehicle crash, maternal battering)3. cocaine abuse resulting in vasoconstriction4. previous incidents of abruptio placenta5. cigarette smoking6. premature rupture of embranes7. short umbilical cord8. multifetal pregnancy9. high parity10. adv. maternal age Term Subjective and objective Data, Lab tess, diagnostic procedures for abruptio placenta Definition Subjective: sudden onset of intense, localized uterine pain with bright red vaginal bleedingObjective1. vaginal bleeding that is bright red or dark2. board-like abd. that is tender3. firm, rigid uterus with contractions (uterine hypotension)4. fetal distress5. signs of hypovolemic shockLab Tests1. Hgb and Hct dec.2. coagulation factors dec.3. clotting defects (disseminated intravascular coagulation)4. cross and type match for possible blood transfusions5. Kleihauer-Betke test (used to detect fetal blood in maternal circulationDiagnostic procedures 1. ultrasound for fetal well-being and placental assessment2. biophysical profile to ascertain fetal well-being Term Nursing Care and Meds, outcomes for abruptio placenta Definition Care1. palpate uterus for tenderness and tone2. assess FHR pattern (refrain from vaginal exam)3. Admin IV fluids4. Admin O2 8-10L via face maskMeds1. Admin blood products and fluid volume replacements to maintain urine output at 30 mL/hr or more and Hct at 30% or greater2. Admin corticosteroids to promote fetal lung maturityOutcome1. birth of viable neonate Term Vasa previa Definition Presence of fetal blood vessels crossing the amniotic membranes over the cervical os.High newborn mortality rate; risk assoc with fetal hemorrhage as cervix dilates or membranes ruptureRarely diagnosed before start of labor Term Objective data, lab test, and diagnostic procedures for vasa previa Definition Objective data1. painless heavy bleeding upon rupture of membrane2. Fetal bradycardiaLab tests1. Hgb and Hct dec.2. cross and type match for possible blood transfusionsDiagnostic procedures1. confirmed by sonography Term Nursing care, meds, edu, outcomes for vasa previa Definition Nursing care1. assess bleeding rate, amt. color2. amin IV fluids3. admin O2 8-10 L via face mask4. prepare for an emergency C sectionMed1. Admin blood procuts and fluid volume replacements to maintain the clients urine output at 30 mL/hr on more and Hct at 30% or greaterEdu1. Provide emotional supportOutcome1. birth viable neonate Term HIV/AIDS Definition 1. Retrovirus that attacks and causes destruction of T lymphocytes2. causes immunosuppression in client3. transmitted from mother to neonate perinatally thru placenta and postnatally through breast milk4. Routine lab testing in early prenatal period as well as in third trimester for those at risk5. Amniocentesis and episiotomy avoided due to risk of exposure 6. Use of internal fetal monitors, vacuum extraction, and forceps during labor avoided because of risk of fetal bleeding7. admin injections and blood testing do not take place until first bath is given to neonate Term Risk factors Definition 1. IV drug use2. Multiple sexual partners3. Bisexuality4. Maternal hx of multiple STDs5. blood transfusion Term Subjective and Objective data, lab tests for HIV/AIDS Definition Subjective1. fatigueobjective1. diarrhea2. weight loss3. anemisLab tests1. Antibody screening test such as enzyme immunoassay; confirm positive results by confirming Western blot testing2. Scree for STDs such as gonorrhea, chlamydia, syphilis, hep B3. obtain frequent viral load levels and CD4 cell counts throughout the pregnancy Term Nursing Care, meds, discharge instruc., outcome of HIV/AIDS Definition Nursing Care1. Provide counseling before and after2. refer to mental health consult, legal assistance, financial resources3. use standard precautions4. admin antiviral combo therapy as prescribed5. obtain prescribed lab testingMeds1. Retrovir (Zidovudine): antiretroviral agent, nucleoside reverse transcriptase inhibitor2. Admin retrovir at 14 wks, throughout pregnancy, and before onset of labor or C-section and admin to neonate following delivery and for 6 wks afterDischarge1. do not breastfeed2. discuss HIV and safe sexual relationsOutcomes1. Client remain free from injury during pregnancy Term TORCH infections Definition Can cross placenta and have teratogenic affects on fetus; does not include all major infectionsTOxoplasmosis: caused by consumption of raw or undercooked meat or handling cat feces; symptoms are similar to influenza or lymphadenopathyRubellaL contracted thru kids who have rashes or neonates who are born to mothers who had rubella during pregnancyCytomegalovirus (member of herpes): transmitted by droplet infection from person to person, virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood. Latent virus may be reactivated and cause disease to the fetus in utero or during passage thru birth canalHerpes simplex virus (HSV): spread by direct contact with oral or genital lesions; transmission to fetus is greatest during vaginal birth if woman has active lesions Term Subjective and Objective data, labs, diagnostics for