Exam 3: NSG222/ NSG 222 (Latest 2024/ 2025 Update) Family Nursing | Review with Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 3: NSG222/ NSG 222 (Latest 2024/
2025 Update) Family Nursing | Review with
Questions and Verified Answers| 100%
Correct| Grade A- Herzing
Q: Gestational Trophoblastic Disease Definition
Answer:
The WHO classification of gestational trophoblastic disease (GTD) includes disorders of
placental development (hydatidiform mole) and neoplasms of the trophoblast (choriocarcinoma)
Q: Gestational Trophoblastic Disease Therapeutic Management
Answer:
Treatment consists of immediate evacuation of the uterine contents as soon as the diagnosis is
made and long-term follow-up of the client to detect any remaining trophoblastic tissue that
might become malignant. D&C is used to empty the uterus. The tissue obtained is sent to the
laboratory for analysis to evaluate for choriocarcinoma. Serial levels of hCG are used to detect
residual trophoblastic tissue for 1 year. If any tissue remains, hCG levels will not regress.
As a result of the increased risk for cancer, the client is advised to receive extensive follow-up
therapy for the next 12 months. The follow-up protocol may include:
Baseline hCG level, chest radiograph, and pelvic ultrasound
Quantitative hCG levels every week until undetectable for three consecutive weeks; then serial
hCG levels monthly for 1 year
Chest radiograph every 6 months to detect pulmonary metastasis
Regular pelvic examinations to assess uterine and ovarian regression
Systemic assessments for symptoms indicative of lung, brain, liver, or vaginal metastasis
Strong recommendation to avoid pregnancy for 1 year because the pregnancy can interfere with
the monitoring of hCG levels
Use of a reliable contraceptive for at least 1 year
Q: Gestational Trophoblastic Disease Nursing Assessment
Answer:
The nurse plays a crucial role in identifying and bringing this condition to the attention of the
health care provider based on sound knowledge of the typical clinical manifestations and astute
prenatal assessments.
Clinical manifestations of GTD are similar to those of spontaneous abortion at about 12 weeks of
pregnancy. Assess the woman for potential clinical manifestations at each prenatal visit. Be alert
for the following:
Report of early signs of pregnancy, such as amenorrhea, breast tenderness, fatigue
Brownish vaginal bleeding/spotting
Anemia
Inability to detect a fetal heart rate after 10 to 12 weeks’ gestation
Fetal parts not evident with palpation
Bilateral ovarian enlargement caused by cysts and elevated levels of hCG
Persistent, often severe nausea and vomiting (due to high hCG levels)
Fluid retention and swelling
Uterine size larger than expected for pregnancy dates
Extremely high hCG levels present; no single value considered diagnostic
Early development of preeclampsia (usually not present until after 24 weeks)
Absence of fetal heart rate or fetal activity
Expulsion of grape-like vesicles (possible in some women)
The diagnosis is made by high hCG levels and the characteristic appearance of the vesicular
molar pattern in the uterus via transvaginal ultrasound.
Q: Cervical Insufficiency patio
Answer:
The exact mechanism contributing to cervical insufficiency is not known. The cervix may have
less elastin, less collagen, and greater amounts of smooth muscle than the normal cervix and thus
results in loss of sphincter tone. Structural cervical weakness is the likely cause of many
recurrent second-trimester losses, but not the only etiology. Cervical length has also been
associated with cervical insufficiency and subsequently preterm birth. Recent studies have
examined the association between a short cervical length and the risk of preterm birth.
Q: Cervical Insufficiency Therapeutic Management
Answer:
Cervical insufficiency may be treated with bed rest; pelvic rest; avoidance of heavy lifting;
progesterone supplementation in women at risk for preterm birth; placement of a cervical pessary
(a round, silicone device at the mouth of the cervix); or surgically via a cervical cerclage
procedure in the second trimester. Cerclage was created more than 50 years ago based on the
hypothesis that for some women, weakness or malfunction of the cervix has a causative role in
the pathway to preterm birth. It can either be performed transvaginally or transabdominally.
Cervical cerclage involves using a heavy purse-string suture to secure and reinforce the internal
os of the cervix
Q: Placenta Previa Monitoring Maternal and Fetal Status
Answer:
Avoid doing vaginal examinations in the woman with placenta previa because they may disrupt
the placenta and cause hemorrhage.
Assess the degree of vaginal bleeding; inspect the perineal area for blood that may be pooled
underneath the woman. Estimate and document the amount of bleeding. Perform a peripad count
on an ongoing basis, making sure to report any changes in amount or frequency to the health care
provider. If the woman is experiencing active bleeding, prepare for blood typing and crossmatching in the event a blood transfusion is needed.
Monitor maternal vital signs and uterine contractility frequently for changes. Have the client rate
her level of pain using an appropriate pain rating scale. Assess fetal heart rates via Doppler or
electronic monitoring to detect fetal distress. Monitor the woman’s cardiopulmonary status,
reporting any difficulties in respirations, changes in skin color, or complaints of difficulty in
breathing. Have oxygen equipment readily available should fetal or maternal distress develop.
Encourage the client to lie on her side to enhance placental perfusion.
