What are 3 common causes of hemorrhage before 20 weeks gestation?
- 1. abortion
- 2. ectopic pregnancy
- 3. hydatidiform mole
What is a hydatidiform mole?
When the placenta grows but the fetus does not
What is spontaneous abortion?
Loss of nonviable fetus before 20 weeks gestation or of a fetus weighing < 500 g
When does spontaneous abortion occur?
In the first 12 weeks of pregnancy
Incidence of spontaneous abortion increases with
2. parental age
What is a common cause of spontaneous abortion?
1. severe congenital abnormalities
3. endocrine disorders
4. reproductive abnormalities
5. all of the above
all of the above
What are the 4 signs and symptoms of spontaneous abortion?
- vaginal bleeding or spotting
- uterine cramping
- persistant headache
- pelvic pressure
Diagnosis and treatment of spontaneous abortion is?
- 1. ultasound exam
- 2. monitor B-hCG levels
- 3. dilation and vacuum curettage (D&C)
- 4. uterine stimulants
Why monitor B-hCG levels with s/s of a spontaneous abortion?
This is the pregnancy hormone which increases with pregnancy. A low hCG level results in fetal demise.
As a nursing responsibility for spontaneous abortion, why would a nurse monitor for s/s of hypovolemic shock?
Because the BP will decrease as HR and RESP increase
What are the nursing responsibilities for spontaneous abortion?
- 1. Monitor for s/s of hypOvolemic shock
- 2. Administer fluids & blood replacement as ordered
- 3. Teach woman to reduce activity (to decrease bleeding) and curtail sexual intercourse to prevent infection
- 4. Monitor peri pads for amount, color, odor, & tissue discharge
- 5. Offer emotional support
What is disseminated intravascular coagulation?
Disseminated Intravascular Coagulation (DIC) is a complication of a "missed abortion" where clotting factors are decreased and bleeding is increased.
What is s/s and treatment for disseminated intravascular coagulation (DIC) ?
- s/s: hemoraging from D&C, IV site, gums and nosebleed
- tx: delivery of the fetus and placenta, blood transfusions
Name the term for when the fetus dies and remains inside the placenta for a long period of time
What is the term for implantation of a fertilized egg in an area outside the uterus?
What are early s/s of ectopic pregnancy?
- missed period
- abdominal & pelvic pain
- vaginal bleeding
what are late s/s of ectopic pregnancy?
- sudden, deep, severe pelvic pain
- intra-abdominal hemorrhage
- shoulder & neck pain
True or False: the rupture of the fallopian tube due to ectopic pregnancy can cause death, infection and interfere with future pregnancies?
What are the diagnostic tests for an ectopic pregnancy?
- transvaginal ultrasound
- serum tests of B-hCG and progesterone
Why monitor B-hCG and progesterone levels to diagnose an ectopic pregnancy?
lower than normal levels of these hormones indicate an abnormal, nonviable pregnancy
What is the treatment for an ectopic pregnancy?
- administer cytotoxic drugs (interfere with cell reproduction) or perhaps give an antagonist to folic acid (a drug that destroys folic acid).
- perform linear salpingostomy (incision to go into the fallopian tube and remove the fetus)
What is linear salpingostomy ?
incision into the fallopian tube and removal of the fetus
Name 6 nursing interventions for ectopic pregnancy?
- 1. prevent or identify hypovolemic shock
- 2. control pain
- 3. explain side effects of cytotoxic drugs (N/V)
- 4. instruct woman to report pelvice, neck or shoulder pain, dizziness, increased vaginal bleeding
- 5. instruct to avoid sexual intercourse until B-hCG levels disappear
- 6. offer psychological support
What is abnormal development of the peripheral cells that attach the fertilized ovum to the uterine wall which results in development of placenta and not fetus?
true or false: hydatidiform mole is life threatening
true. PE and cancerous cells may develop! It is monitored for a year after.
What is a s/s for hydatidiform mole?
The height of fundus may be higher than usual and happens quickly
true or false: women at risk for molar pregnancy are young and no history of molar pregnancies
false. women at risk are older and those with a h/o previous molar pregnancies
How is molar pregnancy diagnosed?
B. ultrasound shows vesicles with no fetal gestation or HR
what are s/s of molar pregnancy?
- 1. vaginal belleding
- 2. a uterus larger than normal
- 3. excessive n/v
- 4. preeclampsia
what is treatment for molar pregnancy?
evacuation of the mole and follow-up to detect malignant changes
What are the two major causes of hemorrhage occurring after 20 weeks of pregnancy?
- 1. placenta previa
- 2. abruptio placenta
The condition in which the placenta is implanted in the lower uterus is called ____________
placenta previa is common in (choose all that apply)
1. younger women
2. older woman
6. h/o C/S or Suction curettage
7. asians & africans
8. smokers & cocaine users
- older women
- h/o C/S or suction curettage
- asians & africans
- smokers & cocaine users
What are the s/s for placenta previa?
classic sign is sudden onset of bright red bleeding and painless after 20 weeks gestation
what is placenta previa?
condition in which the placenta is implanted in the lower uterus, blocking the cervix, resulting in c-section
What is the treatment at home if no active bleeding for placenta previa?
