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Ectopic Pregnancy Implantation of fertilized ovum outside of the uterus.
Causes: IUD, previous hx, crohns, STD's,IVF,Infertility, Multiple abortions. highly vascularized area, when ruptures it is very heavy bleeding.
Clinical Manifestations: Missed menstrual period,positive pregnancy test, abdominal pain, vaginal spotting.Poss. elevated HR, low BP,possible scapular pain can be sign of rupture.
Tx: Large bore IV (2), Normal saline, Blood, CBC.
Placenta Previa Placenta attaches to the lower uterine segment Total, partial, marginal. 3per 1000 births. Cocaine use, scarring, abdominal trauma, HTN, multiple pregnancies.
Abruptio Placenta Premature separation of the placenta from the decidual lining of the uterus. higher risk of fetal mortality incidence is less. High resting tone of uterus, extremely painful.
Clinical presentation: Severe pain, bleeding, check fetal heart tones(priority assessment), check mom next, Determine amount of bleeding , 1 GM = 1 ml of blood. Totally saturated chucks pad = 500 mls
Late decels, decreased variability on fetal heart monitor.
Cocaine use, scarring, abdominal trauma, HTN, multiple pregnancies. #1 cause is abuse!
Hypovolemic shock in pregnant woman higher blood volume= lose more blood before symptoms show, fibrinogen is higher in blood. (normal is up to 400 for pregnant woman)
s/sx: losing hgb and oxygen carrying capacity, MAP decreased tells you how much pressure is needed to perfuse organs, normal MAP = 60-100.
Stimulates: Baroreceptors, SNS, Release catecholemines(epi norepi), widespread vasoconstrictions, Aerobic and anaerobic cellular metabolisms
VERY FIRST THING YOU WILL SEE IS INCREASED HR. INCREASED RESPIRATIONS to compensate for low O2.
IF continues to worsen: Renin--aldosterone--retain water and salt---pituitary--- ADH= retaining more water---epi and nor epi. Shunting blood to vital organs...
S/Sx:Anxiety, restlessness, Impending doom, decreased bp , decreased urine output, weak peripheral pulses, pallor, cool extremities, low H&H, electrolyte changes, ACIDOTIC ABG's.
WORSENS: decreased LOC, decreased perfusion to vital organs, HR goes down BP continues to decrease, more pallor, MODS, RESPIRATIONS DECREASE>
DIC: Disseminating Intravascular Coagulation petechiae, little clots Tx: blood products, anticoagulants,coagulation inhibitors, strict monitoring.
CLOTTING PROCESS GOES INTO OVERDRIVE Labs: d-dimer, cbc, ABG, Prothombin, platelets, hgb, ptt , fibrinogen,
S/Sx: petechiae, shock,
Complications: Thrombus formation, MODS, intrarcranial hemorrhage and MI, microemboli why ddimer and fibrinogen , bleeding and clotting at the same time.
TX: Anticoagulants, blood products.
Preeclampsia: After 20 weeks. Lebatolol usually used,, do not use ACE inihibitors. Proteinuria, last half of pregnancy.
Risk factors: more coming in first pregnancy, DM, multilple gestations, Family hx, NEw baby with new partner. Trophoblastic disease.
Problem is with the placenta, pt's develop resistance to angiotensin 2. Immune adaption SIA gene abundance in placenta, something goes wrong with the gene doesn't recognize self anymore. Generalized vasospasm and endothelial damage occurs; Increased thromboxane/prostacyclin ration=vasoconstriction and platelet aggregation. Increased sensitivity to angiotensin 11= vasoconstriction retain water, sodium Increased endothelin= constriction of bv's, HTN LOTS OF EDEMA.
S/SX: gaining too much weight= 1 lb a week equals norm.
Chronic HTN HTN occuring before pregnancy before 20 weeks. >or=
Hpov shock hgb-o2-drop in map 60-100, how well the heart is perfusing tissues, aortic arch and carotids, baro receptors, CNS, catecholemines, increased hr, map continues to decrease signals kidneys to release renin angiotensin(1-2) aldosterone system to hold onto sodium and water falls, shunting blood to vital organs, subjective: anxiety, irritability, obj: weak peripheral pulses, decreased urine output, pallor cool extremities, bp continuing to drop. Continues further loss of consciousness.
CNS assessment DTR: brachial, patellar, dorsal flex foot taps against hand clonus count num of times it taps against home. seizures, precautions, facial twitching tonic clonic movements, decrease in bf to eyes, change in eyesite can lose vision, can have stroke.
Cardiovascular assessment HTN Edema WEight gain HR CHECK CBC Blood is thicker bc its shunted into interstitial spaces and H&H will be higher Nursing dx: decreased co rt high bp and increased vascular resistance aeb high bp, edema and weight gain admin mag sulf, position changes, hourly vs, check urine output.
Pulmonary Assessment Pulmonary edema, assess lung sounds, decrease in tissue perfusion, o2 sats, o exchange, SOB increase,proteinuria, proteins being forced out from high bp. Somtimes after delivery pt shifts in fluid bc too heavy load for kidney the fluid can go to the lungs.WEIGHT GAIN.
