VNSG 1230 OB EXAM 4
STUDY GUIDE
List conditions that increase maternal and fetal risk. (5 questions)
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Describe the effects of the DM Mother on the infant
Gestational diabetes mellitus, is the inability to produce enough insulin to maintain normal
glucose levels during pregnancy. Risk factors for the development of gestational diabetes includes
older than age 25 years at the time of pregnancy, family history of DM, history of GDM, nonwhite
race, obesity, and hypertension. Maternal complications include vaginal infections and UTI, difficult
labor related to increased fetal size (which often leads to C section), vascular complications (including
retinopathy), azotemia, ketoacidosis, hypertensive disorders such as preeclampsia, and cesarean
birth. Fetal complications include stillbirth, spontaneous abortion, hydramnios (excessive amniotic
fluid), large placenta, alteration in size for gestational age (macrosomia), congenital anomalies,
neonatal hypoglycemia, neonatal hyperbilirubinemia, respiratory distress syndrome, and fetal or
neonatal death. When blood glucose levels are elevated the classic symptoms of diabetes – polyuria,
polydipsia, and polyphagia. Perform urine testing at all prenatal visits. Hgb A1c is not a reliable test
during pregnancy. The patient who is diagnosed with gestational diabetes or who has been diagnosed
with diabetes mellitus before pregnancy often has labor induced before due date in an effort to avoid
complications. Determination of the estimated due date and assessments as the pregnancy
progresses to determine fetal lung maturity are performed. Because of possible teratogenic effects
patents with type 2 DM have oral hypoglycemic medications discontinued and insulin prescribed. DM
is initially controlled with dietary interventions if that isn’t successful then insulin therapy is
prescribed. Complications in the infant include risk for preterm delivery and macrosomia.
Describe the risk factors on a multiple fetus pregnancy
Monozygotic twins begin with one fertilized ovum causing identical twins, because the genetic
message is identical the twins are of the same sex and carry an identical genetic code and each has a
separate umbilical cord. Dizygotic twins are the result of two separate ova being fertilized at the same
time, these twins almost always have a separate placental. Maternal and fetal risks include
spontaneous abortions, maternal anemia, gestational hypertension (GH), hydramnios, and bleeding
from placenta previa or abruptio placentae are more common in women with twins. The fetuses are
more likely to have congenital anomalies, problems with entangled cords, and growth problems. An
incomplete separation of the embryonic disk can result in conjoined twins. Labor may be complicated
by the loss of uterine tone that results from overstretching of the musculature, abnormal
presentations, and preterm labor. Almost all births require a C section. Twins usually deliver before
term and may have extended hospital stays. Breast feeding of twins is possible the mother may need
additional help because breast feeding multiples consumes a lot of time and energy.
Describe the risk factors of bleeding during pregnancy
Risk factors with placenta previa include cesarean birth possibly related to endometrial
scarring; multiple gestation because of larger placental area; closed spaced pregnancies; and
advanced maternal age older than 35 years. Risk factors associated with abruptio placentae include
women who use cocaine during pregnancy will have a significant incidence of premature separation of
the placenta. Blunt external abdominal trauma, usually the result of motor vehicle accidents or
maternal battering is an increasingly significant cause of placental abruption. Disseminated
intravascular coagulation is a potentially life-threatening disorder that results from alterations in the
normal clotting mechanism. DIC is always a secondary diagnosis and it may be seen with abruptio
placentae, incomplete abortion, hypertensive disease, or infectious process. It may occur with post
term delivery. Risk factors for postpardum hemorrhage are women who have an extended second
stage of labor, instrument assisted delivery, large for gestational age newborn, or induction or
augmentation of labor or who are obese. The most common causes of early hemorrhage are uterine
atony, retained placental fragments, and perineal lacerations. Uterine atony may be caused by
excessive distention of the uterus from multiple pregnancy, hydramnios (excessive amount of
amniotic fluid). And a large infant.
