Pregnancy Complications and Screening Quiz

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Questions and Answers

What is the primary purpose of thioamides like methimazole in pregnant women?

To reduce thyroid activity (correct)

To enhance glucose metabolism

To increase appetite

To stimulate thyroid activity

Which of the following symptoms is NOT commonly reported among pregnant women?

Increased appetite

Increased urination (correct)

Dehydration

Increased thirst

What indicates a diagnosis of diabetes after a glucose tolerance test?

Random plasma glucose greater than 200 mg/dL

Glucose level below 140 mg/dL after 60 minutes

Two abnormal blood samples out of four (correct)

Fasting glucose below 95 mg/dL

What are ketone bodies primarily a result of in the body?

Fat breakdown for energy Signup and view all the answers

During a glucose screening test, what is the threshold for the blood sample taken 60 minutes after ingesting a glucose load?

140 mg/dL or higher Signup and view all the answers

What is the consequence of blockage to the placental circulation during pregnancy?

Low birth weight and possible fetal death Signup and view all the answers

Which screening test is recommended at the first prenatal visit for women with a specific condition?

Hemoglobin analysis Signup and view all the answers

What is a key indicator of Von Willebrand disease in women?

Normal platelet counts with prolonged bleeding time Signup and view all the answers

How is sickle cell disease characterized at the genetic level?

Homozygous with two gene substitutions Signup and view all the answers

What is a treatment option to prevent excessive bleeding during labor for women with Von Willebrand disease?

Cryoprecipitate or fresh frozen plasma transfusion Signup and view all the answers

What potential issue arises from sickle-shaped red blood cells during high altitudes?

Clumping of cells and vessel blockage Signup and view all the answers

What is a primary symptom of Thalassemia?

Severe anemia Signup and view all the answers

Which group is most commonly affected by Thalassemia?

Mediterranean, African, and Asian populations Signup and view all the answers

What is a characteristic skin change associated with Systemic Lupus Erythematosus (SLE)?

Erythematous butterfly-shaped rash on the face Signup and view all the answers

What is one of the risks associated with the formation of thrombi in women with SLE?

Obstruction of blood flow to vital organs Signup and view all the answers

How long should a woman wait to conceive after tuberculosis infection becomes inactive?

1-2 years Signup and view all the answers

What procedure is recommended for early pregnancy if the appendix is suspected to be inflamed?

Laparoscopy Signup and view all the answers

What complication can arise from a ruptured appendix during pregnancy?

Peritonitis Signup and view all the answers

What is the relationship between gallstones and cholesterol?

Gallstones are formed from cholesterol Signup and view all the answers

Which of the following is NOT a sign of complications from SLE?

Increased lung capacity Signup and view all the answers

What should a mother with a history of tuberculosis ensure before caring for her infant?

3 negative sputum cultures Signup and view all the answers

What is the most common age range for girls to develop scoliosis?

12 to 14 years Signup and view all the answers

What potential issue may arise from an extremely curved spine during labor?

Difficulty in administering epidural anesthesia Signup and view all the answers

Which of the following medications can safely be administered during pregnancy to manage scoliosis?

ACTH Signup and view all the answers

What is a common sign of hyperthyroidism that may be observed in pregnant women?

Heat intolerance Signup and view all the answers

Which condition is most commonly associated with hyperthyroidism during pregnancy?

Graves disease Signup and view all the answers

What should women taking levothyroxine and planning to conceive be advised to do?

Consult their doctor to adjust the dosage Signup and view all the answers

When managing hyperthyroidism during pregnancy, how much should the levothyroxine dosage typically be increased?

20% to 30% Signup and view all the answers

Which of the following medications should NOT be taken with levothyroxine to avoid absorption issues?

All of the above Signup and view all the answers

What is a characteristic feature of Myasthenia Gravis?

Presence of IgG antibodies against acetylcholine receptors Signup and view all the answers

Which medication is safe for use during pregnancy for a woman with Myasthenia Gravis?

Neostigmine Signup and view all the answers

What symptom may indicate a woman is suffering from Hepatitis during pregnancy?

Fatigue and jaundice Signup and view all the answers

What is the recommended post-birth care for an infant born to a mother with Hepatitis?

Immunization against Hepatitis B Signup and view all the answers

Which of the following conditions is NOT a sign of Multiple Sclerosis?

Increased muscle reflexes Signup and view all the answers

What is the purpose of plasmapheresis in the management of Myasthenia Gravis?

To remove immune complexes from the bloodstream Signup and view all the answers

What complication can occur later in pregnancy in a woman with Hepatitis B?

Increased risk of spontaneous miscarriage Signup and view all the answers

How should a labor be managed if a woman has a distorted pelvis due to Myasthenia Gravis?

