0516csulbtrimester.files.wordpress.com
Risks for Teen Pregnancy:Physical Risks:Age <16 Competition for growthAbuse (if FOB >2 yrs or if teen is <12yrs = report) HTNCPD: Risk to body image, fear of being cut, scarringMilar Pregnancy (<20yrs)Preterm laborAnemiaPsychological Risks:DepressionSuicideDomestic violenceLow self-esteemEmbarrassmentScaredEconomical Risks:Less likely to get good educationWell-fare & poverty (don’t know how to get help)Single parent w/ little supportUnstable parenting/ divorseUnrealistic of what it takes to raise a childPero lyke why?:Desire to be loved, want to punish parents, attention, poor school performance, abuse (physically, emotionally, or sexually), personal fable (wouldn’t happen to me), narcissistic, impulsive. Gestational Diabetes Mellitus:Risk to Fetus:Risk to MomWho is at risk?SABCongenital anomaliesMacrosoma > 4000g Birth injuryIUGRPolycythemiaHyperbilirubinemiaNeonatal RDSHypoglycemiaHIP 4x more likelyUTIHydramniosHyperglycemiaKetoacidosisPTL or PROMDifficult laborInjury to birth canalC-sectionPP hemorrhageObese womenChronic HTN>30yrsFamily hxPrior birth of LGAPrior with if infants w/ unexplained congenital anomaliesPrior sitll birth GD in prior pregnancies Preterm Labor:Causes:S/S:Treatments:AnemiaBacterial vaginosisCervical problems (abnormal pap)UTOPolyhydramniosTwinsMaternal age <18 or >35 Substance abuseSTD (>10/day)Low maternal weight gainLabor between 20-36wks GA4 contractions in 20 min or 8 con/hrCrampingPushinglowdull backachevaginal bleedingcervical change >2cm dilated 80% effaced, cervical length <25cmBedrest & hydrationTocolytics (Terbutaline, MagSulf)ProcardiaIndocinLongterm indomethacin (>48hrs, do not use >32wks) Do not stop labor if:Hemorrhageinfectionacute fetal distressfetus is matureEclampsia:Signs and symptomsRisk Factors:Nursing Care:1. Assess for s/s of impending seizure:Headache, scotomata, epigastric pain, n/v, possible >DTR)More at risk closer to termAll the symptoms of focal, multifocal, or generalized seizuresTurn pt to left side and suctionPad rails to prevent injuryNo tongue blade to avoid gag reflexMonitor fetal status: risk for hypoxia, precipiitous labor & placental abrubptionMonitor for complications of pulmonary edema, coma, or organ failure. Preeclampsia:Mild:Severe:BP 140,90, but <160/90 AsymptomaticBP >160/110Proteinuria 2+ or greaterDecreased urine ouput <30cc/hrHeadacheRUQ pain Visual disturbancesLiver or kidney transplantTreatment:DeliveryTreatment:Fetal monitoring, bed rest, L-lateral, decrease in sensory stimulationVS q1hDTR and clonus q1h Take daily weightseizure precautionsHELLP syndrome:Risk factors:Signs and SymptomsTreatment:26-34 weeksHemolysisincreased liver enzymesdecreased plateletsFlu-like symptomsMalaiseN/vJaundice (severe)epigastric painVolume expandersSevere BRAntithrombotic medicationsConditions of Pregnancy:Hypertension >20wksHypertension <20 weeksPainLow HCGElevated HCGNauseaPreelampsia w/o severe featuresPreeclampsia w/ severe features EclampsiaChronic HTN Gestational HTNOccurs afted mid pregnancyProteinuriaRUQ epigastric painHeadacheSpontaneous AbortionsDizygotic twinsMolar pregnancyHyperemesis GravitorumMultiple GestationsDifferentiate Bleeding in Pregnancy:Spontaneous Abortion (SAB):Ectopic:Molar: Aka miscarriageTypes of SAB:Threatened: bleeding, no dilation, +FHTInevitable: Bleeding, -FHT = deadComplete: bleeding, decreased POCIncomplete: bleeding, -FHT, increased