Nle - High-risk Pregnancy
-
Upload
tachycardia01 -
Category
Documents
-
view
228 -
download
0
Transcript of Nle - High-risk Pregnancy
-
8/14/2019 Nle - High-risk Pregnancy
1/113
HIGHHIGH--RISK PREGNANCYRISK PREGNANCY
Prepared by:
ROSELYN S. PACARDO, MAN, MM, RN, RM
-
8/14/2019 Nle - High-risk Pregnancy
2/113
A. ABORTIONAny interruption of pregnancy
before 20 to 24 weeks of
gestation; at least 500 g
BLEEDING IN PREGNANCY
First Trimester
Bleeding
-
8/14/2019 Nle - High-risk Pregnancy
3/113
TYPES SIGNS AND SYMPTOMS MANAGEMENT
1.
Threatened
*Avoid strenuous
activity for 24 to
48 hours; if
bleeding will stopit usually stops
within this time.
No coitus for 2
weeks after
bleeding stops.
Advise patient to
save all pads,
clots, and
expelled tissues
TYPES OF ABORTION
Slight, bright red
vaginal bleeding
Mild abdominal
cramping No cervical
dilatation on IE
No passage of
fetal tissue
-
8/14/2019 Nle - High-risk Pregnancy
4/113
TYPES SIGNS AND SYMPTOMS MANAGEMENT
2. Inevitable
AbortionModerate vaginal
bleeding
Rupture of
membranes
Cervical dilatation
Strong abdominal
cramping
Possible passage
of products of
conception
Vacuumcurettage
Prostaglandin
analogs to
empty uterus ofretained
tissue
-
8/14/2019 Nle - High-risk Pregnancy
5/113
TYPES SIGNS AND SYMPTOMS MANAGEMENT
3. Incomplete
abortion (passage
of some of the
products of
conception)
Client stabilization
Dilatation andcurettage
4. Complete
abortion (passage
of all products of
conception)
No surgical or
medical intervention
necessary
Follow-up
appointments to
discuss family
planning
Intense abdominalcramping
Heavy vaginal
bleeding
Cervical dilatation
History of vaginal
bleeding and
abdominal pain
Passage of tissue
with subsequent
decrease in pain and
significant decrease in
vaginal bleeding
-
8/14/2019 Nle - High-risk Pregnancy
6/113
-
8/14/2019 Nle - High-risk Pregnancy
7/113
TYPES SIGNS AND SYMPTOMS MANAGEMENT
6. Habitual
Abortion
Identification and
treatment ofunderlying cause
Cervical cerclage in
second trimester if
incompetent cervix is
the cause
History of three ormore consecutive
spontaneous abortions
Not carrying the pregnancy
to viability or term
-
8/14/2019 Nle - High-risk Pregnancy
8/113
B. ECTOPIC PREGNANCY- Any pregnancy
outside the uterus
-
8/14/2019 Nle - High-risk Pregnancy
9/113
Signs and Symptoms Management
Severe, sharp, knife-like
stabbing pain
in either the right or left lower
quadrant
Rigid abdomen
(+) Cullens sign (bluish
umbilicus)
Excruciating pain when
cervix is moved on IE
Signs of shock: falling BP,
PR more than 100/min, rapid
RR, lightheadedness
Laparoscopy
Salpingostomy if fallopian
tube can still be replaced and
preserved, but the pregnancy
has to be terminated
Sal[ingectomy removal of
fallopian tube plus blood
transfusion
Combat shock:
-Elevate foot of the bed
- Cover with a thick blanket
-
8/14/2019 Nle - High-risk Pregnancy
10/113
A. HYDATIDIFORMMOLE
- Abnormal proliferation
and degeneration ofthe
trophoblastic villi
SECOND TRIMESTER BLEEDING
-
8/14/2019 Nle - High-risk Pregnancy
11/113
COMPLETE MOLE
-
8/14/2019 Nle - High-risk Pregnancy
12/113
PARTIAL MOLE
-
8/14/2019 Nle - High-risk Pregnancy
13/113
SIGNS AND SYMPTOMS
Highly positive urine test for
Pregnancy (marked hCG level) Marked nausea and vomiting
Rapid increase in fundic
height and weight
PIH signs and symptoms
appear before the 24th week ofgestation
No fetal heart tones
Vaginal bleeding seen as
clear, fluid-filled, grape-sized
vesicles
ultrasound snowstorm
pattern
MANAGEMENT
D & C to evacuate the mole
Prophylactic course ofmethotrexate, the drug of
choice for choriocarcinoma
Following evacuation, pelvic
exam and chest x-ray are
done; Serum test for hCGevery 2 weeks till normal
Serum hCG tested every 4
weeks for 6 to 12 months
Advise not to get pregnant
for at least a year
* The client with H-mole is at risk of
developin choriocarcinoma.