If the woman has an intravenous (IV) line inserted, inspect the IV site frequently. Alternately,
anticipate the insertion of an intermittent IV access device such as a saline lock, which can be
used if quick access is needed for fluid restoration and infusion of blood products. Obtain
laboratory tests as ordered, including complete blood count (CBC), coagulation studies, and Rh
status if appropriate.
Administer pharmacologic agents as necessary. Give Rh immunoglobulin if the client is Rhnegative at 28 weeks’ gestation. Monitor tocolytic (anticontraction) medication if prevention of
preterm labor is needed.
Q: Patho of Spontaneous Abortion
Answer:
Miscarriage
The causes of spontaneous abortion are varied and often unknown. The most common cause for
first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Cervical
Insufficiency
Q: Nursing Assessment Spontaneous Abortion
Answer:
Supportive Care
When a pregnant woman calls and reports vaginal bleeding, she must be seen as soon as possible
by a health care professional to ascertain the etiology.
Varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of
products of conception tissue may be reported.
Ask the woman about the color of the vaginal bleeding (bright red is significant) and the
amount—for example, question her about the frequency with which she is changing her peripads
(saturation of one peripad hourly is significant) and the passage of any clots or tissue. Instruct
her to save any tissue or clots passed and bring them with her to the health care facility.
Obtain a description of any other signs and symptoms the woman may be experiencing, along
with a description of their severity and duration. It is important to remain calm and listen to the
woman’s description.
When the woman arrives at the health care facility, assess her vital signs and observe the amount,
color, and characteristics of the bleeding.
Ask her to rate her current pain level, using an appropriate pain assessment tool.
Evaluate the amount and intensity of the woman’s abdominal cramping or contractions, and
assess the woman’s level of understanding about what is happening to her.
Q: 2 Questions to ask for ectopic pregnancy
Answer:
Ask last menstrual period
Did you know you were pregnant or do you know the gestational age?
Q: Ectopic Pregnancy 3 Symptoms
Answer:
Abdominal Pain
Bleeding
Hemorrhage
Q: Gestational Trophoblastic Disease What to monitor and How long to carry
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Mild Shock Mild: 20% blood loss, Symptoms: diaphoresis, increased cap refill, cool extremities, maternal anxiety
If a women who has lupus is wonder when she should have a baby Have there is not a flare up
Moderate Shock Moderate: 20-40% blood loss Symptoms: Tachycardia, postural hypotension, oliguria
Severe Shock Severe: over 40% blood loss Symptoms: Hypotension, agitation/confusion, hemodynamic instability
Pathophysiology of Ectopic Pregnancy Normally, the fertilized ovum implants in the uterus. In ectopic pregnancy, the journey along the fallopian tube is arrested or altered in some way. With an ectopic pregnancy, the ovum implants outside the uterus. The most common site for implantation is the fallopian tubes (96%), but some ova may implant in the ovary, the intestine, the cervix, or the abdominal cavity
Risk factors of ectopic pregnancy Chlamydia infection resulting in tubal damageOther associated risk factors for ectopic pregnancy include previous tubal surgery, infertility, PID, previous pregnancy loss (induced or spontaneous), use of an intrauterine contraceptive system, previous ectopic pregnancy, uterine fibroids, sterilization, smoking (which alters tubal motility), history of multiple sexual partners, use of progestin-only oral contraceptives, douching, and exposure to diethylstilbestrol
Gestational Trophoblastic Disease Definition The WHO classification of gestational trophoblastic disease (GTD) includes disorders of placental development (hydatidiform mole) and neoplasms of the trophoblast (choriocarcinoma)
Gestational Trophoblastic Disease Therapeutic Management Treatment consists of immediate evacuation of the uterine contents as soon as the diagnosis is made and long-term follow-up of the client to detect any remaining trophoblastic tissue that might become malignant. D&C is used to empty the uterus. The tissue obtained is sent to the laboratory for analysis to evaluate for choriocarcinoma. Serial levels of hCG are used to detect residual trophoblastic tissue for 1 year. If any tissue remains, hCG levels will not regress.As a result of the increased risk for cancer, the client is advised to receive extensive follow-up therapy for the next 12 months. The follow-up protocol may include:Baseline hCG level, chest radiograph, and pelvic ultrasoundQuantitative hCG levels every week until undetectable for three consecutive weeks; then serial hCG levels monthly for 1 yearChest radiograph every 6 months to detect pulmonary metastasisRegular pelvic examinations to assess uterine and ovarian regressionSystemic assessments for symptoms indicative of lung, brain, liver, or vaginal metastasisStrong recommendation to avoid pregnancy for 1 year because the pregnancy can interfere with the monitoring of hCG levelsUse of a reliable contraceptive for at least 1 year
Gestational Trophoblastic Disease Nursing Assessment The nurse plays a crucial role in identifying and bringing this condition to the attention of the health care provider based on sound knowledge of the typical clinical manifestations and astute prenatal assessments.Clinical manifestations of GTD are similar to those of spontaneous abortion at about 12 weeks of pregnancy. Assess the woman for potential clinical manifestations at each prenatal visit. Be alert for the following:Report of early signs of pregnancy, such as amenorrhea, breast tenderness, fatigueBrownish vaginal bleeding/spottingAnemiaInability to detect a fetal heart rate after 10 to 12 weeks’ gestationFetal parts not evident with palpationBilateral ovarian enlargement caused by cysts and elevated levels of hCGPersistent, often severe nausea and vomiting (due to high hCG levels)Fluid retention and swellingUterine size larger than expected for pregnancy datesExtremely high hCG levels present; no single value considered diagnosticEarly development of preeclampsia (usually not present until after 24 weeks)Absence of fetal heart rate or fetal activityExpulsion of grape-like vesicles (possible in some women)The diagnosis is made by high hCG levels and the characteristic appearance of the vesicular molar pattern in the uterus via transvaginal ultrasound.
