High-Risk Disorders Flashcards

1
Q

What instructions should the nurse give the woman with a threatened abortion?

A

Maintain strict bed rest for 24 to 48 hours. Avoid sexual intercourse for 2 weeks.

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2
Q

Identify the nursing plans and interventions for a woman hospitalized with hyperemesis gravidarum.

A
  • Weigh daily
  • Check urine ketone three times daily
  • Give progressive diet
  • Check FHR every 8 hours
  • Monitor for electrolyte imbalances
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3
Q

Describe discharge counseling for a woman after hydratiform mole evacuation by D&C.

A

Prevent pregnancy for 1 year. Return to clinic or MD for monthly hCG levels for 1 year. Postoperative D&C instructions: Call if bright-red vaginal bleeding or foul-smelling vaginal discharge occurs or temperature spikes over 100.4F

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4
Q

What condition should the nurse suspect if a woman of childbearing age presents to an emergency room with bilateral or unilateral abdominal pain, with or without bleeding?

A

Ectopic pregnancy

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5
Q

List three symptoms of abruptio placentae and three symptoms of placenta previa.

A
  • Abrupto placentae: fetal distress; rigid, boardlike abdomen; pain; dark-red or absent bleeding
  • Previa: pain-free; bright-red vaginal bleeding; normal FHR; soft uterus
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6
Q

What specific information should the nurse include when teaching about HPV detection and treatment?

A

Detection of dry, wartlike growths on vulva or rectum. Need for Pap smear in the prenatal period. Treatment with later ablation (cannot use podophyllin during pregnancy). Associated with cervical carcinoma in mother and respiratory papillomatosis in neonate. Teach about immunization for females age 9 to 30 with Gardasil.

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7
Q

State three principles pertinent to counseling and teaching a pregnant adolescent.

A

Nurse must establish trust and rapport before counseling and teaching begin. Adolescents do not respond to an authoritarian approach. Consider the developmental tasks of identity and social and individual intimacy.

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8
Q

What complications are pregnant adolescents particularly prone to develop.

A

Preeclampsia, IUGR, CPD, STDs, anemia

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9
Q

All pregnant women should be taught preterm labor recognition. Describe the warning symptoms of preterm labor.

A

More than five contractions per hour; cramps; low, dull backache; pelvic pressure; change in vaginal discharge

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10
Q

List the factors predisposing a woman to perterm labor.

A

Urinary tract infection; overdistention of uterus; diabetes; preeclampsia; cardiac disease; placenta previa; psychosocial factors such as stress

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11
Q

When is preterm labor able to be arrested?

A

Cervix is <50% effacement, and membranes are intact and not bulging out of the cervical os.

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12
Q

What is the major side effect of beta-adrenergic tocolytic drugs (Terbutaline)?

A

Tachycardia

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13
Q

What special actions should the nurse take during the intrapartum period if preterm labor is unable to be arrested?

A

Monitor the FHR continuously and limit drugs that cross placental barriers so as to prevent fetal depression or further compromise.

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14
Q

A prolonged latent phase for a multipara is ___ and for a nullipara is ___. Multiparas’ average cervical dilation is ___ cm/hr in the active phase, and nulliparas’ average cervical dilation is ____ cm/hr in the active phase.

A

> 14 hours. .20 hours. 1.5, 1.2

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15
Q

What are the major goals of nursing care related to pregnancy-induced hypertension with preeclampsia?

A

Maintenance of uteroplacental perfusion; prevention of seizures; prevention of complications such as HELLP syndrome, DIC, and abruption

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16
Q

Magnesium sulfate is used to treat preeclampsia.

A. What is the purpose of administering magnesium sulfate?
B. What is the main action of magnesium sulfate?
C. What is the antidote for magnesium sulfate?
D. List the three main assessment findings indicating toxic effects of magnesium sulfate

A

A. To prevent seizures by decreasing CNS irritability
B. CNS depression (seizure prevention)
C. Calcium gluconate
D. Reduced urinary output, reduced respiratory rate, and decreased reflexes

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17
Q

What are the major symptoms of preeclampsia?

A

Increase in BP of 30 mm Hg systolic and 15 mm Hg diastolic over previous baseline; proteinuria (albuminuria); CNS disturbances

18
Q

What is the priority nursing action after spontaneous or AROM?

