Diabetes
Label given to type 1 or type 2 diabetics that existed before pregnancy
Pregestational diabetes
Hypertension prior to 20 weeks gestation
Chronic hypertension
Regular uterine contractions along with cervical change occuring between 20 and 37 weeks of gestation
Preterm labor
An infection of the amnion, chorion, or both commonly seen the premature rupture of membranes
chorioamnionitis
This drug is given prophylactically when a women's membranes rupture prematurely
Antibiotics
This is key to optimal outcome of a diabetic pregnancy throughout pregnancy
Mary's BP rose from 118/66 to 142/88 at 37 weeks of gestation. No other signs such as proteinuria were noted. How would you describe her condition?
Gestational Hypertension
Rupture of membranes prior to 37 weeks gestation
premature preterm rupture of membranes
This tool evaluates cervical dilation, effacement, station, consistency, and position
The bishop score
This medication is given to promote fetal lung development
Corticosteroid (betamethasone)
A patient comes into the office to have a 1 hour (50 g) glucose test completed. A result greater than what value would mean that a 3 hour glucose test needs to be performed?
Greater than 130 mg/dL
At 32 weeks of gestation, Maria with hypertension since 28 weeks, hyperactive DTRs with clonus and proteinuria, has a convulsion. What term would you choose to describe her condition?
Ecclampsia
What is a major concern with premature rupture of membranes
Infection
Kate is 42 weeks gestation and arrives to the doctor's office to determine if she will be able to be induced today. She is has a Bishop Score of 6. Will Kate be able to be induced with Pitocin today?
No. A score of 8 or higher is considered favorable and required before Pitocin can be started.
The primary expected outcome for nursing care associated with the administration of magnesium sulfate would be met if which assessment finding is present?
1. Patient exhibits decrease in SBP and DBP
2. Patient experiences no seizures
3. Patient states that she feels more relaxed and calm
4. Patient urinates more frequently, resulting in decreased edema
2 No more seizures
Elena (2-1-0-0-1) is a 32 year old Hispanic American in week 28 of her pregnancy. Her BMI is 30. Her mother was recently diagnosed with type 2 diabetes. Her first preganancy resulted in the birth of a 10 lbs 6 oz daughter who is now two. What are Elena's risk factors for gestational diabetes?
age, hispanic, BMI/obesity, family history of diabetes, previous birth >4500g or 9.9 lbs
1. evaluate FHR and pattern for signs of decreasing variability, late decelerations, or bradycardia
2. Assess status of maternal airway, respiratory effort and pulse
3. Determine if membranes have ruptured and if the amniotic fluid contains meconium
4. Prepare to increase the amount of magnesium sulfate being infused from 1g/hr to 2g/hr
2. all choices are appropriate but remember that ABC's should always be priority
A nurse is caring for a pregnant woman suspected of being in preterm labor recognizes which sign as diagnostic of preterm labor?
1. Cervical dilation of 3 cm
2. Uterine contractions every 15 minutes
3. Spontaneous rupture of membranes
4. The patients urge to bear down
1. Cervical dilation of 3 cm or more is diagnostic of preterm labor
A pregnant woman has been in a motor vehicle action. What action should the nurse take?
1. Place the woman in a side laying position
2. Begin to induce the woman's labor
3. Place a wedge under the woman's hip
4. Avoid giving the woman oxygen as it will give the fetus oxygen toxicity
A woman is receiving magnesium sulfate. Which measure should be implemented during the infusion?
1. limit IV fluid intake to 125 ml/hr
2. Discontinue infusion if maternal respirations are less than 12 breaths/minute
3. Ensure indomethacin is available in case toxicity occurs
4. Assist women to maintain comfortable semi recumbent position
Specific guidelines should be followed when planning a diet with a pregestational diabetic woman (BMI of 24) to ensure proper blood sugar control. Which dietary practice needs modified by the nurse (select all that apply?)
1. follows diet that reflects 45 kcal per kg daily based on her perception of her BMI
2. Eats 3 meals a day along with midmorning, mid afternoon, and bedtime snack
3. Drinks cup of tea and piece of dry toast as bedtime snack.
4. Divides daily carb intake as 50% simple carbs and 50% complex carbs
5. Maintains fat intake of approximately 25% totally daily kcal recommendation
6. Monitors appropriate nutritional intake by checking blood levels before and after meals
A, C, D
The patients BMI is normal. Therefore calories should be 30-35 kcal/kg/day. Bedtime snack should be substantial to prevent starvation ketoacidosis. Simple carbs should be avoided.
A woman is diagnosed with preeclampsia without mild symptoms and will be treated at home. In teaching the woman about her treatment regimen for preeclampsia, the nurse should tell her to: (select all that apply)
1. Follow low salt diet
2. Use dipstick to check clean catch specimen of her urine for protein
3. Maintain fluid intake of six to eight 8 oz glasses of water per day
4. Increase roughage in diet
5. Perform gentle range of motion exercises of upper and lower extremities
6. Ask friends to avoid visiting or calling because she needs to rest
2, 3, 4, 5. Roughage and water intake will prevent constipation. Proteinuria should be monitored. Range of motion improves circulation and muscle tone. No need to limit salt or avoid visitors.
Sara who is currently 22 weeks gestation comes into the office very nervous. She states that she had her other child at 26 weeks and felt like she had no warning. She asks "Is there anything I can do this time to have my baby later or at least know that the labor is starting so I can call the doctor?" What are signs of preterm labor that you can educate Sara about?
Uterine contractions occurring more frequently every 10 minutes persisting for 1 hr or more
Change in vaginal discharge: thicker or thinner, increased amount, color, odor
Lower abdominal cramping, back pain, suprapubic pain, urinary urgency, pelvic pressure or heaviness
A woman has just been admitted with a diagnosis of hyperemsis gravidarum. She has been unable to retain any oral intake and as a result has lost weight and is exhibiting signs of dehydration with electrolyte imbalance and acetonuria. The nurse anticipates the that care management for this patient will include:
1. Administering Vitamin K to control nausea and vomiting
2. Separating liquids from solids, alternating them every 2 to 3 hours once she is able to tolerate oral intake
3. Avoid oral hygiene until the woman in able to tolerate oral fluids
4. Provide 3 daily meals of bland foods with warm fluids once the woman is able to tolerate oral intake
2. Oral hygiene is important when NPO and after vomiting. Taking fluids between meals rather than with meals reduces nausea and increases tolerance for oral nutrition
A nurse is caring for a pregnant woman at 30 weeks gestation in preterm labor. The woman's physician orders betamethasone 12 mg IM for two doses with the first dose at 11 am. In implementing this order the nurse should:
1. consult the physician because the dose is too high
2. Explain to the woman that this medication will reduce her heart rate and help her breath easier
3. Prepare to administer the medication IV between contractions
4. Schedule the second dose for 11 am on the next day
4. Betamethasone doses should be spaced 24 hours apart and 48 hours should be given for the medication to be effective.