Cervical Insufficiency patio The exact mechanism contributing to cervical insufficiency is not known. The cervix may have less elastin, less collagen, and greater amounts of smooth muscle than the normal cervix and thus results in loss of sphincter tone. Structural cervical weakness is the likely cause of many recurrent second-trimester losses, but not the only etiology. Cervical length has also been associated with cervical insufficiency and subsequently preterm birth. Recent studies have examined the association between a short cervical length and the risk of preterm birth.
Cervical Insufficiency Therapeutic Management Cervical insufficiency may be treated with bed rest; pelvic rest; avoidance of heavy lifting; progesterone supplementation in women at risk for preterm birth; placement of a cervical pessary (a round, silicone device at the mouth of the cervix); or surgically via a cervical cerclage procedure in the second trimester. Cerclage was created more than 50 years ago based on the hypothesis that for some women, weakness or malfunction of the cervix has a causative role in the pathway to preterm birth. It can either be performed transvaginally or transabdominally. Cervical cerclage involves using a heavy purse-string suture to secure and reinforce the internal os of the cervix
Placenta Previa Monitoring Maternal and Fetal Status Avoid doing vaginal examinations in the woman with placenta previa because they may disrupt the placenta and cause hemorrhage.Assess the degree of vaginal bleeding; inspect the perineal area for blood that may be pooled underneath the woman. Estimate and document the amount of bleeding. Perform a peripad count on an ongoing basis, making sure to report any changes in amount or frequency to the health care provider. If the woman is experiencing active bleeding, prepare for blood typing and cross-matching in the event a blood transfusion is needed.Monitor maternal vital signs and uterine contractility frequently for changes. Have the client rate her level of pain using an appropriate pain rating scale. Assess fetal heart rates via Doppler or electronic monitoring to detect fetal distress. Monitor the woman’s cardiopulmonary status, reporting any difficulties in respirations, changes in skin color, or complaints of difficulty in breathing. Have oxygen equipment readily available should fetal or maternal distress develop. Encourage the client to lie on her side to enhance placental perfusion.If the woman has an intravenous (IV) line inserted, inspect the IV site frequently. Alternately, anticipate the insertion of an intermittent IV access device such as a saline lock, which can be used if quick access is needed for fluid restoration and infusion of blood products. Obtain laboratory tests as ordered, including complete blood count (CBC), coagulation studies, and Rh status if appropriate.Administer pharmacologic agents as necessary. Give Rh immunoglobulin if the client is Rh-negative at 28 weeks’ gestation. Monitor tocolytic (anticontraction) medication if prevention of preterm labor is needed.
Patho of Spontaneous Abortion MiscarriageThe causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Cervical Insufficiency
Nursing Assessment Spontaneous Abortion Supportive CareWhen a pregnant woman calls and reports vaginal bleeding, she must be seen as soon as possible by a health care professional to ascertain the etiology.Varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of products of conception tissue may be reported.Ask the woman about the color of the vaginal bleeding (bright red is significant) and the amount—for example, question her about the frequency with which she is changing her peripads (saturation of one peripad hourly is significant) and the passage of any clots or tissue. Instruct her to save any tissue or clots passed and bring them with her to the health care facility.Obtain a description of any other signs and symptoms the woman may be experiencing, along with a description of their severity and duration. It is important to remain calm and listen to the woman’s description.When the woman arrives at the health care facility, assess her vital signs and observe the amount, color, and characteristics of the bleeding.Ask her to rate her current pain level, using an appropriate pain assessment tool.Evaluate the amount and intensity of the woman’s abdominal cramping or contractions, and assess the woman’s level of understanding about what is happening to her.
2 Questions to ask for ectopic pregnancy Ask last menstrual periodDid you know you were pregnant or do you know the gestational age?
