Childbearing - Maternal Complications

Question 1

Nursing plan/implementation for spontaneous abortion

Answer 1

Monitor VS
Monitor for bleeding, cramping, pain
Monitor hydration status, electrolyte balance
Administer Rhogram if needed (pos fetus, neg mother)
save all tissues
teach purpose of bedrest
emotional support

Question 2

Ectopic pregnancy

Answer 2

fertilized egg implants outside uterus  
could rupture - shock from blood loss
assess: - unilateral LQ pain
rigid tender abdomen
Low Hct, hCG
bleeding

Question 3

Pregnancy Induced Hypertension (PIH). Predisposing factors

Answer 3

Large fetus
Older than 35; younger than 18
Primagravada
multiple fetuses
poor nutrition
hx of diabetes, renal or vascular disease
family hx

Question 4

Mild preeclampsia

Answer 4

Begins past 20th week
BP 140/90 or increease of 30/15
1+ to 2+ proteinuria
well balanced diet
daily weight

Question 5

Severe preeclampsia

Answer 5

BP 150-160/100-110
3+ to 4+ proteinuria
headache, epigastric pain, extreme irritability, suden onset generalized edema, hemorrhage and pulm edema
hyperreflexia
HELLP: Hemolysis, Elevated Liver enzymes, Low Platelet count

Question 6

Eclampsia - assessment

Answer 6

Hypertension
Proteinuria
Tonic-Clinic generalized seizures, coma

Question 7

Eclampsia - Implementation

Answer 7

Maintain IV line with large bore needle - monitor fluid balance
Minimize stimuli
Have airway and O2 available
Give meds (Mag, apresoline, valium, procardia)
Prepare for possible delivery of fetus
monitor fetal status
type and cross match for blood
Postpartum - monitor VS and watch for seizures

Question 8

Placenta Previa. Definition and assessment

Answer 8

Placenta implants in lower uterine segment. May partially or totally cover uterine opening
Assess: first and second trimester spotting
Third trimester - sudden, bright red, painless

Question 9

Placenta previa - Implementation

Answer 9

Bedrest side-lying or trendelenburg
ultrasound to locate placenta
no vaginal or rectal exams
daily Hgb, Hct
monitor bleeding

Question 10

What is abruptio placentae

Answer 10

premature separation of placenta from uterine wall.
increases with maternal htn and cocaine use
Painful vaginal bleeding. possible fetal distress and contractions
Immediate c section needed

Question 11

Molar pregnancy (Hydatidiform mole)

Answer 11

Over development of tissue that was supposed to develop into the placenta.

• Partial: abnormal placenta and some fetal development
• Complete - no fetus