GI system Liver is primarily effected decreased circulation to hepatic system, increased liver enzymes,Subcapsular hematoma. epigastric pain, Acute pain rt hepatic inflammation aeb pt reports pain level 7/10 in right upper quadrant, assist pt to left side lying position,monitor labs ALT and AST , notify dr of values outside normal range. Non pharm pain reduction help pt into bath or whirlpool. S
GU assess ua , protein in urine, voiding changes, bun creatinine, uric acid, decreased urinary output, increase in reticulocytes dt erythropoeitin release, FLuid volume deficit rt hyrostatic pressure AEB assess weight edema vitals insert urinary cath as ordered, fluids, strict io, evaluate BUN creatinine and uric acid for damage. MONITOR IO CRITICAL!
Fetus assess kick count, fetal monitor, fundal growth, baby hr, monitor fetal movement with kick count
Pt admitted to hospital Questions: Fetal movement, HA, epigastric pain, SOB, Changes in visions, Urine output, ASSESS: VITAL SIGNS! UA, Dipstick test for protein,
Mag Sulfate Loading dose- 4-6 g IV, Maintenance dose 1-3 g/hr IV diluted in LR, Smooth muscle relaxation to decrease bp and reduce risk of seizure, maintain serum mag levels 4-8 mEq/L, IM. S/SX: Miserable when they get this drug, sx make them very hot, cool the room, loading dose 20 minutes. Resp depression, monitoring reflexes when mag level too high, sweating, Kidney function, urine output too low at risk for mag tox. Antidote: Calcium Gluconate, 1 gm over 8 minutes Mag toxicity: Urine output, resp, DTRS, mag level on labs (4-8) If 8-10: DTRS up to 12:- Diaphragm 12-15: resp paralysis 20+ stop heart. Monitor q15 min mom and baby.
HELLP SYNDROME Hemolysis: Burr cells, elevated liver enzymes ALT AST, low platelet counts. s/sx: n/v, epigastric pain or upper right quadrant,HA, flu like symptoms,
Eclampsia Epigastric pain, visual disturbances, HA,twitching facial, hyper reflexia, During seizures: pads, bed in lowest position,side rails,o2, suction,time seizure, characteristics of seizure,stay with them, put them on their side, AFter: Airway is she breathing, fetus!HR, Vitals. Mag sulfate, poss. dilantin.
Diabetes Mellitus beta cell hyperplasia=more insulin availability,needs decrease bc of hormone levels laying down fat stores and provide more energy for baby, more sensitive to insulin later: less sensitive to insuling, glyemic control Risk directly related to glycemic control managing bs, insulin and planning meals, plan one meal,
Sugar Insulin Carbs Ketones
Sugar: Check your bs every 2-3 hrs even more with pregnancy and children.
Insulin: Continue to take your insulin even if you are sick, to avoid DKA.
Carbs: Make sure you take in enough carbs and drink enough fluids, if glucose is high do sugar free fluids, If glucose is low drink carb containing drinks
Ketones: Check blood or urine ketone levels. Rapid acting insulin if ketones are present. Drink plenty of water to flush ketones.
Meconium Aspiration Syndrome meconium in the lungs, occurs most in infants who are post term, small for gestational age, and are compromised before birth by placental insufficiency with decreased amniotic fluid and cord compression. Meconium is an irritant to the lung and causes an inflammatory reaction.
S/Sx: tachypnea, cyanosis, retracions, nasal flaring, grunting, rales, and in severe barrel chest from hyperinflation. Stained yellow on babies nails, skin and umbilical cord. TX:Endotraacheal tube, may need warmed humidified o2 or extensive resp support with mechanical ventilation.
NOT ON TEST
Premature born before 38 weeeks/ late pre term 34 -36 weeks Low birth weight is <2500 grams, Extrememly is < 1000 grams Small for gestational age is less then 10th%
Causes: preeclampsia, infection, substance abuse, malnutrition, more than one baby.
Prevention: Adequate prenatal care, education. characteristics: muscles under developed , no/little subcutaneous fat, skin red and translucent, vernix and lanugo. underdeveloped cartilage, genitals weak cry
tX: cpap, nasal cannula, o2 has to be warmed and humididfied, stomach, suction
thermoregulation, thin skin absent fat, surface blood vessel, poor feeding, LOSS OF WEIGHT using calories for heat. Irritability 96.8-97.7 for newborn skin 97.3 -? Axillry Hard to maintain fluid and electrolytes loose more fluid normal output is 1-3 mL per kg/ hr/ signs of dehydration is sunken fontanel, less than 6-8 wet diapers, overhydration = bulging fontanel, weight. BUratrol and pump monitor careful with iv meds may be fed through ng or og tube.
Skin protection: position changes, skin prep, lotion, padding.things that do not adhere to the skin
prevent: vaccinations, hand washing , minimize , gowning, gloving
Pain and stress: periods of rest, quiet environment, kangaroo care, little bits of activity at a time.
Nutrition:105-130 kilocals/kg/day should gain 15-20 grams/kg/day
Neuro: hemorrhage caused by hypoxia, monitor o2 sat and co2 if intubted extremely important. s/sx: cry faace, vitals change, high pitched cry.
intrauterine growth restriction (IUGR) Fall below the 10th % Causes: Uterine/placental, fetal, maternal, preeclampsia, congenital anomalies, sometimes infection, maternal chronic illness, smoking, fundal height decreased, have ultrasound, bed rest, adequate nutrition, low dose ASA rarely given
Delivery: blood glucose closely,measurements,
Transient tachypnea respirations > 60 up to 100, bc of fluid air gets trapped, grunting nasal flaring, retractions, sisaw breathing, norm rr: 30-60, management: may get o2, monitor vs, gavage feedings so not working too hard to breath or eat