Ectopic Pregnancy 3 Symptoms Abdominal PainBleedingHemorrhage
Gestational Trophoblastic Disease What to monitor and How long to carry It is not a baby; it is an incomplete pregnancy. Tissues with no fetusDo not carry to term, induce for immediate evacuationMonitor hCG for next year (metastasis), do not get pregnant for next yearWant hCG to go down
What is cervical insufficiency Thinning and dilation of cervix before it should be. Cervical changes without labor
What to do for patient with cervical insufficiency Bed rest, TrendelenburgCerclage, surgical closure of cervixGive progesterone
What to know about placenta previa (what is mom at risk for? how to deliver? what exams cannot be done) Cannot have vaginal deliveryMom and baby vitalsMom at risk for hemorrhage, monitor for bleedingNothing in Vagina, no vaginal exam or intercourse (no orgasm causes uterus to contract)
What happens in abruptio placenta? Can pregnancy be completed? Placenta tears away from uterine wallCannot maintain pregnancy if it is a complete abruption, partial can monitor
What to monitor for and have with abruptio placenta Monitor for blood loss, contractionsNeed 2 IV lines (saline/meds and blood)Blood ready
Chronic Hypertension Hypertension that exists prior to pregnancy or that develops before 20 weeks’ gestation with blood pressure readings greater than 140/90 mm Hg
Gestational Hypertension A new-onset blood pressure elevation (140/90 mm Hg) identified after 20 weeks’ gestation without proteinuria; blood pressure returns to normal by 12 weeks’ postpartum
Preeclampsia/HELLP Most common hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks’ gestation; a multisystem disease process, which is accompanied by at least one of the following: proteinuria, elevated creatinine, liver involvement, epigastric or abdominal pain, neurologic complications, hematologic complications, and uteroplacental dysfunction; eclampsia occurs when seizure activity develops
What 4 things are given for HELLP Liver enzymes and platelets and Magnesium and Fluids
Main differences between gestational hypertension and preeclampsia Reflexes, vision changes, headaches in preeclampsia Preeclampsia has protein in urine
2 phases of preeclampsia Preeclampsia is a two-stage event; the underlying mechanisms involved are vasospasm and hypoperfusion. In the first stage, the key feature is widespread vasospasm. In addition, endothelial injury occurs, leading to platelet adherence, fibrin deposition, and the presence of schistocytes (fragments of erythrocytes). The second stage of preeclampsia is the woman’s response to abnormal placentation, when symptoms appear (i.e., hypertension, proteinuria, headache, nausea and vomiting, retinal vascular changes causing blurred vision, and hyperreflexia due to hypoperfusion).
Hyperemesis Gravidarum management Manage electrolytes and dehydration from vomitingI&OsMake sure they are gaining enough weight
Pathophysiology of Hyperemesis Gravidarum In hyperemesis gravidarum, the hCG levels are often higher and extend beyond the first trimester. Symptoms exacerbate the disease. Decreased fluid intake and prolonged vomiting cause dehydration; dehydration increases the serum concentration of hCG, which in turn exacerbates the nausea and vomiting
Hyperemesis Gravidarum Risk Bigger risk when you have had it previously in a pregnancy
Lab Results for HELLP Low hematocrit that is not explained by any blood lossElevated LDH (liver impairment)Elevated AST (liver impairment)Elevated ALT (liver impairment)Elevated BUN (renal impairment)Elevated bilirubin level (liver impairment)Elevated uric acid and creatinine levels (renal involvement)Low platelet count (less than 100,000 cells/mm3)
Polyhydramnios Makes Higher Risk for Prolapsed cord, boggy uterus, hemorrhage
Polyhydramnios What is it? Too much amniotic fluid Measuring large for gestational ageLarger pockets of amniotic fluid on ultrasound
Severe Polyhydramnios Treatments In severe cases in which the woman is in pain and experiencing shortness of breath, an amniocentesis or artificial rupture of the membranes is done to reduce the fluid and the pressure. Removal of fluid by amniocentesis is only transiently effective. A noninvasive treatment may involve the use of a prostaglandin synthesis inhibitor (indomethacin) to decrease amniotic fluid volume by decreasing fetal urinary output, but this may cause premature closure of the fetal ductus arteriosus
Symptom to watch out for with polyhydramnios shortness of breath
Premature Rupture of Membranes Causes Causes: stress, injury/trauma, Amniocentesis
Assessment Premature Rupture of Membranes Assess color, amount, how long ago, any sedimentAmnisure
What is premature rupture of membranes Amniotic sack is ruptured before term, with or without labor present
When to concieve if you have systemic lupus erythematosis try to conceive when you are not in a flare up (6 months after last flare up) at risk for adverse pregnancy if you are in acute exacerbation
Herpes and Pregnancy No vaginal birth without preventative measuresGive anti-viral before birth start at 34-36 weeks
Group B Streptococcus What to know Test for it at 36 weeksEye ointmentIt just happens, it is not an STIStart antibiotics when mom is in labor (at least 4 hours before delivery)Monitor Baby for:Temp (fever)
What to watch for in HIV positive mother Bleeding
Interventions for HIV positive mom Interventions to reduce HIV transmission include antiretroviral therapy for the mother and the newborn, consideration of elective cesarean section in women with elevated plasma viral load, and the avoidance of breastfeeding. With these interventions, the risk of HIV transmission in the United States is now less than 1%
What kinds of medications are given to HIV positive mother Drug therapy is the mainstay of treatment for pregnant women infected with HIV. The standard treatment is oral antiretroviral drugs given daily until giving birth, IV administration during labor, and oral zidovudine (AZT) for the newborn within 6 to 12 hours of birth The goal of therapy is to reduce the viral load as much as possible, which reduces the risk of transmission to the fetus.
