NUR 406 EXAM 2
- (eg.,Rh incompatibility, diabetes, preeclampsia, basic information r/t to the TORCH
infections, preterm labor),
Answer
- Goals of care of high risk pregnancies
Answer • foster growth and development and mother and baby
• minimize maternal, fetal and neonatal mortality
- Pregnancy Complications
Answer Identify/distinguish normal complications/ ab- normal assessment findings
- Pregnancy Complications
Answer General pathophysiology behind complications (basic mechanisms, general lab assessments- not specifics/details- more clinical judgement oriented)
- Pregnancy Complications
Answer · Appropriate nursing care/interventions vs. in- appropriate nursing care/interventions for both normal and abnormal find- ings
- Pregnancy Complications
Answer 1 / 4
· Includes medications with focus on those dis- cussed in lecture/lab/clinical
- Pregnancy Complications
Answer · Diabetes during pregnancy (gestational or pre- viously existing)
The "normal" pregnant woman has an increases resistance to insulin beginning in the 2nd half of pregnancy.
• placenta produces more hormones, which increase resistance to insulin, demand rises 3x • body actually produces more insulin while pregnant, but hormones produced by the placenta increase the body's resistance to the insulin
- Gestational Diabetes
Answer Diabetic pregnant women can't increase their production of insulin
- pancreas unable to produce sufficient insulin
- insulin not being used effectively
Especially complicates 2nd and 3rd trimester when insulin demands increase Pathophysiology • without adequate insulin; glucose circulates blood stream unable to enter cells, energy starved cells break down fats and proteins for energy causing; ketosis from fat wasting, negative nitrogen balance from protein breakdown and muscle tissue wasting • high levels of glucose spill over into the urine; glycosuria
- Assessing for Diabetes in pregnancy
Answer All women screened Complications; fetal HTN, macrosomnia, polyhydramnios, infection, still birth
Screening
- done at every prenatal visit (glucose urine test) 2 / 4
- hour Glucose Tolerance Test
• done in the office between 24-28 weeks, oral glucose test advised
> If results abnormal; 3 hour glucose test done
- instruct pt to eat high CHO diet x 3 days then fast overnight (150 g a day)
-screen late in the 1st trimester if theres a history of insulin resistance, age >40, prior stillbirth, miscarriage or large/malformed infant
- Assess for 4 cardinal signs of diabetes;
Answer polydipsia, polyuria, polyphagia, weight loss
- Management of Diabetes in pregnancy
Answer Strict regulation of maternal glucose levels is essential to optimal perinatal outcome.
• manage diabetes preconceptually • insulin is drug of choice during pregnancy • careful review of oral hypoglycemic agents (some are contraindicated) Instruct on use of insulin with incidences of N & V???• dietary control is key • fasting 70-100 • <120 2 hours after meals
large fluctuations in blood sugar can jeopardize the fetus
****bed time snack most important - protein and complex carbs to prevent hypo- glycemia during sleep
• encourage compliance to med regimen, prenatal visits, dietary changes, etc
- How to evaluate fetoplacental functioning?
Answer Alpha Fetoprotein Screening at 16-20 weeks 3 / 4
Monitor fetal activity starting at 28 weeks Assess fetal growth with an ultrasound at 18 and 28 weeks Fundal height
- macrosomia
- polyhydramnios
- IUGR
Administer nonstress test
- start at 28 weeks, weekly
- twice weekly at 32 weeks
- if nonreactive, the biophysical profile is done
Assessment of fetal maturity -L/S ratio (lung development) amniocentesis
may be falsely elevated in a diabetic, may need to be as high as 3
Answer 1
- Anemia during pregnancy
Answer Pregnancy may exacerbate preexisting anemia
• Fe- deficiency and megaloblastic anemia may be caused by pregnancy • Hemodilution - physiologic anemia of pregnancy 1000 mg extra Fe needed during pregnancy Inadequate Hgb < 11 If not supplied by iron supplements, maternal risk for infection and hemorrhage increase, risk of prematurity, stillborn, hypoxia, and death
Supplement with ferrous sulfate 30-60 mg a day between meals with orange juice **
- Bleeding in Pregnancy
- / 4
Answer 1st and 2nd trimesters;