Exam 1 Test Map 3 Flashcards
cervix is dilated so INEVITABLE that the contents will come out of the uterus; rupture of membranes (ROM), & passage of products of conception occurs
inevitable miscarriage
expulsion of the fetus with retention of the placenta; retained products of conception (POC); fetus came out, but products of placenta were retained so HUGE risk of bleeding & INFECTION
incomplete miscarriage
no POC retained cervix has already closed after all the fetal tissue was expelled; slight bleeding may occur & milk uterine cramps; NOTHING left inside
complete miscarriage
a pregnancy in which the fetus has died but the products of conception are retained in utero for up to several weeks; fetus died, but not expelled
missed miscarriage
When the door of the uterus is OPEN (the door of the uterus is the cervix)…
there is NOTHING to hold the contents of the uterus IN! So, the CERVIX holds in the contents of the uterus!
termination of pregnancy before 20 weeks; fetus is <500 grams
abortion
types of abortions
Abortion can be elective (social/therapeutic reasons) or Spontaneous (natural causes)
a pregnancy that ends as a result of natural causes before 20 weeks of gestation
Miscarriage (spontaneous abortion
3 or more spontaneous pregnancy losses before 20 weeks successively
Habitual/Recurrent
the cervix will open for no reason & this can cause habitual abortion so we can put a suture around the cervix to help it not open
cervical incompetence (aka cervical insufficiency)
infection
septic
: A benign degenerative process of the placenta; the chorionic villi degenerate into edematous, cystic, avascular, transparent vesicles that hang in grape-like clusters; the chromosomes were incorrect to make a baby-there were some components of DNA that met, but there was no baby; placenta grows & overgrows!
molar pregnancy
Looks like hanging grapes in clusters on sonogram-NO fetus!! COUNTED AS A PREGNANCY (gravida), but not a Parity because it will not make it to 20 weeks; considered an A in GTPAL! Ultrasound helps diagnose this!
molar pregnancy
fertilization of the egg with NO nucleus/DNA; the sperm nucleus duplicates itself; “Mole” grows rapidly! The vesicles that form in the uterus can rupture the uterus or come out of the vagina. At 20 weeks the uterus should be in the umbilicus & at 20 weeks with a Molar Pregnancy-the SIZE is MUCH GREATER than the DATE (10-12 weeks pregnant, but uterus is up in the umbilicus)
complete molar pregnancy
S/S of molar pregnancy
Abnormal uterine bleeding, uterus larger than dates, anemia from blood loss (mom show signs of anemia: light-headedness, etc.), excessive vomiting (HCG levels go extremely high because the placenta is developing so fast),, abdominal cramps (because uterus is growing so fast), preeclampsia (HTN) before 20 weeks, No Fetal Heart Tones or Fetal Skeleton, Increased HCG Levels
Careful follow up after Molar Pregnancy
often need prophylactic chemotherapy (because of the HIGH RISK FOR CHORIOCARCINOMA)-give Methotrexate as part of chemo regimen
where the fertilized ovum is implanted somewhere other than in the uterine cavity (can be in the tube, abdominal, cervical, ovarian regions) but the ONLY place capable of growing/developing the fetus is the BODY OF THE UTERUS! Therefore will NOT go to term.
ectopic pregnancy
Abortion, Ectopic Pregnancy, & Molar Pregnancy all lead to
lead to pregnancy loss-SUPPORT & COUNSEL-let them know you are there for them if there is anything they need and use therapeutic communication
S/S of ectopic pregnancy
MOST COMMON COMPLAINT-unilateral (one-sided), sharp abdominal or pelvic pain and it is very early in pregnancy (1st trimester)
why are ectopic pregnancies a MAJOR issue
the tube may rupture and lead to massive hemorrhaging which can lead to SHOCK!
where the placenta is malpositioned and attached in the lower uterine segment rather than the fundus (want the placenta HIGH in the fundus)
placenta previa
anytime there is Placenta Previa we must deliver…
by C-Section (because you cannot deliver the placenta before the baby or the baby will have no oxygen)! This can cause MASSIVE BLEEDING;
what can placenta previa lead to
to shock for mom & lack of oxygen for baby!
where the placenta barely covers the cervical os (when the cervix starts to dilate & open this will cause abruption)
marginal placenta
placenta partially covers the cervical os (cervical opening)
partial placenta
placenta completely covers the cervical os (cervical opening)
total placenta
S/S of Placenta Previa
bright red vaginal bleeding that is PAINLESS & uterine tone is normal
premature separation of the placenta before birth (when the placenta comes off the uterus wall); VERY URGENT-can cause loss of life to mom & baby; this is a Major Medical Emergency!
