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Terms in this set (656)

multiparity: should not assume they need less help just cause they have been there. need time to process strategies to handle multiple children. challenges of giving attention to all kids equally.

maternal age: maternal identity is very difficult to achieve for the adolescent who is in the throes of evolving her own identity as an adult independent from her family. she will function at a lower level of competence. the younger the more difficult to accept body changes, seek health care, and plan for changes and higher rate of abuse.
*early adolescence: ages 11-15 are self centered and oriented towards the present and pregnancy is usually the result of abuse or coercion.
*middle adolescence: 14-16 years more capable of abstract thinking and understanding of behaviors and their consequences
*by age 17-20 late adolescence and are likely to be capable and active participant in health care decisions.
*older mothers over 35: chronic diseases, fetal chromosomal abnorms, low birth weight, premature births, multiple births, but better equipped psychosocially but difficulty in changing her life from a career woman to a mother.

lesbian mothers: lack social support. nurse needs to strive to use language and to avoid making assumptions about gender orientation. include birth partners as much as possible

single parent: may live below poverty level, higher stress, need to make a decision whether to proceed with the pregnancy.

multigestation: if carrying more than 3 they may need counseling to pick which to keep so they can let the remaining fetuses grow to term but this poses a ethical dilemma.

socioeconomic: financial barriers, immigrant women face significant economic barriers.

Abused: IPV(intimate partner violence), screen all pregnant women.

military: for veterans pregnancy can make mental health conditions worse. get support from on base clinics.

nursing actions: use ALPHA a screening tool. establish a trusting relationship.
gestational age of >20week and <37weeks
regular UCs >6hr and at least one of the following
ROM
cervical changes: cervix >1cm dilated or 80%effaced.
medical mgmt.:
tocolytic drugs to suppress uterine contractions in preterm labor: may prolong for up to 2-7days along with steroids to improve lung maturity, delaying delivery for several days to give corticosteroids time to work and to treat group b strep infections. IV hydration, Progesterone, corticosteroid therapy like betamethasone,

when to not treat PTL:
hemorrhage, maternal disease, fetal compromise, chorioamnionitis, fetal death, PPROM

*bedrest leads to muscle atrophy, cardiovascular deconditioning, maternal weight loss, stress for the woman and her family.

nursing actions: obtain fFN as ordered before sterile vag exam, don't if ROM, bleeding, sexual intercourse or prior collection in last 24 hours. assess urinary infection, ROM, bleeding discharge, dehydration, report fetal tachy, IV hydration, tocolytic agents, glucocorticoids, on side to increase uteroplacental perfusion and decrease pressure on maternal inferior vena cava, report BP greater than 140/90 or less than 90/50 a temp greater than 100, or HR greater than 120. auscultate lungs for pulmonary edema, assess cervical changes, emotional support, what for se of tocolytic drugs such as chest tightness or discomfort, cough, shortness of breath, o2sat of less than 95 and increased resp and HR, changes in behavior such as apprehension, anxiety, or restlessness. WBC are elevated in women who have received corticosteroids and indicate infection,
Patho: normally in pregnancy the womans blood pressure falls due to general relaxation of muscles.
*microvascular fat deposition within the liver causing epigastric pain, liver damage may progress to HELLP syndrome which is Hemolysis, Elevated Liver enzymes and Low Platelets. right upper quad pain and signals worsening preeclampsia.
*protein is excreted in the urine, uric acid creatinine and calcium clearance are decreased and oliguria develops. Oliguria is a sign of severe PE.
*platelet count below 100,000 is an indication of severe preeclampsia
*hyperreflexia and severe headaches and can progress to eclampsia
*blurring or double vision, photophobia, scotoma
*decreased serum albumin and results in tissue edema.
*pulmonary edema from volume overload related to left ventricular failure as the result of extremely high vascular resistance.

risks: nulliparity, younger than 19 or older than 35, obesity, multiple gestation, family hx, preexisting hypertension, previous PE, DM.

risks for the woman: cerebral edema, hemorrhage, stroke, DIC, pulmonary edema, CHF, Hepatic failure, renal failure, abruptio placenta.

risks for fetus: premature delivery, IUGR, LBW, fetal intolerance to labor because of decreased placental perfusion, stillbirth

assess: BP, proteinuria, Lab values of liver function enzyme increase, diminished kidney function and altered coagulopathies.

mgmt.: antihypertensive drugs(hydralazine IV vasodialator, Aldomet, Labetalol a beta blocker, calcium channel blocker Procardia) are used but the only cure is delivery. Mag sulfate: CNS depressant. and Delivery.

nursing: assess, administer medication, assess for CNS changes, assess for epigastric or RUQ pain, weight daily, urine for protein, Lab values: normal creatinine is 72 and youll see elevations, hematocrit >35, Low platelet count under 100,000, elevated serum AST >41, ALT>30, I&O, maintain bed rest in lateral recumbent position.
*chlamydia: silent disease: fetus contact at delivery causes conjunctivitis and premature birth, treat with amoxicillin, can lead to PID treat all partners.

