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OB > ch 28 + 30: hemorrhagic disorders > Flashcards

ch 28 + 30: hemorrhagic disorders Flashcards

1
Q

3 most common reasons for bleeding during early pregnancy

A

-miscarriage (spontaneous abortion)
-incompetent cervix
-ectopic pregnancy

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2
Q

types spontaneous abortions (7)

A

-threatened
-inevitable
-incomplete
-complete
-missed
-septic
recurrent

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3
Q

risks with missed spontaneous abortion

A

-DIC
-infection (leads to septic)

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4
Q

Tx for threatened miscarriage (mom might lose baby)

A

-bed rest 1-2 days
-pelvic rest 2 weeks (“nothing in the vagina”)

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5
Q

Tx inevitable/incomplete miscarriage

A

-allow spontaneous resolution (expectant management, up to 2 weeks)
-meds: prostaglandin (cytotec induces labor)
-suction curettage

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6
Q

Tx missed miscarriage

A

-expectant, meds, or surgical management
-monitor clotting factors (with expectant management)

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7
Q

D&C

A

dilation and curettage

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8
Q

Tx complete miscarriage

A

-no intervention
-as long as adequate uterine contractions after to prevent hemorrhage

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9
Q

Tx septic miscarriage

A

-immediate D&C
-cervical C&S
-Abx therapy
-monitor for septic shock

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10
Q

woman who has had 3+ miscarriages

A

recurrent miscarriage

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11
Q

1 priority with nursing care of miscarriage

A

physiologic stabilization
ASSESS:
-EGA
-type miscarriage
-bleeding
-pain
-emotional status
-VS
-labs (CBC, blood type, indirect coombs)

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12
Q

how often do you do VS with miscarriage

A

q15 mins - 1 hr (depending on severity of situation)

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13
Q

what is identified in type and screen blood test

A

ABO
Rh
major antibodies

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14
Q

what is identified in type and cross blood test

A

minor antibodies
(evaluate pt blood with blood bank sample)

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15
Q

test for Rh antibodies in blood

A

indirect coombs
*negative result = receives RhoGAM

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16
Q

minimum IV gauge for miscarriage stabilization

A

18 G

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17
Q

Interventions for miscarriage stabilization

A

-IV access
-monitor for complications (VS, bleeding, DIC, infection)
-administer RhoGAM if indicated
-manage medical Tx side effects

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18
Q

top 4 nursing priorities with miscarriage

A
  1. physiologic stabilization
  2. pain management
  3. psychosocial-spiritual
  4. discharge teaching
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19
Q

side effects prostaglandins

A

N/V/D
fever

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20
Q

psychosocial spiritual assessment for post-miscarriage

A

-current state
-meaning of loss to pt/family
-religion/spirituality
-support person
-effectiveness of current coping mechanisms

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21
Q

psychosocial spiritual interventions for post- miscarriage

A

-grief protocol
-cry with them
-pray with them
-contact support persons
-therapeutic response/touch
-active listening
-teach/explain
-offer option of seeing/holding fetus
-control environment
-memory packet
-explain grief process and refer to community resources

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22
Q

S+S complications to report to teach pt post-miscarriage

A

-fever (>100.4)
-foul smelling discharge
-bright red bleeding and clots bigger than a dime

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23
Q

discharge teaching post-miscarriage

A

-S+S complications
-peri care
-pelvic rest (two weeks, no tub baths)
-diet: increase iron and protein
-physical, psychosocial, and spiritual recovery
-support group/community resources

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24
Q

-recurrent (3+x) premature dilation of cervix
-passive, painless dilation during 2nd tri
-short cervix (<25 mm)

A

cervical insufficiency (incompetent cervix)

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25
Q

2 options Tx for cervical insufficiency

A

-cerclage (suture)
-progesterone (vaginal suppository, IM, PO)

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26
Q

when is cerclage suture removed

A

-in labor with vaginal bleeding
-36 weeks EGA

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27
Q

S+S to teach pt to report after cerclage

A

-fever
-contractions/back pain
-leakage of fluid
-vaginal bleeding

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28
Q

risk factors ectopic pregnancy (4)

A

-risk of tube obstruction (h/o tubal surgery, h/o of tubal infection STI or PID)
-smoking
-assisted reproductive technologies
-IUD use

