exam 2 hemorrhagic disorders SHEET Flashcards
What is a threatened abortion?
Vaginal spotting early in gestation. No passage o embryonic or fetal tissue. Abdominal cramping. Cervix is closed. Threat = NO HR, ex: mom has a temp of 104 (mom septic and baby septic… lead baby to die)
what is the management for threatened abortions?
Possible mild activity restriction with bedrest 24-48 hours, sedation. Instructed to avoid stimulation of sexual intercourse and orgasm for 2 weeks.
what is inevitable abortions?
Pregnancy loss that cannot be prevented. Bleeding may be moderate/heavy.Cervix is dilated with tissue in cervix.
what is the management for inevitable abortions?
If products of conception are not passed spontaneously, vacuum curettage or administration of prostaglandin analog to evacuate the uterus. A D&C may be performed.
what is incomplete abortions?
Passage of some of the products of conception. Ultrasound reveals retained material in the uterus. Cervix is open
what is the management for incomplete abortions?
Cervix is open but may require additional dilation before curettage.
what is a complete abortion?
All fetal tissue and products of conception passed in bleeding. Ultrasound reveals an empty uterus.
what is the management for a complete abortion?
No further intervention may be needed if uterine contractions adequate to prevent hemorrhage and there is no infection. No need for treatment but follow up care to discuss related issues.
what is a septic abortion?
Fever, abdominal pain and tenderness. Bleeding from scant to heavy, usually malodorous. Cervix usually dilated.
what is the management for a septic abortion?
Care includes termination of pregnancy; culture and sensitivity studies to initiate appropriate antibiotic therapy.
what is a missed abortion?
Retained nonviable embryo or fetus for 6 weeks or more. Fetus has died and placenta atrophied but products of conception retained. Cervix is closed.
what is the management for a missed abortion?
If spontaneous evacuation of the uterus does not occur within one month, uterus is evacuated by method appropriate to duration of the pregnancy. Blood clotting factors are monitored. DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12.
what is a habitual or recurrent abortion?
three or more consecutive losses before 20 weeks of gestation. Cervix open.
what is the management for a habitual or recurrent abortion?
Identification and treatment of underlying cause if possible. Prophylactic cerclage if r/t cervical insufficiency.
what do you need to know about spontaneous abortions?
*Vaginal bleeding from conception to 20 weeks gestation (Fetal Viability)
*Medical term for pregnancy loss before 20 weeks is abortion, regardless of elective (induced) or spontaneous
*Fetal viability is 20 weeks gestation and/or fetus weight 500 g or greater.
*Any signs of abortion have to go back and get checked of any signs of conception
What are the types of spontaneous abortions?
threatened
inevitable
incomplete
complete
septic
missed
habitual or recurrent
what is the assessment for abortions?
Less than 20 weeks gestation fetus is nonviable. Greater than 20 weeks or 500 g, funeral arrangements are needed
Symptoms include uterine cramping, backache and pelvic pressure
If bleeding is noted count of perineal pads/hour
Be aware of S/S of shock
* HR elevated; Weak thready pulse
* Skin: Pallor. Cool, clammy
* Hypotension
what are the nursing interventions for abortions?
Id type of abortion and management
Monitor UC if necessary
Monitor VS , LOC until stable
Start IV with large bore (over 18)
Administer RhoGAM to Rh negative clients with Rh+ baby.
Teach client to notify nurse if:
* Temp > 100.4
* Foul odor to vaginal discharge
* Bright red bleeding
* Bleeding with any tissue fragments
what is Cervical Insufficiency or short cervix?
Cervical Internal OS opening or prolapsed fetal membranes
management: Cerclage – 12-14 week closing of the cervix with a purse-string stitch
misc: Make sure cerclage is clipped before delivery
what is Ectopic pregnancy (Tubal pregnancy)?
Abdominal pain, spotting, positive pregnancy test, verified by US, signs of shoulder pain (Ruptured tube) signs of shock
management: Methotrexate to dissolve the pregnancy
May need a tubal ligation
Misc: Double flush toilet (Very Toxic)
Avoid Folic Acid, sun exposure, sexual intercourse, may cause N&V and gastric discomfort. Keep all appointments
what is Hydatidiform Mole (Molar Pregnancy) (grape cluster)?
Transvaginal US & serum hCG
management: Dilation & Curettage (D&C)
Misc: Not a true pregnancy, it is a gestational trophoblast disease. (empty egg) Places pt at high risk for Cancer. Follow-up necessary. Not a true pregnancy, it is a gestational trophoblast disease. (empty egg) Places pt at high risk for Cancer. Follow-up necessary.
Weekly hCG levels until it becomes normal and stays normal for 3 weeks. Then monthly hCG levels for 6 to 12 months. DO NOT get pregnant for 1 year.
What is Placenta Previa?
placenta is implanted in lower uterine segment
Painless bright red bleeding after 20 weeks
Test: pt with vag bleeding how will u protect the pt from the other nurse? Tell the other nurse to NOT DO A VAG EXAM fingers are going to go right into the placenta (disrupted everything with the placenta and the baby)
PAINLESS
Complete placenta previa make sure mom is getting a C-SECTION
Placenta hanging over the allce = partial
Marginal placenta = may expand up and go over the allce if early in pregnancy
Placentas are USUALLY at the top and SHOULD NOT BE DOWN LOW
management: Observation and bed rest
Misc: NO vaginal exams, C/section delivery
Complete may have a gush where a marginal may have a trickle
What is Abruptio Placentae (Placenta Abruption)?
premature separation of the placenta
Painful abdominal pain with or without bleeding, uterine tenderness, confirmed after delivery
Bright red bleeding, HA, feels like someone is stabbing you in the abdomen, etc. the mom NEEDS to come back into the hospital
management: immediate delivery
Misc: 3 grades based on separation
1 (mild) 10-20%, <500mL, slight pain, no shock
2 (moderate) 20-50% 1000-1500 mL Mild pain, mild shock
3 (severe) >50% >1500 mL Agonizing pain, sudden profound shock
what is Vasa Previa?
implanted into the fetal membranes instead of the placenta. The vessels cross over the internal OS
Seen on U/S
Membranes –> shredded looking
Can attack to any organ outside the uterus –> if it does attach to another organ (the uterus must be taken out)
management: delivery by C-section
what is Accreta Increta Percreta?
Placenta not on the uterine wall
Percreta –> attaches to other organs of the uterus
Management: Deliver by C-section after U/S has determined where placenta is located. Also called a Cesarean hysterectomy.
