Week 5 OB Prework.doc - Week 5 PreWork fSubmit Prework for Week 5 under Journal Week 5 on BB Due Sunday Week 5 no later than 2359 May be typed or

Week 5 OB Prework.doc - Week 5 PreWork fSubmit Prework for...

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Unformatted text preview: Week 5 PreWork fSubmit Prework for Week 5 under Journal Week 5 on BB Due: Sunday, Week 5 @ no later than 2359 May be typed or handwritten ATI: Under Test tab find: N306 F5 o Complete with a score of 76% or better o Click download report o Submit report with Prework under Journal Week 5 on BB Chapter 7 DURHAM: High Risk Antepartum Nursing Care Outline format Define and list risk factors, signs and symptoms, medical management, nursing interventions and patient education for the following: Preterm Labor (PTL): Regular contractions between 20 6/7-36 6/7 weeks o Risk factors for PTL & PTB: History of preterm labor History of preterm birth Hx of second trimester loss Hx of incompetent cervix Cerclage IVF pregnancy Multiple gestation Uterine/cervical abnormalities Hydramnios/oligohydramnios Infection PROM Short pregnancy interval (less than 9mo.) Preg assoc. w/HTN, diabetes, vaginal bleeding Chronic HTN, diabetes, clotting disorders Inadequate nutrition, low BMI, low pre-preg weight <17 years old or >35 years old Late/no prenatal care Obesity, high BMI, excessive weight gain Low BMI Ancestry/ethnicity (highest for African American) Maternal unmarried status IPV Lack of social support Smoking, alcohol, illicit drug use Lower education & socioeconomic status, poverty o Pathophysiology of PTL: Specific cause unknown. Series of complex interactions. Contributing factors: Uterine overdistention Decidual activation, Premature activation of the normal physiological initiators of labor, activation of maternal-fetal HPA axis Inflammation & infection of decidua, fetal membranes & amniotic fluid tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork PROM: Premature rupture of membranes before 37weeks o Medical Management: Depends on gestational age Balance premature newborn w/risk for infection o Nursing Interventions: Assess FHR & uterine contractions Monitor for infection: Fever Maternal/fetal tachycardia Uterine tenderness Vaginal discharge Testing: Non-stress test & biophysical profile Prophylaxis antibiotics o Patient Education: Educate on risk to fetus May induce labor Bed rest o Risk Factors: Infection PPROM: Preterm premature rupture of membranes o Medical Management: May choose to induce labor o Nursing Interventions: Assess FHR Monitor for infection Perform a non-stress test Antibiotics (prophylaxis) o Patient Education: Educate on risk to fetus Monitor & educate for s/s of infection Bedrest o Risk Factors: Infection Chorioamnionitis: Infection of the chorioamniotic membranes o Medical Management: Antibiotics Deliver the fetus o Nursing Interventions: Administer antibiotics as prescribed Induction & delivery of baby Administer antibiotics to baby as well tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork o Patient Education: Promptly report rupture of membranes Chemoprophylaxis if + for Group B Streptococcus o Risk Factors: Premature labor/birth Prolonged labor Group B strep UTI Nulliparity Pregestational Diabetes: Diabetes before pregnancy o Medical Management: Glycemic control Increase diagnostic testing Dietician to educate mother Increase insulin requirement o Nursing Interventions: Education Dietary counseling Monitor glucose levels & urine ketone levels o Patient Education: Monitor & control glucose levels Record keeping of blood glucose levels, insulin, food intake, & activity o Risk Factors: Fetal heart & CNS abnormalities Gestational Diabetes: Low glucose tolerance during pregnancy between 24-28 wks o Medical Management: Insulin management C-section recommended if over 4.5kg fetus Monitor for DM after delivery o Nursing Interventions: Glycemic control-check 4x/day, one fasting & one postprandial checks Teach about diet, exercise, s/s of hyper/hypo glycemia, self-admin of insulin o Patient Education: Controlled w/diet & exercise Self-monitor glucose levels & urine ketones Exercise beneficial Monitor after pregnancy for type 2 DM after birth o Risk Factors: Fetal heart & CNS abnormalities Preeclampsia: Hypertension accompanied w/proteinuria o Medical Management: Monitor weekly for worsening conditions tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork Delivery in severe cases o Nursing Interventions: Mg Sulfate HTN meds Monitor BP Educate on disorder Monitor for CNS changes Monitor proteinuria o Patient Education: Delivery (preeclampsia ends once fetus is delivered) Bed rest Self-monitoring of BP o Risk Factors: Decrease organ perfusion after 20wks Eclampsia Syndrome: Convulsions that cannot be attributed to other causes in a woman w/pre-eclampsia can occur ante, intra, & post-partum. o Medical Management: Aspiration (leading cause) Safety precautions o Nursing Interventions: Monitor sz time & type Assess airway Administer O2 Remain w/patient o Patient Education: Safety precautions o Risk Factors: Decrease organ perfusion Preeclampsia superimposed on chronic hypertension: Hypertensive prior to pregnancy o Medical Management: Maternal & fetal monitoring Admin Mg & HTN meds o Nursing Interventions: Assess vitals consistently Maternal & fetal monitoring Record hourly I&Os Maintain IV access Assess deep tendon reflexes o Patient Education: S/S HTN: headache, blurred vision, dizziness, epigastric pain Bedrest Emotional support tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork o Risk Factors: HTN Cardiac problems Falls Gestational hypertension: BP greater than or equal to 140/90 after 20wks w/o proteinuria. Final dx is made postpartum but usually BP returns to baseline 6wks postpartum o Medical Management: HTN meds o Nursing Interventions: Monitor BP Monitor urine for protein Daily FKC o Patient Education: Bedrest Limit sodium HTN meds Teach FKC o Risk Factors: HTN Cardiac probs Chronic hypertension: BP 140/90 before conception & persists after 12wks postpartum o Medical Management: First line: hydralazine, methyldopa, labetalol Second line: nifedipine o Nursing Interventions: Monitor BP o Patient Education: Take meds as prescribed o Risk Factors: HTN Cardiac probs HELLP Syndrome: Serious complication of high blood pressure during pregnancy. Hemolysis, elevated liver enzymes, low platelet count. o Medical Management: Immediate delivery of fetus & placenta Resolves in 48hrs Replace lost platelets o Nursing Interventions: Elevated labs Notify physician if values plummet tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork Admit platelets Teach about disorder Emotional support o Patient Education: Resolution w/in 48hrs Complications of severe pre-eclampsia o Risk Factors: Loss of platelets Infection Decreased oxygen transport Breakdown of RBCs Placenta Previa: Placenta attaches to lower segment of uterus instead of near fetus o Medical Management: Hemorrhage likely to occur Emergency c-section Blood transfusion o Nursing Interventions: Vitals Bed rest IV access for blood Monitor FHR/UC, stability, lab values o Patient Education: C-section needed Bed rest Blood transfusion necessary o Risk Factors: Hemorrhage Decreased fluid volume Hypotension Placental abruption: Premature separation of normally implanted placenta o Medical Management: C-section Restore blood loss Hemorrhage o Nursing Interventions: Restore blood loss Monitor coagulation factors O2 Monitor FHR, bleeding, labs o Patient Education: C-section o Risk Factors: Hemorrhage tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork Hypotension Decreased fluid volume Venous Thromboembolic Disease: DVT & PE o Medical Management: DVT: ultrasound, MRI, venography PE: chest x-ray, EKG, CT scan, prevent further clotting o Nursing Interventions: Manage pain Teach heparin administration If PE, prepare for embolectomy increase fibrin, decrease fibrolytics & increase coagulation factors o Patient Education: Bed rest Take anticoagulants o Risk Factors: PE Maternal obesity: Increase complication when obese. BMI >30. o BMI Category: >30 o Medical Management: Maternal risks Exercise, eat well Increase elevation throughout pregnancy o Nursing Interventions: Teach S/S of pre-eclampsia Encourage healthy behaviors Nutritional counseling o Patient Education: Maternal/fetal risks Nutritional/exercise increased Sleep in chair to decrease compression of vena cava o Risk Factors: Fetal NTD & still birth Incompetent Cervix: Defect of cervix, painless dilation in second trimester. o Medical Management: Cerclage suture placed cervically to reinforce a weak cervix Prophylaxis antibiotics o Nursing Interventions: Monitor UC, bleeding, ROM, infection o Patient Education: S/S infection Monify & decrease activity & rest tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork o Risk Factors: Membranes fall out of vagina premature fetal delivery Infection Hyperemesis Gravidarum: Severe vomiting o Medical Management: First line: Vit B6 IV hydration for pts who cannot tolerate PO liquids Correct ketosis & Vit def. o Nursing Interventions: Assess for factors causing nausea & vomiting Reduce triggers (odors, foods, etc.) Antiemetics as ordered Emotional support Comfort measures ex. Oral hygiene Iv hydration as prescribed Check weight daily Monitor I&O, urine spec gravity Monitor lab values for fluid & electrolyte imbalances o Patient Education: Educate on triggers causing nausea/vomiting o Risk Factors: Having empty stomach Eating too much/too little Rising before eating Ectopic pregnancy o Medical Management: Surgery of unruptured ectopic pregnancy Transvaginal ultrasonography Methotrexate causes dissolution of ectopic mass o Nursing Interventions: Stabilize cardiovascular status Offer explanations & reassurance related to plan of care Ass response to dx Provide support for pregnancy loss Explain f/u care Give RhoGAM if needed o Patient Education: F/U