Explain the complications and care of the patient with HSV
Wear gloves, masks, gowns, and glasses during procedures that involve splashing of body
fluids such as amniotomy. Use gloves when cleaning or assessing the breasts or perineal area. Also use
gloves when performing the initial newborn bath or changing diapers. Thourough handwashing as
always is essential. Women with active herpes infection should deliver via cesarean birth. The
pregnancy effect of HSV include spontaneous abortion, preterm labor, and intrauterine growth
restriction.
Explain the complications for the fetus when there is smoking during pregnancy
Complications due to smoking for the fetus include prematurity, LBW, fetal demise,
developmental delays, increased incidence of SIDS, pneumonia
Compare and contrast abruptio placentae and placenta previa, noting signs and symptoms,
complications, and nursing and medical management. (4 questions)
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Describe the assessment, treatment and diagnosis of DIC
All women with complications that may result in DIC should be observed closely for signs of
bleeding, such as epistaxis (nosebleeds), bleeding gums, or petechiae, particularly around the blood
pressure cuff on the patient’s arm. Excessive bleeding may occur from a site of slight trauma, such as
venipuncture sites, intramuscular or subcutaneous injections sites, nicks from shaving of perineum or
abdomen, and injury from insertions of urinary catheter. Continue to monitor the maternal and fetal
conditions with assessment of vital signs, FHR, and I&O and with general careful assessment. Blood
testing includes determination of Hgb and Hct levels. Clotting factor studies such as fibrinogen levels,
platelet counts, prothrombin time, and partial thromboplastin time typically are ordered for the
patient. Emergency care for DIC includes IV administration of fibrinogen, blood, and other substances
that help restore normal clotting mechanisms. Heparin via continuous infusion pump and O2 with a
tight fitting mask at 10-12 L/min. Monitor urinary output, it must be maintained at more than 30
mL/hr because renal failure occurs with DIC. If the women is still pregnant position her in a side lying
tilt to maximize blood flow to the uterus.
Describe the s&s of Abruptio Placentae
The major symptoms of abruptio placentae are sudden severe pain accompanied by uterine
rigidity. The uterus may also increase in size because of the hemorrhage. The first sign during labor
may be strong and constant contractions (tetany). Symptoms vary with the degree of separation.
Describe the s&s of Placenta Previa
S/S include painless, bright red vaginal bleeding that occurs after 20 weeks of gestation. The
bright red bleeding may be intermittent, may occur in gushes, or more rarely may be continuous. It
may start while the patient is resting or during any activity. Examination reveals a soft (relaxed)
nontender uterus of normal tone.
Describe the complications Abruptio Placentae
Abruptio placentae constitutes an obstetric emergency. The treatment often, but not always,
includes delivery via cesarean birth and blood replacement. A modified side-lying position with a
wedge placed under the patient’s right hip facilitates uterine-placental perfusion. Carefully monitor
blood and fluid replacement therapy. Insert a retention catheter to monitor urinary output. The fetus
is monitored and delivered when indicated. If signs of fetal compromise such as hypoxia are present
or if the expectant mother exhibits signs of excessive bleeding, either obvious or concealed, the fetus
is delivered immediately.
Identify diagnostic tests used to determine high-risk situations. (1 question)
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Explain when a digital vaginal exam would be contraindicated
Providers must consider culturally based differences that could affect the treatment of diverse
groups of women, and women must share practices and beliefs that could affect their nursing care or
their willingness to comply. Health care providers are obligated to respect their patients’ various
sources of information and beliefs about sickness and health. Recognize that many women may be
reluctant to disrobe and may avoid physical examination unless absolutely necessary. Consider who in
the family traditionally makes the “major” decisions. In some families, the husband may be charged
with these decisions, including those that affect the woman’s health. Religious beliefs may dictate a
care plan (e.g., with birth control measures or blood transfusions).
Compare and contrast hypertensive disorders experienced during pregnancy. (8 questions)
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Describe the S&S hypertensive disorder
Gestational hypertension is encountered during pregnancy or early in the puerperium, and is
characterized by increasing hypertention. It begins after 20 weeks’ gestation and unlike preeclampsia
it is not accompanied by proteinuria.
Preeclampsia and eclampsia is increasing blood pressure after 20 weeks’ gestation and the
hypertension is accompanied by albuminuria and generalized edema. The condition may be mild or
severe. Additional symptoms of the condition include headache, visual disturbances, and epigastric
pain. These symptoms may signal worsening of the condition.