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29
Q

classic S+S ectopic pregnancy

A

-abdominal pain
-missed period
-abnormal vaginal bleeding (spotting)
-positive pregnancy test

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30
Q

S+S acute rupture ectopic pregnancy

A

-vaginal bleeding (dark red, brown, “prune juice”)
-lower abdominal/pelvic mass
-sharp pelvic pain
-*referred shoulder pain
-fainting, shock

31
Q

indicates bleeding into abdomen: bruising around belly button

A

cullens sign

32
Q

interventions for ectopic pregnancy

A

-IV access (large bore)
-notify hcp
-explain procedures
-prepare pt for abdominal sonogram
-prepare for laparotomy (pre+post op instruction, conset)
-type and crossmatch

33
Q

med for ectopic pregnancy if rupture has not occurred

A

methotrexate (attacks rapidly providing cells)

34
Q

removal of products of conception from fallopian tube

A

salpingectomy

35
Q

removal of fallopian tube

A

salpingostomy

36
Q

what should you suspect in any woman of childbearing age who presents with sharp unilateral or bilateral abdominal pain

A

ectopic pregnancy (often misdiagnosed as appendicitis)

37
Q

3 causes bleeding in mid to late pregnancy

A

-gestational trophoblastic disease
-placenta previa
-placental abruption

38
Q

“molar pregnancy”

A

gestational trophoblastic disease/
hydatidiform mole

39
Q

S+S gestational trophoblastic disease

A

-increased fundal height (bigger than expected)
-vaginal bleeding (dark or bright red)
-anemia
-S+S preeclampsia prior to 24 weeks (HTN, proteinuria)
-excessive N/V (bc excessive HCG levels)
-abdominal cramping

40
Q

nursing interventions for hydatidiform mole

A

-diagnosed with HCG levels and sonogram (“snow storm pattern”)
-most abort spontaneously
-suction curettage
-RhoGAM prn

41
Q

HESI hint: what is often masked by pregnancy and should be suspected if hCG levels do not diminish (molar pregnancy)

A

choriocarcinoma

42
Q

discharge teaching molar pregnancy

A

-prevent pregnancy for 1 year
-follow up hCG levels for 1 year
-S+S complications to report (fever, bright red bleeding, foul smelling discharge)

43
Q

low implantation of the placenta - complete or marginal (within 1 inch of cervix)

A

placenta previa

44
Q

risk factors placenta previa

A

-previous uterine scars/surgery (C/S)
-uterine fibroids
-advanced maternal age (>35-40 yo)
-multiparity
-h/o suction curettage
-smoking
-multiple gestations
-previous placenta previa

45
Q

1 risk factor for placenta previa

A

uterine scar (C/S)
-greater risk with multiple C/S

46
Q

S+S placenta previa

A

-PAINLESS bright red bleeding 2nd/3rd tri
-*soft, relaxed, nontender uterus
-VS normal until shock
-decreased urinary output
-normal FHR until major detachment
-abnormal fetal position

47
Q

why do you always assume pregnant woman with painless vaginal bleeding at 20+ weeks EGA have a placenta previa until proven otherwise

A

could rupture placenta with SVE

48
Q

Tx placenta previa for 36+ weeks EGA, excessive blood loss, or unstable fetus

A

immediate birth through C/S

49
Q

Tx placenta previa for <36 wk stable mom and fetus (expectant management)

A

-steroids if <34 wks EGA
-fetal and maternal monitoring

50
Q

when could mom with placenta previa be put on home care

A

-<36 wks
-stable mom and fetus
-no bleeding for 48+ hrs
-compliant
-understands risk
-constant access to transportation
-lives close to hospital

51
Q

nursing care: active management of placenta previa

A

-NO VAGINAL EXAMS
-lateral position, bed rest
-VS q15mins
-IV, labs
-continued FHR and UA monitor
-quantify blood loss
-Foley, I&O
-oxygen prn
-monitor for PPH

52
Q

3 types placental abruption

A

-concealed (edges are still attached, forms hematoma)
-partial
-complete

53
Q

risk factors placental abruption

A

-maternal HTN
-high gravity (G5+)
-cocaine
-previous abruption
-blunt external abdominal trauma
-smoking
-malnutrition
-twin gestation
-short umbilical cord