4 major risk factors for Dystocia infant of diabetic momLGAAnalgesic Use or epidural that decreases sensitivity to pushingAdolescents (young mom
Magnesium Sulfate Action in Preterm Labor Relaxes uterine muscles to stop contractions Seizure prophylaxis
Indomethacin (Indocin) Action in Preterm Labor Inhibits prostagladins which stimulate contractionsInhibits uterine activity to arrest preterm labor
Nifedipine (Procardia) Action in Preterm Labor Blocks calcium movement into muscle cells, inhibits uterine activity to arrest preterm labor
Betamethasone (Celestrone) Action in Preterm Labor Promotes fetal lung maturity and stimulates surfactant production
Assessment for Labor Induction gestational age, cervix (bishop score, if low give cervical ripening medication)
Induction vs. Augmentation Induction: Not in labor at allAugmentation: Started progressing but not as quickly as we wantGoal is to avoid C-section
Vaginal Birth after C-section Risk for Uterine rupture
What to do for umbilical cord prolapse Cord comes out before the baby, medical emergencyPut your hand up and push baby back up and relieve pressure from umbilical cordStraight to ORCan be caused by polyhydramnios
What to have ready for postpartum hemorrhage 2 IV lines
Why are women at risk for venous thromboembolic conditions with pregnancy Extra clotting factors from excess blood when pregnantLook for risk factors in the woman’s history such as use of oral contraceptives before the pregnancy; smoking; employment that necessitates prolonged standing; history of thrombosis; thrombophlebitis or endometritis; or evidence of current varicosities. Also look for other factors that can increase a woman’s risk, such as prolonged bed rest, diabetes, obesity, cesarean birth, progesterone-induced distensibility of the veins of the lower legs during pregnancy, severe anemia, varicose veins, maternal age older than 34 years, and multiparity. The likelihood of thrombophlebitis is increased through most of pregnancy and for approximately 12 weeks after childbirth.
Assessment for venous thromboembolic conditions Dorsal (toes to nose)Temp difference between calvesSwelling and tendernessCalf Pain (holden sign)Calf swelling and tenderness, difference in leg circumference, erythema, warmth, tenderness, pain with calf pressure, and pedal edema may be noted.
Postpartum Blues Give meds or no No medication
Education and Assessment for Postpartum Blues Education about how common it isAssess support and ability to care for baby
Risk for LGA Mom has diabetes or is overweight or history of large baby
LGA Weight Large for gestational age (LGA) describes newborns whose birth weight is above the 90th percentile on a growth chart and who weigh more than 4,000 g (8 lb 13 oz) at term due to accelerated overgrowth for length of gestation
LGA At risk for Hypoglycemia
Respiratory System Premature baby not enough surfactant, lung sounds, skin color, RR, nasal flaring, O2 sat on foot or wrist, stimulation to breath, rolling on side, suction airway, give them oxygen, resuscitation,
Gastrointestinal System Premature Baby how many poops, bowel sounds, look at abdomen for distention, patent anus, assess weight, suck-swallow reflex is slower to develop
CNS Premature Baby affected the most, assessment of reflexes
Managing Pain for newborn Topical management for painComfort measuresRub forehead
Promoting Oxygenation in Premature Baby Oxygen administration is a common therapy in the neonatal intensive care unit
Late Preterm Baby 34 weeks and 36 6/7 weeks Nails longer and more hairDry and cracked skinAlert and wide eyedMonitor for hypoglycemiaSome of the most common complications for late preterm infants are cold stress, respiratory distress, hypoglycemia, sepsis, cognitive delays, hyperbilirubinemia, and feeding difficulties (suck-swallow)more likely to be affected by infections, hypothermia, hypoglycemia, respiratory distress, apnea, jaundice, feeding difficulties, and neurodevelopmental delays in the first years of life.
Therapeutic Management of Abruptio Placenta . Emergency measures include starting two large-bore IV lines with normal saline or lactated Ringer’s solution to combat hypovolemia, obtaining blood specimens for evaluating hemodynamic status values and for typing and cross-matching, and frequently monitoring fetal and maternal well-being. After the severity of abruption is determined and appropriate blood and fluid replacement is given, cesarean birth is done immediately if fetal distress is evident. If the fetus is not in distress, close monitoring continues with birth planned at the earliest signs of fetal distress.
Classic Manifestations of Abruptio Placenta “Classic manifestations of abruptio placentae include painful, dark-red vaginal bleeding (port-wine color) because the bleeding comes from the clot that was formed behind the placenta; “”knife-like”” abdominal pain; uterine tenderness; contractions; and decreased fetal movement. Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality.”
