NURSING 306 OB Exam 3 Study Guide & Review Questions Chapter 7: know risk factors, diagnosis, and interventions of the complications, A+ Guide(2020).

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OB Exam 3 Study Guide Chapter 7: know risk factors, diagnosis, and interventions of the complications 1. Hyperemesis Gravidarum: vomiting during pregnancy that is so severe it leads: ● Dehydrati... on ● Electrolyte Imbalance ● Acid-Base Imbalance ● Starvation Ketosis ● Weight Loss > Due to ^ hCG, progesterone & estrogen ➔ Risk Factors ◆ Maternal age younger than 20 years ◆ History of migraines ◆ Obesity ◆ First pregnancy ◆ Multifetal gestation ◆ Gestational trophoblastic disease or fetus with chromosomal anomaly ◆ Psychosocial issues and high levels of emotional stress ◆ Transient hyperthyroidism ➔ DX: ◆ Prolonged, frequent, severe vomiting ◆ Weight Loss ◆ Acetonuria & Ketosis ◆ Dehydration: ● Dry mucous membranes ● Poor skin turgor ● Malaise ● Hypotension ➔ Interventions: ◆ Vit B6 + Doxylamine ◆ IV hydration (dextrose, vitamins, thiamine) ◆ Monitor liver/kidney fx ◆ Ginger ◆ Adm antiemetics as indicated ◆ Good oral hygiene ◆ Check daily weight ◆ Monitor I&O TX: 1. Ensure the pt remains NPO until vomiting is controlled for 24-48hrs 2. Once vomiting is controlled, start on BRAT diet with small frequent meals & assess if they are able to maintain the food down (minimize fluid intake w/ each meal) 3. If pt begins to vomit, place them back on NPO 2. Ectopic Pregnancy:a result of the blastocyst implanting outside of the endometrial lining of the uterus ● Nonviable Pregnancy ➔ Risk Factors ◆ Abd distension ◆ Smoking ◆ Assisted Reproduction ◆ Pelvic Inflammatory disease ◆ Prior tubal damage ➔ Assessment Findings ◆ PRIOR TO TUBAL RUPTURE ● Pelvic/Abd pain or tenderness ● Abnormal bleeding ● Minimal Uterine changes ● Stable VS ◆ TUBAL RUPTURE > L. sided abd pain main concern = intraperitoneal bleeding ● Severe abd pain ● Sharp, Stabbing, Tearing pain ● Vertigo/Syncope ● Hypovolemia due to hemorrhage ● SHOULDER PAIN due to diaphragmatic irritation ➔ DX ◆ Physical symptoms ◆ Positive hCG ◆ Transvaginal Ultrasonography ◆ Serum Progesterone levels ➔ TX ◆ Laparoscopy (if hemodynamically stable) ◆ Methotrexate, folic acid antagonist & type of chemotherapy agent causing the dissolution of the ectopic mass > mother should not feel any more abd pain after 2-3 days ➔ Interventions ◆ Ensure CV status ◆ Give RhoGAM if indicated ◆ Acknowledge pt feelings ◆ Teach mother to monitor for abd pain 3. Incompetent Cervix: a mechanical defect in the cervix that results in painless cervical dilation in the second trimester that can progress to ballooning of the membranes into the vagina & delivery of premature fetus > Once the cerclage is placed, NO PENIS IN the Vagina :( ➔ Risk to Mother ◆ Repeated 2nd & 3rd trimester births ◆ Spontaneous Abortions (repeated) ◆ Preterm Delivery ◆ Rupture of the membranes- Infection ➔ Risk to Fetus ◆ Preterm birth & consequences of prematurity ➔ Assessment Findings ◆ Pelvic Pressure & ^ vaginal DC ◆ Shortened cervical length or funneling of the cervix ➔ TX: ◆ Cerclage: purse string suture placed cervically to reinforce weak cervix ● Prophylactic(12-16 wks) placed as a precaution due to prev. history of unexplained recurrent painless dilation & 2nd trimester birth ● Rescue(up to 24 wks) placed after cervix has dilated with no perceived contractions ◆ Remove sutures if labor develops, membrane ruptures or infection occurs ➔ Post-Op ◆ Palpate for uterine activity ◆ Monitor vaginal bleeding or abnormal DC ◆ Monitor for Infection ● Fever ● Uterine Tenderness ◆ Adm tocolytics ◆ Teach mother to modify activities & rest their pelvis for a week 4. Diabetes: https://www.youtube.com/watch?v=N3jnRuzseoM > Screening must be done at 24-28 wks: ● Glucose Tolerance Test: ○ Non-fasting 1 hour 50g oral glucose tolerance test ○ 3 hour after woman ingests 100g glucose dose ○ Plasma glucose levels drawn 1, 2,3 hrs post glucose dose ○ If 2 of these tests return positive = GDM ■ Fasting > 95 mg/dL ■ 1 hr > 180 mg/dL ■ 2 hr > 155 mg/dL ■ 3 hr > 140 mg/dL ◆ Risk Factors to the mother ● Hypo/Hyperglycemia ● DM Ketoacidosis ● HTN & Preeclampsia ● Metabolic Disturbances ○ Hyperemesis ○ Nausea ○ Vomiting ● Preterm Labor ● Spontaneous Abortion ● Poly/Oligohydramnios ● C-section ◆ Risk Factors to the baby ● Fetal Macrosomia: due to fetal insulinemia > may lead to birth injury brachial plexus injury ● Shoulder Dystocia: McRobert’s maneuver “turtle sign” ● Congenital Defects ● Hypoglycemia/Hypomagnesemia ● RDS ● Polycythemia (hematocrit <65%) = Hyperbilirubinemia ● Premature ● Stillbirth after 36 wks, if untreated ➔ The risks are the same for pregestational & gestational DM, except there is no risk for congenital abnormalities for gestational ➔ Pregestational(goal: control blood glucose before pregnancy) ◆ Assessment Findings: ● Hist of Type 1 or Type 2 DM ● Abnormal Glucose levels ● Glycosylated Hemoglobin (HbA1C) test to determine average glucose levels within the past 4-8 wks ● Cardiac, Renal & Ophthalmic function assessment & evaluation ◆ TX: ● Medical Nutritional Therapy (MNT) ● Teach the pt’s the physiological & insulin changes ● Refer the pt to a dietician ➔ Gestational: the mother develops glucose intolerance ◆ Risk Factors ● Obesity ● Hist of DM in family ● Hist of Fetal Macrosomia ◆ Assessment Findings ● Abnormal glucose screening results ◆ TX ● Controlled with Diet & Exercise ● Insulin may be needed ● C-section planned for >4500 g ● Need to be monitored after birth ➔ Nursing Actions for Both ◆ Pt Self-Management: Teach pt to ● Monitor blood glucose (4-8 times/day) before, after meals & at bedtime ● Check urine for ketones ● Monitor Food Intake ● Exercise 3 times/week for 20min ● Recognize S/S of ○ Hypoglycemia:always keep a carb snack with her (10-50 g carb) ◆ Diaphoresis ◆ Tachy ◆ Shakiness ◆ Cold ◆ Clammy skin ◆ Blurred vision ◆ Extreme Fatigue ◆ Mental Confusion ◆ Irritability ◆ Somnolence ◆ Pallor ○ Diabetic Ketoacidosis: ◆ Abd Pain ◆ N/V [Show More]

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