L&D 4

juniperk's version from 2017-11-18 04:18


Question Answer
What are 9 predisposing factors for pregestational diabetes?1. Family history of diabetes 2. History of more than two spontaneous abortions 3. Hydramnios 4. Previous baby with a weight over 4000 g (8 lb 13.5 oz) 5. Previous baby with unexplained congenital anomalies 6. High parity 7. Obesity 8. Recurrent monilial vaginitis 9. Glycosuria
What are the 3 P's for diabetes?polyphagia, polydipsia, and polyuria
Why are oral hypoglycemics not taken during pregnancy?Oral hypoglycemics are not taken during pregnancy because of the potential teratogenic effects on the fetus. Insulin is used for therapeutic management.
Can insulin cross the placenta or breastmilk?Insulin does not cross the placental barrier or breastmilk.
How does estrogen-containing birth control pills affect glucose metabolism? increasing resistance to insulin
Gestational diabetes- Name 7 neonatal complications1. Macrosomia 2. IUGR 3. Hypoglycemia, hypocalcemia 4. Hyperbilirubinemia, polycythemia 5. Congenital anomalies 6. Infection 7. Prematurity
List three symptoms of abruptio placentae and three symptoms of placenta previaAbruptio placentae: fetal distress;rigid, boardlike abdomen; pain; dark-red or absent bleeding Previa: pain-free; bright-red vaginal bleeding; normal FHR;soft uterus
All pregnant women should be taught preterm labor recognition. Describe the warning symptoms of preterm laborMore than five contractions per hour; cramps; low, dull backache; pelvic pressure; change in vaginal discharge
List the 7 factors predisposing a woman to preterm labor.Urinary tract infection; overdistention of uterus; diabetes; preeclampsia; cardiac disease; placenta previa, psychosocial factors such as stress
A prolonged latent phase for a multipara is _____ and for a nullipara is _____. Multiparas’ average cervical dilatation is _____ cm/hr in the active phase, and nulliparas’ average cervical dilatation is _____ cm/hr in the active phase.>14 hours, >20 hours, 1.5, 1.2
What is the most common complication of oxytocin augmentation or induction of labor? List three actions the nurse should take if such a complication occursTetany. Turn off Pitocin. Turn pregnant woman onto side.Administer O2 by mask.
List the symptoms of water intoxication resulting from the effect of Pitocin (oxytocin) on the antidiuretic hormone (ADH).Nausea and vomiting, headache, and hypotension
Name 3 maternal and 3 fetal complications of gestational diabetes.Maternal: hypoglycemia, hyperglycemia, ketoacidosis Fetal: macrosomia, hypoglycemia at birth, fetal anomalies
Why is regular insulin used in labor?. It is short-acting, predictable, can be infused intravenously, and can be discontinued quickly if necessary
List three conditions clients with diabetes mellitus are more prone to develop.Preeclampsia, hydramnios, infection
When is cardiac disease in pregnancy most dangerous?At peak plasma volume increase, between 28 and 32 weeks’ gestation, and during stage 2 labor
What interventions can the nurse implement to maintain cardiac perfusion in a laboring cardiac client?Position client in a semi- or high Fowler position. PreventValsalva maneuvers. Position client in a side-lying position for regional anesthesia. Avoid stirrups because of possible popliteal vein compression and decreased venous return.
Describe discharge counseling for a woman after gestational trophoblastic mole evacuation by D&C.Prevent pregnancy for 1 year. Return to clinic or MD for monthly hCG levels for 1 year. If hCG levels do not diminish, choriocarcinoma may develop
What are 5 symptoms of placental abruption?A.Bleeding: concealed or over t (if over t, is dark red) B.Uterine tenderness C. Persistent abdominal pain. D.Rigid, board-like abdomen E. FHR abnormalities
What are 5 symptoms of placental previa?A. Painless, bright-red vaginal bleeding in third trimester B. Soft uterus C. Possible signs of shock D. Placenta in lower uterine segment (indicated by ultrasound) E. FHR is usually normal.
Clients with abruptio placentae or placenta previa (actual or suspected) should NOT undergo what? (5)no abdominal or vaginal manipulation. • No Leopold maneuvers •No vaginal examination • No rectal examinations, enemas, or suppositories •No internal monitoring
What are 3 dangers related to substance abuse during pregnancy. Smoking, cocaine, and alcohol.1. Smoking: low-birth-weight infant 2. Alcohol: fetal alcohol syndrome 3. Cocaine: preterm labor and abruptio placentae; subtle neurologic changes in the neonate
What is spontaneous abortion?It is indicated by bleeding between conception and 20 weeks’ gestation.
4 symptoms of spontaneous abortionUterine cramping, backache, pelvic pressure, and bright-red vaginal bleeding
What are the 4 nursing interventions for spontaneous abortion?Assess bleeding, monitor for shock/DIC, instruct to save all clots and emotional support.
What are 2 medical interventions for spontaneous abortion?RhoGAM and D&C
What is the medical intervention for incompetent cervix?cerclage- A cerclage (a McDonald suture) is placed around the cervix to constrict the internal os. The cerclage may be removed prior to labor if labor is planned or left in place if cesarean birth is planned.
What instructions should the nurse give the woman with a threatened abortion?Maintain strict bed rest for 24 to 48 hours. Avoid sexual intercourse for 2 weeks.
What is an inevitable or incomplete spontaneous abortion and what is the treatment?Moderate to heavy bleeding with tissue & products of conception present; open cervical os Tx: hospitalization; D&C
What is a complete spontaneous abortion and what is the treatment?All products of conception passed; cervix closed 2. Treatment: no need for treatment
What is a missed spontaneous abortion and what is the treatment?Fetus dead; placenta atrophied but passage of products of conception has not occurred; cervix closed 2. Treatment: watchful waiting; check clotting factors and possibly terminate pregnancy to lessen the chances of developing disseminated intravascular coagulation (DIC).
What is a recurrent spontaneous abortion and what is the treatment?Loss of 3 or more previable pregnancies 2. Treatment: Varies based on cause; if premature cervical dilatation (incompetent cervix) is cause, prophylactic cerclage may be done.
What result on the Coombs test indictates the mother needs RhoGAM?, RhoGAM is given to an Rh-negative mother who delivers an Rh-positive fetus and has a negative indirect Coombs test.

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