abruption placenta
mom’s blood bleeding into uterus & baby’s blood bleeding into placenta; very small amounts of blood because it is a small tear which clotted off- “concealed”
Partial Separation/Concealed Hemorrhage
no clotting and apparent vaginal bleeding; mom & baby at risk for massive hemorrhage! “Apparent” blood is coming out & placenta is torn partially off the wall
Partial Separation/Apparent Hemorrhage
completely off the wall & may be apparent or concealed depending on how fast it happens; baby is getting NO oxygen since baby is hemorrhaging their blood out into the placenta and mom is hemorrhaging her blood out into the uterus
Complete Separation/Concealed or Apparent Hemorrhage
S/S of Abruptio Placenta
RIGID, BOARD-LIKE ABDOMEN with PAINFUL uterine or abdominal tenderness
pain is so severe that if she has an epidural-the pain can break through the epidural; Uterine bleeding, Look for DECREASED fetal heart tones (if there is a loss of oxygen to the placenta through the gap we will see a DECREASE in fetal heart tones) & Palpate mom’s abdomen-if it is RIGID, BOARD-LIKE we think bleeding!
3 assessments to look for with bleeding
1) where is the bleeding coming from
2) How much blood is coming out? (measured in peripad saturation)
3) changes in vitals?? (1- widened pulse pressure 2-elevated HR 3-decrease in BP)
immediate interventions for bleeding
1) call for help
2) give O2 per 10 L non rebreather
3) start 1 or 2 large bore IV lines and hang fluid replacement
4) monitor for FHT and be ready for potential surgery (ie/ suction or ectopic)
5) monitor VITALS
major responsibility of nurse during bleeding interventions
start 1 or 2 large bore IV lines and hang fluid replacement
first step min screening for gestational diabetes
screen consisting of a 50-g oral glucose load followed by a plasma glucose measurement 1 hour later
glucose level of what is considered a positive screen for gestational diabetes is followed by what
glucose value of 130-140 mg/dl
a positive screen for gestational diabetes is followed by what
step 2-a 3-hour (100-g) oral glucose tolerance test (OGTT) on another day
pregnancy-specific condition in which hypertension develops after 20 weeks of gestation in a woman who previously had neither condition
preeclampsia
The signs and symptoms of preeclampsia also can develop for the first time when
during post partum period
symptoms of preeclampsia
BP greater than 140/90 at least 4 hours apart after 20 weeks gestation in previously normative woman AND ONE OF THE FOLLOWING: Proteinuria greater than 300 mg in a 24-hour specimen, Thrombocytopenia which is a platelet count less than 100,000, Elevated liver enzymes, Serum Creatinine level of greater than 1.1 mg/dl significant of renal insufficiency, pulmonary edema, and new onset cerebral or visual disturbances
Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction
NOT a separate illness
HELLP syndrome
HELLP syndrome characterized by what
hemolysis (H), elevated liver enzymes (EL), and low platelet (LP) count.
what is HELLP syndrome the result of
Result of arteriolar vasospasm, endothelial cell destruction with fibrin deposits, and adherence of platelets in blood vessels
symptoms associated with HELLP
malaise, influenza like symptoms, epigastric or right upper quadrant pain, and symptoms that worsen overnight and improve during the day.
also known as consumptive coagulopathy
Disseminated intravascular coagulation (DIC)
pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both and clotting
NEVER a primary diagnosis
DIC
results from some event that triggered the clotting cascade, either extrinsically, by the release of large amounts of tissue thromboplastin, or intrinsically, by widespread damage to vascular integrity.
DIC
If someone if floated to Labor and Delivery:
1-you treat her like she is a brand new nurse with no experience 2-give her routine care/ a stable patient- that is delivered 3-Give the nurse a patient who is closely related to the unit she was floated from eg. ER nurse- give her the postpartum patient who is in pain because she works every day with patients in pain 4-She cannot interpret tests such as fetal monitoring tests which requires a class or unit specific teaching
Understand and be able to assign an LPN in the Women’s Service Area:
They cannot do comprehensive physical assessments. Therefore, routine such as: baths, tasks (caths/ pericare and feeding babies would be appropriate.
They cannot educate because that requires an assessment of the understanding of the education of the pt. LPNs cannot EAT- EVALUATE, ASSESS, or TEACH!!!
Prevention/ treatment of iron deficiency anemia
ferrous sulfate
nursing interventions for ferrous sulfate
Advise patient that stools may turn dark green or black. Assess bowel function for constipation/ diarrhea. Monitor H+H every 3 weeks for first 2 months of therapy
Prevention of seizures associated with severe eclampsia and pre-eclampsia
magnesium sulfate
nursing interventions for magnesium sulfate
Avoid use for more than 5-7 days for preterm labor. Avoid continuous use during active labor or within 2 hours of delivery. Monitor Pulse, BP, resperations (at least 16 min before each dose). Initiate seizure precautions. Monitor I’s + O’s. Patellar reflex should be tested before each dose (if absent, hold dose).
Antidote for Magnesium Sulfate. Treatment and Prevention of Hypocalcemia.
calcium gluconate
nursing interventions for calcium gluconate
Observe patient closely for hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, Chvostek’s or Trousseau’s sign). Do not take with milk, 1-2 hours within any other med.