-
8/14/2019 Nle - High-risk Pregnancy
14/113
B. PREMATURE CERVICAL DILATATION/INCOMPETENT
CERVIX-Cervix that dilates prematurely and cannot hold a fetus until
term;- Chief cause of habitual abortionSIGNS AND SYMPTOMS MANAGEMENT
Presence of show (pink-
stained vaginal discharge)
Painless dilatation Increased pelvic pressure
followed by rupture of the
membranes and discharge of
amniotic fluid
Uterine contractions
McDonald/Shirodkar
Procedure
Cerclage procedure whereinpursed string sutures are
placed around the cervix on the
14th to 18th week of gestation;
McDonalds
Removed during a vaginaldelivery; in caesarean section,
Shirodkar method is used
-
8/14/2019 Nle - High-risk Pregnancy
15/113
SHIRODKAR
METHOD
-
8/14/2019 Nle - High-risk Pregnancy
16/113
Third Trimester BleedingThird Trimester Bleeding
A. Placenta Previa -Low implantation of the
placenta
Low-lying placenta
-
8/14/2019 Nle - High-risk Pregnancy
17/113
Partial placenta previa Complete placenta
previa
-
8/14/2019 Nle - High-risk Pregnancy
18/113
Signs and Symptoms Management
Painless, bright red
vaginal bleeding
Ensure that the client
gets adequate rest
Monitor V/S of the
mother and the FHR
Prepare oxygen and
blood
Never perform an IE If IE should be done,
prepare a double set-
up
-
8/14/2019 Nle - High-risk Pregnancy
19/113
B.ABRUPTIO
PLACENTA
Premature separation of a
normally implanted
placenta
-
8/14/2019 Nle - High-risk Pregnancy
20/113
Premature Separation of the
Placenta: Degrees of
Separation
Grade Criteria
0 No symptoms of separation were apparent
from maternal or fetal signs; diagnosis is
made after the delivery of the placenta
when there is a recent adherent blood cloton the maternal surface.
1 Minimal separation but enough to cause
vaginal bleeding & changes in maternal
V/S; no fetal distress or shock
2 Moderate separation; with fetal distress;uterus is tense and painful
3 Extreme separation; without immediate
interventions, maternal shock and fetal
death will result
-
8/14/2019 Nle - High-risk Pregnancy
21/113
Signs and Symptoms Management
Severe knife-like stabbing
pain high in the fundus
Hard, board-like uterus;
rigid abdomen
Signs of shock
Concealed bleeding, ifextensive causes the uterus
to lose its ability to contract;
becomes ecchymotic and
copper-colored called
Couvelaire uterus, causingsevere bleeding
Fluid replacement
Oxygen by mask to limit
fetal anoxia
Monitor FHR
Monitor maternal V/S every
5 to15 minutes Lateral or side-lying
position
No IE or pelvic exam
No enema
For Grades 2 and 3separation: Caesarean
section
Massive bleeding:
hysterectomy
-
8/14/2019 Nle - High-risk Pregnancy
22/113
POSTPARTUM HEMORRHAGEPOSTPARTUM HEMORRHAGE
-
8/14/2019 Nle - High-risk Pregnancy
23/113
A. EARLY POSTPARTUM HEMORRHAGE occurs during
the
first 24 hours; greater than 500 mL blood loss in a 24 hourperiod
Types Signs and Symptoms Management
Uterine Atony
(most common
cause)
Uterus not well-
contracted,
relaxed or boggy
Lacerations Bleeding even if
the uterus is well
contracted and
there is no retained
Repair
Massage first nursing
action
Ice compress
Oxytocin administration
Empty the bladder
Bimanual expression of
retained
placental fragments Hysterectomy last
resort
-
8/14/2019 Nle - High-risk Pregnancy
24/113
-
8/14/2019 Nle - High-risk Pregnancy
25/113
B. LATE POSTPARTUM HEMORRHAGE -Blood loss more
than 500 mL ;
occurs 24 hoursafter birth up to 6
weeksTypes Signs & Symptoms Management
RetainedPlacental
fragments
Bleeding even if theuterus is well
contracted and there
are no lacerations
Dilatation andCurettage
Hematoma injury to blood
vessels
Collection of blood inthe subcutaneous
tissue of the perineum
Ice compress Analgesics
Site is incised
and bleeding
vessel is ligated
-
8/14/2019 Nle - High-risk Pregnancy
26/113
HEMATOMA
-
8/14/2019 Nle - High-risk Pregnancy
27/113
SITUATION H: Georgina attended a lecture about high
risk pregnancy. One of the most common danger signalsis hemorrhage.
36. In taking care of a client with placenta previa, the
nurse should do the following, EXCEPT:A. Perform an internal examination.
B. Inform significant others to prepare blood for possible
transfusion
C. Monitor the vital signs
C. Prepare a double set-up delivery when labor is
imminent
-
8/14/2019 Nle - High-risk Pregnancy
28/113
SITUATION H: Georgina attended a lecture
about high risk pregnancy. One of the most
common danger signals is hemorrhage.
