Term
| What is the benefit of prevention of neural tube defects? |
|
Definition
| 50-70% can be prevented if a woman has adequate levels of folic acid during earliest weeks of organogenesis—before she receives her prenatal vitamins |
|
|
Term
What is the benefit of prevention of Birth Defects related to poor glycemic control of mother (including sacral agenesis, cardiac defects and neural tube defects)
? |
|
Definition
| Can be reduced from ~10% to 2-3% through glycemic control of the woman before organogenesis |
|
|
Term
What is the benefit of preventing a prospective mother’s contact with teratogenic exposures such as prescribed medications, environmental exposures and alcohol
? |
|
Definition
| Teratogenic substances interfere with normal organ development primarily during the period of organogenesis |
|
|
Term
| What are the CDC guidelines for immunizations/medications in pregnancy? |
|
Definition
| Recommended/should be considered: Hep B, Influenza (inactivated) Tetanus/Diptheria (Tdap), Meningococcal, Rabies |
|
|
Term
| What are the contraindicated vaccines? |
|
Definition
| Influenza (live, attenuated vaccine) nasal spray, Measles, Mumps, Rubella, Varicella, BCG (tuberculosis), Meningococcal, Typhoid |
|
|
Term
| What are the drugs that can be used in pregnancy? |
|
Definition
| Meds for seizures, high blood pressure, asthma, depression if the benefits outweigh the risks |
|
|
Term
| Why should you not use herbal supplements while pregnancy? |
|
Definition
some contain chemicals that cross the placenta, may cause harm to fetus
Not evaluated in controlled studies
inconsistent potency in active ingredients |
|
|
Term
| Why are over the counter medications as dangerous as prescribed? |
|
Definition
| may be as potent as prescribed meds |
|
|
Term
|
Definition
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Ex: folic acid, vitamin B6, thyroid medicine |
|
|
Term
|
Definition
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
Antibiotics, Tylenol, artificial sweatner, Pepcid, Prednisone, Insulin, Ibuprofen |
|
|
Term
|
Definition
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Compazine, Diflucan, Cipro, some antidepressants |
|
|
Term
|
Definition
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Alcohol, Lithium, Dilantin, Chemo therapy |
|
|
Term
|
Definition
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
Accutane, Coumadin, antithyroid medications for over-active thyroid, radiation therapy, ect. |
|
|
Term
| What are the HTN diseases associated w/ pregnancy? |
|
Definition
Chronic Hypertension
Gestational Hypertension
Preeclampsia
Eclampsia
HEELP Syndrome |
|
|
Term
| When is Chronic Hypertension diagnosed? |
|
Definition
| Diagnosed before the 20th week or present before the pregnancy |
|
|
Term
|
Definition
> 140-180 mmHg systolic
> 90-100 mmHg diastolic |
|
|
Term
| When is gestational htn diagnosed? |
|
Definition
| Develops after 20 weeks of gestation |
|
|
Term
| Is protein urea associated w/ g. HTN? |
|
Definition
|
|
Term
| When does BP go back to normal w/ gestational HTN? |
|
Definition
|
|
Term
| In Gest. HTN, Morbidity is directly related to> |
|
Definition
|
|
Term
| What is the criteria for diagnosis of preeclampsia? |
|
Definition
Develops after 20 weeks
Blood pressure elevated on two occasions at least 6 hours apart
Associated with proteinuria and edema
May occur less than 20 weeks with gestational trophoblastic neoplasia |
|
|
Term
| What is normal preeclampsia? |
|
Definition
Previously normotensive woman
> 140 mmHg systolic
> 90 mmHg diastolic
Proteinuria > 300 mg in 24 hour collection
Nondependent edema |
|
|
Term
| What is severe preeclampsia? |
|
Definition
BP > 160 systolic or >110 diastolic
> 5 gr of protein in 24 hour urine or > 3+ on 2 dipstick urines greater than 4 hours apart
Oliguria < 500 mL in 24 hours
Cerebral or visual distrubances (headache, scotomata)
Pulmonary edema or cyanosis
Epigastric or RUQ pain
