Pregnancy related-complications Chapter 25

  1. Spontaneous abortion is a leading cause of pregnancy loss.  Treatment focuses on preventing complications, such as hypovolemic shock and infection, providing emotiona support for grieving
  2. The incidence of ectopic pregnancy in the United states is increasing as a result of pelvic inflammation associated with sexually transmitted diseases.  The goals of therapeutic managment are to prevent severe hemorrhage and to preserve the fallopian tube so that future fertility is retained.
  3. Managment of hydatidiform mole involves two phases:
    1) evacuation of the molar pregnancy 

    2) regular follow up for 1 year to detect malignant changes
  4. A woman with placenta previa typically presents with painless vaginal bleeding during the last half of pregnancy.  Bleeinf from abruptiol placentae may be visible or concealed and is less likely to be accompanied by pain, uterine tenderness and uterine hyperactivity
  5. DIC is a life-threating complication of missed abortion, abruptio placentae and preeclampsia in chich procoagulation and anticoagulation factors are simultaneously acitvated.
  6. The goals of managment for HEG are to prevent dehydration, malnutrition, and electrolyte imbalance.  Emotional support is a most important therapy and a responsibility of nurses
  7. Generalized vasospasm, which occurs with preeclampsia decreases circulation to all organs of the body including the placenta.  Major maternal organs affected include the liver kidneys and brain.
  8. The treatment of preeclampsia includes bed rest, reducing environmental stimuli, and administering anticonvulsants.
  9. Magnesium sulfate is used to prevent seizures in preeclampsia.  Its most serious adverse effect is central nervous system depression, which includes depression of the respiratroy center.  Hyporeflexia precedes respirartory depression.
  10. Nurses monitor the woman with preeclampsia to determine the effectiveness of medical therapy and to indentify signs that the condition is worsening, such as greater hyperreflexia.  Nurses aslso control external stimuli and initiate measures to protect the woman in case of eclamptic seizures.
  11. Woman who have chronic hypertension are at increased risk for preeclampsia and should be monitored closely for proteinuria and generalized edema.  Antihypertensive medication should be continued or inititated if diastolic blood pressure is consistently higher that 100 mm Hg.
  12. Rh incompatibility can occur when an Rh-negative woman conceives a child who is Rh-positive.  Maternal antibodies may then develop after exposure to fetal Rh-positive red blood cells in subsequent pregnancies.  Administration of RhoGam prevents production of anti-Rh antibodies, thus preventing destructin of Rh-positive red blood cells in susequent pregnancies.
  13. ABO incompatibility usually occurs when the mother has type O blood and has naturally occurring anti-A and anti-B antibodies , which cause hemolysis if the fetal blood is not type O. ABO incompatibility may result in hyperbilirubinemia of the infant, but it usually is a mild conditon.
  14. encircling the cervix with sutures
  15. Bilirubin accumulation within the brain that may cause damage.
  16. Degeneration of a fetus retained in the uerus after death
  17. Define spontaneous abortion?
    Termination of a pregnancy without action taken by the woman or any other person.
  18. Describe altered laboratory studies seen in desseminated intravascular coagulopaty (DIC)
    Fibrinogen and platelets - decreases 