36. In taking care of a client with placenta previa,
the nurse should do the following, EXCEPT:
A. Perform an internal examination.B. Inform significant others to prepare blood for
possible transfusion
C. Monitor the vital signs
D. Prepare a double set-up delivery when labor isimminent
Pillitteri p. 414
-
8/14/2019 Nle - High-risk Pregnancy
29/113
37. If a pregnant woman on her first
trimester of pregnancy has abdominal
cramping and bright red vaginal spottingbut the cervix is not dilated the woman
should suspect that she is most likely
experiencing a/an:
A. Missed abortion
B. Threatened abortionC. Inevitable abortion
D. Complete abortion
-
8/14/2019 Nle - High-risk Pregnancy
30/113
37. If a pregnant woman on her first trimester of
pregnancy has abdominal cramping and bright
red vaginal spotting but the cervix is not dilatedthe woman should suspect that she is most likely
experiencing :
A. Missed abortion fetal death in utero
B. Threatened abortion
C. Inevitable abortion cervix is dilated
D. Complete abortion products of conceptionare expelled
Pillitteri p. 404
-
8/14/2019 Nle - High-risk Pregnancy
31/113
38. The nurse giving the lecture explains
further that a manifestation of a knife-likestabbing pain in either the right or left
lower quadrant of the abdomen with a
bluish umbilicus is an indication of:
A. Gestational trophoblastic disease
B. Incompetent Cervical osC. Ectopic pregnancy
D. Abruptio placenta
-
8/14/2019 Nle - High-risk Pregnancy
32/113
38. The nurse giving the lecture explains further that
a manifestation of a knife-like stabbing pain in
either the right or left lower quadrant of the
abdomen with a bluish umbilicus is an indication of:
A. Gestational trophoblastic disease grape-likeB. Incompetent Cervical os painless, pink-stained
bleeding
C. Ectopicpregnancy
D. Abruptio placenta painful vaginal bleedingwith low back pain; uterus board-like
Pillitteri p. 409
-
8/14/2019 Nle - High-risk Pregnancy
33/113
39. What would the first nursing action if
a client is having a uterine atony?
A. Massage the hypogastric area slightly
B. Apply cold compressC. Administer the oxytocin as prescribed
D. Encourage the client to empty her
bladder
-
8/14/2019 Nle - High-risk Pregnancy
34/113
39. What would the first nursing action
if a client is having a uterine atony?A. Massage thehypogastric area
slightly
B. Apply cold compress
C. Administer the oxytocin as
prescribed
D. Encourage the client to empty her
bladder
Pillitteri pp. 657 - 658
-
8/14/2019 Nle - High-risk Pregnancy
35/113
-
8/14/2019 Nle - High-risk Pregnancy
36/113
40. Which of the following measurements, best
describes delayed postpartum hemorrhage?
A. Blood loss in excess of 300 mL, occurring 24
hours to 6 weeks after delivery
B. Blood loss in excess of500 mL,occurring
24 hours to 6 weeks afterdeliveryC. Blood loss in excess of 800 mL, occurring 24
hours to 6 weeks after delivery
D. Blood loss in excess of 1000 mL, occurring 24
hours to 6 weeks after delivery
Ricci p. 614
-
8/14/2019 Nle - High-risk Pregnancy
37/113
PREGNANCYPREGNANCY--INDUCEDINDUCED
HYPERTENSIONHYPERTENSION
-A vascular disease of unknown cause which occurs any
time after the 24th week of gestation up to two weeks
postpartum; vasospasm occurs both in small and largearteries.
Triad of Symptoms:
a. Hypertensionb. Edema
c. Proteinuria
-
8/14/2019 Nle - High-risk Pregnancy
38/113
Diagnosis: Roll-over
Test
-Assesses the probability
of developing PIH when
performed between the28th and 32nd week of
pregnancy
Procedure:
Patient lies in the lateralrecumbent position for15
minutes until BP is
stabilized.
Patient then rolls over to
supine position.
BP is taken at one
minute and 5 minutes
after having rolled over.
Interpretation:
If diastolic pressureincreases
20 mmHg or more,
patient is prone to PIH.
-
8/14/2019 Nle - High-risk Pregnancy
39/113
a. Mild Preeclampsia
Sudden excessive weightgain of1 to 5 lbs per week
(earliest sign); 2 lb per wk in
2nd trimester and 1 lb/wk in
3rd trimester due to edema
which is found in the upper
half of the body (e.g. cantwear wedding ring)
Systolic BP of140, or an
increase of30 mmHg or
more; Diastolic BP of 90
or a rise of15 mmHg or more
taken 6 hours apart Proteinuria: 1+ or 2+ on a
reagent test strip in a
random sample; or 0.5
gm/liter or more
b. Severe Preeclampsia
BP of160/110 mmHg on at leasttwo occasions 6 hours apart at bed
rest
Proteinuria: 5 gm/liter or more in 24
hours; 3+ or 4+ on a random urine
sample Oliguria of 500 mL or less in 24
hours (normal urine output per day =
1500 mL); elevated serum creatinine
more than 1.2 mg/dL
Cerebral or visual disturbances Pulmonary edema and cyanosis
Epigastric pain considered an
aura to the development of
convulsions
1.
