Podcast
Questions and Answers
What is the most appropriate immediate management for the patient described?
What is the most appropriate immediate management for the patient described?
- Perform an ultrasound to assess placental location
- Start intravenous oxytocin for induction of labor
- Administer Betamethasone for fetal lung maturity
- Prepare for emergency cesarean section (correct)
Which factor is most likely contributing to the risk of hemorrhage in this patient?
Which factor is most likely contributing to the risk of hemorrhage in this patient?
- Previous cesarean section (correct)
- Preterm labor
- Gestational trophoblastic disease
- Ectopic pregnancy
What are the triad signs associated with gestational trophoblastic disease?
What are the triad signs associated with gestational trophoblastic disease?
- Sudden, stabbing pain, Cullen's sign, shoulder pain
- Big uterus, hCG of 1 million, vaginal bleeding (correct)
- Dark brown vaginal discharge, grape-like vesicles, nausea
- Low protein intake, Asian ethnicity, age below 35
In preterm labor, at what gestational age range does it typically occur?
In preterm labor, at what gestational age range does it typically occur?
What is the most common site for an ectopic pregnancy to occur?
What is the most common site for an ectopic pregnancy to occur?
What is the indication for using Betamethasone in pregnancy?
What is the indication for using Betamethasone in pregnancy?
What does psychological violence refer to?
What does psychological violence refer to?
Which of the following is an example of economic abuse?
Which of the following is an example of economic abuse?
What is the purpose of a Temporary Protection Order (TPO)?
What is the purpose of a Temporary Protection Order (TPO)?
What does a Permanent Protection Order (PPO) require for issuance?
What does a Permanent Protection Order (PPO) require for issuance?
Which of the following does NOT constitute psychological violence?
Which of the following does NOT constitute psychological violence?
What kind of support might an abused woman need until she can develop better self-esteem?
What kind of support might an abused woman need until she can develop better self-esteem?
What is the drug of choice to prevent preterm labor from progressing?
What is the drug of choice to prevent preterm labor from progressing?
When should RhoGAM be administered for a woman affected by Rh incompatibility?
When should RhoGAM be administered for a woman affected by Rh incompatibility?
What is the management for a pregnant woman with Class III (markedly compromised) heart disease?
What is the management for a pregnant woman with Class III (markedly compromised) heart disease?
What is the management for an Rh-negative mother with a Rh-positive fetus?
What is the management for an Rh-negative mother with a Rh-positive fetus?
What symptoms would a pregnant woman with Class IV (severely compromised) heart disease exhibit?
What symptoms would a pregnant woman with Class IV (severely compromised) heart disease exhibit?
What is the standard treatment protocol for a pregnant woman with no rupture of membranes and mild cramping?
What is the standard treatment protocol for a pregnant woman with no rupture of membranes and mild cramping?
What symptoms are mostly seen in left-sided heart failure related to pulmonary congestion?
What symptoms are mostly seen in left-sided heart failure related to pulmonary congestion?
What symptoms may a pregnant woman with peripartum cardiomyopathy exhibit?
What symptoms may a pregnant woman with peripartum cardiomyopathy exhibit?
Which condition is characterized by hypertension, edema, and proteinuria during pregnancy?
Which condition is characterized by hypertension, edema, and proteinuria during pregnancy?
What should be avoided with a patient experiencing seizures due to eclampsia?
What should be avoided with a patient experiencing seizures due to eclampsia?
What diagnostic test is recommended for checking protein levels during pregnancy-induced hypertension?
What diagnostic test is recommended for checking protein levels during pregnancy-induced hypertension?
What should a nurse prioritize when managing a pregnant woman with mitral valve stenosis?
What should a nurse prioritize when managing a pregnant woman with mitral valve stenosis?
What is the most likely cause of hemorrhage postpartum?
What is the most likely cause of hemorrhage postpartum?
Which factor is most likely to lead to genital tract laceration during birth?
Which factor is most likely to lead to genital tract laceration during birth?
What should a nurse assess first when evaluating a postpartum client's uterus?
What should a nurse assess first when evaluating a postpartum client's uterus?