Mild preeclampsia has few clinical symptoms. Generalized edema may be evident in the face,
the hands, and the ankles. Periorbital edema may be a more ominous finding. Weight may increase as
much as 3 pounds (1.4 kg) per month in the second trimester and 1 pound (0.5 kg) per week in the
third trimester. Urine testing frequently shows 1+ to 2+ albumin readings. The urinary output is at
least 500 mL/24 hr. Change in blood pressure readings increase by 30 mm Hg systolic and 15 mm Hg
diastolic.
Severe preeclampsia may show symptoms suddenly. BP readings of 160/110 mm Hg or higher
on two separate occasions 6 hours apart with the women on bed rest are common. Edema becomes
increasingly obvious and may be observed in the face, the hands, the sacral area, the abdomen, and
throughout the lower extremities. Weight increases dramatically. The woman may gain as much as 2
pounds (0.9 kg) in a matter of a few days or a week. Urine testing for albumin shows 3+ to 4+
readings. The urinary output is less than 500 mL/24 h. The patient often reports headache, blurred
vision, and epigastric discomfort. The assessment reveals hyper-reflexia. Clonus is noted with pending
seizure activity
Eclampsia is the most severe form of pre-eclampsia. The most dramatic characteristic is
seizure activity. The patient exhibits tonic (pertaining to or characterized by muscular tension) and
clonic (spas-modic alteration of muscular contractions) phases. This generally is followed by a coma
that lasts from minutes to hours. Other signs are elevated blood pressure, albuminuria, and oliguria. If
untreated, this sequence of seizure-coma may repeat, and death may follow.
Describe areas of Pt teaching for the patient with a Hypertensive disorder
Teach all pregnant women the danger signs of complications in pregnancy and the importance
of regular medical supervision. Many of the symptoms of GH, particularly the mild, early symptoms,
are detected only with regular physician contact. If GH is diagnosed, explain the consequences of
failure to comply. Encourage high-quality protein, vitamin, and mineral intake. Salt restriction below
the normal dietary levels (4 to 6 g/24 h) usually is not recommended. Be certain that the patient
understands that bed rest is vital because it slows metabolism and relieves dependent edema
Explain when you would hold the medication Magnesium sulfate
When urine output it less than 30 mL/hr
Describe the s&s and complications of Preeclampsia
Certain symptoms, such as continuous headache, drowsiness, or mental confusion, indicate
poor cerebral perfusion and may be precursors of convulsions. Visual disturbances, such as blurred or
double vision or spots before the eyes, indicate arterial spasms and edema in the retina. Some
symptoms such as epigastric pain or “upset stomach” are particularly ominous, because they indicate
distention of the hepatic capsule and often warn that a convulsion is imminent. Decreased urinary
output indicates poor perfusion of the kidneys and may precede acute renal failure.
The hypertension is accompanied by albuminuria and generalized edema. The condition may
be mild or severe. Additional symptoms of the condition include headache, visual disturbances, and
epigastric pain. These symptoms may signal worsening of the condition
Describe assessment, treatment, and pt teaching for the patient with Pregnancy induced hypertension
(PIH)
Assess blood pressure routinely throughout pregnancy, labor, delivery, and the postpartum
period. GH can occur any time after the 20th week and persist until 2 days after delivery. Record
weight at each prenatal visit and compare it with norms. Excessive or rapid weight gain, particularly
when accompanied by edema, should be reported promptly. Assess for edema at each visit (see Fig.