PREECLAMPSIA
-
8/14/2019 Nle - High-risk Pregnancy
40/113
2. ECLAMPSIA with seizure
(convulsions) accompaniedby signs and symptoms of
preeclampsia plus:
a. Increased BUNb. Increased uric acid
c. Decreased carbon dioxide
combining power
* Seizure Precautions
-
8/14/2019 Nle - High-risk Pregnancy
41/113
MANAGEMENT
MILD PIH Bed Rest
-Sodium is excreted faster
when the body is in a
recumbent position (promote
lateral) Emotional Support
SEVERE PIH Hospitalized forBed Rest
to be enforced
Limit visitors
Avoid loud noise
Private room Darken the room
Raise side rails
Avoid stress
Let client verbalize feelings
Monitor maternal well-being
Monitor fetal well-being
Diet: Moderate to high in
protein and moderate sodium
-
8/14/2019 Nle - High-risk Pregnancy
42/113
MEDICATION
Magnesium sulfate
Muscle relaxant CNS depressant
prevents seizures
Vasodilator decreases
BP
Cathartic causes a shift
of fluid for the
extracellular spaces into
the intestines to excrete
the fluid
Antidote for toxicity:
10 mL of10% calcium
Drug of choice
Loading dose IV 4 to 6 g;
Maintenance dose 1 -2 g perhour IV
Infuse slowly over15 30
minutes
Always administer as a
piggyback infusion
Maintain a serum level of 5 to 8
mg/mL
Assess respiratory rate, urine
output, DTR, and clonus everyhour
Criteria for administration:
a. Urine output: over30 mL per
hour
b. Respiratory rate: over12 per
-
8/14/2019 Nle - High-risk Pregnancy
43/113
PATELLAR REFLEX
SCORING
Absence of DTR
earliest sign of toxicity
0 No response;
hypoactive; abnormal
1+ Somewhat diminished
response but not
abnormal
2+ Average response
3+ Brisker than average
but not abnormal4+ Hyperactive; very brisk;
abnormal
-
8/14/2019 Nle - High-risk Pregnancy
44/113
ANKLE CLONUS
2
Movements
Mild
3 5
movements
Moderate
Over 6
movements
Severe
-
8/14/2019 Nle - High-risk Pregnancy
45/113
-
8/14/2019 Nle - High-risk Pregnancy
46/113
SITUATION I: Andrea, 30 year old G4P3 is
admitted to the high risk antepartal unit with a
diagnosis of pregnancy-induced hypertension.
41. Which of the following is the main
difference between preeclampsia andeclampsia?
A. Increased blood pressure
B. Proteinuria
C. Oliguria
D. Presenceofconvulsions
Pillitteri p. 428
-
8/14/2019 Nle - High-risk Pregnancy
47/113
42. What is the prodromal symptom of
the seizures associated with PIH?
A. (- ) deep tendon reflex
B. Sudden elevation of blood pressureC. Oliguria
D. Epigastric pain
-
8/14/2019 Nle - High-risk Pregnancy
48/113
42. What is the prodromal symptom of the
seizures associated with PIH?A. (- ) deep tendon reflex sign of toxicity
B. Sudden elevation of blood pressure - PIH
C. Oliguria sign of toxicityD. Epigastric pain due to abdominal edema
or ischemia to thepancreas and liver
Pillitteri p. 428
-
8/14/2019 Nle - High-risk Pregnancy
49/113
43. Andrea receives magnesium sulfate for
severe preeclampsia. Which of the
following adverse effects is associated
with magnesium sulfate?
A. Anemia
B. Decreased urine outputC. Hyperreflexia
D. Increased respiratory rate
-
8/14/2019 Nle - High-risk Pregnancy
50/113
43. Andrea receives magnesium sulfate
for severe preeclampsia. Which of thefollowing adverse effects is associated
with magnesium sulfate?A. Anemia
B. Decreasedurineoutput below 30
mL/hour
C. Hyperreflexia absent DTRs
D. Increased respiratory rate - decreased
Pilltteri p. 430 - 431
-
8/14/2019 Nle - High-risk Pregnancy
51/113
44. The latest assessment of Andrea reveals
that she has deep tendon reflexes of (+) 1, BP
of 150/100 mmHg, a pulse of 92 beats perminute, and urine output of 20 mL per hour.
Which of the following actions would be
most appropriate?
A. Continue monitoring per standards of care.
B. Stop the magnesium sulfate infusion.
C. Increase the infusion rate by 5gtts/minute
D. Decrease the infusion rate by 5
gtts/min
-
8/14/2019 Nle - High-risk Pregnancy
52/113
44. The latest assessment of Andrea reveals that
she has deep tendon reflexes of (+) 1, BP of150/100 mmHg, a pulse of 92 beats per minute,
and urine output of 20 mL per hour. Which of the
following actions would be most appropriate?
