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NU3 21 Exam 4 With
Complete Solution
1 to 4% - ANSWER percent of pregnancies that are complicated by heart disease
10 to 25% - ANSWER percent of maternal mortalities that are caused by complications of heart disease
class I - ANSWER patient is asymptomatic without limitation of physical activity
class II - ANSWER patient is symptomatic with slight limitations to activity
class III - ANSWER patient is symptomatic with marked limitation to activity
class IV - ANSWER patient is symptomatic with inability to carry out any physical activity without discomfort
pulmonary hypertension, complex cyanotic heart disease, aortic coarctation complicated by aortic dissection, poor ventricular function, Marfan syndrome
- ANSWER cardiovascular conditions that contraindicate pregnancy
well - ANSWER how do heart transplant patients fare during pregnancy?
PIH, preterm birth, LBW - ANSWER risks for mothers with donor hearts
anemia - ANSWER most common medical disorder of pregnancy; causes exacerbation of existing heart conditions because of increased cardiac output
prenatal vitamins, diet - ANSWER ways to prevent anemia in pregnant
women
iron supplements, fluids, vitamin C - ANSWER treatment of anemia during pregnancy
11 - ANSWER hemoglobin value that indicates anemia in first and third trimesters
10.5 - ANSWER hemoglobin value that indicates anemia in second trimester
infection, blood loss during delivery - ANSWER major concerns associated with anemia during pregnancy
iron deficiency - ANSWER most common type of anemia during pregnancy
poor diet (boiling the ever living hell out of veggies), home canning, malabsorption - ANSWER factors that may lead to folate deficiency
cleft deformities, neural tube defects - ANSWER what folic acid deficiency anemia is associated with developmentally
UTI, preterm birth, IUGR, pyelonephritis, bone abnormalities, strokes, cardiomyopathy, preeclampsia - ANSWER what sickle cell mothers are at higher risk for during pregnancy; generally do well though
thalassemia - ANSWER inherited defect in ability to produce hemoglobin, leading to hypochromia
stillbirth, preeclampsia, preterm birth - ANSWER what 50% of pregnancies in women with thalassemia have as outcomes
monitoring hemoglobin, transfusion, iron chelation therapy - ANSWER management of thalassemia during pregnancy
hyperemesis, preterm birth, preeclampsia, gestational diabetes, IUGR,
intense grief - ANSWER parents undergo loneliness, emptiness, guilt, anger, resentment, bitterness, fear of becoming pregnant again
reorganization - ANSWER parents search for meaning, reduction of distress, reentering normal life; can make future plans, including another pregnancy
tell honestly, use concrete terms, allow parents to speak, allow parents to see, hold, and name infant - ANSWER ways to allow parents to actualize the loss of a fetus
explain what to expect, warm blankets prior to handoff, involve the parents in bathing if possible, hold child as if live, point out what is normal, provide alone time, put up appropriate door marker - ANSWER how to responsibly provide information to parents who have lost a fetus
autopsy, organ donation, baptism, burial/cremation - ANSWER decisions that will have to be made by parents regarding fetal loss
normalize grief, meet physical needs, assist in getting support from family, create memories - ANSWER how to provide for parents who have lost a fetus prior to discharge
pictures, hair, clothing, footprints, handprints, molds - ANSWER ways to create memories for a lost fetus
anyone - ANSWER who can perform a baptism if parents wish?
late gestational loss, neurotic personality, preexisting psych symptoms, no other children - ANSWER factors that may complicate grief in the case of fetal loss
diabetes - ANSWER most common endocrine disorder associated with pregnancy
gestational diabetes - ANSWER any degree of glucose intolerance with the onset or first recognition occurring during pregnancy
28 to 32 weeks - ANSWER timeframe where oral glucose tolerance test is performed
1 and 3 hours - ANSWER when glucose levels are checked during oral glucose tolerance test
yes - ANSWER does glucose cross the placenta?
no (insulin) - ANSWER does insulin cross the placenta?
