West Coast University-NURS 223L Week 4 Quiz-5 Study Guide(Chapter 7)

Week: 4 Quiz #5 Chapter 7 Gestational Complications:  Common risk factors o A high-risk pregnancy is one that threatens the health or the life of the mother or fetus. o Risk factors for high risk pregnancies inclu ...

Week: 4 Quiz #5 Chapter 7 Gestational Complications:  Common risk factors o A high-risk pregnancy is one that threatens the health or the life of the mother or fetus. o Risk factors for high risk pregnancies include:  Existing health conditions: high blood pressure, diabetes, and HIV positive  History of prior pregnancy complications  Complications that arise during pregnancy: gestational diabetes and preeclampsia  Being overweight or obesity  Carrying more than one fetus  Being lass then 18 years of age  Advanced maternal age increases the risk because pre-existing health problems and increase risk of pre-eclampsia and diabetes. Preterm Labor:  Defined as regular contractions of the uterus resulting in changes in the cervix before 37 weeks of gestation.  Between 20-36 weeks. o Characteristics:  Individual behavior  Psychosocial factors  Neighborhood characteristics  Environmental exposures  Medical conditions  Infertility treatments  Biological factors  Genetics o Spontaneous pre-term labor:  Unintentional, unplanned delivery before 37 weeks of pregnancy.  Causes: usually unknown o Can be related to infection or inflammation o History of preterm babies o Medically indicated pre-term birth:  Health care provider recommends pre-term delivery due to the existence of a serious medical condition, such as; pre-eclampsia. o Non-medically indicated (elective):  Some late preterm birth result from inducing labor or having a cesarean delivery in the absence of being medically necessary to do so even though this practice is not recommended.  Long-term sequalae for pre-term infants include: o Cerebral palsy o Hearing and vision impairment o Chronic lung disease  Risk factors for preterm labor and birth: o Most common:  Prior pre-term birth  Multiple gestation (twins)  Uterine cervical abnormalities, diethylstilbestrol (DES) exposure (synthetic estrogen). o Other risk factors:  Fetal anomalies  IVF pregnancy  Premature rupture of membranes  Short pregnancy interval  Hydramnios or oligohydramnios  Infections  Hypertension, diabetes, vaginal bleeding, inadequate nutrition, obesity, ancestry ethnicity, younger than 17. o Warning signs of preterm labor:  Call the doctor if any of the following occur  Water break  Decrease fetal movement  More than _____ contraction in an hour  Low backaches, menstrual cramps, pelvic pressure, or intestinal cramps with or without diarrhea  Increase vaginal discharge  Fever higher than 100.4 F (38 C)  Feeling that something is not right  Prediction and detection of preterm labor: o Fetal fibronectin has a low positive predictive value but a high negative predictive value, thereby, making it a useful test to predict those women who will NOT deliver preterm.  Diagnosis of pre-term labor: o Generally based on clinical criteria of regular uterine contractions, accompanied by a change in cervical dilation, effacement, or both, or initial presentation with regular contractions and cervical dilation of at least 2cm. Tocolytic Drugs  Medications used to suppress uterine contractions in preterm labor.  First line is the beta-adrenergic agonist therapy, calcium channel blockers, or NSAID’s for short term prolongation of pregnancy.  Calcium channel blocker (Nifedipine) o Assess for side effects: Hypotension, dizziness, and palpitations, monitor LFT, assess BP and pulse before and after administration, assess woman when ambulating  NSAID (indomethasine) o Assess for GI upset, assess level of pain  Beta androgenic receptor agonist (terbutaline, Ritodrine) o Monitor HR, BP, and RR. o Strict I/O for fluid overload. o Assess blood glucose levels o Evaluate patient for anxiety and tremors o Use cautiously when administering to an asthma patient and monitor for respiratory distress.  Magnesium sulfate  Used for fetal neural protection o Maternal side effects:  Lethargy  Drowsiness  Flushing  Diaphoresis  N/V  Headache  Pulmonary edema  Loss of DTR  Respiratory depression  Hypotension  Cardiac arrest, suppressed HR, contractility, and left ventricle systolic pressure when used with calcium channel blockers. o Adverse effects:  Neonatal suppression o Contraindications:  Myasthenia gravis o Nursing care:  Assess DTR  Assess respiratory status  Monitor serum magnesium levels (5-7mg/dL)  Keep calcium gluconate available as antidote  Monitor I/O