High- Risk Pregnancy: Complications
A pregnant client in her third trimester presents with painless, bright red vaginal bleeding. Which nursing action is strictly prohibited?
Performing a digital vaginal examination
-digital vaginal exams are absolutely prohibited because they can puncture the placenta and cause catastrophic bleeding
A pregnant client at 28 weeks of gestation reports fatigue, weakness, and occasional dizziness. Lab results show a hemoglobin of 9.2 g/dL, hematocrit of 28%, and microcytic, hypochromic red blood cells. What intervention
What condition typically increases the chances of developing gestational diabetes?
PCOS
Name risk factors for gestational hypertension
Maternal age younger than 19, older than 40
primigravida, obesity, multi fetal gestation, chronic renal disease, HTN, family history of preeclampsia, diabetes, rheumatoid arthritis, lupus
Risk factors for hyperemesis gravidarum
Maternal age younger than 30, multifetal gestation, gestational trophoblastic disease (molar pregnancy), psychological issues, hyperthyroid issues, diabetes, GI disorders, family history of hyperemesis.
A nurse is providing discharge instructions to a client who received methotrexate for an unruptured ectopic pregnancy. Which instruction should be included?
Avoid all supplements and food containing folic acid
-methotrexate is a folic acid inhibitor that works by destroying rapidly replicating cells to preserve the fallopian tube; therefore clients must avoid folic acid to ensure the drug is effective
Name 4 Risk factors for iron deficiency anemia
1. Less than 2 years between pregnancies
2. Heavy menses
3. Diet low in Iron
4. Unhealthy weight loss programs
Tell me predisposing conditions (risk factors) to gestational diabetes
Older then 35, previous perinatal loss, previous child born with congenital anomalies
PCOS, Obesity, multiple gestation, family history
Non white race, hypertension, use of glucocorticoids, delivery of baby over 9lbs
Preeclampsia is diagnosed when what two conditions are combined?
Proteinurea and gestational hypertension
Explain the physical assessment findings with hyperemesis
Excessive vomiting with prolonged periods, dehydration, electrolyte imbalance, weight loss, increased pulse rate, diabetes, gastrointestinal disorders, family history of hyperemesis
Which clinical finding should the nurse prioritize as a classic sign of placental abruption?
Sudden, sharp abdominal pain and a board-like, rigid uterus
What assessment findings will you see when looking at a pregnant woman who you suspect of having iron-deficiency anemia?
Fatigue, weakness, malaise, anorexia, susceptibility of infection (frequent colds), pale mucous membranes, tachycardia, pallor, pica
Remember 1 in 4 women will have iron deficiency anemia, women need 30mg iron per day
Tell me the increased risk factors to the fetus
Macrosomia, birth defects, electrolyte imbalances, and neonatal HYPOglycemia, infections, ketoacidosis, cord prolapse (polyhydraminos), preterm birth, subsequent childhood obesity, carbohydrates intolerance, Intrauterine growth restriction
Name some expected findings associated with gestational hypertension
Severe continuous headache, nausea, blurring of vision, flashes of light or dots before the eyes
How would you advance the diet for a client with hyperemetics gravidarum?
Advance diet to clear liquids and bland foods once vomiting has stopped. Frequent small meals. Bland foods includes: dry toast, crackers, or baked chicken: then to a normal diet as tolerated.
A nurse is assessing a client with premature rupture of membranes (PROM). Which finding is the most critical indicator of chorioamnionitis?
Fetal heart rate of 175 beats per minute
-signs of chorioamnionitis include persistent fetal tachycardia (>160 BPM), maternal fever, and foul-smelling amniotic fluid
What education would you give your client with iron-deficiency anemia in regards to supplement intake and diet?
Take on empty stomach and swig some OJ
Eat vitamin C rich foods, and iron-rich foods (legumes, dark greens, dried fruits, and meat)
Increase fiber and fluids (constipation)
A patient with gestational diabetes says this after you educated them on their condition “I need to avoid exercise because of the negative effects on insulin production?”
This is wrong: exercise is safe and lowers the blood glucose level.
A pregnant patient with preeclampsia suddenly develops a generalized tonic-clonic seizure. What condition has the client developed?
Eclampsia
Nursing care: what interventions are you going to do?
Monitor I&Os, Assess skin turgor and mucous membranes, monitor vital signs, monitor weights, have client remain NPO until vomiting stops
A nurse is caring for a client at 34 weeks of gestation who has preeclampsia. The client reports a severe headache and seeing “spots” in her vision. Her blood pressure is 168/112 mmHg. The nurse reviews the PEACE assessment framework. Which action should be the nurse take first?
Assess the client for signs of worsening neurologic status and prepare to administer prescribed magnesium sulfate.
-severe headache, visual disturbances, increased risk for seizure. Worsening neurological symptoms prepare magnesium sulfate to prevent seizures
During pregnancy, iron-deficiency anemia is especially concerning because maternal anemia can decrease the amount of ________ delivered to the fetus.
Oxygen
A client at 32 weeks gestation with gestational diabetes reports increased thirst and frequent urination. Which finding requires the nurse’s priority follow up?
A. Fasting glucose 92
B. 1hr postprandial glucose 185
C. 3lb weight gain over 2 weeks
D. Fundal height measuring 34cm
1hr postprandial glucose control increasing the risk of fetal macrosomia and other complications
A patient client with HELLP syndrome has a platelet count of 72,000 and elevated ALT/AST. Which assessment findings requires the most immediate intervention?
Mild peripheral edema, proteinuria, severe right upper quadrant pain, blood pressure 150/94
Severe right upper quadrant pain
-RUQ/ epigastric pain indicates liver involvement and possible hepatic complications, which rapidly become life-threatening
Explain DIC
maybe