54
Q

S+S placental abruption

A

-dark or bright red vaginal bleeding
-persistant severe abdominal pain
-uterine tenderness
-**rigid abdomen
-contractions with increased resting tone
-FHR abnormalities
-enlarging uterus
-shock out of proportion to blood loss
-coagulopathies (DIC)

55
Q

Tx placental abruption for 36+ wks EGA, excessive blood loss, or unstable fetus

A

-immediate birth: vag or C/S

56
Q

Tx placental abruption for <36 wks EGA stable mom and fetus

A

expectant management
-stay in hospital
-corticosteroids

57
Q

S+S DIC

A

-bleeding gums, nose, injection sites, IV site
-altered clotting studies
-ecchymosis

58
Q

nursing interventions DIC

A

-ensure patent IV
-pad side rails
-notify NICU
-notify hcp

59
Q

normal cardiovascular changes of pregnancy

A

-increased intravascular volume
-decreased systemic vascular resistance (vasodilation and placenta)
-fluctuations in cardiac output during L&D
-intravascular volume changes just after birth

60
Q

common cardiac diseases seen in pregnant women

A

-congenital defect
-valve disease (mitral valve disease, valve prolapse/stenosis due to rheumatic heart disease)
-myocardial disease (higher obesity rates)

61
Q

classifications of cardiac disease in pregnancy and how they affect maternal physical activity

A

-class 1: unrestricted physical activity
-class 2: limited physical activity
-class 3: moderate to marked limitation of activity
-class 4: no activity allowed

62
Q

management of cardiac disease in pregnancy

A

-limit physical activity to remain free of symptoms
-avoid excess weight gain
-prevent anemia (iron and folic acid supplements)
-prevent infections (get flu, DPT, pneumonia vaccines)
-monitor for CHF
-meds: anticoagulants, antidysrhythmics prn, antibiotics

63
Q

can pregnant women receive coumadin for cardiac disease

A

no, teratogenic
heparin instead

64
Q

antepartum teaching for woman with cardiac disease

A

-S+S to report
-need 8-10 hrs sleep
-self admin of heparin prn
-diet plan (increased iron, increased protein, adequate calories)

65
Q

highest risk times antepartum for mom with cardiac disease (2)

A

-28-32 wks (reaches max blood volume)
-3rd stage of labor (placenta delivered, 1000 mL blood shunted back throughout body)

66
Q

nursing care intrapartum for mom with cardiac disease

A

-calm environment
-maintain cardiac perfusion: lateral semifowler position, prevent valsalva, avoid hypoTN, avoid use of stirrups)
-careful management IV fluids to avoid fluid overload
-O2
-pain relief

67
Q

nursing care postpartum for mom with cardiac disease

A

-watch for S+S fluid overload
-tailor care to functional classification
-positioning (head elevated, lateral)
-progress ambulation
-stool softeners
-monitor S+S UTI/infections
-report cardiac decompensation

68
Q

S+S cardiac decompensation

A

-tachycardia
-tachypnea
-dry cough
-rales in bases

69
Q

S+S cardiac disease in newborn

A

-weak cry
-cyanosis (worsens with crying)
-lethargy, hypotonia, flaccidity
-persistent brady/tachycardia
-tachypnea/resp distress
-decreased/absent pulses

70
Q

nursing interventions newborn with cardiac disease

A

-thermoregulation
-no nippling (pacifiers, nursing, stimulation)
-transfer to NICU

71
Q

meds for seizure control that are associated with increased risk fetal anomalies

A

-carbamazepine (tegretol)
-valproate (depakote)

72
Q

fetal anomalies associated with use of antiseizure meds

A

-cleft lip/palate
-congenital heart disease
-NTDs

73
Q

surgical considerations in pregnant women

A

-you have 2 pts
-monitor FHR and UA before, during, and after
-she has altered lab values
-preop: antacids, increased emptying time of stomach
-intraop: positioning (tilted)
-postop: tocolysis to stop Cxs if preterm labor

74
Q

risks that are increased in obese women perinatally

A

-pregnancy associated HTN disorders
-gestational diabetes
-postterm birth
-induction of labor
-C/S and emergency C/S
-thromboembolism
-wound dehiscence and infection

OB (21 decks)

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