exam 2 hemorrhagic disorders SHEET

Question 1

What is a threatened abortion?

Answer 1

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)

Question 2

what is the management for threatened abortions?

Answer 2

Possible mild activity restriction with bedrest 24-48 hours, sedation. Instructed to avoid stimulation of sexual intercourse and orgasm for 2 weeks.

Question 3

what is inevitable abortions?

Answer 3

Pregnancy loss that cannot be prevented. Bleeding may be moderate/heavy.Cervix is dilated with tissue in cervix.

Question 4

what is the management for inevitable abortions?

Answer 4

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.

Question 5

what is incomplete abortions?

Answer 5

Passage of some of the products of conception. Ultrasound reveals retained material in the uterus. Cervix is open

Question 6

what is the management for incomplete abortions?

Answer 6

Cervix is open but may require additional dilation before curettage.

Question 7

what is a complete abortion?

Answer 7

All fetal tissue and products of conception passed in bleeding. Ultrasound reveals an empty uterus.

Question 8

what is the management for a complete abortion?

Answer 8

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.

Question 9

what is a septic abortion?

Answer 9

Fever, abdominal pain and tenderness. Bleeding from scant to heavy, usually malodorous. Cervix usually dilated.

Question 10

what is the management for a septic abortion?

Answer 10

Care includes termination of pregnancy; culture and sensitivity studies to initiate appropriate antibiotic therapy.

Question 11

what is a missed abortion?

Answer 11

Retained nonviable embryo or fetus for 6 weeks or more. Fetus has died and placenta atrophied but products of conception retained. Cervix is closed.

Question 12

what is the management for a missed abortion?

Answer 12

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.

Question 13

what is a habitual or recurrent abortion?

Answer 13

three or more consecutive losses before 20 weeks of gestation. Cervix open.

Question 14

what is the management for a habitual or recurrent abortion?

Answer 14

Identification and treatment of underlying cause if possible. Prophylactic cerclage if r/t cervical insufficiency.

Question 15

what do you need to know about spontaneous abortions?

Answer 15

*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

Question 16

What are the types of spontaneous abortions?

Answer 16

threatened
inevitable
incomplete
complete
septic
missed
habitual or recurrent

Question 17

what is the assessment for abortions?

Answer 17

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

Question 18

what are the nursing interventions for abortions?

Answer 18

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

Question 19

what is Cervical Insufficiency or short cervix?

Answer 19

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

Question 20

what is Ectopic pregnancy (Tubal pregnancy)?

Answer 20

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

Question 21

what is Hydatidiform Mole (Molar Pregnancy) (grape cluster)?

Answer 21

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.

Question 22

What is Placenta Previa?

Answer 22

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

Question 23

What is Abruptio Placentae (Placenta Abruption)?

Answer 23

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

Question 24

what is Vasa Previa?

Answer 24

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

Question 25

what is Accreta Increta Percreta?

Answer 25

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.