Nursing Role in Caring for the Pregnant Family

Question 1

incompetent cervix

Answer 1

premature cervical dilation
Risk factor- congenital or structural defects of the cervix , hx of cervical truma , short prior labor
S/S - pink stained vaginal DC or BLEEDING, contraction , possible ROM , Pelvic pressure
Diagnosis
TRANSVAGINAL ULTRASOUND - SHORTENDE CERVIX (LENGTH )
CERVICAL FUNNELING
CERVICAL EFFACEMENT
PROPHYLACTIC CERVICAL CERCLAGE
12-14 weeks for best result
removed at 36-38 weeks for the onset of labor
NURSING CARE
Pelvic Rest - NO Intercourse, Bedrest
Oral hydration
No Tapons , No Douching
Monitor For Cercical Changes
Teach and Monitor for signs of early Labor

Question 2

abruptio placentae

Answer 2

premature separation of placenta from uterus:
partial or complete detachment
leading cause of maternal death
significatnt maternal and fetal morbidity
can have abrupt onset
bleeding may not reflect true amount of loss
dark old blood
or bright red bleeding
May not be recognize until delivery of placenta
Chronic abruption / concealed
rising resting tone
non - reassuring fetal heart rate pattern
vaginal bleeding
abdominla / low back pain - persistent may have rigid , board - like abdomen
uterine irritability
uterine tenderness
port - wine colored amniotic fluid
Nursin intervention- assess bleeding , assess pain , assess vital signs , assess fetus , assess uterine activity , obstetric hostory
LABS- CBC , BLOOD TYPE AND SCREEN , CROSS MATCH , KLEIHAUER - BETKE ( TO SEE MATERNAL AND FETAL BLOOD HAS MIXED ) COAGULATION STUDIES , DRUG SCREEN
ASSESS FUNDAL HEIGHT
risk factor - maternal hypertension ( chronic or gestational )
cocaine use
blunt external abdominal truma

Question 3

lacerations

Question 4

ectopic pregnancy

Answer 4

Abnormal implantation occurring outside the uterine cavity
Most common site is fallopian tube
Can cause rupture and fatal hemorrhage
Risk factors - HX of STIS ,PID , Previous ectopic , Tubal Ligation , IUD , Multiple abortion , greater than 35 years of age
SIGNS AND SYMPTOMS - Unilateral stabbing pain and tenderness in the lower quadrant
Delayed 1-2 week cycle , lighter than usual , irregular menses
Spotting to red vaginal bleeding ( progression )
S/S of shock
Referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture
-Methotrexate prescribed to dissolve pregnancy

Question 5

gestational diabetes

Question 6

hyperemesis gravidarum

Question 7

HELLP syndrome

Answer 7

HEMOLYSIS ( H )
ELEVATED LIVER ENZYMES ( EL )
LOW PLATELETS ( LP )
MAY REQUIRE CRITICAL CARE ADMISSION 
HIGH RISK OR MATERNAL DEATH
Virus like symptoms , epigastric pain , N/V , Monitor for bleeding - easily possibly going to DIC