insulin acts like growth hormone - ANSWER cause of fetal macrosomia in infants born to diabetic mothers
4500g - ANSWER macrosomia weight
congenital malformations - ANSWER most important cause of perinatal loss in pregestational diabetic pregnancies
hyperglycemia, hyperinsulinemia - ANSWER glycemic control events that increase the risk of RDS in fetuses
30 to 60 min - ANSWER timeframe after birth where infants born to diabetic mothers will bottom out their blood sugars
Native American, history of diabetes, over 25, history of macrosomic infant, hydramnios, unexplained stillbirth, miscarriage, congenital anomalies, preeclampsia - ANSWER risk factors for gestational diabetes
24 to 28 weeks - ANSWER when initial screen for gestational diabetes is performed (may be earlier in high risk moms)
hyperemesis gravidarum - ANSWER severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus
nulliparous, increased BMI, hx of migraines, twins, molar pregnancy, ambivalence regarding pregnancy - ANSWER risk factors for hyperemesis gravidarum
spontaneous abortion - ANSWER what women with hyperemesis gravidarum are at DECREASED risk for
high estrogen, esophageal reflux, decreased gastric motility - ANSWER etiologic components of hyperemesis gravidarum
psych/social assessment, IV fluids, antiemetics, parenteral nutrition, supplements, strict InO - ANSWER treatment of hyperemesis
fertility issues, miscarriage - ANSWER events associated with hypothyroidism in pregnant women
7, 13, 12 - ANSWER percent of prevalence of depression during pregnancy based on trimesters
SSRI - ANSWER first line of treatment for depression during pregnancy
cough syrup - ANSWER taking this concurrently with SSRIs should be avoided
anxiety - ANSWER most common mental disorder during pregnancy
antidepressants, nonpharmacologic methods - ANSWER preferred treatment options for anxiety during pregnancy (benzos are teratogenic)
lowest dose possible to manage, monotherapy - ANSWER principle of medication administration during therapy
bleeding complications, miscarriage, stillbirth, LBW, SIDS, behavioral issues - ANSWER risks of smoking during pregnancy
heroin - ANSWER one condition where methadone replacement is safer than acute opiate detox
low education attained, lower rates of employment, poor self esteem,
tendency to seek pleasure, history of family dysfunction, psychiatric illness, history of physical/sexual abuse, victims of violence - ANSWER risk factors for substance abuse
social stigma, labeling, guilt, fear of losing custody, don't understand consequences of continued use - ANSWER barriers to treatment for mothers with substance abuse problems
no (drugs) - ANSWER can you test for drugs without a pregnant woman's permission
HTN, stillbirth, cirrhosis, nutritional deficiencies, miscarriage, anemia, premature birth, pancreatitis, deficient let down - ANSWER potential outcomes of alcohol abuse during pregnancy
94% - ANSWER WHO goal for percent of pregnant women who abstain from alcohol
reduces oxygen supply to fetus - ANSWER main physiologic outcome of marijuana consumption during pregnancy
polysubstance, poor nutrition, STI, HepB, stress, anger, poor self esteem, abuse - ANSWER factors associated with cocaine use
neurobehavorial effects on neonate - ANSWER major outcome with PCP abuse during pregnancy
70% - ANSWER percent of women that experience mild depression or baby blues
less than 33% - ANSWER percent of women with substantial postpartum depression/anxiety whose symptoms were picked up by routine care ( :((( )
prenatal depression, stress of child care, life stress, marital problems, postpartum blues, unplanned/wanted pregnancy, difficult infant temperament, low self esteem, prenatal anxiety, lack of support, single status, teen parent - ANSWER risk factors for postpartum depression
postpartum depression - ANSWER intense and pervasive sadness with severe and labile mood swing; more serious and persistent than postpartum blues
guilt, feelings of inadequacy, food cravings, binges, sleep disturbances, irritability, sobbing, outburst at SO, rejection of infant - ANSWER s/sx of postpartum depression
