#SPLE2018

#NLENOV2018

Medical OBSTETRICS

MADE IT EASY

1. Women with hyperthryoidism usually suffer what for the first 4-8 weeks of pregnancy
- severe N/V

2. how is hyperthyroidism treated in pregnancy

- PTU

3. how long does it take for PTU to reach its max effectiveness for the tx of hyperthyroidism
- 6-8 weeks

4. women with hypothyroidism have a high risk of what?

- infertility
rupture

5. how is hypothyroidism treated in preg

- synthroid

6. what lab level is monitored with hypothyroidism?

- TSH

7. what nursing education needs to be stressed to women who are preg w/ hypothyroidism?
-timeliness of med admin
strict adherence to meds

8. name cardiovasc changes that occur during preg

incr intravasc vol

decr systemic vasc resistance
CO changes during labor and birth
intravasc vol changes that occur just after birth

9. how is CV disease classified?

class I-class IV

10. class I CV disease

asympt @ normal actvity level

11. class II CV disease

sympt w/ ordinary activity

12. class III disease

sympt w/ decr ordinary activity

13..class IV disease

sympt @ rest

14. when is CV disease classification evaluated in a preg?

3 months and again @ 7 or 8

15. women with CV diseases have a higher risk of what?

miscarriages
preterm birth and labor
intrauterine growth restriction
congenital heart lesions incr in babies
decr CO to the baby

16. what delivery method is preferred for heart transplant moms?

vaginal

17. how long should conception be post-poned for after heart transplant?

at least 1 yr

18. infants of heart transplant mothers may exhibit what during the 1st week of life?

immunosuppressive effects

19. if a mother is a heart transplant, they cannot breastfeed if they are taking which med?

cyclosporine

20. what should be at the bedside or nearby of a mom with asthma regardless of when their last
attack was?
inhaler

21. if an infant or mother has CF, they will be ______ of the CF gene?

carriers

22. what is an important characterization of Cystic Fibrosis?

exocrine glands produce and release excessive viscous secretions

23. what is Lupus Erythematosus?

autoimmune antibody production that affects skin, joints, kidneys, lungs, CNS, and other body
organs

24. what is the concern for Lupus patients during preg?

immunosuppressive meds not reccommended during preg

25. what is the objective for care of Lupus patients?

reducing the risk of infections

26. what is super important for HIV + moms before conception (if possible)

preconception counseling

27. when is a mom tested for HIV in her preg?

@ 8 weeks

28. what do HIV moms have an incr risk for?

-concurrent infecs
-std's
-sti's
-PID

29. what is the absolute objective of care for HIV pregnancy?

decreasing the neonates exposure to mom blood and secretions

30.what medical precautions are taken during care of HIV preg?

standard precautions

31. what risks are assoc with smoking moms?

- bleeding complications
-miscarriage/stillbirth
-prematurity
-placenta previa
-placental abruption
-low birth weight
-SIDS

32. what is the best approach to tx for DM moms?

multidisciplinary

33. what is the key to optimum outcome for DM?

glucose control prior to and throughout preg

34. what are serious risks/complications assoc w/ GDM?

ketoacidosis
hypoglycemia

35. ketoacidosis is assoc w/

hyperglycemia

36. when is a GDM mom at highest risk for hypoglycemia and why?

-early in the pregnancy

-hepatic production is diminished
-insulin/meds may need to be tweaked
-N/V
-decreased food intake by mom
-glucose transfer to embryo

37. insulin needs during the first trimester and why

- insulin needs reduced

- incr insulin production by the pancreas
-incr peripheral sens to insulin

38. insulin needs on day of delivery

- insulin needs drop drastically to pre-preg levels

39. insulin needs of breastfeeding mothers

low insulin requirements

40.insulin needs of non-breastfeeding mother

insulin needs of pre-preg level within 7-10 days

41. what is a macrosomic baby at risk for?

hypoglycemia

42. diabetic mothers are at incr risk for what and what types?
-infections like
UTI's
yeast

43. what birth complication are GDM patients at risk for

-shoulder dystocia

40. what is the minimum glucose level of infants

40

Undying Concept in CARDIO

Identify signs and symptoms of Myocardial Infarction and give 5 initial nursing interventions for a
patient complaint of chest pain suggestive of Myocardial Infarction at Emergency Department?

Model Answer

Chest pain described as a pressure sensation, fullness or squeezing in the central of the chest.
Chest pain radiate to the jaw or teeth, shoulder, arm, and / or back
It usually occur at rest

The pain often associated with:

Sweating
Shortness of breath or dyspnoea
Epigastric discomfort with or without nausea and vomiting
Syncope or near syncope without other cause
Restlessness
Pale
Initial nursing intervention :
Push patient to red zone immediately
Attach on cardiac monitor
Perform ECG
Insert intravenous access.
Send blood investigation for
Cardiac markers
Troponin T and Troponin I
Creatine Kinase (CK)

Administer primary treatment to patient:

Morphine - Pain relief: eg: Diamorphine 2.5 5 mg IV
Oxygen
Nitrates - as vasodilatation effect reduces cardiac preload and afterload and decreases the
myocardial oxygen requirements.
Aspirins - Antiplatelet Medication as ordered, eg: Aspirin 300mg chewed and Clopidogrel 300mg
Standby emergency trolley to anticipate emergency situation.
Nurse patient on complete rest in bed.