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Questions and Answers
What is the main purpose of dilation and curettage (D&C) after pregnancy loss?
What is the main purpose of dilation and curettage (D&C) after pregnancy loss?
Which symptom indicates that a patient should contact their healthcare provider after a D&C procedure?
Which symptom indicates that a patient should contact their healthcare provider after a D&C procedure?
In patients experiencing ectopic pregnancy, which of the following is NOT a common clinical manifestation?
In patients experiencing ectopic pregnancy, which of the following is NOT a common clinical manifestation?
Which of the following dietary instructions should be given to a patient receiving methotrexate therapy?
Which of the following dietary instructions should be given to a patient receiving methotrexate therapy?
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What is a crucial instruction for a patient undergoing treatment for ectopic pregnancy with methotrexate?
What is a crucial instruction for a patient undergoing treatment for ectopic pregnancy with methotrexate?
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What is the recommended waiting period before attempting another pregnancy after a D&C?
What is the recommended waiting period before attempting another pregnancy after a D&C?
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Which diagnostic method is NOT typically used for diagnosing ectopic pregnancy?
Which diagnostic method is NOT typically used for diagnosing ectopic pregnancy?
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What is the primary aim of therapy for patients with gestational diabetes?
What is the primary aim of therapy for patients with gestational diabetes?
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Which of the following is NOT a typical risk factor for developing gestational diabetes mellitus (GDM)?
Which of the following is NOT a typical risk factor for developing gestational diabetes mellitus (GDM)?
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What is the correct timing for universal screening for gestational diabetes according to recommended guidelines?
What is the correct timing for universal screening for gestational diabetes according to recommended guidelines?
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Which intervention is recommended for managing gestational diabetes apart from dietary changes?
Which intervention is recommended for managing gestational diabetes apart from dietary changes?
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What condition arises from Rh incompatibility during pregnancy?
What condition arises from Rh incompatibility during pregnancy?
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What is the primary cause of antepartum hemorrhage?
What is the primary cause of antepartum hemorrhage?
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What is the incidence rate of placental abruption?
What is the incidence rate of placental abruption?
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Which of the following is NOT a common risk factor for placental abruption?
Which of the following is NOT a common risk factor for placental abruption?
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What are the potential fetal complications associated with severe placental abruption?
What are the potential fetal complications associated with severe placental abruption?
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Which grade of placental abruption is classified as severe?
Which grade of placental abruption is classified as severe?
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What is an expected management action if the fetus is under 36 weeks of gestation and not in distress?
What is an expected management action if the fetus is under 36 weeks of gestation and not in distress?
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Which maternal complication may result from severe placental abruption?
Which maternal complication may result from severe placental abruption?
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Which substance use is particularly noted as a risk factor for placental abruption?
Which substance use is particularly noted as a risk factor for placental abruption?
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Which condition can lead to maternal sensitization if the fetal blood type is Rh positive?
Which condition can lead to maternal sensitization if the fetal blood type is Rh positive?
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What is the primary purpose of using corticosteroids in the context of fetal care?
What is the primary purpose of using corticosteroids in the context of fetal care?
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Which condition is considered the most common cause of severe consumptive coagulopathy in obstetrics?
Which condition is considered the most common cause of severe consumptive coagulopathy in obstetrics?
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During which stage of DIC does overactive clotting lead to the consumption of clotting factors?
During which stage of DIC does overactive clotting lead to the consumption of clotting factors?
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What immediate action is indicated if a patient's condition deteriorates during pregnancy?
What immediate action is indicated if a patient's condition deteriorates during pregnancy?
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What can cause damage to organs during DIC?
What can cause damage to organs during DIC?
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What fetal monitoring method is mandated until fetal maturity is achieved?
What fetal monitoring method is mandated until fetal maturity is achieved?
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Which of the following is a possible trigger for DIC?
Which of the following is a possible trigger for DIC?
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How does DIC primarily affect the levels of clotting factors and platelets?
How does DIC primarily affect the levels of clotting factors and platelets?
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What complication arises from retaining a dead fetus, which could contribute to DIC?
What complication arises from retaining a dead fetus, which could contribute to DIC?
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Why might Rh negative patients receive Rho(D) immunoglobulin?
Why might Rh negative patients receive Rho(D) immunoglobulin?
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What physiological effect does arteriolar vasospasm primarily cause in relation to blood flow?
What physiological effect does arteriolar vasospasm primarily cause in relation to blood flow?
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Which of the following complications is associated with severe pre-eclampsia?
Which of the following complications is associated with severe pre-eclampsia?
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What is the key feature indicating HELLP syndrome?
What is the key feature indicating HELLP syndrome?
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Which organ function can be depressed by 40 to 60% due to arteriolar vasospasm in pregnant women?
Which organ function can be depressed by 40 to 60% due to arteriolar vasospasm in pregnant women?
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What nursing care measure is crucial for assessing a patient with pre-eclampsia?
What nursing care measure is crucial for assessing a patient with pre-eclampsia?
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What is commonly taught to patients regarding symptoms related to pre-eclampsia?