postpartum psychosis - ANSWER syndrome characterized by depression, delusions, and thoughts by the mother of harming either the infant or herself
primiparas - ANSWER population where postpartum psychosis is seen more commonly (still not common at all tho)
hospitalization, medication, supervision - ANSWER management of postpartum psychosis
medication, education, psychotherapy, CBT - ANSWER treatment of postpartum panic disorder
pregnancy induced hypertension - ANSWER multiorgan vasospastic process of reduced organ perfusion
5 to 10% - ANSWER percent of pregnancies that are impacted by hypertensive disorders
uteroplacental insufficiency, preterm birth - ANSWER risks of hypertensive disorders for fetus
renal failure, coagulopathy, cardiac or liver failure, placental abruption, seizure, stroke - ANSWER risks of hypertensive disorders in pregnant mother
140/90 - ANSWER BP reading that designates hypertension
30/15 - ANSWER change in systolic or diastolic blood pressure that indicates that there is a concern for hypertension
primigravida, less than 19, older than 35, chronic hypertension, pregestational diabetes, nephropathy, family history, paternity, maternal infection, obesity, race - ANSWER risk factors for preeclampsia
multiple gestation, fetal hydrops, hydatidiform mole - ANSWER factors that put a mother at an extremely high risk for preeclampsia
fetal hydrops - ANSWER an abnormal accumulation of fluid in at least two fetal body cavities
hydatidiform mole - ANSWER a benign tumor of the placenta consisting of multiple cystic and resembling a bunch of grapes
65% - ANSWER recurrence rate of preeclampsia if it previously occured prior to 30 weeks gestation
25% - ANSWER recurrence rate of preeclampsia if it previously occurred in
the last trimester
hypoperfusion, vasospasm, endothelial cell damage, platelet aggregation - ANSWER factors that preeclampsia may be related to; etiology is currently unknown
greater than 160/110, severe proteinuria, oliguria, cerebral/visual disturbances, pulmonary edema, RUQ pain, thrombocytopenia, IUGR, eclampsia, HELLP - ANSWER s/sx that indicate severe preeclampsia
aspiration, CVA, cerebral edema, anoxia, coma, maternal death - ANSWER risks associated with eclampsia
hemolysis, elevated liver enzymes, lowered platelets - ANSWER HELLP syndrome
call the pregnancy - ANSWER what is done as soon as HELLP is diagnosed
uric acid (will be significantly increased), BUN, 24 hour urine protein/creatinine, serum creatinine, CBC, CMP - ANSWER labs to be drawn with preeclamptic patients
myasthenia gravis, heart block, myocardial insufficiency, renal disease - ANSWER contraindications to mag sulfate therapy
labetolol - ANSWER med to be careful with if given concurrently with mag sulfate
4 to 6 g IV bolus over 20 to 30 min - ANSWER initial dosing of mag sulfate
2 to 4 g over hour - ANSWER maintenance infusion rate of mag sulfate
barbiturates, narcotics - ANSWER meds that may have additive effects with mag sulfate
4 to 7 - ANSWER therapeutic range for mag when dosing mag sulfate
1.5 to 2 - ANSWER normal range for magnesium
5 to 10 - ANSWER range of magnesium where ECG changes may be noticable
flushing, lethargy, nausea, depressed reflexes, cardiac dysrhythmias, resp
paralysis, diaphoresis, blurred vision, hypocalcemia - ANSWER side effects of mag sulfate
strict InO, frequent vitals, hourly reflexes, monitor for toxicity, assess lungs, provide seizure precautions, lochia, incisional bleeding, neuro level, mag level
- ANSWER nursing interventions for mag sulfate
q 5 to 15 min with loading dose; q 30 to 60 depending on status - ANSWER vitals schedule with mag sulfate dosing
shock, resp distress, arrythmias, s/sx DIC - ANSWER conditions to monitor for in as a patient worsens on mag sulfate
pre mixed solution, standard strength, label lines, use pump, remove med completely if finished, double check (like blood!) - ANSWER safety checks with mag sulfate admin
calcium gluconate - ANSWER antidote for mag sulfate
antepartal hemorrhage - ANSWER leading cause of maternal death
miscarriage - ANSWER pregnancy that ends as a result of natural causes