A. Continue monitoring per standards of care.
B. Stop themagnesium sulfate infusion.
C. Increase the infusion rate by 5 gtts/minute
Decrease the infusion rate by 5 gtts/min
Pillitteri pp. 430 - 431
-
8/14/2019 Nle - High-risk Pregnancy
53/113
45. Which of the following drugs is the
antagonist for magnesium sulfate toxicity?
A. Calcium gluconateB. Hydralazine hydrochloride
C. Naloxone
D. Rho (D) immune globulin Rh in
-
8/14/2019 Nle - High-risk Pregnancy
54/113
45. Which of the following drugs is the
antagonist for magnesium sulfate toxicity?
A. Calciumgluconate
B. Hydralazine hydrochloride - (Apresoline)
for HPNC. Naloxone hydrochloride hydrochloride
(Narcan) for Demerol toxicity
D. Rho (D) immune globulin (RhoGAM) for
Rh incompatibility; (Mother Rh (-); Fetus Rh(+)
Pillitteri p. 430; Leifer p.95
-
8/14/2019 Nle - High-risk Pregnancy
55/113
DIABETES MELLITUSDIABETES MELLITUS
-Chronic hereditary disease characterized by
hyperglycemia due to relative insufficiency or lack
of insulin from the pancreas which leads to
abnormalities in the metabolism of carbohydrates,proteins, and fats.
- Normal blood sugar: 80 to 120 mg/dL
-
8/14/2019 Nle - High-risk Pregnancy
56/113
Effects of Hyperglycemia Effects of Hypoglycemia
* Baby
Hydramnios
Gestational hypertension
Ketoacidosis
Preterm labor secondary to
PROM
Cord prolapse Stillbirth
Hypoglycemia
UTI
Moniliasis
Difficult labor Macrosomia
Others
Pallor
Tremors
Jitteriness
Lethargy
Poor feeding
-
8/14/2019 Nle - High-risk Pregnancy
57/113
Goals: To maintain glycemic control and minimize the risks
of the disease on the fetus.
1. Dietary Management
Adhere to the same nutrient requirements and
recommendations for weight gain as the non-diabetic
client. Avoid weight loss and dieting during pregnancy.
Ensure food intake is adequate to prevent ketone
formation and promote weight gain.
Eat three meals a day plus three snacks to promote
glycemic control. (1,800 2, 200 calorie diet) Include complex carbohydrates, fiber, and limited fat and
sugar in the diet.
Continue dietary consultation throughout pregnancy.
MANAGEMENT
-
8/14/2019 Nle - High-risk Pregnancy
58/113
2. Insulin Requirements
-Medication of choice
- Increased need during the 2nd
and 3rd
trimesters- Regulated to keep +1 for sugar (minimal glycosuria is
necessary to prevent acidosis) but negative for acetone
- Long-acting insulin (Ultralente) will have to be changed to
regular insulin (Lente) during thelast few weeks of
pregnancy.4.3. Fetal and Maternal Surveillance
4. Mode of Delivery:
a. Vaginal birth preferred if at all possible.
b. Cesarean section for macrosomic baby
-
8/14/2019 Nle - High-risk Pregnancy
59/113
-
8/14/2019 Nle - High-risk Pregnancy
60/113
SITUATION J: Bianca, 30 years old G2P0, on her
37 weeks of gestation is admitted to the labor room
and is having gestational diabetes mellitus.
46. The physician estimates that the fetus weighs at
least 10 pounds. Bianca asks the nurse, What causes
the baby to be so large?The nurse should explain that fetal macrosomia is usually
related to:A. Genetic history of large infants
B. Fetal anomalies
C. Maternal hyperglycemia leads tofetal hyperglycemia;
increased insulin tocounteract hyperglycemia acts a
growth stimulantD. Fetal hypoglycemia
Ricci p. 546;Pillitteri p. 377
-
8/14/2019 Nle - High-risk Pregnancy
61/113
47. The goal of nursing care for Bianca is
to achieve and maintain normal maternalglucose at which of the following levels in
a 24-hour period?
A. 30 to 50 mg/dL
B. 120 to 140 mg/dL
C. 60 to 80 mg/dLD. 80 to 120 mg/dL
-
8/14/2019 Nle - High-risk Pregnancy
62/113
47. The goal of nursing care for Bianca is to
achieve and maintain normal maternalglucose at which of the following levels in a
24-hour period?