Schedule a cesarean birth for safety Signup and view all the answers

What is the recommended initial management for restoring factor IX in pregnant women with coagulation disorders?

Infusion of factor IX concentrate or fresh frozen plasma Signup and view all the answers

What specific factor affects renal workload during pregnancy?

Excretion of waste products for both mother and fetus Signup and view all the answers

Which of the following is a precautionary measure recommended for women with chronic renal disease during pregnancy?

Frequent voiding at least every two hours Signup and view all the answers

What potential issue can arise in pregnant women with chronic renal disease?

Development of severe anemia due to lack of erythropoietin Signup and view all the answers

Why is the use of Ascorbic Acid (Vitamin C) not recommended during pregnancy?

It can cause the newborn to develop scurvy Signup and view all the answers

What is the normal creatinine level in mg per 100 ml of blood during pregnancy?

0.7 Signup and view all the answers

What treatment is given to pregnant women with pyelonephritis after being hospitalized?

Maintenance on a drug such as Oral Nitrofurantoin Signup and view all the answers

What position is suggested to alleviate pressure on the uterus for pregnant women?

Knee chest position for 15 minutes Signup and view all the answers

Study Notes

NCM 109 - Care of Mother and Child at Risk or with Problems (Acute and Chronic) - LECTURE

Course offered at Wesleyan University, Philippines, College of Nursing
This is a preliminary period lecture, week 2

Chapter 20 - Care Given to a Mother Experiencing a Pregnancy Complication from a Pre-existing or Newly Acquired Illness

Nursing Care Plan:
- Focus on signs and symptoms of illness (subjective and objective data)
- Examples:
  - Woman's level of exhaustion (subjective)
  - Extent of edema (objective, vital signs).
- Nursing Diagnosis: based on gathered data
- Examples:
  - Ineffective tissue perfusion (cardiopulmonary) related to poor heart function secondary to mitral valve prolapse during pregnancy
  - Pain related to pyelonephritis secondary to uterine pressure on ureters
  - Social isolation related to prescribed bed rest during pregnancy secondary to concurrent illness
  - Ineffective role performance related to increasing level of daily restrictions secondary to chronic illness and pregnancy.
Outcome Identification and Planning:
- Example: Maintaining woman's health, minimizing hospitalization, and family disruptions for chronic illness, allowing women to participate in her care and maintain self-esteem is of paramount importance, and step forward to parenthood for new mothers.

Normal Heart Diagram

Includes: Superior Vena Cava, Inferior Vena Cava, Pulmonary Veins, Pulmonary Valve, Atrial Septum, Pulmonary Artery, Aorta, Mitral Valve, Tricuspid Valve, Aortic Valve, Ventricular Septum, Right Atrium, Left Atrium, Right Ventricle, Left Ventricle

Cardiovascular Disease and Pregnancy

Danger of pregnancy for women with cardiac disease occurs primarily due to increasing circulatory volume.
Most dangerous time is during weeks 28-32 after blood volume peaks.
Conditions like mitral stenosis, mitral insufficiency, and aortic coarctation affect the left ventricle's capacity to move blood from the pulmonary circulation forward.

Implementation

Teach measures to maintain health during pregnancy
Specific examples given, including rest periods, exercise program, and taking medicine for thyroid condition

The Level of Failure in Pregnancy Cardiac Disorders

Can be at the level of the mitral valve
Normal physiologic tachycardia of pregnancy shortens diastole and decreases the time for blood flow
Ineffective mitral valve pushing blood forward leads to pulmonary hypertension, decreased systemic blood pressure, and hypotension

Surgical Management

Balloon valve angioplasty (to loosen mitral valve adhesions)
If anticoagulant required, heparin is the drug of choice (does not cross the placenta)
Right-sided heart failure occurs when the right ventricle's output is less than the blood volume received from the vena cava.
Congenital heart defects (pulmonary stenosis, ventricular septal defects), lead to blood congestion and decreased cardiac output to the lungs

Pulmonary Edema

Orthopneic; suddenly wakening during night with shortness of breath
Most effectively when resting

Medication Management for Pulmonary Edema

Antihypertensive medications
Diuretics
Beta blockers
Low-sodium diet

Signs and Symptoms of Pulmonary Conditions

Productive cough with blood-speckled sputum
Risk factors include: spontaneous miscarriage, preterm labor, and maternal death
Reduced oxygen saturation of blood due to alveolar dysfunction leads to increased respiratory rate (RR)
Fatigue, weakness, dizziness, increased heart rate (HR), peripheral constriction are common symptoms.

Pregnant Patient with Peripartum Heart Disease

Rare condition originating during pregnancy in those without previous heart disease
Unknown cause; possibly stress of pregnancy
Symptoms include shortness of breath, chest pain, nondependent edema, and cardiomegaly; treatment includes reducing physical activity, diuretics, arrhythmia medication, and immunosuppressive therapy.