What is commonly taught to patients regarding symptoms related to pre-eclampsia?
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Which of the following is NOT a potential risk associated with severe pre-eclampsia?
Which of the following is NOT a potential risk associated with severe pre-eclampsia?
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What should be monitored to assess fetal health in pregnant women with pre-eclampsia?
What should be monitored to assess fetal health in pregnant women with pre-eclampsia?
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What serious maternal condition can arise due to severe pre-eclampsia?
What serious maternal condition can arise due to severe pre-eclampsia?
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Which of the following symptoms is least likely to be associated with HELLP syndrome?
Which of the following symptoms is least likely to be associated with HELLP syndrome?
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Study Notes
High-Risk Pregnancy: Social and Physiological Factors
- Adolescent pregnancy poses increased risk for eclampsia, puerperal endometritis, and systemic infections.
- Maternal mortality is higher in adolescents.
- Perinatal complications are the leading cause of death for 15-19-year-old girls globally.
- Early pregnancy or marriage contributes to 5-33% of girls (aged 15-24) leaving school.
Age Considerations: Advanced Maternal Age
- Pregnancy after 35 carries increased risks, including maternal death (higher over 40).
- Miscarriage, stillbirth, preterm birth, low birth weight, and Down syndrome are more prevalent.
- Despite these risks, overall risks are relatively low for healthy women without pre-existing conditions.
Women with Disabilities
- Women with disabilities face higher risks of social, economic, and physical problems.
- Care providers and families may hold stigmas or assumptions.
- Social service involvement is more frequent.
- Pre-planning and social support are needed.
- CHN's (Community Health Nurses) should consider biases and assumptions in their assessments and support.
Intimate Partner Violence (IPV) and Pregnancy
- Abuse during pregnancy increases risk of injury to the uterus, miscarriage, stillbirth, or premature birth, as well as bleeding during the first and second trimesters.
- Pre-pregnancy abuse, women under 25, substance use by the woman or partner, single or lone parents, recently separated or ending a relationship, Indigenous women, women with disabilities and women belonging to low SES groups are at higher risk of IPV.
- Associated with preterm labor, prematurity, low birth weight, neonatal and infant/maternal mortality, and maternal depression/substance use.
Substance Use During Pregnancy
- Alcohol and other drugs easily pass from the mother to the baby through the placenta.
- Cocaine, heroin, meth, and alcohol pose serious health risks.
- Miscarriage, stillbirth, prematurity, low birth weight, and congenital anomalies are common complications.
- Substance-use treatment programs may not address the unique needs of pregnant women and long waiting lists and lack of women-only recovery spaces are further barriers.
Nursing Care for Substance Use During Pregnancy
- Assessing for a history of violence, abuse, and mental health issues to provide support and ensure confidentiality.
- Promoting a non-judgmental, trauma-informed approach.
- Supporting the patient's desire to stop using substances while providing harm reduction strategies.
- Encouraging prenatal care, counselling, and treatment.
- Educating women about the effects of cannabis.
- Providing discharge planning, postpartum follow-up, and monitoring.
Application (Specific Scenarios)
- Application questions and the best approaches to address specific issues such as a client who continues to smoke.
- Application questions and the best approaches to address specific issues such as a client and partner who insist on being present during prenatal checkups.
Early Pregnancy Bleeding
- Miscarriage (spontaneous abortion) is the loss of a pregnancy before 20 weeks gestation (less than 500 g fetal weight).
- 80% of miscarriages occur before 12 weeks.
- Majority related to chromosomal abnormalities, teratogenic drugs, faulty implantation, maternal abnormalities.
- There are other issues, like maternal illness, endocrine imbalances, and maternal infections.
- Late loss encompasses week 12-20, commonly caused by advanced maternal age and premature dilation.
Discharge Teaching After Pregnancy Loss
- Advise to report any heavy, profuse, or bright red bleeding (and other significant changes).
- Avoid vaginal items until bleeding stops completely.
- Take medications as prescribed.
- Report foul-smelling discharge or elevated temperature.
- Advise to eat iron- and protein-rich foods.
- Important to acknowledge the loss and encourage family and friend support.
Ectopic Pregnancy
- Fertilized ovum implants outside the uterine cavity (most often fallopian tube; 95%).
- Clinical manifestations include abdominal pain, abnormal vaginal bleeding (spotting), missed menstrual period, referred shoulder pain (diaphragmatic irritation).
- Diagnosis includes ultrasonography, serum progesterone, and β-hCG levels.
- Medical management may involve methotrexate and possible surgery.
Teaching for Patients Receiving Methotrexate Therapy
- Advise patients to avoid foods and vitamins containing folic acid, "gas-forming" foods, sun exposure, and sexual intercourse until β-hCG is undetectable.
- Advise to keep scheduled appointments and report severe abdominal pain.
Premature Dilation of the Cervix
- Cervical insufficiency involves passive and painless dilation of the cervix without contractions.
- Structural weakness of the cervix is often due to collagen disorder or uterine anomalies and can be caused by cervical trauma (birth or mechanical dilation).