TORCH Definition Subjective1. Toxoplasmosis: similar to influenza or lymphadenopathy2. malaise, muscle aches3. rubella joint and muscle pain4. cytomegalovirus: asymptomatic or mononucleosis-like symptomsObjective1. signs of rubella: rash, mild lymphedema, fever, fetal consequences (miscarriage, congenital anomalies, death)2. herpes simplex virus: initially with lesions3. Toxoplasmosis: fever, tender lymph nodesLabs1. for HSV, obtain cultures for those who have HSV or are at or near termDiagnostic1. TORCH screen: immunologic survey used to identify existence of infections in mother or in newborn2. prenatal screening Term Nursing care, meds, edu, outcomes for TORCH Definition Care1. monitor fetal well-being2. edu. on prevention practicesMeds1. admin antibiotics as prescribed2. toxoplasmosis: sulfonamides, combo of pyrimethamine and sulfadiazineEdu1. Rubella = vaccination, avoid crowds of young women2. no treatment for cytomegalovirus so prevent exposure with frequent hang hygiene before eating, and avoiding crowds of young kids3. emphasize imp. of compliance4. provide emotional supportOutcomes1. remain free from infection Term Streptococcus B-hemolytic, Group B and risk factors Definition Bacterial infection that can be passed to a neonate during labor and deliveryRisk factors:hx of positive culture with prev. preg.positive culture with pregnancyprolonged rupture of membranespreterm delivery Term Objective Data, Lab tests, Nursing care, meds, edu, outcomes for Streptococcus B-hemolytic, Group B Definition Obejctive: maternal and fetal effects including premature rupture of membranes, preterm labor and delivery, chorioamnionitis, infections of urinary tract, maternal sepsisLabs: vaginal and rectal cultures at 35-37 wksCare: admin prophylaxis antibiotics during laborMeds:1. Penicillin G or ampicillin (Principen) to treat positive GBS2. Admin penicillin 5 mill units initially IV bolus then 2.5 mill units intermittent IV bolus Q4hr3. Ampicillin 2 g IV initially then 1 g Q4hr4. Bactericidal antibiotic used to destroy GBSEdu: Instruct to notify labor and delivery nurse of GBSOutcomes: blood culture is negative for GBS with no clinical signs of sepsis Term Chlamydia and risk factors Definition Bacterial infection caused by chlamydia trachomatis; most common STD.Diff to diagnose b/c typically asymptomaticRisk factors: multiple sex partners and unprotected sexual practices Term Subjective and Objective Data, Labs, Nursing care, meds, edu, outcomes of chlamydia Definition Subjective: vaginal spotting and vulvar itchingObjective: white, watery vaginal dischargeLab: endocervical cultureCare: instruct to take entire prescription, identify and treat all sexual partners, those who are pregnant should be retested 3 weeks post med regimenMeds: Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)-broad spectrum antibiotic, bactericidal action-admin erythromycin (Romycin) to all neonates following deliveryOutcome: infection free Term Gonorrhea and risk factors Definition Neisseria gonorrhoeae; bacterial infection primarily spread by genital to genital contact (can also be anal to genital or oral to genital); can be transferred to neonate during delivery.Women frequently asymptomaticRisk factors: multiple sex partners and unprotected sexual practices Term Subjective and Objective Data, Labs, Nursing care, meds, outcomes of gonorrhea Definition Subjective1. Male: urethral discharge, painful urination, freq.2. Female: lower abd. pain, dysmenorrheaObjective1. urethral discharge2. yellowish-green vaginal discharge3. reddened vulva and vaginal walls4. can cause PID, heart disease, arthritisLab: urethral and vaginal cultures, urine cultureCare1. provide info regarding disease transmission2. instruct to take entire prescription3. identify and treat all sexual partnersMeds: Ceftriaxone (Rocephin) IN or azithromycin (Zithromax) PO1. given for 7 days2. broad spectrum antibiotic3. bactericidal actionOutcome: infection free Term Candida Albicans and risk factors Definition fungal infectionRisk factors1. diabetes mellitus2. oral contraceptives3. recent antibiotic treatment Term Subjective and Objective Data, Labs, Nursing care, meds, edu, outcomes of candida albicans Definition Subjective: vulvar itchingObjective1. thick, creamy white vaginal discharge2. vulvar redness3. white patches on vaginal walls4. gray-white patches on tongue and gums (neonate)Lab: wet prepDiagnostics: Potassium hydroxide prep, presence of hyphae and pseudohyphae indicates positive findingMeds: Fluconazole (Diflucan)1. antifundal agent2. fungicidal action3. OTC clotrimazole (monistat)Edu: avoid tight fitting clothesoutcome: infections free Supporting users have an ad free experience! Tweet My Flashcards My Sets Collaborative Sets Study Sessions Favorites Flashcard Pages Images Audio Flashcard Library Browse Search Browse About About FlashcardMachine Contribute Share Support Form Privacy Policy Terms of Use Help FAQ Getting Started Signup Links Mobile Apple App Store Google Play Amazon Apps


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