8.17 in Adult Health Nursing). Edema typically is described with a scale of 1+ to 4+: 1+ Minimal edema
on pedal and pretibial area 2+ Obvious edema of lower extremities 3+ Edema of face, hands, sacrum,
and abdomen 4+ Massive, generalized edema (anasarca) Test urine for albumin with dipstick reagents
at each visit and on admission for labor. Mild preeclamp-sia may be managed at home. Activity at
home is restricted, with rest strongly encouraged. Severe Table 29.2 Assessment of Deep Tendon
Reflexes DEGREE Hyperactive response (brisk with intermittent or transient clonus) More than normal
(brisk), slightly hyperactive Normal, active, expected response Sluggish or diminished No response
GRADING 4+ 3+ 2+ 1+ 0 symptoms necessitate hospitalization. Bed rest typically is ordered, preferably
in the left lateral recumbent position, to reduce pressure on the inferior vena cava and promote
venous return. A well-balanced diet with adequate protein is important. Moderate sodium intake is
allowed, but high-sodium foods should be avoided. Patients with gestational hypertension and
preeclampsia do not face restricted-sodium diets. Balance is more the goal. In cases of severe
preeclampsia or eclampsia, medication therapies including magnesium sulfate (MgSO4 ) may be
prescribed parenterally to prevent seizure activity. Antihypertensive medications are not used
routinely for the patient with mild pre-eclampsia or gestational hypertension. Antihypertensive
medications are prescribed for blood pressure readings that exceed 160/100 mm Hg. Many of the
symptoms of GH, particularly the mild, early symptoms, are detected only with regular physician
contact. If GH is diagnosed, explain the consequences of failure to comply. Encourage high-quality
protein, vitamin, and mineral intake. Salt restriction below the normal dietary levels (4 to 6 g/24 h)
usually is not recommended. Be certain that the patient understands that bed rest is vital because it
slows metabolism and relieves dependent edema.
Describe the components of a patient teaching plan for the patient with a hypertensive disorder
Describe patient teaching to decrease risk factors for hypertensive disorders
Explain the components of the assessment for the patient with gestational hypertension
Identify preexisting maternal health conditions that influence pregnancy. (1 question)
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Explain the risk factors to the infant of a mother with Type 2 diabetes
List the infectious diseases most likely to cause serious complications. (2 questions)
Topics:
Explain the risk for infection post rupture of membranes
Explain the effects on the infant with a Rubella positive mother
Rh incompatibility occurs only when the mother is Rh negative and the fetus is Rh positive.
For this to occur, the father of the fetus must be Rh positive (Fig. 29.9). The term Rh negative indicates
that the woman does not possess a specific blood antigen. If the woman is sensitized (i.e., exposed to
the antigen), she produces antibodies.
Discuss the care of the pregnant adolescent. (1 question)
Describe the risk factors specific to the pregnant adolescent
Pregnancy interrupts the process of identifying formation and developmental tasks.
Attempting to accomplish developmental tasks of pregnancy and of normal adolescence
simultaneously may be overwhelming. The psychological burden may lead to depression and to
postponement in attaining an adult identity. The pregnant adolescent faces further developmental
tasks of parenthood. Several physiologic concerns are associated with the young pregnant adolescent.
These include an increased risk for GH, cephalopelvic disproportion that results in cesarean birth,
abruptio placentae, low birth weight, IUGR, anemia, infection, preterm delivery, and perinatal death.
Pregnant teenagers also commonly fear or deny the pregnancy and go without medical attention until
late in pregnancy. Lack of prenatal care increases the risk to the pregnant teenager and her infant.
Discuss the problems created by alcohol and drug abuse. (3 questions)
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Describe the general complications of substance abuse during pregnancy
The use of legal substances, such as alcohol and tobacco, or illicit drugs, such as cocaine and
marijuana, increases the risk for medical complications in the mother and poor birth outcomes in the
infant. Approximately 1 in 10 infants is exposed to one or more mood-altering drugs during pregnancy
Describe Fetal Alcohol Syndrome
facial and cranial anomalies, developmental delay, mental retardation, short attention span),
fetal alcohol effects (milder form of FAS)
Describe the specific effect of Alcohol and drugs during pregnancy
Tobacco use leads to decreased placental perfusion, anemia, PROM, preterm labor,
spontaneous abortion for the mother, and prematurity, LBW, fetal demise, developmental delays,
increased incidence of SIDS, and pneumonia for the infant. Alcohol leads to spontaneous abortion for
the mother, and fetal demise, IUGR, FAS (facial and cranial anomalies, developmental delay, mental
retardation, short attention span), fetal alcohol effects (milder form of FAS). Cocaine use causes
Hyperarousal state, generalized vasoconstriction, hypertension, increased incidence of spontaneous
abortion, abruptio placentae, preterm labor, cardiovascular complications (stroke, heart attack),
seizures, increased STIs for the mother, and Tachycardia; stillbirth; prematurity; LBW; tremors; IUGR;
irritability; decreased ability to interact with environmental stimuli; poor feeding reflexes; nausea,
vomiting, diarrhea; decreased intellectual development; distended, flabby, creased abdomen (prunebelly syndrome) caused by absence of abdominal muscles for the newborn. Marijuana will Often be
used with other drugs (alcohol, cocaine, tobacco), increased incidence of anemia and inadequate
weight gain for the mother, and it is unclear, more study needed; believed related to prematurity,
IUGR, tremors, sensitivity to light for the neonate.
