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NCMN 109B > H-Mole and Ectopic Pregnancy > Flashcards

H-Mole and Ectopic Pregnancy Flashcards

1
Q

Abnormal proliferation and degeneration of the trophoblastic villi

A

H-mole

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2
Q

Clear fluid-filled, grape-sized vesicles

A

H-mole

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3
Q

H-mole is associated with

A

choriocarcinoma

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4
Q

Types of H-mole

A

complete hyatidiform mole
partial hyatidiform mole
coexistent mole and live fetus
invasive mole
choriocarcinoma
placental site trophoblastic

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5
Q

How many chromosomes in complete molar pregnancy

A

46

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6
Q

Chromosomes include the sperm and an empty ovum (46XX OR 46 XY)

A

Complete mole

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7
Q

ALL trophoblastic swells and become cystic, if embryo forms, it dies at early at 1 or 2 mm in size

A

Complete mole

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8
Q

Some of the villi will form normally and Embryo will grow 9 weeks then macerates

A

partial mole

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9
Q

how many chromosomes in partial molar pregnancy

A

69

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10
Q

DIAGNOSTIC TEST for H-mole

A

Ultrasound
Serum hCG
Histopathological exam
Pelvic exam
CBC
Clotting functions

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11
Q

Nursing assessment for H-mole

A
  • Uterus expand faster
  • 1-2 million hCG
  • Similar characteristics with multiple pregnancy (multiple placenta or miscalculated due date)
  • Pronounced nausea and vomiting (hyperemesis)
  • High BP, edema, proteinuria before 20 weeks
  • No fetal heart sounds
  • No skeleton in ultrasound result
  • Vaginal bleeding at 16 weeks ( starts with darkbrown blood or profuse flesh flow.
  • Anemia
  • Pelvic pain
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12
Q

MEDICAL MANAGEMENT for H-mole

A
  • Uterine evacuation= Suction curettage or dilatation and
    curettage
  • Monitor serum hCG level every few days for 2 weeks then
    weekly until negative, every 4 weeks for the next 1 to 3
    months
  • Rh immunoglobulin administration
  • Chemotherapy
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13
Q

Increasing hCG may indicate

A

malignancy(choriocarcinoma)

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14
Q

Surgical management for H-mole

A
  • Hysterectomy
  • Laparoscopic surgery
  • Dilatation and Curettage
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15
Q

complications of H-mole

A
  • Change to invasive molar disease or choriocarcinoma
  • Preeclampsia
  • Thyroid problems
  • Reoccurrence of molar pregnancy
  • Complications of surgery
  • Excessive bleeding
  • Side effects of anesthesia
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15
Q

Nursing diagnosis for H-mole

A
  • Deficient Fluid Volume
  • Acute Pain
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16
Q

THE IMPLANTATION OCCURRED OUTSIDE THE UTERINE CAVITY

A

Ectopic Pregnancy

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17
Q

common sites for ectopic pregnancy

A

Fallopian tube (ampulla) is the most common site (80%), 12% in the isthmus, 8% in interstitial or fimbrial

18
Q

TYPES OF ECTOPIC PREGNANCY

A
  • Tubal
  • Non-tubal
19
Q

it occurs when the egg has implanted in the fallopian tube

A

Tubal pregnancy

20
Q

This is the most common type of ectopic pregnancy and the majority of ectopic pregnancies

A

Tubal pregnancy

21
Q

comprise pregnancies implanted at sites other than the fallopian tube

A

Nontubal pregnancies

22
Q

These non-tubal pregnancies may implant on the

A

cervix, cesarean section scar, cornua of the uterus, ovary, or abdominal cavity

23
Q

Risk factors of ectopic pregnancy

A
  1. Previous ectopic pregnancy
  2. Adhesions from infections such as Pelvic inflammatory disease (PID) and chronic salpingitis
  3. Endometriosis
  4. Previous abdominal or pelvic surgery
  5. Risk factors of ectopic pregnancy
  6. Fertility treatments, such as in vitro fertilization (IVF)
  7. Smoking
  8. Uterine tumor
  9. Congenital malformations (webbing-fibrous bands)
  10. Infertility
  11. Use of contraceptives
24
Nursing assessment of Ectopic Pregnancy
1. Increasing lower abdominal pain, which may be sharp or crampy 2. Scanty vaginal bleeding (spotting) 3. Shoulder pain (due to internal bleeding irritating the diaphragm) 4. Weakness, dizziness, rapid pulse, or fainting (due to blood loss) 5. Pregnancy symptoms, such as breast tenderness and nausea
25
Diagnostic tests for ectopic pregnancy
- Urinalysis - to detect HCG levels - Transvaginal ultrasound scan It is also called an endovaginalultrasound - Hysterosalpingogram or ultrasound - Quantitative serum beta–humanchorionic gonadotropin (beta-hCG) - Ultrasonography - Magnetic Resonance Imaging(MRI - Laparoscopy - Culdoscopy
26
MEDICAL AND SURGICAL MANAGEMENT of Ectopic Pregnancy
Administration of methotrexate Administration of mifepristone Withdrawing of blood sample and Intravenous Therapy LAPAROSCOPY
27
a folic acid antagonist chemotherapeutic agent, attacks and destroys fast-growing cells
methotrexate
28
an abortifacient, is also effective at causing sloughing of the tubal implantation site
mifepristone
29
TO REPAIR DAMAGED VESSELS, REMOVE OR REPAIR DAMAGED TUBE
laparoscopy
30
NURSING MANAGEMENT for Ectopic Pregnancy
- Place the patient flat in bed - Ensure that appropriate physical needs are addressed and monitor for complications - Assess for bleeding, pain and vital signs to establish baseline data and - Determine if the patient is under shock - Maintain accurate intake and output to establish the patient’s renal function - Patient must exhibit moist mucous membranes, good skin turgor and adequate capillary refill - Provide client and family teaching to relieve anxiety - Address emotional and psychosocial needs - Diversional activities aids in refocusing attention and enhancing coping with limitations - Provide comfort measures like backrubs, deep breathing
31
NURSING DIAGNOSIS for Ectopic Pregnancy
Powerlessness Acute Pain Risk for Deficient Fluid Volume Anxiety
32
Patients with an ectopic pregnancy commonly present with pain and vaginal bleeding between ________________________. The pain can be ___________________ and is often ___________.
6 and 10 weeks’ gestation; persistent and severe; unilateral
33
A woman who has a ruptured ectopic pregnancy might present signs of shock such as
rapid, thread pulse, rapid respirations, and decreased blood pressure.
34
H-mole has a higher occurence with?
Asians, history of H-mole, history of miscarriages, Hyperthyroidism
35
H-mole is common to women aged
more than 35 yrs old and less than 15 yrs old
36
a single sperm with 23 chromosomes fertilizes an egg with 23 chromosomes
normal pregnancy
37
the maternal chromosomes are lost and the paternal chromosomes double up. this results in a conceptus with 46 chromosomes but all of them are derived from the father
complete mole
38
two sperms fertalize an egg . this results in a triploid conceptus with 69 chromosomes
partial mole
39
before 20 weeks
High BP, edema, proteinuria
40
vaginal bleeding at
16 weeks
41
Monitor serum hCG level ______________________ then weekly until negative, ______________ for the next ________________
every few days for 2 weeks; every 4 weeks; 1 to 3 months
42

NCMN 109B (7 decks)

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