Nursing Assessment Abruptio Placenta Health and Physical AssessmentVital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shockAssess Lab and Diagnostic TestsEnsure Tissue PerfusionProvide Support and Education
Therapeutic Management of Hyperemesis Gravidarum “. The first choice for fluid replacement is generally normal saline, which aids in preventing hyponatremia, with vitamins (pyridoxine, or vitamin B6) and electrolytes added. Oral food and fluids are withheld for the first 24 to 36 hours to allow the gastrointestinal tract to rest. Antiemetics may be administered rectally or intravenously to control the nausea and vomiting initially because the woman is considered NPO (not able to ingest anything by mouth). Once her condition stabilizes and she is allowed oral intake, medications may be administered orally.If the client does not improve after several days of bed rest, “”gut rest,”” IV fluids, and antiemetics, total parenteral nutrition or feeding through a percutaneous endoscopic gastrostomy tube is instituted to prevent malnutrition”
Pathophysiology of Hyperemesis Gravidarum Elevated levels of hCG are present in all pregnant women during early pregnancy, usually declining after 12 weeks. This corresponds to the usual duration of morning sickness. In hyperemesis gravidarum, the hCG levels are often higher and extend beyond the first trimester. Symptoms exacerbate the disease. Decreased fluid intake and prolonged vomiting cause dehydration; dehydration increases the serum concentration of hCG, which in turn exacerbates the nausea and vomiting
HELLP Stands for HELLP syndrome is an acronym for hemolysis, elevated liver enzymes, and low platelet count
Patho of HELLP HELLP syndrome is characterized by abnormal vascular tone, vasospasm, and coagulation defects. The hemolysis that occurs is called microangiopathic hemolytic anemia. This cascade of events is thought to happen when red blood cells become fragmented as they pass through small, damaged blood vessels. Elevated liver enzymes are the result of reduced blood flow to the liver secondary to obstruction from fibrin deposits. At the same time, endothelial damage and fibrin deposition in the liver may lead to liver impairment and can result in hemorrhagic necrosis, indicated by right upper quadrant tenderness, nausea, and vomiting. Hyperbilirubinemia and jaundice result from liver impairment. Low platelets result from vascular damage, the result of vasospasm, and platelets aggregate at sites of damage, resulting in thrombocytopenia in multiple sites
Nursing Assessment for Polyhydraminos Begin the assessment with a thorough history, staying alert to risk factors such as maternal diabetes or multiple gestations.Determine the gestational age of the fetus, and measure the woman’s fundal heightNote any reports of uterine contractions, which may result from overstretching of the uterus. Assess for shortness of breath resulting from pressure on her diaphragm and inspect her lower extremities for edema, which results from increased pressure on the vena cava. Palpate the abdomen and obtain fetal heart rate. Often the fetal parts and heart rate are difficult to obtain because of the excess fluid present.Prepare the woman for possible diagnostic testing to evaluate for the presence of possible fetal anomalies. An ultrasound is usually done to measure the pockets of amniotic fluid to estimate the total volume. In some cases, ultrasound is also helpful in finding the etiology of polyhydramnios, such as multiple pregnancy or a fetal structural anomaly.
Risk Factors for Premature Rupture of Membranes Review the maternal history for risk factors such as infection, increased uterine size (potential polyhydramnios, macrosomia, and multiple gestation), uterine and fetal anomalies, lower socioeconomic status, STIs, cervical insufficiency, vaginal bleeding, and cigarette smoking during pregnancy. Ask about any history or current symptoms of UTI (frequency, urgency, dysuria, or flank pain) or pelvic or vaginal infection (pain or vaginal discharge
Assessments for Premature Rupture of Membranes Assess for signs and symptoms of labor, such as cramping, pelvic pressure, or back pain. Also assess vital signs, noting any signs indicative of infection such as fever and elevated white blood cell count (more than 18,000 cells/mm3) Institute continuous electronic fetal heart rate monitoring to evaluate fetal well-being. Conduct a vaginal examination to ascertain the cervical status in PROM. If PPROM exists, a sterile speculum examination (during which the examiner inspects the cervix but does not palpate it) is done rather than a digital cervical examination because it may diminish latency (period of time from rupture of membranes to birth) and increase newborn morbidity.Observe the characteristics of the amniotic fluid
If woman is pregnat with SLE What do you Assess Duration and presence of SLE signs and symptoms (fatigue, fever, malaise, polyarthritis, skin rashes, and multiorgan involvement)Evidence of anemia, thrombocytopenia, and thrombophiliaUnderlying renal disease (check the urine for protein and specific gravity)Signs of flare-upsAbnormalities in laboratory testsSigns of infection (check at each prenatal visit especially urinary tract infections and upper respiratory infections since prednisone can mask signs of infection and lower resistance)Fetal well-being and growth (check using ultrasound, fundal height measurements, nonstress tests, and biophysical profiles)
Treatment of SLE with Pregnancy Treatment of SLE in pregnancy is generally limited to NSAIDs like ibuprofen (Advil), prednisone (Deltasone), and an antimalarial agent, hydroxychloroquine (Plaquenil). During pregnancy in the woman with SLE, the goal is to keep drug therapy to a minimum
What does dystocia result from “Dystocia can result from problems or abnormalities involving the expulsive forces (known as the “”powers””); presentation, position, and fetal development (the “”passenger””); the maternal bony pelvis or birth canal (the “”passageway””); and maternal stress (the “”psyche””). Requires a C-section”
Reasons for a c-section Fetal distress, breech, abruption, previa
Post Partum Blues “The woman typically experiences rapid cycling mood symptoms during the first postpartum week. She will exhibit mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, despondency, feelings of being overwhelmed, difficulty thinking clearly, insomnia, loss of appetite, and fatigue. Emotional lability is the most prominent symptom of the maternity blues. The “”blues”” typically peak on postpartum days 4 and 5 and usually resolve by postpartum day 10Although the woman’s symptoms may be distressing, they do not reflect psychopathology and usually do not affect the mother’s ability to function and care for her infant.”
