Study Guide Exam 4

1. Maternal Nutrition a. Expected pattern of weight gain Total 25-35 pounds, depending on pre-pregnancy weight Pre-pregnancy obesity total 15-25 pounds b. Diet recommendations: Well Balanced + Increase calories First trimester none Second trimester 340 calories/day Third trimester 452 calories/day i. Iron: Need 1000 mg/day during Not easy through just food, in many foods but in limited quanitites ii. Folic acid Prevention of neural tube defects Should take before pregnancy and during first trimester Need 400 mcg/day before & 600 mcg during iii. Calories for pregnancy and for breastfeeding First trimester none Second trimester 340 calories/day Third trimester 452 calories/day Breast feeders need Extra 500 Calories/day iv. Calcum--? Increase? Post Preggo-Continue Prenatal Vitamins till 6 wk. check up Increase fiber and fluids Dont diet dummy!

Study Guide Exam 4

2. Diagnostic testing a. NST Non stress Test i. Why are they done? What is reassuring?

Chk Fetal Health:^FHR 120-160 + 2 acceles in 20min (15 x 15) w/ Fetal movement b. Amniocentesis i. What are they looking for? Chromosomal Abnormally by Checking Amniotic Fluid: Fetal Development then Chromosomal Abnorms then Lung Maturity Fluid Should be clear, but might be Green=Meconium Yellow=Bilirubin ii. Risks after procedure: Infection, ROM, Miscarry, Induce c. MSAFP i. Abnormals? Low Downs Synd & HIGH Thin Tissue/ Spinabifida ii. Next testing if abnormal US 3. Vaginal Bleeding a. Know nursing interventions for anyone with vaginal bleeding i. Bed rest, vital signs, assess for s/s of shock, estimate blood loss by weighing pads, fluid replacement, monitor FHT after 12 weeks, NO vaginal exams until after ultrasounds in case of placenta previa.(Low Placenta b. Know causes for each trimester i. First trimester 1. Abs (Abortions) a. Incomplete--Some tissue passed, some left in cervix. b. Complete--All tissue passed, cervix closes, bleeding stops. c. Missed--No signs of pregnancy or abortion. Fetus is not alive, but is still in uterus. d. Threatened Abortion=when vaginal bleeding occurs, but cervix is undilated. Rising levels of b-hCG Without intervention, pregnancy can be lost. Monitor for tissue passage.

Study Guide Exam 4

e. Inevitable=Contractions, dilated cervix, ROM, potential heavy bleeding. Abortion is imminent. f. Late-term abortion will require full delivery/induction of labor. Early term is may be removed by D&E. g. Recurrent/habitual--Three lost pregnancies in a row. 2. Ectopic pregnancy a. What is it? Implantation of fertilized ovum in location outside of uterine cavity (fallopian, abdominal). b. s/s Bleeding/spotting, missed period, abdominopelvic pain, pelvic hemorrhage. Bleeding may not always be seen, can be internal--monitor for signs of shock & blood loss. Always check for RH factor. *Blue Naval c. Control bleeding and prevent shock. ii. second trimester 1. hydatiform molePlacental cells keep growing take over and proliferate. Caused by abnormally developed villi or uterine wall. Placenta develops, baby doesnt. Clots from placenta can embolize to the lungs. a. s/s vaginal bleeding, large uterus, n/v profusely, early development of preeclampsia, hyperthyroidism. b. Treatment: D&E. 2. incompetent cervix a. what is it? Two or more spontaneous abortions in a row. Cervix deemed too weak to stay closed. b. treatment McDonald suture placed between 10 and 14 weeks, removed at 36th week.

iii. Third trimester 1. Placenta previa: Low implantation of placenta a. s/s Sudden onset of painless, bright red uterine bleeding. i. Marginal--Placenta implanted in uterus, greater than 3cm from cervix. May need C-section.

Study Guide Exam 4

ii. Partial--Lower border of placenta within three centimeters of cervix. Classical C-section. iii. Total--Placenta completely covers opening of cervix. Classical C-section. b. NO vaginal exams until location confirmed. By US!! c. pp complications- Monitor ^bleeding cause way contractions happen lower = less recontractability of uterusto clamp off the flow 2. placenta abruption a. s/s Vaginal bleeding, severe abdominal and lower back pain, Fetal Tachycardia, hemorrhage (may be hidden), increased pulse, decreased blood pressure, late decelerations, uterine contractions. b. how different from previa Painful, bleeding can be hidden, placenta in normal location, detachment not caused by dilation. 4. Diabetes a. Nursing intervention= Monitor, Freq Glucose checks, Avoid Infection, Diet, Urine Testing, Exercise, Insulin b. Complications: PIH, Diabetic Neropathy, Renal Issues, RDS, Embolisms. c. Diet: No simple Sugars, ^Complex Carbs, ^Proteins 5. TORCH infections T-oxoplasmosis= Flu like s/s, Meningitis, blindness O-ther=Intra-Uterine Fetal Death, Hepatitiss R-ubella= congenital anomalies, hearing loss, heart disease C-ytomegalovirus Virus=Fetal Death, Retard H-erpes=Intra Uterine Growth Retard + Mental Retard 6. Cardiac disease a. s/s of complications ^ b. patient education 7. Armenia iron deficiency

Study Guide Exam 4

a. Treatment b. Complications 8. PIH: =Systolic 30 /Diastolic 15 mm - Above pregnancy level

a. Caus e:

Unknown b. Risks: Chronic renal disease Chronic hypertension Family history Twins Primes Age 19 or 40 Diabetes Rh incompatibility obesity

c. s/s: Proteinuria, Edema, Hyperreflexia, Headaches, blurry vision. Classifications Gestational hypertension Mild preeclampsia Severe preeclampsia eclampsia

Study Guide Exam 4

d. Nursing interventions: Bedrest, Good nutrition, Frequent assessments VS and FHT, Strict I & O, daily weights, Assessment, edema,, H/A, blurred vision, Medication:labetalol or hydralazine, Emotional support, may have to deliver baby early , delivery is only cure

9. HELLP syndrome~Hemolysis Elevated Liver enzymes Low Platelets