- Nursing care includes cervical cerclage (placed at 12-14 weeks) and continuous close observation and supervision.
- Early signs such as preterm labor, rupture of membranes, and infection should be reported.
Late Pregnancy Bleeding: Placenta
- Placenta previa: implantation of the placenta in the lower uterine segment, covering the internal cervical os completely (as opposed to partially or low-lying).
- Placenta previa is often associated with bright-red bleeding that is painless and can present during labor.
- Risk factors include: smoking, multiple pregnancies, previous uterine surgeries, advancing maternal age, low-socioeconomic status, short interpregnancy intervals, and infertility treatment.
- Placental abruption is the premature separation of the placenta.
- It's usually associated with painful bleeding and frequently is a significant medical emergency requiring immediate intervention
Nursing and Interprofessional Care for Late Pregnancy Bleeding
- Expectant management.
- Reduced activity and close observation, especially essential for a patient less than 36 weeks pregnant.
- In cases where labor has not yet started, the patient may be admitted to give time to stabilize, with no internal examinations performed.
- Appropriate surveillance tools include checking and weighing pads, NST, and BPPs.
- Antepartum steroids may be ordered; active management may lead to a cesarean birth, especially if high-risk.
Hypertensive Disorders in Pregnancy
- Hypertensive disorders in pregnancy are a leading cause of maternal mortality.
- Severe hypertension is defined as systolic BP greater than 160 mm Hg and diastolic BP greater than 110 mm Hg.
- Pre-eclampsia/eclampsia is gestational hypertension with proteinuria.
Pre-eclampsia & HELLP Syndrome
- Key components of pre-eclampsia include gestational or chronic hypertension and new-onset proteinuria (greater than 0.3 g/L per 24 hours).
- Additional organ dysfunction, such as acute kidney or liver dysfunction, seizures, blindness, stroke, severe headaches, thromobocytopenia, and DIC, may also be present.
- HELLP refers to an associated syndrome characterized by hemolysis, elevated liver enzymes, and low platelets, and is considered a severe form of pre-eclampsia.
- These conditions require aggressive medical management and hospitalization.
Nursing Care for Pre-eclampsia & HELLP Syndrome
- Blood pressure assessment is crucial to assess any change and the use of deep tendon reflexes to detect any presence of ankle clonus.
- Patient must be aware of complications, especially concerning fetal well-being. Fetal assessments are crucial.
- Assess and monitor for any increase in blood pressure, protein in urine, or decreased fetal movement.
- Urine dipstick test and activity monitoring will determine appropriate interventions.
Eclampsia
- Eclampsia is the occurrence of seizures in a pregnant woman.
- Proper nursing care includes ensuring a patent airway, administering magnesium sulfate, observing for signs of toxicity, assessing fetal status, providing postpartum care, and following up with appropriate healthcare professionals.
Contraction Stress Test (CST)
- Use to measure the fetus's response to contractions to determine if the fetus can handle contractions and get the required oxygen.
- Two procedures exist, nipple or oxytocin stimulation, with interpretation similar to the NST.
- Positive- late decelerations of the fetal heart rate, typically seen during uterine contractions.
- Negative- no late decelerations.
Biophysical Profile (BPP)
- BPP is a non-invasive test that assesses fetal well-being.
- It evaluates fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume.
- The absence/presence of these factors indicate fetal status and potential risk factors for fetal compromise.
- Each factor is scored; a total score of 8-10 signifies normal, 6 is equivocal, and <6 is abnormal.
Nursing Care for Patients with High-Risk Pregnancies
- Proper nursing care strategies should be implemented which focus on providing psychosocial support for those diagnosed.
- Patients should be given access to appropriate resources from healthcare professionals to ensure that they have clear support for their well-being and concerns.
Hyperemesis Gravidarum
- Hyperemesis gravidarum is persistent vomiting that causes severe dehydration, weight loss, and electrolyte imbalances.
- Usually starts between 4 and 8 weeks of pregnancy, often resolving by the 20th week.
Nursing Care for Hyperemesis Gravidarum
- Assessment of vital signs and hydration status is crucial to provide accurate nursing interventions to the patient.
- Management of dehydration and nutritional deficiencies using interventions for controlling symptoms, particularly nausea and vomiting.
- Careful administration of medications, especially when needed for alleviating symptoms, should be carried out in accordance with protocols and best practices for patient safety.
Other Relevant Topics (From Additional Pages)
- Rh incompatibility: Rh incompatibility occurs when the mother is Rh-negative and the fetus is Rh-positive.
- Gestational Diabetes Mellitus (GDM): Elevated glucose levels occurring during pregnancy.
- Clotting Disorders in Pregnancy (DIC): A rare disorder where the proteins controlling blood clotting become overactive and use up clotting factors, leading to widespread bleeding.
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Description
Test your knowledge on obstetrics and gynecology topics, including procedures like D&C, ectopic pregnancy management, and gestational diabetes. Understand key clinical manifestations and treatment recommendations essential for patient care. This quiz aims to highlight important guidelines for healthcare providers.