A. 30 to 50 mg/dL
B.120 to 140 mg/dL
C. 60 to 80 mg/dL
C. 80 to 120 mg/dL
Source:Pillitteri p. 377
-
8/14/2019 Nle - High-risk Pregnancy
63/113
48. The recommended calorie intake
for Bianca is:
A. 1000 1500 calories
B. 500 1000 calories
C. 1800 2200 calories
D. 2200 3000 calories
-
8/14/2019 Nle - High-risk Pregnancy
64/113
48. The recommended calorie
intake for Bianca is:
A. 1000 1500 caloriesB. 500 1000 calories
C. 1800 2200 calories
D. 2200 3000 caloriesPillitteri p. 380
-
8/14/2019 Nle - High-risk Pregnancy
65/113
49. The delivery of choice for
Bianca is:
A. Normal spontaneous vaginal
deliveryB. Caesarean section
C. Forceps delivery
D. Vacuum extraction
-
8/14/2019 Nle - High-risk Pregnancy
66/113
49. The delivery of choice for
Bianca is:
A. Normal spontaneous vaginal
deliveryB. Caesarean section
C. Forceps delivery
D. Vacuum extractionPillitteri p. 383; p.605
-
8/14/2019 Nle - High-risk Pregnancy
67/113
50. All of the following are the
manifestations of hypoglycemia
in Biancas baby, EXCEPT:
A. Tremors
B. Shrill, high-pitched cry
C. Vigorous suck
D. Hypotonia
-
8/14/2019 Nle - High-risk Pregnancy
68/113
50.All of the following are the
manifestations of hypoglycemia
in Biancas baby, EXCEPT:
A. Tremors
B. Shrill, high-pitched cry
C. Vi
gorous s
uckD. Hypotonia
Ricci p. 678
-
8/14/2019 Nle - High-risk Pregnancy
69/113
CARDIAC DISEASECARDIAC DISEASEClassificatio
n
Class Description
1 Uncompromised: No limitation of
physical activity; ordinary physicalactivity causes no discomfort; no
symptoms of cardiac insufficiency and
no anignal pain (asymptomatic)
II Slightly compromised: Slight limitationof activity; ordinary activity causes
excessive fatigue, palpitation, and
dyspnea or anginal pain (symptomatic
with increased physical activity)
-
8/14/2019 Nle - High-risk Pregnancy
70/113
III Markedly compromised: moderate to
marked limitation of physical activity;
less than ordinary activity, experience
excessive fatigue, palpitations,dyspnea, or anginal pain
(symptomatic)
1V Severely compromised: unable to
carry out any physical activity withoutexperiencing discomfort; experience
symptoms of cardiac insufficiency or
anginal pain
Prognosis:
a. Classes I and II normal pregnancy and delivery
b. Classes III and IV poor candidates
-
8/14/2019 Nle - High-risk Pregnancy
71/113
Signs and Symptoms
Shortness of breath on exertion
Cyanosis of lips and nail beds Swelling of face, hands, and feet
Rapid respirations
Abnormal heart beats, racing heart, or
palpitations (murmurs) Chest pain
Syncope
Increasing fatigue
Moist, frequent cough
Decreased cardiac output
Ascites
-
8/14/2019 Nle - High-risk Pregnancy
72/113
-
8/14/2019 Nle - High-risk Pregnancy
73/113
-
8/14/2019 Nle - High-risk Pregnancy
74/113
SITUATION K: Loida, 30 years, 36 weeks of
gestation is admitted to the hospital with a
Class III heart disease.
51. All of the following are the cardiac
manifestations of Loida, EXCEPT:
A. Loud, harsh murmur associated with thrill.
B. Cardiomegaly
C. Increased cardiac outputD. Decreased cardiac output
-
8/14/2019 Nle - High-risk Pregnancy
75/113
SITUATION K: Loida, 30 years, 36 weeks of
gestation is admitted to the hospital with aClass III heart disease.
51. All of the following are the cardiac
manifestations of Loida, EXCEPT:A. Loud, harsh murmur associated with thrill.
B. Cardiomegaly
C. Increasedcardiacoutput
D. Decreased cardiac output
Pillitteri pp.354 356; Ricci p. 556
-
8/14/2019 Nle - High-risk Pregnancy
76/113
52. The primary goal of nursing care for
a client with cardiac problem is to:
A. Limit physical activity
B. Prevent anemiaC. Avoid excessive weight gain
C. Reduce the cardiac workload
-
8/14/2019 Nle - High-risk Pregnancy
77/113
52. The primary goal of nursing carefor a client with cardiac problem is to:
A. Limit physical activityB. Prevent anemia
C. Avoid excessive weight gain
D. Reduce the cardiac workload(umbrella)
Pillitteri p. 356
-
8/14/2019 Nle - High-risk Pregnancy
78/113
53. Which of the following drugs
should not be given to Loida:
A. Iron preparations
B. Epinephrine
C. DigoxinD. Diuril
-
8/14/2019 Nle - High-risk Pregnancy
79/113
53. Which of the following drugs
should not be given to Loida:
A.Iron preparations prevent anemia
B. Epinephrine causes
palpitations increasing workload
C.Digoxin decrease contractility ofthe heart
D. Diuril diuretic to reduce edema
Pillitteri p. 359
-
8/14/2019 Nle - High-risk Pregnancy
80/113
54. Class III classification of heart disease is
best described as:A. Uncompromised: women have no
limitations of physical activity.