*Gonorrhea: no symptoms or burning and yellow green discharge, can lead to PID, treat with cephalosporin. contact of fetus at birth leads to opthalmia neonatorum may cause blindness treat with antibiotic ointment into eyes of all newborns.

*GBS: asymptomatic carriers, UTI's, chorioamnionitis, transmission is low but can result in fetal permanent neurological sequelae, penicillin or ampicillin IV during labor.

*HBV: low grade fever anorexia, N/V, fatigue, rashes, leads to cirrhosis of liver and liver cancer, can cause fetal liver caner and cirrhosis, no specific treatment. but immunoprophylaxis of all newborns born to positive women, HBIG to neonate at delivery and Hep B series initiated.

*HCV: no symptoms, liver cancer and cirrhosis, treat with ribavirin and interferon can still breastfeed.

*HPV: asymptomatic, genital warts are flat, popular or pedunculated growth on the genitals, can cause respiratory papilomatosis in newborn, treat with wart removal during pregnancy, don't necessarily have to have a cesarean birth.

*Syphilis: ulcer or chancer then a rash advancing to CNS damage, congenital syphilis causes preterm birth, physical deformity, neurological complications, stillbirth and death, treat with penicillin

*trichomonas: malodorous yellow green discharge and vulvar irritation, can lead to PROM and PTL, can lead to fetal resp and genital infection, treat with metronidazole.

*candidiasis: disturbance in vaginal flora, pruritus, soreness, dyspareunia, abnormal discharge with yeasty odor, treat with topical azole therapies.

bacterial vaginosis: fishy odor, preterm labor, PROM, treat with metronidazole

*HIV/AIDS: weakens immune system, fever fatigue sore throat and lymphadenopathy, fetus in early treatment of antiretroviral is affective in reducing transmission, maternal IgG antibodies to HIV are present up to 18months. treat with antiviral, No breastfeeding, cesarean birth.
Early: nadir lowest point, mirror the contractions: causes are UC, fetal head is subjected to pressure that stimulates vagal nerve, fetal head compression and decreased transient blood flow with corresponding Po2 decrease. no mgmt. required.
Variable: SUDDEN ABURPT decelerations of >15bpm lasting 15sec-2min: most common seen in labor, an acceleration that follows a deceleration is a shoulder a compensated response to hypoxemia and an increase in the FHR of 20bpm for <20seconds. periodic or episodic, U/W/Y shaped, causes are umbilical cord occlusion/compression, prolonged cord compression with rebound tachycardia, head compression, mgmt. is to consider anmioinfusion, tocolytics and delivery, 10L oxygen, FSE, SVE, modify pushing.
Late: nadir of decelerations occurs after the peak of contraction, and recovery of decel occurs after the UC: fetal intolerance to labor, uteroplacental insufficiency, maternal hypertension, or placental changes or abnormalities. mgmt. is to consider tocolytics and delivery, changes in maternal position, DC oxytocin, assess hydration, VAS, Oxygen at 10L, FSE.
Prolonged: apparent abrupt decrease by 15bpm below base for longer than 2min but shorter than 10min: causes are interruption of uteroplacental perfusion by tachysystole, maternal hypotension, abruptio placenta, cord compression, cord prolapse, profound head compression, rapid fetal descent, treat is amnioinfusion, tocolytics, delivery, change position, oxygen at 10L, IV hydration, SVE, FSE
sinusoidal: visually apparent smooth sine wave undulating pattern with a frequency of 3-5min that persists for >20min
PID: infection of upper genital tract structures in women: genital gonorrhea and douching, lower abdominal, ovarian or fallopian and cervical motion tenderness should reveive empiric treatment, antibiotics. condoms. abstinence.

Trichomoniasis: in females: purulent thin discharge, itching, painful urination, pain with intercourse, postcoital bleeding, worse during menstruation. Men: less sever, asymptomatic spontaneous resolution. clear or mucoid discharge and or pain. only reliable test for male is called a PCR test of the urine.
treat: avoid alcohol, antibiotic treatment, no sex until treatment is complete and symptoms are gone. and followup.

Gonorrhea: spread to blood or the joints causing painful arthritis with red, swollen joints. spread by contact with infected sites, most through sexual contact in adolescents, mother to infants during delivery, severe eye infection in infants can lead to blindness. give ilioticin in infant eyes at birth to all. symptoms: pain, yellow white sometimes green discharge in men, anal itching, soreness, bleeding, painful bowel movement, rectal infection. start antibiotics, condoms, abstinence

chlamydia: most common STD, asymptomatic, conjunctivitis and pneumonia in infants born to mothers through birth canal. antibiotic therapy, condoms and abstinence. test all females in pregnancy.

syphilis: singl sore then chancre, then rash of red rough spots on hands and feet, muscle aches and fatigue, sore throat, headaches, final stage: difficult coordinating muscles and paralysis. in congenital in babies: nasal congestion, enlarged liver and spleen, rash on palsm and soles, turns dark or even coppery, seizures, developmental delay and missing milestones. treat with antibiotics and penicillin,