Promoting Oxygen in Premature Baby First, keep the newborn warm, preferably in a warmed isolette or with an overhead radiant warmer, to conserve the baby’s energy and prevent cold stress.Handle the newborn as little as possible, because stimulation often increases the oxygen requirement.Provide energy through calories via intravenous dextrose or gavage or continuous tube feedings to prevent hypoglycemia.Treat cyanosis with an oxygen hood or blow-by oxygen placed near the newborn’s face if respiratory distress is mild and short-term therapy is needed.
What to assess every hour in premature baby with oxygen problems Respiratory rate, quality of respirations, and respiratory effortAirway patency, including removal of secretions per facility policySkin color, including any changes to duskiness, blueness, or pallorLung sounds on auscultation to differentiate breath sounds in upper and lower fieldsEquipment required for oxygen delivery, such as:Blow-by oxygen delivered via mask or tube for short-term therapyOxygen hood (oxygen is delivered via a plastic hood placed over the newborn’s head)Nasal cannula (oxygen is delivered directly through the nares) (Fig. 23.4A)Continuous positive airway pressure (CPAP), which prevents collapse of unstable alveoli and delivers high levels of inspired oxygen into the lungsMechanical ventilation, which delivers consistent assisted ventilation and oxygen therapy, reducing the work of breathing for the fatigued infant
Three C of Esophageal Atresia and Tracheoesophageal Fistula Coughing Choking Cyanosis
What is Esophageal Atresia and Tracheoesophageal Fistula Esophageal atresia and tracheoesophageal fistula are gastrointestinal anomalies in which the esophagus and trachea do not separate normally during embryonic development
First step for meconium aspiration wipe face, suction, oxygen
Persistent Pulmonary Hypertension Nursing Implications Cardiology involvedHard on newbornCluster careDo care in warm area and do not bath unless it is a warm environment (do not maintain body temp)
Risk Factors for Birth Injuries prolonged or abrupt labor, abnormal or difficult presentation, cephalopelvic disproportion, or mechanical forces, such as forceps or vacuum used during deliveryReview the history for multiple fetus deliveries, large-for-date infants, extreme prematurity, large fetal head, or newborns with congenital anomalies.
Nursing Assessment Birth Injuries Complete a careful physical and neurologic assessment of every newborn admitted to the nursery to establish whether injuries exist. Inspect the head for lumps, bumps, or bruises. Note if swelling or bruising crosses the suture line. Assess the eyes and face for facial paralysis, observing for asymmetry of the face with crying or appearance of the mouth being drawn to the unaffected side. Ensure that the newborn spontaneously moves all extremities. Note any absence of or decrease in deep tendon reflexes or abnormal positioning of extremities.Assess and document symmetry of structure and function. Be prepared to assist with scheduling diagnostic studies to confirm trauma or injuries, which will be important in determining treatment modalities.
Types of Birth Injuries ClaviclesBrachial lexisCaputMoldingHematomas
Patho of Birth Injuries The process of birth is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immunity complicates this process, the forces of labor and birth may lead to tissue damage, edema, hemorrhages, or fractures in the newborn. For example, birth trauma may result from the pressure of birth, especially in a prolonged or abrupt labor, abnormal or difficult presentation, cephalopelvic disproportion, or mechanical forces, such as forceps or vacuum used during delivery.
Care for Alcohol Spectrum Baby Support and comfort for babyGentle, non-stimulating environmentAssessments scheduled and as needed
Fetal alcohol spectrum disorder Fetal alcohol spectrum disorder (FASD) is the umbrella term used to describe a range of preventable conditions, birth defects and intellectual and/or developmental disabilities resulting from prenatal alcohol exposureThe distinctive pattern identified three specific findings: growth restriction (prenatal and postnatal), craniofacial structural anomalies, and CNS dysfunction.
What protocol is put in place for pregnant mom drinking alcohol NAS
Promoting Care for Neonatal Abstinence Syndrome Pharmacologic treatment is warranted if conservative measures, such as swaddling and decreased environmental stimulation, are not adequate. The AAP recommends that for newborns with confirmed drug exposure, drug therapy is indicated if the newborn has seizures, diarrhea, and vomiting resulting in excessive weight loss and dehydration, poor feeding, inability to sleep, and fever unrelated to infection. Common medications used in the management of newborn withdrawal include an opioid (morphine or methadone) and sublingual buprenorphine or phenobarbital or clonidine as secondary drugs if the opiate does not adequately control symptoms. Administer the prescribed medications and document the newborn’s behavioral responses.
Neonatal Abstinence Syndrome Baby At Risk For The newborn is at risk for skin breakdown. Weight loss, diarrhea, dehydration, and irritability can contribute to this risk. Provide meticulous skin care and protect the newborn’s elbows and knees against friction and abrasions.