- bed rest
- teach woman to monitor vaginal bleeding
- count fetal movements daily
- assess uterine activity daily
- omit sexual intercourse
What is treatment in the hospital for placenta previa?
- monitor bleeding & fetal heart activity
- bed rest in lateral position (allows for better oxygenation through placenta) with oxygen readily available
- observer for s/s of preterm labor or ROM (rupture of membranes)
what are s/s of preterm labor ?
- vaginal bleeding
- rupture of membrane, leaking of amniotic fluid
What is the separation of a normally implanted placenta before the fetus is born?
what causes abruptio placenta?
bleeding and formation of a hematoma on the maternal side of the placenta
Name 3 major complications of abruptio placenta
- 1. hemorrhage
- 2. hypovolemic shock
- 3. clotting abnormalities
Is cocaine use and smoking a risk factor for abruptio placenta?
true or false, physical abuse is common in abruptio placenta
true, as is any abdominal trauma
A short umbilical cord is a risk factor in __________
What are 4 classic s/s for abruptio placenta?
- classic s/s is dark red vaginal bleeding
- dull abdominal or low back pain
- frequent low intensity contractions with high uterine resting tone
- localized uterine tenderness
what are 3 other s/s for abruptio placenta?
- 1. port wine color of amniotic fluid
- 2. hard, boardlike abdomen
- 3. increased fundal height
what is treatment for abruptio placenta?
hospitalization to monitor maternal and fetal condition
stable condition: bed rest in lateral position with HOB flat and admin of tocolytic drugs and IV fluids
unstable condition: immediate delivery of the fetus
What is major concern in abruptio placenta?
fetal hypoxia and excessive bleeding
what are tocolytic drugs for?
stop and/or decrease uterine activity
Name the term for uncontrolled vomiting
what is treatment for hyperemesis gravidarum?
- IV fluid and electrolyte replacement
- admin of antiemetics
true or false... the cause of hyperemesis is unknown
What are the nursing considerations for the woman with hyperemesis gravidarum?
- 1. monitor i/o
- 2. describe character of emesis, urine, and bowel movement (hard stools, decreased output, = s/s dehydration)
- 3. monitor urine specific gravity and keytones - s/b zero normally
- 4. assess skin turgor and mucous membranes
- 5. monitor daily weight
- 6. offer small, frequent meals
List 3 hypertensive disorders during pregnancy
- 1. preeclampsia
- 2. eclampsia
- 3. gestational hypertension
- eclampsia=the woman has one or more seizures
list classic s/s of preeclampsia
- 1. hypERtension
- 2. proteinuria
- 3. vascular constrictiona nd narrowing of the small arteries is seend when examining the retina
- brisk deep tendon reflexes
true or false, the cause of preeclampsia is unknown
preeclampsia is a major cause of
1. down syndrome
2. IUGR (intra uterine growth restriction)
3. perinatal death
4. IUGR and perinatal death
What is not a risk factor for preeclampsia?
A. anemia is not a risk factor for preeclampsia
true or false... early and regular prenatal evaluation of BP, weight gain and urinary protein
- (3 main checks: BP, urine and reflexes)
what is the homecare therapeutic management of mild preeclampsia?
- limit womans activity - stop working
- monitor fetal activity & growth - kickcounts
- monitor BP
- monitor daily weight
- monitor urinary protein levels (dipsticks)
- maintain regular diet (no salt restrictions)
- monitor quantity of amniotic fluid (done in the office)
true of false... a complication of preeclampsia is seizures
true or false... the woman feels pain with preeclampsia
false, the woman usually feels great
With mild preeclampsia, the woman should lay down for 1.5 hours in what position?
What is the management for severe preeclampsia?
- Hospital care
- maintain bed rest & quiet environment (limit visitors, dim light)
- administer meds
- steroids to accelerate fetal lung growth and maturity
a common med to accelerate fetal lung maturity is
celestone, aka betamethasone
Describe nursing assessment for the hospitalized preeclampsia woman
- assess daily weights
- monitor frequent vitals
- assess lung sounds for pulmonary edema
- measure urinary output - verify no olyguria
- monitor fetal HR and activity
- check for protein in the urine
- check brachial, radial and patellar reflexes
- monitor symptoms of headache, visual disturbances, epigastric pain, n/v
- watch for signs of magnesium toxicity (olyguria, lower bp, no deep tendon reflexes)
What are s/s of magnesium toxicity?
- lower BP
- no deep tendon reflexes
what are classic signs of an impending seizure?
