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NURS 501 > Exam 3 - Ectopic, Hydatidiform Mole, and Hyperemesis Gravidarum > Flashcards

Exam 3 - Ectopic, Hydatidiform Mole, and Hyperemesis Gravidarum Flashcards

1
Q

What is the mechanism of ectopic pregnancy?

A

Blastocyst implants anywhere other than the endometrium

  • Most commonly in fallopian tubes
    • Also in ovaries, abdomen, cervix
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2
Q

Risk factors for ectopic pregnancy

A
  • IUD
  • Previous ectopic pregnancy
  • Prior tubal surgery
  • Pelvic infection
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3
Q

What are the three pillars to ectopic pregnancy presentation?

A
  • Unilateral pelvic pain
  • Vaginal bleeding
  • Palpable adnexal mass or adnexal tenderness
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4
Q

Physical and lab signs of possible ectopic pregnancy

A
  • Fewer presumptive symptoms
  • Pregnancy test likely positive but hCG levels are lower and will rise more slowly
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5
Q

Two signs that would warrant the provider to add ectopic pregnancy on differential

A
  • Vaginal spotting/bleeding
  • Abdominal pain
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6
Q

What signs and symptoms would the provider be worried about a possible ruptured ectopic pregnancy?

A
  • Hemorrhage
  • Sharp and stabbing sever lower abdominal pain
  • Hypotension
  • Signs of shock

Can be treated with methotrexate

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7
Q

What is the mechanism of hydatidiform moles (aka molar pregnancies)?

A

Atypical growth of trophoblastic cells from abnormal union of sperm and egg –> implants in placenta and results in proliferation of abnormal placental tissue

  • Contains no fetal tissue (blighted ovum)
  • Normally benign but can become malignant
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8
Q

How can hydatidiform moles present on ultrasound?

A

Uterine cavity filled with edematous, grape-like structure, snowstorm appearance

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9
Q

Signs and symptoms of hydatidiform mole (molar pregnancy)

A
  • Severe and persistent N/V
  • Uterine bleeding
  • Large for date uterus
  • Enlarged tender ovaries
  • No fetal heart tones, no fetal activity observed
  • No fetal parts palpable
  • Preeclampsia before 24 weeks
  • Elevated hCG levels
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10
Q

Hydatidiform mole risk factors

A
  • Younger or older maternal age
  • Previous history of molar pregnancy
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11
Q

When is vomiting most common for patients with hyperemesis gravidarum?

A

First 9 weeks of pregnancy

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12
Q

Consequences of hyperemesis gravidarum

A
  • Nausea accompanied by severe vomiting
  • Nausea that does not subside
  • Vomiting that causes severe dehydration
  • Vomiting that does not allow you to keep food down
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13
Q

Risk factors for hyperemesis gravidarum

A
  • Previous history with hyperemesis gravidarum
  • Previous molar pregnancy
  • Multiple gestation
  • Elevated hCG levels
  • GI disorders
  • Hyperthyroidism
  • Pregnancy with psychiatric disorders
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14
Q

True/false: Anxiety, depression, and psychological disorders are causes of hyperemesis gravidarum

A

False - anxiety, depression, and psychological disorders are consequences of hyperemesis gravidarum

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15
Q

What questions should the provider ask when assessing for hyperemesis gravidarum?

A
  • Frequency of vomiting episodes
  • Dietary history
  • Medications
  • Elimination - constipation, diarrhea
  • Hematemesis
  • Fever
  • Viral infection exposure
  • Food contamination exposure
  • Abdominal pain
  • Eating disorder history
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16
Q

What components of the physical exam should be included when assessing patients wtih hyperemesis gravidarum?

A
  • Weight compared with previous weights
  • Vital signs, skin turgor, mucous membranes, tongue
  • Abdominal palpation bowel sounds
  • Uterine size
17
Q

What labs should be collected with assessing patients with hyperemesis gravidarum?

A
  • CBC
  • Urinalysis for specific gravity and ketones
  • Electrolytes
  • LFTs
  • Rule out hepatitis, pancreatitis, cholestasis
  • TSH and T4 to rule out thyroid disease
18
Q

How would the provider manage patients with hyperemesis gravidarum?

A
  • Replace fluids with saline
  • Begin NPO status or give minimal sips of clear fluids, ice chips to rest gut
  • If pregnancy weight gain stabilizes, there is no adverse outcome associated with hyperemsis
19
Q

What fluid formulation should be avoided in patients with hyperemesis gravidarum?

A

IV fluids containing dextrose

20
Q

Pharmacological management of hyperemesis gravidarum

A
  • Promethazine (phenergan)
  • Prochloperazine (compazine)
  • Ondansetron (zofran)
  • Metoclopramide (reglan)

NURS 501 (66 decks)

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