    Prothrombin and partial thromboplastin time- Prolonged

    fibrin degradation products - increased
  19. Write a simply worded response that you might use if a woman expresses the feeling that she did something to cause her spontaneous abortion?
    The nurse can explain that the most spontaneous abortions occur because of factors or abnormalities that could not be avoided.  In addition, allow the patient the opportunity to express her feelings.
  20. WHat is the possible signigicance of sudden shoulder pain during early pregnancy?
    Abrupt onset of shoulder pain may occur with a ruptured ectopic pregnancy because blood accumulated in the abdomen irritates the diaphragm
  21. What teaching is needed for the woman having methotrexate therapy for an early ectopic pregnancy?
    Explain the side effects such as N/V. Teach the woman to refrain from drinking alchohol ingesting vitamins containing folic acid or having sexual intercourse until human chorionic gonadotropin (hCG) is not detectable in the serum (usually 2 to 4 weeks)
  22. The typical signs and symptoms of a hydatidiform mole?
    • Elevated hCG vaginal bleeding that varies in amount and color uterine enlargement greater than expected for the gestation 
    • nondetectable fetal heart activity 
    • excessive N/V early onset of pregnancy-induced hypertension.
  23. What is the relationship beween hydatidiform mole and cancer? What precautions related to cancer detection are taken after evacuation of the mole?
    Most molar tissue is benign but choriocarcinoma is a posibility . Serum hCG will be evaluated every 1 to 2 weeks.  Pregnancy must be avoided until normal prepregnancy levels of hCG are attained.
  24. List nursing teaching associated with home care when a woman has placenta previa?
    To the woman and her family should be taught to assess the vaginal discharge, fetal movement counts and uterine activity. SHe should be given guidelines for what to report. Curtailment of sexual intercourse should be discussed.
  25. WHat is the relationship between cocaine use and abruptio placentae?
    Cocaine is a vasoconstrictor including constriction of the uterine endometrial arteries which leads to premature placental separation.
  26. Why is the amount of external bleeding in abruptio placentae not a reliable indicator of the true amount of blood loss.
    Much or all the blood may be trapped by the placenta which may remain attached at the edges.
  27. Describe how generalized vasospasm of preeclampsia affects this organ and how these effects are manifested? Kidneys
    Reduced blood flow causes a reduced glomerular filtration rate which causes a rise in blood urea nitrogen (BUN) creatinine and uric acid.  Glomerular damage resuting from reduced perfusion allows protein to leak across the glomerular membrane resulting in intertial fluid accumulation hypovolemia and increased blood viscosity and hematocrit  (hemoconcentration) Angiotensis II and aldostreone are secreted in response to hypovolemia further increasing the blood pressure.
  28. Describe how generalized vasospasm of preeclampsia affects this organ and how these effects are manifested? Liver
    Reduced perfusion decreases liver function.  Hepatic edema and subcapsular hemorrhage may occur.  Serum may have elevated liver enzymes
  29. Describe how generalized vasospasm of preeclampsia affects this organ and how these effects are manifested? Brain
    Vasoconstriction leads to pressure-induced rupture of small capillaries resulting in small cerebral hemorrhages.  Symptoms such as headache and visual distubances may result.
  30. Describe how generalized vasospasm of preeclampsia affects this organ and how these effects are manifested? Lungs
    Reduced osmotic pressure may result in pulmonary edema
  31. Describe how generalized vasospasm of preeclampsia affects this organ and how these effects are manifested? Placenta
    Reduced perfusion may cause infarctions or abruptio placentae. The risk of DIC is also higher.  The fetus may have growth restriction and persistent hypoxemia.
  32. What is the primary difference between the expected edema of pregnancy and that of preeclampsia?
    Edema of preeclampsia typically occurs above the waist face and fingers.  A sudden weight gain often precedes visible edema.
  33. What is the significance of epigastric pain in a woman with preeclampsia?
    Epigastric pain occurs with liver capsule distention, which often heralds an imminent convulsion
  34. List signs of magnesium toxicity?
    Central nervous system depression results in diminished deep tendon reflexes and resp depression, reduced urinary output can cause magnesium to accumulate to unsafe levels.
  35. What is the antidote for magnesium toxicity?
    Calcium gluconate
  36. What feature distinguishes chronic hypertension from pregnancy-induced hypertension?
    Chronic hypertension is present befor 20 weeks of gestation
  37. What is the primary distinction between threatened and inevitable abortion?
    Rupture of membranes
  38. A woman is admitted to the emergency department with a possible ectopic pregnancy. whats the sign/ symptoms that should be immediately reported to her physician?
    pulse increase from 78 to 100 bpm
  39. When caring for the woman who had a hydatidiform mole evacuated the clinic nurse should primarly
    reinforce the need to delay a new pregnancy for 1 year.
  40. The woman who is receiving methotrexate for an ectopic pregnancy should be cautioned to avoid?
    Taking vitamins with folic acid
  41. A woman who is 34 weeks pregnant is admitted with contractions every 2 min lasting 60 seconds and a high uterine resting tone.  She says she had some vaginal bleeding at home and there is a small amount of blood on her perineal pad.  The priority action of the nurse is to?
    Evaluate the maternal and fetal circulation and oxygenation
  42. Nursing teaching for the woman who has hyperemesis gravidarum should include?
    Eating simple foods such as bread and fruits
  43. The nurse makes the following assessment on a woman who is receiving intravenous magnesium sulfate: FHR 148 to 158 bpm, pulse 88 bpm, resp 10 breaths/min, blood pressure 158/96 mm Hg. the priortiy nursing action is to?
    Stop the magnesium infusion
  44. When providing intrapartal care for the woman with severe preeclampsia priority nursing care is to?
    Promote placental blood flow and prevent maternal injury
  45. Clonus indicates that the?
    central nervous system is very irritable
  46. THe feature that distinguishes preeclampsia from eclampsia is the?
    onset of convulsions
  47. Which woman should receive Rho(D) immune globulin after birth?
    • Rh-negative mother:
    • Rh-positive infant,
    • negative direct coombs test.
  48. A woman arrives in the emergency department with abrupt sharp right sided lower quadrant abdominal pain and bright red vaginal spotting. SHe has missed one menstural cycle.  She tells teh nurse that she cannot be pregnant because she has been using and intrauterine device.  the Nurse should suspect which of the following?
    Ectopic pregnancy
  49. Signs and symptoms of an ectopic pregnancy include unilateral lower quadrant abdominal pain with or without bleeding.  A missed aboriton occurs when products of conception are retained and there is a brownish discharge. Severe preeclampsia does not have vaginal bleeding unless initiated by worsening complications and presents with an epigastric right upper quadrant pain. Hydatidiform mole causes dark brown bleeding in the second trimester and is not generally accompanied by abdominal pain
  50. A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation.  The client reports continued N/V and scant prune colored discharge.  she has experienced no weight loss and has a fundal height larger than expected for the duration of pregnancy. WHich of the following complications should the nurse expect?
    hydatidiform mole
  51. A nurse is providing care for a client who is diagnosed with a marginal abruptio placenta. The nurse is aware that which of the following findings are risk factors for developing the condition.
    Maternal hypertension