A

Assessment of the FHR

19
Q

What is the most common complication of oxytocin augmentation or induction of labor? List three actions the nurse should take if such a complication occurs.

A

Tetany. Turn off Pitocin. Turn pregnant woman onto side. Administer O2 by mask.

20
Q

List the symptoms of water intoxication resulting from the effect of Pitocin (oxytocin) on the antidiuretic hormone (ADH).

A

Nausea and vomiting, headache, and hypotension

21
Q

State three nursing interventions during forceps delivery.

A

Ensure empty bladder: Auscultate FHR before application, during process, and between traction periods. Observe for maternal lacerations and newborn cerebral or facial trauma.

22
Q

What is the cause of preeclampsia?

A

The person who determines the exact cause will be our next Nobel Prize winner! However, the underlying pathophysiology appears to be generalized vasospasm with increased peripheral resistance and vascular damage. This decreased perfusion results in damage to numerous organs.

23
Q

What interventions should the nurse implement to prevent further CNS irritability in the preeclampsia client?

A

Darken room, limit visitors, maintain close 1:1 nurse-to-client ratio, place in private room, plan nursing interventions at all the same time so client is disturbed as little as possible.

24
Q

A woman on Orinase (oral hypoglycemic) asks the nurse if she can continue this medication during pregnancy. How should the nurse respond?

A

No. Oral hypoglycemic medications are teratogenic to the fetus. Insulin will be used.

25
Q

Name three maternal and three fetal complications of gestational diabetes.

A

Maternal: hypoglycemia, hyperglycemia, ketoacidosis

Fetal: macrosomia, hypoglycemia at birth, fetal anomalies

26
Q

When should the nurse hold the dose of magnesium sulfate and call the physicial?

A

When the client’s respirations are <100 mL/4 hr

27
Q

State three priority nursing actions in the postdelivery period for the client with preeclampsia.

A

Monitor for signs of blood loss. Continue to assess BP and DTRs every 4 hours. Monitor for uterine atony.

28
Q

What are the two most difficult times for control in the pregnant diabetic?

A

Late in the third trimester and in the postpartum period, when insulin needs drop sharply (the diabetogenic effecs of pregnancy drop sharply (the diabetogenic effects of pregnancy drop precipitously)

29
Q

Why is regular insulin used in labor?

A

It is short-acting, predictable, can be infused intravenously, and can be discontinued quickly if necessary

30
Q

List three conditions clients with diabetes mellitus are more prone to develop.

A

Preeclampsia, hydraminos, infection

31
Q

When is cardiac disease in pregnancy most dangerous?

A

At peak plasma volume increase, between 28 and 32 weeks’ gestation, and during stage II labor

32
Q

Does insulin cross the placenta-breast barrier?

A

No. Therefore, insulin-dependent women may breastfeed.

33
Q

The goal for diabetic management during labor is euglycemia. How is it defined?

A

70 to 90 mg/dL

34
Q

What contraceptive technique is recommended for diabetic women?

A

Diaphragm with spermicide; clients should avoid birth control pills, which contain estrogen, and IUDs, which are an infection risk

35
Q

List the symptoms of cardiac decompensation in a laboring client with cardiac disease.

A

Tachycardia, tachypnea, dry cough, rales in lung bases, dyspnea, and orthopnea

36
Q

What interventions can the nurse implement to maintain cardiac perfusion in a laboring cardiac client?

A

Position client in a semi-or high Fowler. Prevent Valsalva maneuvers. Position client in a side-lying position for regional anesthesia. Avoid stirrups because of possible popliteal vein compression and decreased venous return.

37
Q

Gentle counterpressure against the perineum during an emergency delivery prevent ___ and ___.

A

Maternal laceration, fetal cerebral trauma

38
Q

When may a VBAC be considered by a woman with a previous cesarean section?

A

If a low uterine transverse incision was performed and can be documented and if the original complication does not recur, such as CPD.

39
Q

Prior to anesthesia for cesarean section delivery, the motor may be given an antacid or a gastric antisecretory drug (histamine receptor antagonist). State the reasons these drugs are given.

A

Antacid buffers alkalize the stomach secretions. If aspiration occurs, less lung damage ensues. An antisecretory drug reduces gastric acid, reducing the risk for gastric aspiration.

40
Q

Clients who have had a cesarean section are prone to what postoperative complications?

A

Paralytic ileus, infection, thromboembolism, respiratory complications, and impaired maternal-infant bonding,