- visual disturbances
- epigastric pain
interventions for the preeclampsia patient
- reduce external stimuli
- monitor for signs of impending seizures
- prevent injury during seizure
- protect woman and fetus during convulsions
Describe seizure precautions
- pad bedside rails
- make sure O2 is available
- don't hold pt down
- don't use tongue blad
- turn on side and protect
More nursing care for the woman with preeclampsia
- provide info and support for the family
- monitor and respond to s/s of magnesium toxicity (an anticonvulsant medication)
Why monitor for magnesium toxicity for a preeclampsia patient?
because magnesium is an anticonvulsant medication often given
What are s/s for magnesium toxicity?
- decreased urinary output (olyguria)
- no deep tendon reflexes
- low blood pressure (hypotension)
what are tonic-clonic movements?
muscle spasms during a seizure
what would you see during a seizure?
- facial twitching
- rigidity of the body
- tonic-clonic movements
- cessation of breathing
would you excpect to administer IV anticonvulsants and diuretics as ordered for an eclampsia pt?
true or false... the only cure for eclampsia is delivery of the fetus
why admin diuretics to the eclampsia pt?
to prevent pulmonary edema, but auscultate lung sounds q1 hour and monitor I/O and O2 sats
what is the name of the substance that possesses the unique configurations enabling the immune system to recognize it as foreign?
antigen (think anti/genocide = both are BAD)
what is the substance that neutralizes and destroys the invading antigen?
what blood test checks for antibodies in the blood?
what is an antibody titer?
a measure of the amount of antibody against a particular antigen present in the blood. a rising titer indicates that the disease is present and the body is reacting to the antigen
what does a rising titer mean?
indicates that the disease is present and the body is reacting to the antigen
What is it when the body is made susceptible to an antigen?
Define Rh negative
when the Rh antigen is not in the RBC's
describe RH incompatibility
- The mother is Rh- and the fetus is Rh+
- The mothers RBC's do not recognize the blood of the fetus because of the Rh factor that the fetus has but the mother does not
The mother's RBC's say "oh this blood is a foreign substance. let's attack it!"
- 15% of white population, less in others
- only the fetus is at risk
What med is given for rh incompatibility?
What does Rhogam do?
Rhogam prevents the mother from developing Rh antibodies, but it does not help if she has already developed them.
What is an indirect coombs test?
a test at 28 weeks with blood drawn from the mothers arm to see if she is developing antibodies for the Rh+ factor
true of false... if the indirect coombs test is negative, there is not need for rhogam
true, a negative coombs test means the mother has already developed antibodies. if there is a high level of antibodies, then rhogam will do no good
true or false... if there is a low level of antibodies in the mothers blood, rhogam will still work
true, but only for low levels. not for high.
If the baby is Rh+ and the mother is Rh- then rhogam should be given to the mother within ____ hours postpartum
Describe ABO compatibility
- expectant mother is blood type O, fetus is blood type A, B, or AB
- A, B and AB blood types contain an antigen
- type O blood develops anti-A or anti-B antibodies known as IgG or IgM
- IgG crosses placenta and causes hemolysis of the fetal RBC's
What causes diabetes Mellitus?
DM is caused by decreased insulin secretion by the pancrease resulting in hyperglycemia
what are classic s/s for DM ?
thirst and dehydraton
true or false... women with Diabetes Mellitus have a harder time conceiving and carrying to term
true, and their babies are usually smaller in size too
true or false... urinary tract infections are common with DM resulting in preterm labor
Gestational diabetes mellitus is:
B. the onset of glucose intolerance during pregnancy after the first trimester
Name the risk factors for gestational diabetes
- + family history
- previous h/o GDM
- maternal age older than 25
- African, hispanic, American-Indian, Asian, Pacific Islander
what is the glucose challenge test (GCT)?
- this is an oral glucose tolerance test to screen for Gestational Diabetes Mellitus (GDM)
- if the 1 hour test is above 140mg/dl then it requires another 3 hour test
Diagnosis of GDM is made if the OGTT (oral glucose tolerance test) is > _____ mg/dl
What is the term for an abnormally large body (> 4000g or 8lbs 13 oz)?
What are the fetal affects of GDM?
- hypoglycemia (< 40mg/dl)
- hypocalcemia (< 7.6 mg/dl)
- respiratory distress
Define labor dystocia
What are the maternal affects of GDM?
- labor dystocia; csection; uterine atony with hemorrhage
- trauma to birth canal
true or false... eliminating concentrated sweets, limiting carbs and a diet of 3 meals/3 snacks is a therapeutic management of GDB
true, as well as exercise, glucose level monitoring and fetal surveillance
A sample assessment of the woman with GDM...
- determine knowledge of diagnosis, self-testing, diet, potential complications, fetal surveillance
- nsg diagnosis: "risk for or actual ineffective health maintenance"
- nsg goal: the woman will demonstrate competence in self-testing & insulin injection, follow appropriate diet, describe s/s of complications, etc.
nursing care of the woman with GDM
- 1. teach self-monitoring of blood glucose
- 2. teach insulin self-administration
- 3. review dietary management
- 4. explain s/s of hypoglycemia and hyperglycemia
- 5. explain procedures, test, and plan of care
- 6. praise when diabetic control is maintained