    Blunt abdominal trauma

    Cigarette smoking
  52. Maternal hypertension, blunt abdominal trauma, cocaine abuse, and cigarette smoking are risk factors for abruption placenta.  Maternal age is not an associated risk for this condition.  However, it is a risk factor for placenta previa
  53. A nurse is providing care for a client who is at 32 weeks gestation and is diagnosed with placenta previa. The nurse notes that the client is actively bleeding.  Which of the following medications should the nurse anticipate that the primary care provider will prescribe?
    Betamethasone (Celestone)
  54. Corticosteroids (Betamethasone ) will be prescribed for fetal lung maturation is delivery of the fetus is anticipated (cesarean birth).  Indocin and terbuatline are used to treat preterm labor.  Methergine is used to treat postpartum hemorrhage
  55. A client presents to labor and delivery with stabbing abdominal pain, rigid abdomen and heavy, bright red bleeding.  The nurse is aware that these findings are associated with which of the following?
    Abruptio placenta
  56. Abruptio placenta is the sudden onset of intense localized uterine pain with bright red vaginal bleeding.  An abdomen that is both rigid and tender is also a common assessment finding.  Placenta previa and vasa previa are conditions with painless vaginal bleeding.  A threatened abortion may have slight abdominal cramping with spotting to moderte vaginal bleeding.
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Pregnancy related-complications Chapter 25
Pregnancy related-complications Chapter 25 SPC nursing