Identify concerns related to preterm infants. (4 questions)
Topics:
Identify the risk factors for the preterm infant
The exact causes of preterm labor are unknown. In some cases, it is related to maternal or
placental problems, but in other cases, the cause cannot be determined. The end result is delivery of
an infant at 37 weeks or less of gestation.
Identify the characteristics of the preterm assessment
The preterm newborn’s posture is froglike or flaccid. The color is usually ruddy, and cyanosis
may be present immediately after birth and for the first few hours of life. The head appears large in
proportion to the body, and the bones of the skull are pliable with large, flat fontanelles. The skin is
thin and translucent with obvious blood vessels and little subcutaneous fat. A layer of fine hair
(lanugo) may coat large areas of the body. Cartilage in the ears is pliable, and the ears can be easily
folded. The genitalia in boys are small, and frequently the testes are undescended. In girls, the labia
majora are small and less prominent than the labia minora. The cry is weak, and reflexes are
immature or absent
#Describe respiratory complications of preterm birth
The preterm infant’s greatest potential problem is respiratory distress syndrome, which
results from an immature respiratory system (see Chapter 31). The first symptom of respiratory
distress is usually grunting on expiration, followed by nasal flaring, circumoral cyanosis, substernal
retractions, and tachypnea. It is treated with oxygen therapy and artificial surfactant. Providing
periods of rest and maintaining body temperature are important components of treatment.
Explain the assessment and complications of Respiratory Distress Syndrome (RDS)
Explain the hemolytic diseases of the newborn. (1 question)
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Explain the complications Abruptio Placentae
Discuss patient problems related to high-risk conditions of the mother and the newborn. (20
questions)
Topics:
Describe the assessment, treatment and diagnosis of DIC
All women with complications that may result in DIC should be observed closely for signs of
bleeding, such as epistaxis (nosebleeds), bleeding gums, or petechiae, particularly around the blood
pressure cuff on the patient’s arm. Excessive bleeding may occur from a site of slight trauma, such as
venipuncture sites, intramuscular or subcutaneous injection sites, nicks from shaving of perineum or
abdomen, and injury from insertion of urinary catheter. Continue to monitor the maternal and fetal
conditions with assessment of vital signs, FHR, and I&O and with general careful assessment.
Emergency care for DIC includes IV administration of fibrinogen, blood, and other substances that
help restore normal clotting mechanisms. Paradoxically, DIC therapy may include heparin via
continuous infusion pump (although its use is controversial) and oxygen therapy with a tight-fitting
mask at 10 to 12 L/min. If the fetus is not yet born, delivery should occur as soon as possible. Carefully
monitor urinary output (it must be maintained at more than 30 mL/h), because renal failure is one
consequence of DIC. If the woman is still pregnant, position her in a side-lying tilt to maximize blood
flow to the uterus. Blood testing includes determination of hemoglobin and hematocrit levels.
Clotting factor studies, such as fibrinogen levels, platelet counts, prothrombin time (PT), and partial
thromboplastin time (PTT), typically are ordered for the patient.