Evidence of hepatic dysfunction
Thrombocytopenia
Intrauterine growth restriciton (IUGR) |
|
|
Term
|
Definition
Diagnosis of preeclampsia
Presence of convulsions not explained by a neurologic disorder
Grand mal seizure activity
Occurs in 0.5 to 4% or patients with preeclampsia |
|
|
Term
|
Definition
A distinct clinical entity with:
Hemolysis, Elevated Liver enzymes, Low Platelets
Occurs in 4 to 12 % of patients with severe preeclampsia
Microangiopathic hemolysis
Thrombocytopenia
Hepatocellular dysfunction |
|
|
Term
| What is the action of mag sulfate? |
|
Definition
| blockage of neuromuscular transmission, vasodilation |
|
|
Term
|
Definition
| Prevention and treatment of eclamptic seizure |
|
|
Term
| What are the nursing implications r/t mag suflate/ |
|
Definition
Loading dose—4-6 gm IV, maintainence dose 2gm (Serum levels: 6-8 mg/dL)
Monitor serum Mag levels
Assess DTRs/ankle clonus
Have CALCIUM GLUCONATE readily available in case of toxicity
Flushing, sweating, hypotension, cardiac depression, CNM depression |
|
|
Term
| What are the s/s of mag toxicity? |
|
Definition
Respiratory rate < 12
DTR’s not detectable
Altered sensorium
Urine output < 25-30 cc/hour
Antidote: 10 ml of 10% solution of calcium gluconate 1 iv over 3 minutes |
|
|
Term
| What is the action of apresoline? |
|
Definition
| : vascular smooth muscle relaxant (improves perfusion to renal, uterine, and cerebral areas) |
|
|
Term
|
Definition
| Reduction in blood pressure |
|
|
Term
| What are the nursing implications r/t apresoline/ |
|
Definition
5-10 mg by slow IV push q 20 mins PRN
Use immediately after opening
Withdraw drug slowly to prevent possible rebound hypertension |
|
|
Term
| What are the adverse effects of apresoline? |
|
Definition
| Palpitations, headache, anorexia, nausea, vomiting, diarrhea |
|
|
Term
| What is the action of Labetalol (Normodyne)? |
|
Definition
|
|
Term
| What is Labetalol (Normodyne) used for |
|
Definition
| Reduction of blood pressure |
|
|
Term
| What are the nursing implications r/t Labetalol (Normodyne)? |
|
Definition
Lowers BP, does not decrease maternal heart rate or cardiac output
Administer IV 20-40 mg q 15 mins as needed, then 2 gm/min infusion as needed for desired BP |
|
|
Term
| What are the adverse effects of Labetalol? |
|
Definition
| Gastric pain, flatulence, constipation, dizziness, vertigo, fatigue |
|
|
Term
| What is the action of Nifedipine (Procardia)? |
|
Definition
| Calcium channel blocker/dilation of coronary arteries, arterioles, and peripheral arterioles |
|
|
Term
| What is Nifedipine (Procardia) used for? |
|
Definition
| reduction of blood pressure, stopping of preterm labor |
|
|
Term
| What are the nursing implications r/t Nifedipine (Procardia)? |
|
Definition
Administer 10-20 mg PO q 4-6 hrs
Adverse effects: dizziness, peripheral edema, angina, diarrhea, nasal congestion, cough |
|
|
Term
| What is the action of Sodium Nitroprusside? |
|
Definition
| rapid vasodilation (arterial and venous) |
|
|
Term
| What is Sodium Nitroprusside used for? |
|
Definition
| severe hypertension requiring rapid reduction in blood pressure |
|
|
Term
| What are the nursing implications r/t sodium nutroprusside? |
|
Definition
Administer via continuous IV infusion with dose titrated according to blood pressure levels
Protect IV infusion from light (wrap with foil) |
|
|
Term
| What are the adverse effects of Sodium Nitroprusside? |
|
Definition
| Apprehension, restlessness, retrosternal pressure, palpitations, diaphoresis, abdominal pain |
|
|
Term
| What is the action of Furosemide (Lasix)? |
|
Definition
| diuretic action, inhibiting the reabsorbtion of sodium and chloride from the ascending loop of Henle |
|
|
Term
| What is the use of Furosemide? |
|
Definition
| Pulmonary edema (used only if condition is present) |
|
|
Term
| What are the nursing implications of furosemide? |
|
Definition