care pain management S/S pain, fever, bleeding Diet high in iron if high blood loss Monitor for infection o Risk Factors: Prior tubal damage Assisted reproduction tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork Pelvic inflammatory disease Smoking Abdominal adhesions Hemorrhage Decreased fertility Define the following: Gestational trophoblastic Disease: A spectrum of placental related tumors. Gestational trophoblastic disease is categorized into molar and non-molar tumors. o Hydatiform mole: A benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grapelike clusters without a viable fetus. This is a nonviable pregnancy. o Molar: Molar tumors are made up of villi that have become swollen with fluid. The swollen villi grow in clusters that look like bunches of grapes. o Non molar: Non molar tumors are grouped as gestational trophoblastic neoplasia or malignant gestational trophoblastic disease. HIV in pregnancy o Treatment for mom: ■ Treatment of at least three antiretroviral drugs o Treatment for newborn: Treatment of antiretroviral drug (Drug is mixed with syrup that gets put into a small syringe and squirted into the baby’s mouth). STI: Includes bacterial vaginosis, herpes simplex, chlamydia, trichomoniasis, gonorrhea, hep B, HIV, and syphilis. o Risk to woman: ■ STIs can cause pelvic inflammatory disease. ■ Pelvic inflammatory disease (PID) can lead to infertility, chronic hepatitis, and cervical and other cancers. ■ STIs during pregnancy can lead to PTL, PROM, and uterine infection o Risk to fetus: STIs can pass to the fetus by crossing the placenta; some can be transmitted to the baby during delivery as the baby passes through the birth canal. ■ Harmful effects to babies include preterm birth, low birth weight, neonatal sepsis, and neurological damage. T.O.R.C.H. Infections: Stands for Toxoplasmosis, Other (hepatitis B), Rubella, and Cytomegalovirus and Herpes simplex virus. TORCH infections are unique in their pathogenesis and have potentially devastating effects on the developing fetus. Each disease is teratogenic to the developing fetus. o Maternal effects o Fetal effects o Prevention and management o Nursing actions tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork Iron-deficiency Anemia: Anemia is present if the hemoglobin drops below 11 g/dL in the first and third trimesters and below 10 g/dL in the second trimester. o Risk factors for mom: tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork ■ ■ ■ ■ ■ History of poor nutritional status or eating disorder Close spacing of pregnancies Multiple gestation Excessive bleeding Adolescence o Risk factors for fetus: ■ Preterm birth ■ Intrauterine growth restriction o Assessment findings: ■ Pallor ■ Fatigue, weakness, and malaise ■ Reduced exercise tolerance and dyspnea ■ Anorexia and/or pica ■ Edema ■ Hemoglobin below 10–11 g/dL ■ Hematocrit below 30% o Medical Management: ■ Iron supplementation ■ Supplement with 325 mg tid ferrous sulfate o Nursing Actions: ■ Refer the woman to a dietitian for nutritional counseling and reinforce dietary interventions. ■ Advise that taking iron supplementation at bedtime and on an empty stomach may increase absorption and decrease gastrointestinal upset. ■ Discuss strategies to deal with constipation PRN. ■ Assess fatigue and develop interventions and a plan of care to deal with fatigue. Substance abuse o Types: Smoking/Tobacco Use Alcohol Illicit Drugs o Risks to pregnancy and fetus: Risks for the Woman Using Substances during Pregnancy: ■ Preterm labor ■ PPROM ■ Poor weight gain and nutritional status ■ Placental abnormalities (placenta previa, abruptio placentae) Risks for the Fetus and Newborn: ■ Effects of maternal substance use on the neonate ■ Stillbirth ■ Low birth weight ■ Preterm birth ■ Intrauterine growth restriction ■ Neonatal withdrawal syndrome (symptoms are dependent on drug used during pregnancy) tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 Week 5 PreWork ■ Sudden infant death syndrome (SIDS) Medications: o Magnesium Sulfate Use: Oral: Laxative for the relief of occasional constipation (OTC labeling) Parenteral: Treatment and prevention of hypomagnesemia; prevention and treatment of seizures in severe preeclampsia or eclampsia, pediatric acute nephritis; treatment of cardiac arrhythmias (VT/VF) caused by hypomagnesemia Topical: Soaking aid for minor cuts and bruises (OTC labeling) Priority nursing interventions: Use caution with renal insufficiency May cause decreased respiratory rate, arrythmias, hypotension, muscle weakness Monitor EKG and respiratory status Monitor Mg levels Ensure dosage with secondary practitioner Calcium gluconate is the antidote S/Sx of toxicity: Respiratory depression Deep tendon reflexes Feeling of warmth Double vision Weakness Flushing tb yu s West Coast UniW v eerss ti t Cy o CaWos etu srUts neCi ovS aey srl lts ai U n i v e Page r s i t1y Revision Date: 1-8-16 Page 1 01-14-20 ...
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