What can continuous seepage of blood from the vagina along with a firm uterus indicate in a postpartum client?
What can continuous seepage of blood from the vagina along with a firm uterus indicate in a postpartum client?
Which condition is characterized by swelling in the calf of one leg?
Which condition is characterized by swelling in the calf of one leg?
What nursing intervention is typically recommended for managing postpartum infection?
What nursing intervention is typically recommended for managing postpartum infection?
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Study Notes
Psychological Violence
- Refers to acts or omissions causing mental or emotional suffering, including intimidation, harassment, stalking, and public ridicule or humiliation
- Also includes causing or allowing the victim to witness physical, sexual, or psychological abuse of a family member, or witness pornography or abusive injury to pets
Protection Orders
- Barangay Protection Orders (BPO) are issued by the Punong Barangay, effective for 15 days
- Temporary Protection Orders (TPO) are issued by the court, effective for 30 days
- Permanent Protection Orders (PPO) are issued by the court after notice and hearing, effective until revoked
Nursing Intervention
- Therapeutic approach: support the abused woman to develop better self-esteem and make simple decisions
- Greatest risk: 28-year-old G1 at 30 weeks' gestation with high blood pressure and history of cigarette smoking
- Management: prepare for emergency CS
Gestational Conditions
Placenta Previa
- Painless, bright red vaginal bleeding
- No uterine contractions; fetal heart rate within normal range
- Immediate management: determine fetal heart sounds using an external monitor
- Most likely factor: previous CS
- Risk associated: hemorrhage
Gestational Trophoblastic Disease (H-mole)
- Symptoms: dark brown vaginal discharge, grape-like vesicles, nausea, and vomiting
- Risk factors: low protein intake, Asian descent, above 35 years old
- Triad signs: big uterus, hcg of 1 million, vaginal bleeding
- Health teaching: remind the patient not to get pregnant for 1 year
Ectopic Pregnancy
- Symptoms: sudden, stabbing pain in the lower quadrant radiating to the shoulder
- Presence of a Cullen’s sign
- Most common site: fallopian tube
Preterm Labor
- Labor between 20 weeks and 37 weeks gestation
- Management: Betamethasone for fetal lung maturity
- Drug of choice: Magnesium sulfate and Terbutaline to prevent preterm labor progression
- Rh Iso immunization: arrange for Rho(D) immune globulin at 28 weeks' gestation
Cardiac Disease
- Symptoms: cough, FHT of 100 beats per minute with non-reassuring variability, pedal edema
- New York State Heart Association Heart Disease Classification:
- Class I (uncompromised) can expect a normal pregnancy and birth
- Class II (slightly compromised) can complete pregnancy with almost complete bed rest
- Class III (markedly compromised) shortness of breath and easy fatigue
- Class IV (severely compromised) heart disease are poor candidates for pregnancy
- Left sided heart failure: pulmonary congestion, symptoms mostly seen in changes in respiration
- Peripartum cardiomyopathy: no previous history of heart disease, symptoms of myocardial failure a few weeks before birth
Hyperemesis Gravidarum
- Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances
PIH and Related Conditions
- Gestational hypertension: hypertension
- Pre-eclampsia: hypertension, edema, proteinuria
- Eclampsia: hypertension, edema, proteinuria, seizure
- Diagnostic test: urinalysis to check for protein
- Management: magnesium sulfate, prepare antedote - calcium gluconate
Postpartum Complications
Uterine Atony
- Prolonged use of Oxytocin
Endometritis
- Infection of the uterus through the vagina, leading to hemorrhage
Uterine Subinvolution
- Delayed postpartum hemorrhage
Cervical Laceration
- Continuous seepage of blood from the vagina of a PP client
- Factors leading to lacerations: primigravida, use of lithotomy position and instruments
Thrombophlebitis
- Fibrinogen level is still elevated from pregnancy, leading to increased blood clotting
- Dilatation of lower extremity veins is still present due to pressure of the fetal head during pregnancy and birth
Disseminated Intravascular Coagulation
- Assess for swelling in the calf in one leg
Infection
- Management: antibiotics
- Nursing intervention: increase fluid intake
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