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NUR 406 ( LATEST 2024 / 2025 ) EXAM 2 | PASSED | A+ RATED GUIDE | NEW FULL EXAM
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NUR 406 ( LATEST 2024 / 2025 ) EXAM 2 | PASSED | A+ RATED GUIDE | NEW FULL EXAM
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NUR 406 EXAM 21. (eg.,Rh incompatibility, diabetes, preeclampsia, basic information r/t to the TORCH
infections, preterm labor),
Answer
2. Goals of care of high risk pregnancies
Answer
• foster growth and development and mother and baby
• minimize maternal, fetal and neonatal mortality
3. Pregnancy Complications
Answer
Identify/distinguish normal complications/ ab- normal assessment findings
4. Pregnancy Complications
Answer
General pathophysiology behind complications (basic mechanisms, general lab assessments-
not specifics/details- more clinical judgement oriented)
5. Pregnancy Complications
Answer
· Appropriate nursing care/interventions vs. in- appropriate nursing care/interventions for both
normal and abnormal find- ings
6. Pregnancy Complications
Answer
,· Includes medications with focus on those dis- cussed in lecture/lab/clinical
7. Pregnancy Complications
Answer
· Diabetes during pregnancy (gestational or pre- viously existing)
The "normal" pregnant woman has an increases resistance to insulin beginning in the 2nd half
of pregnancy.
• placenta produces more hormones, which increase resistance to insulin, demand rises 3x
• body actually produces more insulin while pregnant, but hormones produced by the placenta
increase the body's resistance to the insulin
8. Gestational Diabetes
Answer
Diabetic pregnant women can't increase their production of insulin
- pancreas unable to produce sufficient insulin
- insulin not being used effectively
Especially complicates 2nd and 3rd trimester when insulin demands increase Pathophysiology
• without adequate insulin; glucose circulates blood stream unable to enter cells, energy
starved cells break down fats and proteins for energy causing; ketosis from fat wasting, negative
nitrogen balance from protein breakdown and muscle tissue wasting
• high levels of glucose spill over into the urine; glycosuria
9. Assessing for Diabetes in pregnancy
Answer
All women screened Complications; fetal HTN, macrosomnia, polyhydramnios, infection, still
birth
Screening
- done at every prenatal visit (glucose urine test)
,1 hour Glucose Tolerance Test
• done in the office between 24-28 weeks, oral glucose test advised
> If results abnormal; 3 hour glucose test done
- instruct pt to eat high CHO diet x 3 days then fast overnight (150 g a day)
-screen late in the 1st trimester if theres a history of insulin resistance, age >40, prior stillbirth,
miscarriage or large/malformed infant
10. Assess for 4 cardinal signs of diabetes;
Answer
polydipsia, polyuria, polyphagia, weight loss
11. Management of Diabetes in pregnancy
Answer
Strict regulation of maternal glucose levels is essential to optimal perinatal outcome.
• manage diabetes preconceptually
• insulin is drug of choice during pregnancy
• careful review of oral hypoglycemic agents (some are contraindicated) Instruct on use of
insulin with incidences of N & V???
• dietary control is key
• fasting 70-100
• <120 2 hours after meals
large fluctuations in blood sugar can jeopardize the fetus
****bed time snack most important - protein and complex carbs to prevent hypo- glycemia
during sleep
• encourage compliance to med regimen, prenatal visits, dietary changes, etc
12. How to evaluate fetoplacental functioning?
Answer
Alpha Fetoprotein Screening at 16-20 weeks
, Monitor fetal activity starting at 28 weeks
Assess fetal growth with an ultrasound at 18 and 28 weeks
Fundal height
- macrosomia
- polyhydramnios
- IUGR
Administer nonstress test
- start at 28 weeks, weekly
- twice weekly at 32 weeks
- if nonreactive, the biophysical profile is done
Assessment of fetal maturity
-L/S ratio (lung development) amniocentesis
may be falsely elevated in a diabetic, may need to be as high as 3
Answer
1
13. Anemia during pregnancy
Answer
Pregnancy may exacerbate preexisting anemia
• Fe- deficiency and megaloblastic anemia may be caused by pregnancy
• Hemodilution - physiologic anemia of pregnancy 1000 mg extra Fe needed during pregnancy
Inadequate Hgb < 11
If not supplied by iron supplements, maternal risk for infection and hemorrhage increase, risk of
prematurity, stillborn, hypoxia, and death
Supplement with ferrous sulfate 30-60 mg a day between meals with orange juice
**
14. Bleeding in Pregnancy
Answer
1st and 2nd trimesters;
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