| Administer via slow IV bolus at a dose of 10-40 mg over 1-2 min; monitor urine output |
|
|
Term
| What are the adverse effects of furosemide? |
|
Definition
| dizziness, vertigo, orthostatic hypotension, anorexia, vomiting, electrolyte imbalances, muscle cramps, muscle spasms |
|
|
Term
| What are preterm labor meds? |
|
Definition
| : regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation |
|
|
Term
| What is the most common obstetric complication? |
|
Definition
Preterm birth
Increased 35% in last 20 years
Account for 75% of neurodevelopmental disorders , 85% of all perinatal morbidity and mortality. |
|
|
Term
| What is used to halt per term labor? |
|
Definition
|
|
Term
| Is mag sulfate used to halt labor? |
|
Definition
Yes
relaxes uterine muscles o stop irritability and contractions, to arrest contractions (off-label) |
|
|
Term
|
Definition
| used in seizure prophylaxis and treatment of seizures in preeclamptic and eclamptic clients |
|
|
Term
| What are the nursing implications r/t mag sulfate? |
|
Definition
IV loading dose 4-6gm over 15-30 mins, then 1-4 gms/hr
VS and DTR hourly, level of consciousness, headache, blurred vision, dizziness
Continuous EFM-report decreased variability, hypotonia, respiratory depression
I&O, report decrease (<30ml/hr), decrease in respiratory rate, lung sounds for evidence of pulmonary edema |
|
|
Term
| What are common s/e of mag sulfate? |
|
Definition
| flushing, nausea, vomiting, dr mouth, lethargy, blurred vision, headache, transient hypotension, lethargy |
|
|
Term
|
Definition
| decreased level of consciousness, depressed respirations and DTRs, slurred speech, weakness, and respiratory and cardiac arrest |
|
|
Term
| What is the action of Indomethacin (Indocin)? |
|
Definition
| Inhibits prostaglandins, which stimulate contractions; inhibits uterine activity to arrest preterm labor |
|
|
Term
| What are the nursing implications r/t Indomethacin (Indocin)? |
|
Definition
| monitor VS, administer PO, do not give if peptic ulcer, ***amniotic fluid volume and function of ductus arteriosus, monitor signs of maternal hemorrhage |
|
|
Term
| What are the adverse effects of Indomethacin (Indocin)? |
|
Definition
| nausea and vomiting, heartburn, rash, prolonged bleeding time, oligohydramnios, hypertension |
|
|
Term
| What are the FETAL effects of Indomethacin (Indocin)? |
|
Definition
| constriction of ductus arteriosus, premature ductus closure, necrotizing enterocolitis, oligohdramnios, and pulmonary hypertension |
|
|
Term
| Who is Indomethacin (Indocin) contraindicated in? |
|
Definition
| 32 wks gest., IUGR, hx of asthma, urticaria, allergy to aspirin or NSAIDS. |
|
|
Term
| What is the action of Nifedipine (Procardia)? |
|
Definition
| blocks calcium movement into muscle cells, inhibits uterine activity to arrest preterm labor |
|
|
Term
| What are the nursing implications of Nifedipine (Procardia)? |
|
Definition
may cause hypotension when giving with Mag Sulfate, monitor BP hourly (with MGSO4), report pulse >100bpm,
Monitor for fetal effects such as decreased uteroplacental blood flowbradycardiafetal hypoxia |
|
|
Term
| What are the adverse effects of Procardia? |
|
Definition
| : flushing of skin, headache, transient tachycardia, palpitations, postural hypotension, peripheral edema, transient fetal tachycardia |
|
|
Term
| Who is Procardia contraindicated in? |
|
Definition
| women with cardiovascular disease or hemodynamic instability. |
|
|
Term
| What is the action of Betamethasone (Celestone)? |
|
Definition
| promotes fetal lung maturity—stimulates surfactant production; prevents or reduces of respiratory distress syndrome and intraventricular hemorrhage in the preterm neonate less than 34 wks gestation |
|
|
Term
| What are the nursing implications of Betamethasone (Celestone)? |
|
Definition
administer 2 doses 24 hrs apart
Monitor for maternal infection or pulmonary edema
Discuss potential benefits to preterm infants |
|
|