Describe the assessment, treatment and diagnosis of a molar pregnancy and the role an ovulation
stimulant may play
Women are at higher risk for hydatidiform mole formation if they have undergone ovulation
stimulation with clomiphene (Clomid), are in their early teens, or are older than 40 years of age. the
ovum has no genetic material or the material is inactive. The developing cells resemble a cluster of
grapes. The fluid-filled vesicles grow rapidly, causing the uterus to be larger than expected for the
duration of the pregnancy. Usually, the complete mole contains no fetus, placenta, amniotic
membranes, or fluid. With no placenta to receive maternal blood, hemorrhage into the uterine cavity
and vaginal bleeding occur. About 20% of cases of complete mole progress toward choriocarcinoma.
Passages of vesicles (grapelike clusters) may occur around 16 weeks of gestation. There is no fetal
movement, FHR, or palpable fetal parts. Some women have signs and symptoms of hyperthyroidism.
Diagnosis can be made with ultrasound scan, amniography, and measurement of HCG level in the
blood. The ultrasound shows an enlarged uterus with no identifiable fetal parts. The uterine
trophoblastic cells will be visualized. In most cases, the mole is discovered when abortion is
threatened or in progress.
Describe the assessment, treatment and diagnosis of late postpartum hemorrhage
Describe the assessment, treatment and diagnosis of cervical laceration
Describe the components of post-surgical teaching as it relates to a molar pregnancy
After this is completed, the woman’s medical management includes the assessment of HCG
levels. The levels are assessed weekly until they are negative. Once the levels are negative, the
monitoring is repeated monthly. A return to positive findings may signal the presence of carcinoma.
Rho(D) immune globulin is administered to women who are Rh negative to prevent isoimmunization.
Women who have experienced a molar pregnancy must avoid becoming pregnant for a year. Even
with removal of the products of conception, cells may remain behind and develop into a malignancy.
Describe the assessment, treatment and diagnosis of Postpartum hematoma
Describe the assessment, treatment, risk factors and diagnosis of the patient with hyperemesis
The disease is more common with condition that involve high levels of HCG such as
hydatidiform mole. Consuming small, frequent meals is helpful. Avoidance of greasy or spicy foods is
encouraged. High-protein snacks and intake of carbonated beverages may be helpful.
Explain the causes of Postpartum hemorrhage
Describe the assessment, treatment and diagnosis of the newborn of a mother with gestational diabetes
This infant frequently exhibits macrosomia (excessive size and stature), hypoglycemia,
perinatal asphyxia, hypocalcemia, respiratory difficulties, and hyperbilirubinemia. The infant of the
mother with gestational diabetes also may have congenital anomalies as a result of the uncontrolled
maternal blood glucose levels in early pregnancy. The infant born to a woman with long-term and
poorly controlled diabetes mellitus may be small for gestational age as a result of poor perfusion to
the placenta and fetus.
Describe the assessment, treatment and risk factors of a Meconium-stained infant
Describe the causes, treatment and diagnosis of a patient with a spontaneous abortion
Abortion is the termination of pregnancy before the age of viability—or 20 weeks of gestation
in the United States. Spontaneous abortion is referred to generally as a miscarriage. Most
spontaneous abortions occur during the first trimester of pregnancy. Moremthan half of all
spontaneous abortions are caused by abnormal embryonic development, chromosomal defects, and
inheritable disorders. Most other spontaneous abortions result from maternal causes, such as
advancing maternal age and parity, chronic infections, chronic debilitating diseases, poor nutrition,
and recreational drug use. blood loss with transfusions, as ordered. A dilation and curettage (D&C) or
dilation and evacuation (suction; D&E) may be indicated to remove retained placental tissue (Box
29.3). If significant blood loss occurred, iron supplementation may be ordered. Rh-negative women
need the admin-istration of RhoGAM.