POCMissed: no bleeding, no dilation, -FHT Recurrent: >3 SABTreatment:Progesterone suppositories S/S:7-9wks GAScant, dark brown bleedingCramps (progresses from dull -> knife-like)UnilateralReferred shoulder & back painSyncope, decreased BP, increased HR, shockLow H/H, decreased leukocytesAdnexal & cervical tenderness(adnexal = ovary and fallopian tube)benign neoplasm from chorion layerPartial vs CompleteS/S:normal appearing pregnanceFundus length is large for week of pregnancyBleeding brown liquidSevere vomitingNo FHTHIP <20wks GAIncreased HCG past 100 days (difference between molar and twins) Differentiate Bleeding in Pregnancy con’t:Previa: implantation of placenta in lower uterusAbruption:premature separation of a normally implanted placentaIncompetent Cervix:premature dilation of cervix in 2nd trimesterPainless vaginal bleedingBright redBleeding > 28 wksAssociated w/ IUGRConfirmed w/ ultrasoundNever perform vaginal exam or stimulate contractions.“Herald Bleed”Painful/rigid uterusApparent or concealed uterine bleedingDark red/ brown bloodLonger lasting contractionsS/S:abdominal painSOBincreased HROverdistended uterus If maternal trauma occurs can cause abruption in 4-5 days.monitor for 4-24hrsUsually in 4th or 5th monthPainess/ bloodlessProgressive effacementDilation of cervixBulging of membranesBefore dilation, extended os is detected. Sample GTPAL Calculation:Current PG: 34 wkMale: 32 wkFemale: 40wkSAB: 8wTwins: 35wkG:5, P:4, T:2, P:2, A:1, L:4Para: # of pregnanciesTerm: # of term birthsPreterm: # of preterm birthsAb: abortions Naegele’s Rule:Calculation to estimate delivery date:(First day of LMP - 3months) + 7 days2/14/15 = 11/21/15When was last LMP? = opposite of ^ Signs of Pregnancy:PresumptiveProbablyPositiveSubjective:FatigueMissedn/vUrinary frequenxyQuickeningObjective:Abdominal enlargementGooddell signsChadwicHegar+Urine pregnancy testFetal outlineBraxton-HicksFHTFM by physician UltrasoundDomestic Violence/ Rape/ Grief:Domestic Violence:Rape:Grief:Always power not loveTypes: Physical, sexual, emotional/psychological Cycle of violence:Conflict buildingBatteringHoneymoonTypes:AngerConfidencePowerSadisticRespond and adapt to lossPhases:Shock and NumbnessDisorientation or searching/ yearningAccepting and confronting Nutrition:Good:Bad;1000-1300 mg Ca/ day27mg Fe/ day600-800mg/day Folic acidVitamin A every other day70mg of Vitamin C300 extra calories in 2nd&3rd trimesterWeight gain by trimester:2-4lbs3-4lbs/month 3-4lbs/monthVitamin b12 is important71g protein/day 600mg of Vitamin DAvoid:Alcohol/smokingRaw foodsFish w/mercuryLimit:Fat/ sweetsUncooked meatsSeafoodCaffeineSoft cheeseProcessed foodPossible Test Questions:Which types of pregnancy cause pain?AbruptionSABECtopic Excess vomiting, proteinuria?Hyperemesis gravidarumEOver 20 weeks Gained 10 lbs last two weeks Chem 7 and CBC normal, protein lvl 2+ Preclampsia w/ mild symptomsFundal exam height 22cm, bp 150/100, HCG elevated Molar pregnancy 17wks, funda height 24, bp 120/60, hcg elevated, TwinsBrown vaginal bleed, cramping, painful, blood in vagina, POC present, no FHTIncomplete Brown bleeding, pain in LLQ, left shoulder, Ectopic Complaining of nv/ puffy face, blurry vision, bp 150/90, +2 protein, high ldh, high astHELLP 24 wks, bright red vaginal bleed, + urine pregnancy testPreviaabdomen boardlike, tenderAbruption ................
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