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NURSING 306
NURSING 306OB EXAM
OB Exam 3 STUDY
3 Study Guide GUIDE
Chapter 7: know risk factors, diagnosis, and interventions of the complications
1. Hyperemesis Gravidarum: vomiting during pregnancy that
is so severe it leads: ➔ Risk Factors
◆ Maternal age younger than 20 years
● Dehydration ◆ History of migraines
● Electrolyte Imbalance ◆ Obesity
● Acid-Base Imbalance ◆ First pregnancy
● Starvation Ketosis
◆ Multifetal gestation
● Weight Loss
◆ Gestational trophoblastic disease or fetus with
chromosomal anomaly
◆ Psychosocial issues and high levels of emotional
stress
◆ Transient hyperthyroidism
➔ DX:
◆ Prolonged, frequent, severe vomiting
◆ Weight Loss
◆ Acetonuria & Ketosis
◆ Dehydration:
● Dry mucous membranes
● Poor skin turgor
● Malaise
● Hypotension
➔ Interventions:
◆ Vit B6 + Doxylamine
◆ IV hydration (dextrose, vitamins, thiamine)
◆ Monitor liver/kidney fx
> Due to ^ hCG, progesterone & estrogen ◆ Ginger
◆ Adm antiemetics as indicated
◆ Good oral hygiene
◆ Check daily weight
◆ Monitor I&O
TX:
1. Ensure the pt remains NPO until
vomiting is controlled for 24-48hrs
2. Once vomiting is controlled, start on BRAT
diet with small frequent meals & assess if
they are able to maintain the food down
(minimize fluid intake w/ each meal)
3. If pt begins to vomit, place them back on NPO
2. Ectopic Pregnancy: a result of the blastocyst ➔ Risk Factors
implanting outside of the endometrial lining of the ◆ Abd distension
uterus ◆ Smoking
● Nonviable Pregnancy ◆ Assisted Reproduction
◆ Pelvic Inflammatory disease
◆ Prior tubal damage
➔ Assessment Findings
◆ PRIOR TO TUBAL RUPTURE
● Pelvic/Abd pain or tenderness
● Abnormal bleeding
● Minimal Uterine changes
● Stable VS
◆ TUBAL
RUPTURE
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● Severe abd pain
● Sharp, Stabbing, Tearing pain
● Vertigo/Syncope
● Hypovolemia due to hemorrhage
● SHOULDER PAIN due to
diaphragmatic irritation
➔ DX
◆ Physical symptoms
◆ Positive hCG
◆ Transvaginal Ultrasonography
◆ Serum Progesterone levels
➔ TX
◆
Laparoscopy (if hemodynamically stable)
◆
Methotrexate, folic acid antagonist & type
of chemotherapy agent causing the
dissolution of the ectopic mass > mother
> L. sided abd pain main concern = intraperitoneal bleeding should not feel any more abd pain after 2-3
days
➔ Interventions
◆ Ensure CV status
◆ Give RhoGAM if indicated
◆ Acknowledge pt feelings
◆ Teach mother to monitor for abd pain
3. Incompetent Cervix: a mechanical defect in the cervix ➔ Risk to Mother
that results in painless cervical dilation in the second ◆ Repeated 2nd & 3rd trimester births
trimester that can progress to ballooning of the membranes ◆ Spontaneous Abortions (repeated)
into the vagina & delivery of premature fetus ◆ Preterm Delivery
◆ Rupture of the membranes- Infection
➔ Risk to Fetus
◆ Preterm birth & consequences of prematurity
➔ Assessment Findings
◆ Pelvic Pressure & ^ vaginal DC
◆ Shortened cervical length or funneling of
the cervix
➔ TX:
◆ Cerclage: purse string suture placed
cervically to reinforce weak cervix
● Prophylactic (12-16 wks) placed as
a precaution due to prev. history of
unexplained recurrent painless dilation
& 2nd trimester birth
● Rescue (up to 24 wks) placed
after cervix has dilated with no
> Once the cerclage is placed, NO PENIS IN the Vagina :( perceived contractions
◆ Remove sutures if labor develops,
membrane ruptures or infection occurs
➔ Post-Op
◆ Palpate for uterine activity
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◆ Monitor vaginal bleeding or abnormal DC
◆ Monitor for Infection
● Fever
● Uterine Tenderness
◆ Adm tocolytics
◆ Teach mother to modify activities & rest
their pelvis for a week
4. Diabetes: https://www.youtube.com/watch?v=N3jnRuzseoM ➔ Pregestational (goal: control blood glucose
before pregnancy)
> Screening must be done at 24-28 wks: ◆ Assessment Findings:
● Glucose Tolerance Test: ● Hist of Type 1 or Type 2 DM
○ Non-fasting 1 hour 50g oral glucose ● Abnormal Glucose levels
tolerance test ● Glycosylated Hemoglobin (HbA1C) test
