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Fetal movement, HR, RR, activityPlacental grading (maturation)Client is bleedingQuestionable fundal heightDecreased fetal movements Preterm laborQuestionable ROMNursing actions for a Abdominal Ultrasound:Drink 1-2 quarts prior (in order to fill the bladder)Place client in supine position with wedge under right hip (to displace uterus)Apply gel to abdomen (room temp or warmer)Empty bladder at the end of procedureNursing actions for a transvaginal Ultrasound:
Place client in lithotomy position, lubricate probe, insert (by client or examiner)Tilt table or probe to gain new imageInform client that pressure will be felt when probe is movedPoint out what you are looking at1A- Complications of Pregnancy (8 questions)oGestational Diabetes (1 question)Maternal/Fetal ComplicationsNormal BG is 70-110 during pregnancyOccurs in 50% of womenIncreases risk for spontaneous abortion, infections, hydramnios, ketoacidosis, hypoglycemia, and hyperglycemiaSymptoms:Hypo/hyperglycemiaExcessive weigh gainVomitingRapid pulseLabs:Routine UA with glycosuriaDiagnostics:BPPAmniocentesis with alpha-fetoprotein NSTNursing:InsulinBlood glucoseDaily kick counts oComplications (3 questions)Prenatal Complications Infections (TORCH) ToxoplasmosisFindings similar to influenza Other InfectionsRubellaSymptoms of joint and muscle painCytomegalovirusAsymptomatic or mononucleosis-like manifestationHerpes Virus Symptoms consisting of painful blisters and tinder lymph nodes Gonorrhea Women are frequently asymptomatic Can be transmitted to the newborn Administer erythromycin to infants following delivery Symptoms Dysuria Vaginal bleeding between periods and dysmenorrhea UTIPlacental Abruption Premature separation of the placenta from the uterus
Occurs after 20 weeks and has significant morbidity and mortality, leading cause of maternal death Best to do C-sectionRisk factors include HTN, trauma, cocaine, smoking, ROM, or multiple babiesSymptoms:Intense painDark red vaginal bleedingHypovolemic shock symptomsFetal distressLabs:Hgb and Hct decreasedCoag factors decreased Clotting defects (DIC)Cross type and match for bloodKleihauer-Betke test: detects fetal blood in maternal circulationNursing:Administer oxygen 8-10L per minuteAssess urinary output and monitor fluid balancePreterm Labor Uterine contraction & cervical changes that occur between 20-37 wksRisk factors:Infections of UT, vagina, chorioamnionitis (amniotic sac infection)Previous preterm birthMultifetal pregnancyHydramnios (excessive amniotic fluid)Age below 17 or above 35Low socioeconomic statusSmokingSubstance useDomestic violenceHistory of multiple miscarriages or abortionsDiabetes mellitus or hypertension