B. Slightly compromised: women have slight
limitation of physical activity.
C. Severely compromised: women are unable
to carry out any physical activity without
experiencing discomfort.D. Markedly compromised: women have a
moderate to marked limitation of physical
activity.
54 Class III classification of heart disease is
-
8/14/2019 Nle - High-risk Pregnancy
81/113
54. Class III classification of heart disease is
best described as:
A. Uncompromised: women have nolimitations of physical activity.
Slightly compromised: women have slight
limitation of physical activity.
Severely compromised: women are unable tocarry out any physical activity without
experiencing discomfort.
Markedly compromised: women have a
moderate to marked limitation of physical
activity.
Source Pillitteri p. 354
-
8/14/2019 Nle - High-risk Pregnancy
82/113
55. The preferred position thatLoida should assume during
delivery of the baby would be:
A. Dorsal recumbent position
B. Lithotomy position
C. Supine positionD. Semi-sitting position
-
8/14/2019 Nle - High-risk Pregnancy
83/113
55. The preferred position that Loida
should assume during delivery of thebaby would be:
A. Dorsal recumbent position
B. Lithotomy positionC. Supine position
D. Semi-sittingposition facilitate
easyrespirations
Pillitteri p. 359
-
8/14/2019 Nle - High-risk Pregnancy
84/113
DYSTOCIADYSTOCIA
- Abnormal or difficult labor and
delivery
1. Uterine Inertia - Sluggishness of contractions
-
8/14/2019 Nle - High-risk Pregnancy
85/113
gg
Causes Inappropriate use of analgesics
Pelvic bone contraction Poor fetal position
Overdistension
Types
a. Primaryhypertonic
dysfunctionManagement:
Sedation
relaxations are inadequate and mild,
thus, ineffective; uterine muscles are in
a state of greater-than-normal tension,the latent phase of the first stage of
labor is prolonged.
b. Secondary
uterine
dysfunctionManagement:
contractions have been good but
gradually become infrequent and of
poor quality and cervical dilatation
stops
-
8/14/2019 Nle - High-risk Pregnancy
86/113
2. Precipitate Delivery - Completed in less than 3
hours after the onset of true
labor pains
Causes: oxytocin administration
amniotomy
Complications: Extensive lacerations
Abruptio placenta
Hemorrhage
-
8/14/2019 Nle - High-risk Pregnancy
87/113
3. Prolonged Labor Primis: lasting more than
18 hours
Multis: lasting more than12 hours
Complications: Maternal exhaustion
Uterine atony
Caput succedaneum
4. Uterine Rupture - Uterus undergoes more
straining than it is capable of
sustaining
Causes: Scar from previous classic
CS Unwise use of oxytocics
Overdistension
Faulty presentation
Prolonged labor
-
8/14/2019 Nle - High-risk Pregnancy
88/113
4. Uterine Rupture Occurs when the uterus undergoes
more straining than it is capable of
sustaining
Causes Scar from a previous classic CS
Unwise use of oxytocins
Overdistension
Faulty presentation
Prolonged labor
Signs and Symptoms Sudden, severe pain
Hemorrhage and signs of shock
Change in abdominal contour
Management Hysterectomy
-
8/14/2019 Nle - High-risk Pregnancy
89/113
Physiologic Retraction Ring
-
8/14/2019 Nle - High-risk Pregnancy
90/113
Pathologic retraction ring or
Bandls ring
-
8/14/2019 Nle - High-risk Pregnancy
91/113
5. Uterine Inversion Fundus is forced through the cervix
and the uterus turns inside out
-
8/14/2019 Nle - High-risk Pregnancy
92/113
Causes Insertion of the placenta at the
fundus
Strong fundal push when motherfails to bear down properly during the
second stage of labor
Attempts to deliver the placenta
before signs of placental separation
appearSigns and Symptoms Dramatic
Woman in labor suddenly sits up
and grasps her chest due to dyspnea
and sharp chest pain
Pallor then bluish-gray colorassociated with pulmonary embolism
Death may occur in a few minutes
Management Emergency measures to maintain
life: IV, oxygen, CPR
-
8/14/2019 Nle - High-risk Pregnancy
93/113
6. Trial Labor Borderline pelvic measurements but
fetal position and presentation are
good; can be continued if there isprogressive fetal descent of the
presenting part and the cervix
continues to dilate
Management Monitor FHRs and uterine
contractions
Empty the bladder
Emotional support
-
8/14/2019 Nle - High-risk Pregnancy
94/113
7. Premature Labor and
Delivery
Uterine contractions occur
before the 38th week of
gestationManagement No bleeding, cervical
dilatation; FHR good
premature contractions can be
stopped by drugs:
-Ethyl alcohol blocks the
release of oxytocin
