T4-Hemorrhagic Disorders Flashcards
What are symptoms of shock?
- Rapid thready pulse
- Pallor
- Hypotension
Symptoms of shock are -Rapid thready pulse
- Pallor
- Hypotension
What do we see first? last?
First we see the rapid, thready pulse. One of the last things to see is hypotension
Painless cervical effacement and dilation that is not associated with contractions
Incompetent cervix
What do we do for incompetent cervix?
Cerclage methods
- Shirodkar
- McDonald procedure
Cerclage methods: What is shirodkar?
Ligated submucosa around cervix
Cerclage methods: What is McDonald procedure?
Purse-string suture
Who is a candidate for cervical cerclage?
- Membranes intact
- If they have history of abortions/miscarriages in 2nd trimester
Prophylactic cerclage is placed at ____ weeks on pts known to have prior short cervix or spontaneous miscarriages
11-15 weeks
Discharge home after cerclage procedure..What do they need to know?
- Monitor for s/s of preterm labor/infection (PROM, fever greater than 100.4, contractions, decreased fetal mvnt)
- They may get antibiotic or anti-inflammatory
- If labor begins, they may get tocolytics
- Sutures MUST be removed before bag birth is accomplished!!
If a patient who had a cerclage procedure calls and says they are in labor, what do we tell them?
To come on in to have sutures removed
What is most common site for ectopic preg?
FT
If there is an ectopic pregnancy, as it grows it can rupture causing severe hemorrhage, collapse, and death. This is a medical emergency! This reduces the chance of what and why?
Reduces chance of other pregnancies bc of damage or destruction of a FT
STD and PID are risk factors for ectopic pregnancies because it causes scarring. What STD especially mentioned is a major risk?
Gonorrhea!
What are symptoms of ectopic preg?
- Positive preg test
- Vag spotting or severe bleeding
- Sharp abdominal pain that is UNILATERAL; also this pain may radiate to the shoulder
How is diagnosis of ectopic pregnancy confirmed?
Transvaginal ultrasound
How do we fix ruptured tube from ectopic preg?
Linear salpingectomy (tube is not perserved)
For a tubal preg w.o rupture, what can we give and why?
Methotrexate; destroys rapid dividng cells
A hydatidiform mole is an abnormal growth of ____ tissue
Trophoblastic
H. Mole: How do chorionic vili grow?
Into fluid filled, grape like clusters
What are the 2 types of H. mole?
Complete and partial
What mole develops from an empty ovum (no maternal genetic maternal)?
Complete
What mole develops from a partial mole?
Abnormal embryo that usually aborts in 1st trimester
GTD- What kind of mole predisposes client to choriocarcinoma (malignant GTD)?
Complete molar preg
If you see purple like blood, what is it?
H. mole
How is vag bleeding in H mole?
Brown “prune juice” containing grape like vesicles
What are some assessment finding indicating GTD?
- Prune juice blood
- Fundus higher than expected
- FHT absent
- Elevated hCG levels
- Ultrasound looks like molar pattern
GTD are usually aborted in ____
1st tri
What are 2 complications associated with GTD?
- Excess NV causing hyperemesis gravidarum r/t high hCG levels
- Preeclampsia (severe) during 1st half of preg
GTD care.. what is it (3)?
- Suction evacuation regardless of type
- Tested for malignancy
- Treatment started if malignant tissue found
So tissue was negative for malignancy after GTD suction. What is the follow up care for non-malignant GTD?
- Weekly hCG levels initially, then monthly for 1 year
- Chemo prophylactic or as treatment
- Encourage client to prevent preg for 1 year
