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L&D 6

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juniperk's version from 2017-11-19 03:21

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Question Answer
What is the velamentous insertion of the cord?the umbilical cord inserts on the chorio-amniotic membranes rather than on the placental mass
What is a vasa previa?Fetal blood vessel from the placenta or umbilical cord entrance to the birth canal, beneath the baby
Who's at risk for vasa previa?Placenta previa pts
How is vasa previa managed?Elective Csection prior to 35 weeks. If it ruptures, both mom and baby can bleed out.
What is placental abruption?Premature separation of a normally implanted placenta after 20 weeks.
Who's at risk for placental abruption? (3)Maternal HTN, multiparity, short unbilical cord
How many grades of placental abruption?0-3. 4 grades
What is the clinical manifestation of placental abruption?Dark red vag bleeding, painful abdomen or low back, firm tender uterus, tetanic contractions, hypertonus (board like abdomen), symptoms of shock
5 Nursing interventions for placental abruption1. IV access, labs, IVF bolus, 2. Avoid vag exams 3. O2 4. amniotomy can make it worse but can also confirm dx 5 delivery
8 Interventions for PROM1. Assess for cord prolapse 2 Assess FHR 3. Evaluate temp q 2h 4. monitor WBC 5. Avoid vag exams. 6 Monitor chorioamnionitis 7 GBS culture 8. Administer antibiotics
Complications of PROMInfection and cord prolapse
A preg with BP higher than 140/90 over 20 weeks without proteinuria has what?Gestational HTN
A preg with BP higher than 140/90 over 20 weeks with proteinuria has what?Preeclampsia
A preg with BP higher than 140/90 over 18 weeks without proteinuria has what?Chronic HTN
A preg with BP higher than 140/90 over 18 weeks with proteinuria has what?Preeclampsia superimposed on chronic HTN
Proteinuria leads to what?edema
Related to high BP- what damages the endothelial lining of the vessels?Vasospasms
Why should you be careful for antihypertensives?If BP is lowered too quickly then leads to blood pooling & reduction of placental perfusion
What is BP and proteinuria for severe preeclampsia?BP SBP > 160mmHG, DBP >110mmHg, Proteinuria- >5 gm in 24 h collection 3+ or more on urine dipstick
What are the 6 clinical manifestations for severe preeclampsia?1. Oliguria 2. cerebral & visual disturbances 3. Pulmonary edema 4. Epigastric pain r/t liver issues 5. Thrombocytopenia 6. Hepatic dysfunction
What is HELLP?Hemolysis Elevated Liver Enzymes Low Platelets.
How do Uric acid, albumin, BUN, & creatinine levels react during eclampsia?Uric acid, BUN & creatinine increase. Proteinuria causes a decrease in albumin
What happens to the pulmonary systems during eclampsia? When is the critical period?the decrease of colloidal osmotic pressures push fluid out of the capillaries into the lung tissues causes pulmonary edema. Critical period is 6-24 hours post delivery
Cerebral vasoconstriction can lead to what?cerebral ischemia, seizures, and hemorrhage (stroke)
Preeclampsia and Eclampsia can BEGIN up to when?6 weeks post partum
What are the 7 key points to administration of Mag sulfate?1. Bolus dose of 4g over 20-30 min followed by mainline at 2g/hr. 2 Y'd into mainline at closest port avail 3. MUST always be on a pump. 4 Tag the IV line 5. NEVER mix your own mag sulfate 6 Recommended to have 2nd nurse check initial & subsequent mag sulfate bags/pump 7. Consider anyone recieving mag sulf as high risk
What are 7 (5 objective 2 fetal) signs of Mag toxicity?1. feeling hot 2. Metallic taste in mouth 3. Nausea 4. Headaches 5. Out of body feelings 6. Decreased fetal heart rate variability 7. fewer fetal heart rate accels
What is the half life of Mag Sulf in pt w/ normal renal function?4 hours
What is the therapeutic range for magnesium?4.8 - 9.6 mg/dL
What maternal- fetal assessments are needed for pt on mag sulf?Vital signs 2. O2 3. Level of consciousness 4. DTR 5. Breath sounds (watch for pulmonary edema) 6. I/O 7. Characteristics of FHR 8. Characteristics of uterine contractions.,
What is the freq of assessments during admin of Mag Sul?During bolus DO NOT LEAVE BEDSIDE. 2. Every 5 min during the bolus 3. Every 15 min for the 1st hour 4. Every 30 min for the 2nd hour. 5. hourly
When should you notify the md during Mag Sulf? (10)a) Significant changes in BP from baseline b) Visual disturbances c) Tachycardia or bradycardia d) Resp rate of < 14 or > 24 e) O2 < 95% f) Changes in breath sounds g) Changes in LOC or neurologic status h) Absent DTRs i) Urinary output < 30ml/hr. j) Nonreassuring FHR
3 Mag s. effects on neonate p delivery1. Hypotonia 2. Resp depression 3. decreased suck reflex
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