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A woman arrives at the clinic seeking confirmation that she is pregnant. The following info is obtained; 24 years old, BMI-17.5, she admits to having used cocaine several times during the past year and drinks alcohol occasionally. BP 108/70, pulse 72 bpm, resp. 16 bpm, family history diabetes mellitus and cancer. her sister recently gave birth to an infant with neural tube defect NTD Which characteristics place her at a high risk category

Family history of NTD, low BMI, and substance abuse are all high risk factors

o Polyhydramnios

Too much amniotic fluid

IUGR

Intrauterine Growth Restriction

Oligohydramonions

Not enough amniotic fluid

Kick Counts/Daily Fetal Movement Counts

Assessment of fetal activity by mother, fetal movement not present during sleep cycle

When nurses help their expectant mother assess the daily fetal movement counts, they should be aware that:

the fetal alarm signal should go off when the fetal movements stop entirely for 12 hours

Biophysical Profile

 Fetal breathing movements
 Gross body movements
 Fetal tone
 Reactive heart rate
 Quantitative amniotic fluid volume

Abruptio placentae

Placenta separates from the uterus

Chorionic Villus Sampling (CVS)

Removal of small tissue specimen from fetal portion of placenta

A 39 year old primagravida thinks she is about 8 weeks pregnant although she has had irregular menstrual periods her life history of smoking approx. one pack of cigarette a day tell you she trying to cut down, lab within normal limits

Ultrasound

Percutaneous umbilical blood sampling (PUBS) or Cordocentesis

Direct access to fetal circulation, needle into fetal umbilical vessel

Coombs test

Rh incompatibility , detects other antibodies for incompatibility with maternal antigens

41 week pregnant multigravida present in labor and delivery unit after a non-stress test indicated that her fetus could be experiencing some difficulties in utero, which diagnostic tool would yield more detailed info about the fetus:

Biophysical profile

HA1C

Blood test- history of sugar management over last 3 months

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with

congenital anomalies in the fetus

Amnio used to test for

Lung maturity

In assessing knowledge of pregestational woman with type I diabetes concerning changing insulin needs during pregnancy the nurse recognizes that further teaching is warranted when the woman states

I will need to increase my insulin dosage during the first 3 months of pregnancy

Hypoglycemia

Blood sugar is too low

Target Glucose in Pregnancy

o Postmeal or fasting
 >65 but <95
o Postmeal (1h)
 <130-140
o Postmeal (2h)
 <120

Screening at 24 weeks of gestation reveals that a normal weight pregnant woman has gestational diabetes mellitus (GDM) in planning her care nurse and woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM the nurse identifies that the fetus is at greatest risk for

Macrosomia

A 26 year old primigravida comes to clinic for regular prenatal visit at 12 weeks appears thin nervous, reports eats well balanced diet, although her weight is 5 pounds less than it was at her last visit, lab studies confirm she has a hyperthyroid condition, based on data from the nurse formulate a plan of care, what nursing diagnosis is most appropriate for the woman at this time

Imbalanced nutrition: less than body requirements

Phenylketonuria

o Recognized causes of mental retardation caused by deficiency in enzyme phenylalanine hydrolase

In caring for a pregnant women with sickle cell crisis, the nurse understands that management of this patient includes all except

antibiotics

4 P's

In caring for a pregnant women with sickle cell crisis, the nurse understands that management of this patient includes all except

• Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women the 4 Ps plus is a screening tool designed specifically or identify when there is a need of r a more in death assessment the 4 Ps include all except:

o Present

• A primigravida is being monitored in her prenatal clinic for preeclampsia, which finding should concern her nurse

o A dipstick value of 3+ for protein in her urine

• A pregnant woman has been receiving magnesium sulfate infusion for tx. of preeclampsia for 24 hr., on assessment temp 37.3 degree c, pulse rate 88 bpm respiratory rate of 10 breaths/min blood pressure of 128/90 mm hg absent deep tendon reflexes and no ankle clonus the pt. complains I'm so thirsty and warm"

o Discontinues the magnesium sulfate infusion

• The perinatal nurse is giving instructions to a woman, stay she must take two post-suction curettage secondary to a hydatidiform mole, the woman asks why she must take oral contraceptives for 12 months the best response

o The major risk yo you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produced during pregnancy, if you were to get pregnant it would make the diagnosis of this cancer more difficult

• The most prevalent clinical manifestation of abruptio placenta as opposed to placenta previa is:

abdominal pain

• In caring for the woman with disseminated intravascular coagulation (DIC) what order should the nurse anticipate

o Administration of blood

Exlampsia

 Seizure activity or coma in woman diagnosed with preeclampsia

HELLP

Associated with preeclampsia,  Hemolysis (H)
 Elevated liver enzymes (EL)
 Low platelets (LP)

Tonic-Clonic Convulsions

Stage of invasion, contraction, convulsion

Hyperemesis Gravidarium

Excessive vomiting, weight loss, electrolyte imbalance, ketonuria

Ectopic

Fertilized ovum implanted` outside uterine cavity

Hydatidiform Mole (Molar Pregnancy)

Gestational trophoblastic disease is a spectrum of pregnancy-related trophoblastic disorders without a viable fetus

Complete/Classic

• Mole results from fertilization of egg with lost or inactivated nucleus
• No fetus, placenta, or amniotic membrane

Partial mole

2 sperm fertilizing normal ovum, embryonic parts present and an amniotic sac

• The perinatal nurse is giving instructions to a woman, stay she must take two post-suction curettage secondary to a hydatidiform mole, the woman asks why she must take oral contraceptives for 12 months the best response

o The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produced during pregnancy, if you were to get pregnant it would make the diagnosis of this cancer more difficult

Placenta Previa

Painless, placenta is attached to the cervix

The most prevalent clinical manifestation of abruptio placenta as opposed to placenta previa is

abdominal pain

DIC

Disseminated intravascular coagulation; • Pathologic form of diffuse clotting causing widespread external and internal bleeding

In caring for the woman with disseminated intravascular coagulation (DIC) what order should the nurse anticipate

Administration of blood

TORCH

 Toxoplasmosis
 Other infections
• Hepatitis A
• Hepatitis B
 Rubella
 Cytomegalovirus
 Herpes simplex

Preterm

20-37 weeks

Late Preterm

34-36 weeks

Low birth weight

2500 g or less

In planning for home care of a woman with preterm labor, the nurse needs to address what concern

prolonged bed rest may cause negative physiological effects

A woman in preterm labor at 30 weeks of gestation receives 2 12 mg doses of betamethasone intramuscularly, The purpose of this pharmacologic treatment is to

antenatal glucocorticoids given as intramuscular injections to the mother to stimulates fetal lung maturation (surfactant)

Tocolytics

goal is to delay birth long enough to institute interventions that delay neonatal morbidity and mortality

5 P's of dystocia

Powers, passage, passenger, position, psychologic

A primigravida 40 weeks gestational is having uterine contractions every 1 ½ to 2 minutes and says that they are very painful, her cervix is dilated 2 cm and has not changes in 3 hours. The woman is crying and wants an epidural what is likely status of this woman's labor:

Hypertonic

A woman is having her first child. She has been in labor for 15 hours, 2 hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0, 5 mins ago her vaginal examination indicated that there had been no change what abnormal labor pattern is associated with this description

secondary arrest

• A nurse suspects that a client has been physically abused. The woman refuses to report the abuse to the police. Which statement by the client suggests to the nurse that the relationship may be in the "honeymoon phase'

o My partner said that he will never hurt me again

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