Providing Parent Teaching and Support for Reducing Bilirubin Nurses can help the parents to understand the diagnostic tests and treatment modalities by offering individualized teaching. Nurses are the ones who give discharge instructions to the family. Explore with the family their understanding of jaundice and treatment modalities to reduce anxiety and gain their cooperation in monitoring the infant. Teach the parents about jaundice and its potential risk using written and verbal material. Also show the parents how to identify newborn behaviors that might indicate rising bilirubin levels. Emphasize the need to seek treatment from their pediatrician should any of the following occur:Lethargy, sleepiness, poor muscle tone, floppinessPoor sucking, lack of interest in feedingHigh-pitched cry, irritabilityTeach the parents how to assess their newborn for signs of jaundice because physiologic jaundice may not occur until after the newborn is discharged.
Reducing Bilirubin Levels Encourage early initiation of feedings to prevent hypoglycemia and provide protein to maintain the albumin levels to transport bilirubin to the liver. Ensure newborn feedings (breast milk or formula) every 2 to 3 hours to promote prompt emptying of bilirubin from the bowel. Encourage the mother to breastfeed (eight to 12 feedings per day) to prevent inadequate intake and thus dehydration. Supplement breast milk with formula to supply protein if bilirubin levels continue to increase with breastfeeding only. Monitor serum bilirubin levels frequently to reduce the risk of severe hyperbilirubinemia.Phototheraopy: For the newborn with jaundice, regardless of its etiology, phototherapy is used to convert unconjugated bilirubin to the less toxic water-soluble form that can be excreted. Phototherapy, via special lights placed above the newborn or a fiberoptic blanket placed under the newborn and wrapped around him or her, involves blue wavelengths of light to alter unconjugated bilirubin in the skinExchange Transfusion: If the total serum bilirubin level remains elevated after intensive phototherapy, an exchange transfusion with albumin administered before the transfusion, the quickest method for lowering serum bilirubin levels, may be necessary. Exchange transfusions are a high-risk procedure and should be performed only when the benefit of the procedure offsets the risks
What to check for reducing bilirubin urine and stools
What can lead to increased bilirubin traumatic birth
Symptoms of Respiratory Distress CyanosisBad APGARNot cryingFloppy muscle toneCracklesBad Respirations
What to do for respiratory distress Resuscitation and maintenance (needs support)
Patho of Respiratory Distress Not enough surfactant and lung immaturity Anatomically, the immature lung cannot support oxygenation and ventilation, because the alveolar sacs are insufficiently developed, causing a deficient surface area for gas exchange. Physiologically, the amount of surfactant is insufficient to prevent collapse of unstable alveoli
Hypoxic Iscemic Encephalophathy Patho Asphyxia occurs when oxygen delivery is insufficient to meet metabolic demands, resulting in hypoxia, hypercarbia, and metabolic acidosis. Any condition that reduces oxygen delivery to the fetus can result in asphyxia. These conditions may include maternal hypoxia, such as from cardiac or respiratory disease, anemia, or postural hypotension; maternal vascular disease that leads to placental insufficiency, such as diabetes or hypertension; cord problems such as compression or prolapse; and post-term pregnancies, which may trigger meconium release into the amniotic fluid.
What causes hypoxic ischemic encephalopathy Asphyxia
What to do for hypoxic ischemic encephalopathy “Immediate resuscitation and establish oxygenManagement of the newborn experiencing asphyxia includes immediate resuscitation. Ensure that the equipment needed for resuscitation is readily available and in working orderThe procedure for newborn resuscitation is easily remembered by the “”C-A-B”” s””—Compressions-Airway-Breathing. Continue resuscitation until the newborn has a pulse above 100 bpm, a good healthy cry, or good breathing efforts and a pink tongue. This last sign indicates a good oxygen supply to the brain”
Risk Factors for Intrauterine (Congenital) Newborn Infections Immature immune systemDecreased gastric acid
Mechanism of infection for Intrauterine (Congenital) Newborn Infections Organisms crossing placenta into fetal circulationOrganism into membranes from vagina
Risk factors for early-onset newborn infections Prolonged rupture of membranesUTIPreterm laborDifficult laborMaternal FeverGABMaternal Infection
Mechanism of Infection for early onset newborn infection Infected birth canalLack of gastric acidAspiration during birth
Risk Factors for Late Onset Newborn Infection Low birth weightPrematureMeconium StainingBirth AsphyxiaImproper hand washing
Key to remember for neonatal sepsis FEVER over 100.3 call doctor
LBW Weight < 2,500 g or 5.5 lb VLBW Weight < 1,500 g or 3lb 5oz ELBW Weight < 1,000g or 2lb 3oz AGA •Appropriate for gestational age : approximately 80% of newborns; normal height, weight, head circumference, body mass index SGA •Small for gestational age: weight <2,500 g (5 lb, 8 oz) at term or below the 10th percentile LGA •Large for gestational age: weight >90th percentile on a growth chart; weight >4,000 g (8 lb, 13 oz) at term