Management of Pregnancy with Existing Conditions

Essential to monitor fetal health (through ultrasounds, as well as other measures).
Oxygenation
Monitoring fetal development
Close management to minimize risk of hypotension after epidural anesthesia

Blood Pressure and Circulation Issues with Pregnancy

Blood pressure decreases in the aorta because less blood is reaching it
Increased distention of liver and spleen leads to dyspnea and pain
Fluid builds up in the peritoneal cavity in ascites
Extreme pressure on abdominal vessels from enlarged uterus is a concern.
Right-sided heart failure can be associated with this
Eisenmenger syndrome may be a cause for this issue.

Iron Metabolism

The body absorbs iron from the duodenum, transferring it to the liver, spleen, and bone marrow
Stored as ferritin; vital for effective oxygen transport and red blood cell production
Extreme fatigue and poor exercise tolerance are associated conditions

Hematologic Disorders and Pregnancy (Anemia and Pregnancy)

The blood volume expands, potentially leading to apparent anemia in early pregnancy
True anemia occurs when the hemoglobin (HGB) concentration is less than 11g/dL (or hematocrit less than 33%) during the first or third trimester
If less than 10.5g/dL (hematocrit less than 32%) in the second trimester, it's a concern
Iron deficiency anemia is common in pregnancy; further causes include, heavy menstrual flow, low-income families and improper weight loss programs.

Classification of Heart Disease

1- uncompromised: ordinary physical activity causes no discomfort; no symptoms.
2- slightly compromised: ordinary activity causes noticeable fatigue, palpitations, dyspnea, or angina.
3- markedly compromised: significant fatigue, palpitations, dyspnea, or angina occur with less than ordinary activity.
4- severely compromised: any activity causes discomfort and symptoms occur even at rest.

Megaloblastic Anemia

Enlarged red blood cells
Folate intake is important: increased daily intake may be prescribed
Sickle-Cell Anemia (inherited hemolytic condition) : abnormal amino acid in the beta chain of hemoglobin.

A Woman with Folic Acid-Deficiency Anemia

Importance of folic acid for normal red blood cell formation in pregnant women
Commonly seen in multiple pregnancies, hemolytic illnesses, individuals taking hydantoin(an anticonvulsive) and poor gastric absorption.

Management for Anemia and Iron-Deficiency Anemia

Prescribed prenatal vitamins with iron (27mg)
Dietary recommendations: green leafy vegetables, meat, and legumes
Ferrous sulfate or ferrous gluconate (120-200 mg elemental iron/day)
Consumption of orange juice/vitamin-C (for better absorption of iron)

Management for Therapeutic Anemia

Blood transfusions to replace sickled cells with non-sickled cells (periodically)
Oxygen and fluid management for crises

Coagulation Disorder (Von Willebrand Disease and Pregnancy)

Sex-linked or male-specific coagulation disorders have little effect on pregnancies.
In women, von Willebrand disease leads to longer bleeding times.
Factor VIII - related antigen and factor VIII coagulation activity are reduced, leading to spontaneous and postpartum hemorrhage.
Replacement of missing factors through blood transfusion (cryoprecipitate or frozen plasma) before childbirth, needed in cases of severe disorder.

The Woman with Thalassemia

Inherited blood disorder leading to poor hemoglobin formation and anemia
Common condition in people of Mediterranean, African, and Asian descent
Treatment includes folic acid and blood transfusions containing hemoglobin-rich red blood cells.

Management Regarding Pulmonary Edema

Oxygen administration
Monitoring fetal development
Monitoring pulmonary pressure during labor
Careful monitoring to prevent hypotension after epidural anesthesia

###Diagnosis regarding Urinary Tract Infection (based on symptoms)

Clean catch urine sample with culture and sensitivity test to determine antibiotic
Pyelonephritis: pain in the lumbar region that radiates downward, possibly tender to palpation, nausea/vomiting, malaise, frequent urination and elevated temperature (103-104⁰F)

Hemophilia B (Christmas Disease)

Sex-linked Factor IX deficiency disorder
Occurs only in males; females are carriers with reduced factor IX levels (33% of normal)
Risk of hemorrhage during labor or spontaneous miscarriage
Management: restoration of factor IX through infusion (factor IX concentrate or fresh frozen plasma)
Analysis of maternal serum (to detect fetal factor IX status) during pregnancy.

