405 5 Flashcards
Spontaneous Abortion is indicated by
bleeding between conception and 20 weeks’ gestation
About 75% of spontaneous abortions occur between
8 and 13 weeks
spontaneous abortions are usually r/t
chromosomal defects
Spontaneous Abortion signs
Bright-red vaginal bleeding
cramping, backache, and pelvic pressure
Spontaneous Abortion: major complication to watch for
shock
Spontaneous Abortion: save all
peripads/linens
Spontaneous Abortion: Start an
IV
Spontaneous Abortion: client should notify nurse of any tissue larger than a
dime
Spontaneous Abortion: client should notify nurse of any discharge that is
foul smelling
Spontaneous Abortion: implement grief protocol if fetus loss occurs: Provide a
memory packet (footprints, bracelet)
Spontaneous Abortion: implement grief protocol if fetus loss occurs: allow family to
see the fetus
Types of Spontaneous Abortion: spotting without cervical changes
Threatened
Tx of Threatened Spontaneous Abortion
bed rest for 24 to 48 hours; no sexual intercourse for 2 weeks
Gestational Trophoblastic Disease is aka
Hydatidiform Mole
Hydatidiform Mole: ____ ___ degenerate into a bunch of clear vesicles in grapelike clusters
Chorionic villi
Hydatidiform Mole predisposes the client to
cancer
Signs of Hydatidiform
bleeding in 1st trimester
Uterus larger than expected for GA
Hydatidiform Mole: Instruct to prevent pregnancy for
1 year
Hydatidiform Mole: Instruct to obtain monthly
serum hCG levels for 1 year
Hydatidiform Mole: If hCG levels don’t diminish, you could develop
cancer
Ectopic Pregnancy sign: possible absence of
normal early pregnancy symptoms
Ectopic Pregnancy sign: Pregnancy test is
positive
3 Ectopic Pregnancy signs:
- Missed period
- Full feeling in lower abd
- Lower quadrant tenderness
Ectopic Pregnancy complication: Acute rupture: signs
Abd mass sharp pain Fainting Shock Shoulder pain
Ectopic Pregnancy: perform gentle
palpation and percussion
Ectopic Pregnancy: prepare client for abdominal
ultrasound
Ectopic Pregnancy: prepare client for possible
laparotomy
Ectopic Pregnancy: type and crossmatch client for
2 units packed RBCs
Suspect ectopic pregnancy in any woman
of childbearing age who comes to the hospital with abd pain
Abruptio Placentae
the placenta prematurely detaches from the uterus
Placenta Previa
the placenta attaches to the wrong part of the uterus (the lower part)
Placenta Previa is associated with
previous uterine scars, surgery, and fibroid tumors
Abruptio Placentae abd
rigid
Placenta Previa uterus feels
soft
Abruptio Placentae FHR
abnormal
Placenta Previa FHR
normal
Abruptio Placentae: First intervention
bed rest
No vaginal/rectal, abd manipulation
Placenta Previa: First intervention
Extended bed rest until the fetal lungs are mature, then delivery
No vaginal/rectal, abd manipulation
Abruptio Placentae: watch for signs of DIC which are
bleeding/bruising anywhere
decreased lab values (platelets, PT, fibrino)
Abruptio Placentae: prepare for emergency
C section
Tetracycline and pregnancy
contraindicated because it darkens the baby’s teeth
Toxoplasmosis is usually r/t
cats
Maybe the biggest factor in having a successful teen pregnancy
nutrition
Preterm Labor definition
labor between 20 and 37 weeks
Preterm Labor risk factor: Infection, especially
UTI
Preterm Labor psychosocial risk factor:
any kind of stress
warning signs of preterm labor: Uterine contractions every
10 minutes or more often
warning signs of preterm labor: more than __ contractions in an hour
5
Preterm Labor: Teach need for bed rest with fetus off of the cervix (e.g., no ___ or ____).
sitting or kneeling
Preterm Labor: to increase uterine perfusion position side-lying and
elevation of feet
Preterm Labor: during labor, teach to empty bladder every
2 hours
Preterm Labor: medication that’s used because it decreases uterine activity through relaxation of smooth muscle
Magnesium sulfate
Gestational hypertension: There is no
proteinuria
Gestational hypertension: BP elevation occurs for the first time after
midpregnancy
Transient hypertension definition
It resolves by 12 weeks after birth
Preeclampsia usually occurs after
week 20
Preeclampsia involves gestational hypertension plus
proteinuria
HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets
Although not technically classified as a separate hypertensive disorder of pregnancy, HELLP syndrome is a variant of severe
preeclampsia
Eclampsia
Seizures in a woman with preeclampsia
magnesium sulfate antidote
calcium gluconate
the major side effect of tocolytic drugs
tachycardia
tocolytic definition
drug that suppresses premature labor
Chronic hypertension
Hypertension has been observed before pregnancy or is diagnosed before the 20th week of gestation
Preeclampsia is characterized by a BP greater than
140/90
When does Preeclampsia usually develop
during the last 10 weeks or up to 48 hours post delivery
Preeclampsia occurs predominantly in
primigravida and in multigravida if experienced as a primigravida
preeclampsia patho: Generalized
vasoconstriction
preeclampsia patho: involves the loss of
plasma protein into the interstitial spaces
(fluid is drawn into the extravascular spaces, which
results in hypOvolemia)
preeclampsia: there is decreased perfusion because of the
hypOvolemia
preeclampsia risk factor: Poor ____ intake
protein
preeclampsia assessment: how will they look at first glance
edema of the face and fingers
preeclampsia assessment: weight
gaining more than 2 pounds a week
HELLP syndrome: Many women are ____ and do not have ____
normotensive
proteinuria
Even if HTN is absent, women with HELLP syndrome should be treated prophylactically with
magnesium sulfate
The chances that someone with HELLP will get it again in another pregnancy
high
Antepartum Preeclampsia care: Home management
Inform client that absolute bed rest with bathroom privileges is necessary
Antepartum Preeclampsia care: client should report weight gain of
more than 2 lbs
Antepartum Preeclampsia care: at home the client should test herself for
proteinuria
Antepartum Preeclampsia care: diet
high protein and low salt
Antepartum Preeclampsia care: environment should be
quiet and dim
Antepartum Preeclampsia care: Check for _____ under BP cuff
Petechiae
Intrapartum Preeclampsia care: Keep nurse-to-client ratio at
1:1
Intrapartum Preeclampsia care: activity level/position
absolute bed rest, side-lying and with
side rails up.
Intrapartum Preeclampsia care: Check urine for protein every
hour
Intrapartum Preeclampsia care: Check DTR every
hour
Intrapartum Preeclampsia care: administer
magnesium sulfate
Intrapartum Preeclampsia care: If convulsions or seizures do occur: Do not attempt to
insert something in the mouth
The 2 main goals for preeclampsia is
maintain perfusion to the uterus and prevent seizures
Preeclampsia care: antiHTN drugs are rarely used, but if they are the drug of choice is
hydralazine
Preeclampsia care: antiHTN drugs are rarely used, but if they are it’s because the diastolic BP was above
110
Preeclampsia: although delivery is said to be the “cure” the client can still
seize up to 48 hours after