○ 3 hour after woman ingests 100g glucose dose to determine average glucose levels
○ Plasma glucose levels drawn 1, 2,3 hrs within the past 4-8 wks
post glucose dose ● Cardiac, Renal & Ophthalmic
○ If 2 of these tests return positive = GDM function assessment & evaluation
■ Fasting > 95 mg/dL ◆ TX:
■ 1 hr > 180 mg/dL ● Medical Nutritional Therapy (MNT)
■ 2 hr > 155 mg/dL ● Teach the pt’s the physiological
■ 3 hr > 140 mg/dL & insulin changes
● Refer the pt to a dietician
➔ Gestational: the mother develops glucose intolerance
◆ Risk Factors
● Obesity
● Hist of DM in family
◆ Risk Factors to the mother ● Hist of Fetal Macrosomia
● Hypo/Hyperglycemia ◆ Assessment Findings
● DM Ketoacidosis ● Abnormal glucose screening results
● HTN & Preeclampsia ◆ TX
● Metabolic Disturbances ● Controlled with Diet & Exercise
○ Hyperemesis ● Insulin may be needed
○ Nausea ● C-section planned for >4500 g
○ Vomiting ● Need to be monitored after birth
● Preterm Labor ➔ Nursing Actions for Both
● Spontaneous Abortion ◆ Pt Self-Management: Teach pt to
● Poly/Oligohydramnios ● Monitor blood glucose (4-8
times/day) before, after meals & at
● C-section
bedtime
◆ Risk Factors to the baby
● Check urine for ketones
● Fetal Macrosomia: due to fetal
● Monitor Food Intake
insulinemia > may lead to birth injury
brachial plexus injury ● Exercise 3 times/week for 20min
● Shoulder Dystocia: McRobert’s ● Recognize S/S of
maneuver “turtle sign” ○ Hypoglycemia: always keep
● Congenital Defects a carb snack with her (10-50
● Hypoglycemia/Hypomagnesemia g carb)
◆ Diaphoresis
● RDS
◆ Tachy
● Polycythemia (hematocrit <65%)
◆ Shakiness
= Hyperbilirubinemia ◆ Cold
● Premature ◆ Clammy skin
● Stillbirth after 36 wks, if untreated ◆ Blurred vision
➔ The risks are the same for pregestational & ◆ Extreme Fatigue
gestational DM, except there is no risk for ◆ Mental Confusion
congenital abnormalities for gestational ◆ Irritability
◆ Somnolence
◆ Pallor
○ Diabetic Ketoacidosis:
◆ Abd Pain
◆ N/V
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NURSING 306
NURSING 306OB EXAM
OB Exam 3 STUDY
3 Study Guide GUIDE
Chapter 7: know risk factors, diagnosis, and interventions of the complications
1. Hyperemesis Gravidarum: vomiting during pregnancy that
is so severe it leads: ➔ Risk Factors
◆ Maternal age younger than 20 years
● Dehydration ◆ History of migraines
● Electrolyte Imbalance ◆ Obesity
● Acid-Base Imbalance ◆ First pregnancy
● Starvation Ketosis
◆ Multifetal gestation
● Weight Loss
◆ Gestational trophoblastic disease or fetus with
chromosomal anomaly
◆ Psychosocial issues and high levels of emotional
stress
◆ Transient hyperthyroidism
➔ DX:
◆ Prolonged, frequent, severe vomiting
◆ Weight Loss
◆ Acetonuria & Ketosis
◆ Dehydration:
● Dry mucous membranes
● Poor skin turgor
● Malaise
● Hypotension
➔ Interventions:
◆ Vit B6 + Doxylamine
◆ IV hydration (dextrose, vitamins, thiamine)
◆ Monitor liver/kidney fx
> Due to ^ hCG, progesterone & estrogen ◆ Ginger
◆ Adm antiemetics as indicated
◆ Good oral hygiene
◆ Check daily weight
◆ Monitor I&O
TX:
1. Ensure the pt remains NPO until
vomiting is controlled for 24-48hrs
2. Once vomiting is controlled, start on BRAT
diet with small frequent meals & assess if
they are able to maintain the food down
(minimize fluid intake w/ each meal)
3. If pt begins to vomit, place them back on NPO
2. Ectopic Pregnancy: a result of the blastocyst ➔ Risk Factors
implanting outside of the endometrial lining of the ◆ Abd distension
uterus ◆ Smoking
● Nonviable Pregnancy ◆ Assisted Reproduction
◆ Pelvic Inflammatory disease
◆ Prior tubal damage
➔ Assessment Findings
◆ PRIOR TO TUBAL RUPTURE
● Pelvic/Abd pain or tenderness
● Abnormal bleeding
● Minimal Uterine changes
● Stable VS
◆ TUBAL
RUPTURE
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● Severe abd pain
● Sharp, Stabbing, Tearing pain
● Vertigo/Syncope
● Hypovolemia due to hemorrhage
● SHOULDER PAIN due to
diaphragmatic irritation
➔ DX
◆ Physical symptoms
◆ Positive hCG
◆ Transvaginal Ultrasonography
◆ Serum Progesterone levels