- Vasodilan IV vasodilator
- Ritodrine muscle relaxant
given orally- Bricanyl - bronchodilator
-
8/14/2019 Nle - High-risk Pregnancy
95/113
With premature uterine contractions
accompanied by fetal descent and cervical
dilatation, delivery is inevitable-Pain medications kept to a minimum to
prevent respiratory depression
- Steroids (glucocorticoids) given for
maturation of the fetal lungs
- Caudal, spinal or infiltration anesthesia does not compromise with fetal respiration
- Forceps applied gently
- Cut cord immediately; do not wait for
pulsation to stop
-
8/14/2019 Nle - High-risk Pregnancy
96/113
INSTRUMENTALINSTRUMENTAL
DELIVERIESDELIVERIES
-
8/14/2019 Nle - High-risk Pregnancy
97/113
1. Forceps Delivery metal instrument to extract the
baby; applied at +3 to +4
station and the sagittal suture
is in an anteroposterior
position in relation to the
outlet
Purpose -Shorten the 2nd stage of labor- Prevent excessive pounding on
fetal head
- Poor uterine contractions or
rigid
perineum
Criteria No CPD
Fetal head deeply engaged
Full cervical dilatation and
effacement
-
8/14/2019 Nle - High-risk Pregnancy
98/113
-
8/14/2019 Nle - High-risk Pregnancy
99/113
-
8/14/2019 Nle - High-risk Pregnancy
100/113
FORCEPS MARK
-
8/14/2019 Nle - High-risk Pregnancy
101/113
2. Vacuum Extraction
-
8/14/2019 Nle - High-risk Pregnancy
102/113
3. Cesarean Section Delivery of the fetus through an
incision in the abdomen and uterus
Indications CPD most common cause PIH, placental accidents, fetal
distress
Use of electronic fetal monitoring
maternal age
Types a. Low segment method of choice;
incision in the lower uterine
segment
Advantages:-Minimal blood loss; Incision easy to
repair; low incidence of PP
infection; no possibility of uterine
rupture
b. Classic vertical incision
-
8/14/2019 Nle - High-risk Pregnancy
103/113
SITUATION L: A group of women on their third
-
8/14/2019 Nle - High-risk Pregnancy
104/113
SITUATION L: A groupofwomen on their third
trimesterofpregnancy aregiven information
during a prenatal class about themanifestationsofabnormal ordifficult labor anddelivery as well
as theuseofinstrumental deliveries.
56. All of the following are the causes of dystocia
during labor and delivery, EXCEPT:
A. Maternal exhaustion
B. AnalgesicsC. Pelvic bone contraction
D. Maternal Activity
SITUATION L: A group of women on their third
-
8/14/2019 Nle - High-risk Pregnancy
105/113
SITUATION L: A groupofwomen on their third
trimesterofpregnancy aregiven information
during a prenatalclass about themanifestations ofabnormal or
difficult labor anddelivery as well as theuseof
instrumental deliveries.
56. All of the following are the causes of dystociaduring labor and delivery, EXCEPT:
A. Maternal exhaustion
B. Analgesics
C. Pelvic bone contraction
D. Maternal Activity
Pillitteri p. 590
-
8/14/2019 Nle - High-risk Pregnancy
106/113
57. Hypertonic contractions would lead to
which of the following complications:
A. Inverted uterus
B. Precipitate deliveryC. Prolonged Labor
D. Preterm delivery
-
8/14/2019 Nle - High-risk Pregnancy
107/113
57. Hypertonic contractions would
lead to which of the followingcomplications:
A. Inverted uterus
B. Precipitatedelivery
C. Prolonged Labor
D. Preterm delivery
Pillitteri p. 591- 592, 595; Ricci p. 587
-
8/14/2019 Nle - High-risk Pregnancy
108/113
-
8/14/2019 Nle - High-risk Pregnancy
109/113
58. These are the signs of complete uterine
rupture, EXCEPT:
A. Sudden, sharp abdominal pain
B. Continuation ofuterinecontraction
C. Cessation of uterine contractionD. Change in the abdominal contour
Pillitteri p. 596
59 Which of the following is the criterion
-
8/14/2019 Nle - High-risk Pregnancy
110/113
59. Which of the following is the criterion
for induction of labor?
A. Twins
B. Cervix not dilated
C. Cephalopelvic Disproportion
D. Above 32 weeks of gestation
-
8/14/2019 Nle - High-risk Pregnancy
111/113
59. Which of the following is the
criterion for induction of labor?
A. Twins
B. Cervix not dilatedC. Cephalopelvic Disproportion
D. Above 32 weeks ofgestation
Pillitteri p. 606; Ricci p. 596
60 What type of cesarean section
-
8/14/2019 Nle - High-risk Pregnancy
112/113
60. What type of cesarean section
would have minimal blood loss?
A. Classic CS
B. Low segment CS
C. Peritoneal CS
D. None of the above
-
8/14/2019 Nle - High-risk Pregnancy
113/113
60. What type of cesarean section
would have minimal blood loss?
A. Classic CS
B. Low segment CS
C. Peritoneal CS
D. None of the above
Pillitteri pp. 573 - 574