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Nursing School

Families At Risk
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again, detailed power points, not a whole lot to be written in class...

Families At Risk

 

- Hyperemesis Gravidarium: excessive vomiting, electrolyte imbalance can lead to maternal acidosis, may be d/t increased HCG, may be psychological or may be d/t H. pylori

 

- Premature Rupture of Membranes: defined as before 38 weeks, litmus test will be yellow if it’s urine, will turn blue if alkaline

 

- Chronic HTN: does not necessarily lead to PIH, check for proteinuria or edema

 

- Pregnancy Induced Hypertension: can happen to any mom at any time, baby aspirin to mom may help, mom’s thick sludgy blood damages her vessels and decreases profusion to baby; laying mom on side is the only way to increase profusion but bedrest may do more harm than good.

            - women at risk: primiparas, high stress women, family hx, change in sex partner (ie. 2nd husband...)

            - tx: bed rest? LR to increase circulating blood volume, baby aspirin to decrease clotting, maybe older HTN meds, Na restriction not necessary, increase Ca to help muscle activity, increase protein to keep fluid in circulating blood volume

- Preeclampsia is unique to pregnancy, diastolic above 100, maybe not completely reversible but usually resolves w/in 1 month after delivery, can exacerbate other problems, can harm vital organs, high maternal BP can cause abruption

            - warning signs: sudden weight gain, increased body edema (hands) (lower body edema is normal), increased BP, double vision, visual disturbances

            - severe PIH: this mom needs to be in the hospital

- PIH Assessments: resps will increase, uterine activity might decrease but you don’t want it to!, clonis (spasticity), check neuro status, check renal function (once the liver is involved mom will have abdominal pain d/t liver enlargement & sclerosis), decrease in FHR variability w/long term PIH

            - Tx: Magnesium Sulfate (most be hospitalized) CNS depressant, interferes w/acetylcholine at neurotransmitter junction, must monitor hourly for Mg toxicity (BP decreases, FHR decreases, hyporeflexes, slow speech)

            - Tx: Betamethasone may also be given to help mature fetal lungs

            - If mom has a seizure, C/S will be done because baby is safer outside than in a seizing mom

 

            - HELLP syndrome: can happen before the baby’s born but is usually after, this happens when delivery of the baby doesn’t cure preeclampsia, mom has low hematocrit (increases risk for DIC disseminated intravascular coagulopathy (blood can’t clot)

 

- Premature Onset of Labor (POL) - between 20-37 wks, often d/t infection/dehydration/overdistention of uterus (as in twins)

            - Dx: 22-34 wks Fetal Fibrinectine test: there shouldn’t be any fetal fibrinectine, if present it indicates a higher risk for premature labor, done by vaginal swab; estriol level may also be checked w/urine test, 4cm dilation or ROM are irreversible

            - Tx: tocolytic agents (turbutaline (may cause pulmonary edema) or Magnesium sulfate); Oral turbutaline must be around the clock, it is a smooth muscle relaxant that mom can use at home once contractions stop, can make mom feel crazy like she’s on speed.

 

- Gestational Diabetes: checked at 24-28 wks, blood sugar usually has to be greater than 170 to see sugar in urine, babies are often large (but not necessarily fully developed), babies often have hyperbilirubinemia d/t immature liver, diet is 1st tx followed by insulin (which does not cross placenta); this mom will have non-stress test after 34 wks to check placental viability

 

- Postterm Pregnancy: umbilical cord compression often d/t wharton’s jelly drying up

 

- Abruptio Placenta: PAIN with or without bleeding

 

- Placenta Previa: Bleeding without pain, can be early or near term, bleeding w/sex or at vaginal exam, total/partial have increased risk for hemorrhage at delivery, less fetal death than abruptio placenta

 

- Placental Problems: often indicate fetal anomalies

            - Placenta Accreta: placenta trying to find good blood supply and grows through myometrium, maybe through entire uterus

            - Amniotic Fluid Embolism: placenta detaches & amniotic fluid enters maternal blood circulation & mom dies

 

NOTHING on this website is to take the place of a physician's advice. Everything in this site is meant to be only a helpful tool for me and my nursing student friends.

Feel compelled to help me get through college while working only part-time and driving a million miles a day? Well, I won't twist your arm, but all you have to do is push the button. Either way, the information is free.