➔ TX
◆
Laparoscopy (if hemodynamically stable)
◆
Methotrexate, folic acid antagonist & type
of chemotherapy agent causing the
dissolution of the ectopic mass > mother
> L. sided abd pain main concern = intraperitoneal bleeding should not feel any more abd pain after 2-3
days
➔ Interventions
◆ Ensure CV status
◆ Give RhoGAM if indicated
◆ Acknowledge pt feelings
◆ Teach mother to monitor for abd pain
3. Incompetent Cervix: a mechanical defect in the cervix ➔ Risk to Mother
that results in painless cervical dilation in the second ◆ Repeated 2nd & 3rd trimester births
trimester that can progress to ballooning of the membranes ◆ Spontaneous Abortions (repeated)
into the vagina & delivery of premature fetus ◆ Preterm Delivery
◆ Rupture of the membranes- Infection
➔ Risk to Fetus
◆ Preterm birth & consequences of prematurity
➔ Assessment Findings
◆ Pelvic Pressure & ^ vaginal DC
◆ Shortened cervical length or funneling of
the cervix
➔ TX:
◆ Cerclage: purse string suture placed
cervically to reinforce weak cervix
● Prophylactic (12-16 wks) placed as
a precaution due to prev. history of
unexplained recurrent painless dilation
& 2nd trimester birth
● Rescue (up to 24 wks) placed
after cervix has dilated with no
> Once the cerclage is placed, NO PENIS IN the Vagina :( perceived contractions
◆ Remove sutures if labor develops,
membrane ruptures or infection occurs
➔ Post-Op
◆ Palpate for uterine activity
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◆ Monitor vaginal bleeding or abnormal DC
◆ Monitor for Infection
● Fever
● Uterine Tenderness
◆ Adm tocolytics
◆ Teach mother to modify activities & rest
their pelvis for a week
4. Diabetes: https://www.youtube.com/watch?v=N3jnRuzseoM ➔ Pregestational (goal: control blood glucose
before pregnancy)
> Screening must be done at 24-28 wks: ◆ Assessment Findings:
● Glucose Tolerance Test: ● Hist of Type 1 or Type 2 DM
○ Non-fasting 1 hour 50g oral glucose ● Abnormal Glucose levels
tolerance test ● Glycosylated Hemoglobin (HbA1C) test
○ 3 hour after woman ingests 100g glucose dose to determine average glucose levels
○ Plasma glucose levels drawn 1, 2,3 hrs within the past 4-8 wks
post glucose dose ● Cardiac, Renal & Ophthalmic
○ If 2 of these tests return positive = GDM function assessment & evaluation
■ Fasting > 95 mg/dL ◆ TX:
■ 1 hr > 180 mg/dL ● Medical Nutritional Therapy (MNT)
■ 2 hr > 155 mg/dL ● Teach the pt’s the physiological
■ 3 hr > 140 mg/dL & insulin changes
● Refer the pt to a dietician
➔ Gestational: the mother develops glucose intolerance
◆ Risk Factors
● Obesity
● Hist of DM in family
◆ Risk Factors to the mother ● Hist of Fetal Macrosomia
● Hypo/Hyperglycemia ◆ Assessment Findings
● DM Ketoacidosis ● Abnormal glucose screening results
● HTN & Preeclampsia ◆ TX
● Metabolic Disturbances ● Controlled with Diet & Exercise
○ Hyperemesis ● Insulin may be needed
○ Nausea ● C-section planned for >4500 g
○ Vomiting ● Need to be monitored after birth
● Preterm Labor ➔ Nursing Actions for Both
● Spontaneous Abortion ◆ Pt Self-Management: Teach pt to
● Poly/Oligohydramnios ● Monitor blood glucose (4-8
times/day) before, after meals & at
● C-section
bedtime
◆ Risk Factors to the baby
● Check urine for ketones
● Fetal Macrosomia: due to fetal
● Monitor Food Intake
insulinemia > may lead to birth injury
brachial plexus injury ● Exercise 3 times/week for 20min
● Shoulder Dystocia: McRobert’s ● Recognize S/S of
maneuver “turtle sign” ○ Hypoglycemia: always keep
● Congenital Defects a carb snack with her (10-50
● Hypoglycemia/Hypomagnesemia g carb)
◆ Diaphoresis
● RDS
◆ Tachy
● Polycythemia (hematocrit <65%)
◆ Shakiness
= Hyperbilirubinemia ◆ Cold
● Premature ◆ Clammy skin
● Stillbirth after 36 wks, if untreated ◆ Blurred vision
➔ The risks are the same for pregestational & ◆ Extreme Fatigue
gestational DM, except there is no risk for ◆ Mental Confusion
congenital abnormalities for gestational ◆ Irritability
◆ Somnolence
◆ Pallor
○ Diabetic Ketoacidosis:
◆ Abd Pain
◆ N/V
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