Describe the assessment, treatment and diagnosis of Ectopic pregnancy
The woman often has lower abdominal pain. The pain may be diffuse or one sided. Uterine
examination reveals enlargement in 25% of cases. Vaginal bleeding may be present. If the fallopian
tube has ruptured, she may have vaginal bleeding, referred shoulder pain, and abdominal rigidity. The
risk for hypovolemic shock is present. HCG testing is performed and levels are traditionally lower than
normal for the stage of gestation. Ultrasound scans are done to assess for the location of the
pregnancy. A vaginal examination also is performed. Management of the ectopic pregnancy may be
done surgically or pharmacologically. Surgical treatment, a laparotomy, requires removal of the
pregnancy and related damaged tissue. It may necessitate removal of the fallopian tube
(salpingectomy) or repair of the damaged tube (salpingostomy). If the fallopian tube is ruptured and
significant bleeding occurs, blood transfusions may be necessary. Pharmacologic therapy, when
applicable, may allow for preservation of the tube and help to improve the chances of future
pregnancies. Single or multiple doses of methotrexate may be prescribed for treatment of the
unruptured ectopic pregnancy. Methotrexate is a folic acid antagonist that has been used for years to
treat actively proliferating trophoblastic disease. It destroys the rapidly dividing cells. Administration
of Rho(D) immune globulin (RhoGAM) is indicated for those women who are Rh negative.
Describe possible medications used for an Ectopic pregnancy
Single or multiple doses of methotrexate may be prescribed for treatment of the unruptured
ectopic pregnancy. Methotrexate is a folic acid antagonist that has been used for years to treat
actively proliferating trophoblastic disease. It destroys the rapidly dividing cells. Not all women are
candidates for the use of methotrexate. The fallopian tube must be unruptured and the size of the
pregnancy less than 3.5 cm. The woman must be free of blood, liver, or kidney disorders. The
medication may be administered once or twice if needed. Administration of Rho(D) immune globulin
(RhoGAM) is indicated for those women who are Rh negative.
Describe the reasons for and uses of RhoGAM
Patients who are Rh negative are screened in pregnancy for isoimmunization. If they are not
found to be sensitized and give birth to infants who are Rh positive, they must receive RhoGAM
within 72 hours of delivery. Rho (D) immune globulin (RhoGAM) for prevention of Rh isoimmunization
Describe the components of therapeutic communication for the child bearing family
Describe the assessment, treatment and diagnosis of post-partum depression
Most women with mood disorders experience a mild depression, or “baby blues,” after the
birth of a child. Postpartum depression (PPD) leads to moderate to severe disturbances in the
interaction of mothers and infants, which are predictive of poorer infant learning outcomes.
Identify nursing interventions for the pregnant woman with a cardiac disorder. (3 questions)
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Describe the precautions needed for the pregnant patient with a cardiac disorder
At each prenatal visit, measure the patient’s vital signs and evaluate her ability to participate
in activities. Unusual fatigue with activity may reveal problems. Monitor for edema, weight gain,
murmurs, cough, dyspnea, and abnormal lung sounds. Compare these data with normal changes
during pregnancy. The patient with preexisting heart disease also should be followed by her
cardiologist during her pregnancy. The pregnant woman with cardiac disease needs detailed
assessment to determine the potential for optimal maternal health and a viable fetus throughout the
peripartum period. If she chooses to continue the pregnancy, assess the condition of the woman with
a high-risk pregnancy as often as weekly.
Describe the consequences and risks of cardiac disease on pregnancy
Because extravascular fluid returns to the bloodstream after delivery, the mother is at risk for
development of cardiac decompression during the 48 hours after the birth. The efforts of labor may
necessitate oxygen administration to increase the blood oxygen saturation, which is monitored with
pulse oximetry. During every contraction, 300 to 500 mL of blood shifts from the uterus and placenta
into the central circulation. This extra fluid causes a sharp rise in cardiac workload. Discuss breast-
feeding with the physician because the physical effort may be excessive for the mother and the
transfer of medications in the breast milk may be harmful to the infant.
Explain the S&S cardiac decompensation (failure to maintain adequate circulation)
Edema, cyanosis, tachycardia, palpitations, arrhythmias, chest pain, dyspnea, and fatigue may
occur. Physical exertion may increase the severity of the symptoms. Clinical findings are those of heart
failure (left ventricular failure). The patient has decreased cardiac output and pulmonary congestion,
with fluid collecting in the lungs. Pulmonary edema and pleural effusion also occur, and pulmonary
crackles, hemoptysis, and cough may be present.
Explain the care of a pregnant woman with a pulmonary disorder. (1 question)
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Describe the assessment, treatment and diagnosis of the patient with a pulmonary embolis