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RNSG 1251 UNIT 4 > ch. 28: hemorrhage in pregnancy > Flashcards

ch. 28: hemorrhage in pregnancy Flashcards

1
Q

What is a threatened miscarriage?

A

cervical opening CLOSED with slight vagina bleeding and mild uterine cramping

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2
Q

What is the management for a threatened miscarriage?

A

-bedrest
-pelvic rest
-monitor hCG levels (↑ is good sign)

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3
Q

What is the medical management for inevitable/incomplete miscarriage?

A

-prostaglandin (misoprostol, Cytotec) may be admin PO, into amniotic sac, or vag sup to augment or induce uterine ctxs to expel remaining tissue

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4
Q

What is the surgical management for a miscarriage?

A

-dilation and curettage (D&C) to dilate and clean uterus

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5
Q

What is the discharge teaching after a miscarriage?

A

-clean peri area after each bm/void and change peri pad
-avoid tub for 2 weeks
-total pelvic rest for 2 weeks
-report foul smelling discharge or elevaterd temp
-eat foods HIGH in IRON and PROTEIN
-grief support

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6
Q

What is an incompetent cervix?

A

painless passive dilation of cervix in absence of uterine ctxs

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7
Q

What is the surgical treatment for an incompetent cervix?

A

cerclage: heavy ligature placed around cervix to strengthen it and prevent premature cervical dialtion

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8
Q

When must a cerclage be removed?

A

before onset of labor

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9
Q

What are symptoms of en ECTOPIC pregnancy?

A

-abd pain (dull to colicky to sharp then stabbing)
-delayed menses
-abnormal vag bleeding (spotting)
-s/s usually 6 to 8 wekks after last normal period

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10
Q

What s/s require assessment for ectopic pregnancy?

A

every women w/
-abd pain (knife like in lower abd quad)
-vag spotting
-positive preg test

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11
Q

What is a symptom of a ruptured ectopic pregnancy?

A

referred shoulder pain occurs bc of diaphragmatic irritation caused by blood in peritoneal cavity

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12
Q

What tests are done to dx an ectopic pregnancy?

A

-hormones: hCG ↑, progesterone ↓
-transvag ultrasound

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13
Q

What is the medical management for an ectopic pregnancy?

A

methotrexate: inhibits rapid cell division and prevents fallopian tube rupture

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14
Q

What is the surgical management for an ectopic pregnancy?

A

-after confirming location:
-laparoscopic removal
OR
-salpingostomy or salpingectomy (if tubal location)

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15
Q

What is the criteria for methotrexate?

A

-hemodynamically stable
-normal/liver kidney
-< 3.5 cm mass
-NOT ruptured
-no fetal cardiac
-B-hCG <1000
-able to comply w/ guidelines

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16
Q

What are s/s of a MOLAR PREGNANCY?

A

-uterus expands faster and reaches landmarks earlier
-morning sickness
-dark brown vag bleeding (can also e bright red, scant, or profuse)
-discharge w/ grapelike vesicles
-earlier signs of PIH

17
Q

What is the surgical treatment for a molar pregnancy?

A

D&C or suction
-give Rhogam to Rh- moms postop

18
Q

Molar pregnancies have a high association with the development of _____

A

carcinogenic development (choriocarcinoma)

19
Q

How long is it recommended to wait to get pregnant after a molar pregnancy?

A

at least 1yr

20
Q

What are women at high risk of developing after a molar pregnancy?

A

htn and hyperthyroidism

21
Q

What is placenta previa?

A

placenta abnormally implants in lower seg of uterus, near or over cervical os instead of latching to fundus

22
Q

What does placenta previa result in?

A

bleeding during 3rd trimester as cervix begins to dilate and efface

23
Q

What are risk factors for placenta previa?

A

-hx of placenta previa
-uterine scarring
-mom > 35y/o
-multifetal
-multiple gest or closely spaced perg
-previous c section
-smoking/cocaine
-higher altitudes, male fetus, Asian

24
Q

What dx tests are done for placenta previa?

A

-transabdominal or transvaginal US for placenta location
-fetal monitoring
-CBC
-ABO blood typing and Rh factor
-coagulation

25
Q

What therapeutic procedure is done for placenta previa?

A

emergency c-section

26
Q

What are the s/s of placental previa?

A

1)painless, bright red vag bleeding that increases as cervix dilates
2) soft, relaxed, nontender uterus w/ normal tone
3)fundal height may be greater than expected for gest age
4) palpable placenta via vag exam

27
Q

What are the nursing interventions if pt is not term and not in labor (placenta previa)?

A

-bedrest
-pelvic rest
-large bore IV w/ IVF
-corticosteroids for lung maturity
-may need blood replacement
-continuous fetal monitoring

28
Q

What are the nursing interventions if pt is at term or in labor (placenta previa)?

A

-prepare for C-SECTION
-have blood replacement products ready

29
Q

What is placenta abruption?

A

premature separation of the placenta from uterus, can be partial or complete detachment

30
Q

When does placenta abruption occur?

A

after 20 wks

31
Q

What is the leading cause of maternal death?

A

placenta abruption

32
Q

What are risk factors for placenta abruption?

A

-maternal htn
-blunt external trauma
-cocaine abuse
-hx
-smoking
-PROM
-multifetal
-coagulation defects

33
Q

How is placenta abruption dx?

A

-abd pain, uterine tenderness, ctx
-higher fundus
-elevated uterine resting tone
-abnormal FHR pattern
-coagulopathy may be present
-may develop sym of rigid board like abd & hypovolemic shock

34
Q

What symptoms would make the nurse highly suspect placenta abruption?

A

sudden onset of intense, usually localized uterine pain, w/ o w/o vag bleeding

35
Q

What is the nursing management for a stable pt w/ only mild separation & 20-34 weeks gest?

A

-bed rest
-pelvic rest
-corticosteroids for fetal lung maturity
-close monitoring of mom and fetus
-reg NSTs & BPP

36
Q

What is the active management for placenta abruption?

A

IMMEDIATE BIRTH if preg at term or bleeding is mod to severe
-vag delivery is preferable (always be ready for emergency c-section)
-monitoring
-large bore IVs, foley cath for strict I&O
-H&H, clotting
-type & cross w/ blood products

37
Q

What is DIC?

A

-diffuse clotting that causes widespread external bleedin, internal bleeding, or both

38
Q

What are common causes of DIC?

A

-placenta abruption
-HELLP
-amniotic fluid embolus
-PPH
-sepsis
-retained IUFD

39
Q

What is the management for DIC?

A

-hemodynamic monitoring
-fluid replacement
-blood and blood products
-O2
-additional coag and
-hemostatic agents

RNSG 1251 UNIT 4 (6 decks)

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