###A Person with Chronic Renal Disease in Pregnancy

Pregnant women with chronic renal disease, may have increased workload on the kidney system
Pregnant women with chronic renal disease might be candidates for hemodialysis.
Increased filtration of waste products, and a risk for anemia is present

###The Management with Pyelonephritis

Hospitalization for 24-48 hours
Initiate IV antibiotics
Maintain adequate hydration and diet
Oral Nitrofurantoin is recommended for non-pregnant women

Precautionary Measures Regarding Urinary Tract Infection in Pregnancy

Frequent urination (at least every two hours)
Wiping from front to back after urination
Preferably cotton underwear (to avoid skin infections).
Avoiding holding urination following intercourse
Adequate hydration

###A Woman with Pneumonia

Bacterial or viral infection of lung tissue by pathogens (e.g, Streptococcus pneumoniae, Hemophilus influenzae, Mycoplasma pneumoniae).
Symptoms: acute inflammatory response; lungs' alveoli flood with fluid, reducing breathing space.
Treatment: antibiotics and oxygen administration

###A Woman with Influenza

Virus causing respiratory illness like A, B, or C
Symptoms: fever, sore throat, etc
Treatment: antipyretics and antiviral medication (Oseltamivir)
Vaccination available for prevention

A Woman with Gestational Diabetes Mellitus

Glucose management during pregnancy
Monitoring blood levels (70 to 110 mg/dL fasting, 90-180 mg/dL non-fasting)
Treatment may include medication and or modification of lifestyle.

Management and Treatment of Hyperthyroidism

Levothyroxine(Synthroid) to manage thyroid hormone
Important that dosage of medication increases during pregnancy to meet the demand
Important that the woman is advised to take medications at least 4 hours away from iron, calcium or any soy product to ensure proper absorption of the medication

A Woman with Hypothyroidism

Underproduction of thyroid hormones
Woman may experience difficulties in conception, and spontaneous miscarriage.
Symptoms can include fatigue and weight gain, dry skin, and intolerance to cold

A Woman with Diabetes Mellitus

Pancreas does not produce enough insulin to regulate blood glucose levels
Management involves managing blood glucose levels through diet, exercise, and potentially insulin therapy

Maternal Effects Due to Gestational Diabetes

Hypoglycemia (in early pregnancy)
Increased risk of frequent infections (moniliasis), and polyhydramnios
Potential for dystocia

Fetal Effects Due to Gestational Diabetes

Possible premature birth, hypoglycemia, and macrosomia (excess fetal weight) during pregnancy

Fetal Monitoring After Diagnosis of Gestational Diabetes (GD)

Non-stress tests (NST) or periodic ultrasound checks around 32 weeks to monitor fetal well-being
Monitoring fetal heart rate at rest and during movements.

Signs and Symptoms of Hypocalcemia in Newborns

High-pitched cry
Tremors
Potential for seizures

New Born Effects of Maternal Diabetes

Hypoglycemia due to elevated levels of insulin in the newborn
Requires close monitoring and possible treatment to regulate blood glucose levels

Effects of Gestational Diabetes to the Fetus

Fetal macrosomia arises with maternal hyperglycemia
Fetal increase in insulin production to regulate blood sugar levels
Increased amount of fat stores can elevate fetal weight

Cancer and Pregnancy

Several forms of cancer may affect women of childbearing age
Decisions regarding treatment must carefully consider potential teratogenic effects on the fetus and balance the risk for the mother against the risk for the fetus.

Management and Treatment for Mental Illness in Pregnancy

Specific treatment may vary depending on diagnosis and needs
It may involve therapy or medication to help manage conditions. Care of the newborn deserves extra attention

Classification of Diabetes Mellitus

Type 1: Beta cells in the pancreas are destroyed.
Type 2: Insulin resistance with relative deficiency.
Gestational: Glucose intolerance during pregnancy

Glucose Screening Test

Useful in detecting diabetes during a pregnancy
Blood tests are taken to detect abnormally high levels of blood sugar

Assessment of Glucose Levels Through Laboratory Studies

Random plasma glucose level greater than 200 mg/dL is abnormal.
A 50-g oral glucose tolerance test is performed (24 to 48 weeks).
Diagnosis is confirmed if 2 of 4 results show abnormality.

Symptoms of Gestational Diabetes

Unusual fatigue and frequent urination

###General Management of Type 2 Diabetes

Careful management of blood sugar through a balanced diet, regular exercise, and, potentially, insulin therapy.

High serum cholesterol and keto-acidosis
Increased urination and thirst
Dehydration

Effect of Hyperglycemia on Urine

Presence of glucose in the urine
Increased urine output (polyuria)
Increased thirst (polydipsia).

###Effects of Gestational Diabetes on the Fetus

Macrosomia (large weight) -due to increased glucose production and insulin
Hypoglycemia after birth due to overly high levels of insulin present.

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Description

Test your knowledge on pregnancy complications, screening tests, and common conditions affecting expectant mothers. This quiz covers various medical aspects, including thioamides, glucose tolerance tests, and genetic disorders. Aim for a safe and healthy pregnancy with this informative assessment.