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Maternal-Newborn (Josh) > T4 - Hemorrhagic Disorders (Josh) > Flashcards

T4 - Hemorrhagic Disorders (Josh) Flashcards

1
Q

Symptoms of Shock

A

Rapid thready pulse

Pallor

Hypotension

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2
Q

What is an Incompetent Cervix?

A

PAINLESS cervical effacement and dilation that is NOT associated w/ contractions

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3
Q

When does an Incompetent Cervix usually occur?

A

2nd Trimester

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4
Q

What is the usual result of an Incompetent Cervix?

A

Spontaneous Abortion or Preterm Birth

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5
Q

Which clients are at risk for an Incompetent Cervix?

A

PID (or previous cervical trauma)

Maternal exposure to DES (Diethylstilestrol)

Congenital Uterine Anomalies

History of unexplained 2nd TRIMESTER loss

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6
Q

How would an Incompetent Cervix be assessed?

A

Cervical dilation w/out contractions or pain

Client presents w/ completely dilated and bulging membranes

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7
Q

What are methods for Cerclage?

A

Shirodkar (ligated submucosa around cervix)

McDonald Procedure (purse string suture)

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8
Q

Which clients are candidates for Cerclage?

A

Membranes Intact

History of abortions/miscarriages in 2nd Trimester

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9
Q

When would a prophylactic Cerclage be placed on a client?

A

11-15 wks pregnancy for patients with known history of short cervix or spontaneous miscarriage

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10
Q

Nursing Responsibilities r/t Cerclage Procedure.

A

Monitor for s/s of preterm labor or infection

Antibiotics or Anti-inflammatory drugs may be administered

Sutures must be removed before a vaginal birth is accomplished

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11
Q

With Cerclage, what type of drugs may be administered if labor begins?

A

tocolytics (anti-contraction meds)

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12
Q

Risk factors for Ectopic Pregnancy

A

History of STDs or PID (scarring)
***Chlamydia and Gonorrhea

Previous Tubal Pregnancy

Failed Tubal Ligation

IUD (scarring)

Multiple induced abortions (scarring)

Maternal age > 35

En Vitro

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13
Q

Preventing Symptoms of Ectopic Pregnancy

A

Positive Pregnancy Test

Vaginal Spotting

Sharp, UNILATERAL abdominal pain

SHOULDER pain from bleeding irritating the phrenic nerve

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14
Q

How is Ectopic Pregnancy confirmed?

A

transvaginal U/S

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15
Q

Client presents w/ unilateral abdominal pain that radiates to shoulder.

A

Ectopic Pregnancy

***not necessarily on side of ectopic pregnancy

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16
Q

Interventions for Ectopic Pregnancy

A

Goal is to preserve tube for future pregnancies

Medication mgmt

Laparoscopic surgery possible

Linear salpingectomy (removal of tube)

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17
Q

— is an abnormal growth of trophoblastic tissue

A

Hydatidiform Mole

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18
Q

What is a partial Hydatidiform Mole?

A

abnormal embryo that usually aborts in the 1st Trimester

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19
Q

Complications from Gestational Hydatidiform Mole.

A

Predisposes to Cancer (Choriocarcinoma)

***develops in 20% of clients

***invasive and usually metastatic

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20
Q

Indications of Hydatidiform Mole

A

Typical indicators of pregnancy

Vaginal Bleeding (brown PRUNE JUICE containing grape like vesicles)

Disparity b/t uterine size and gestational age (Fundus higher than expected)

FHT absent

Elevated hCG levels

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21
Q

Complications of Hydatidiform Mole

A

Excessive N/V (Hyperemesis Gravidarum r/t high hCG levels)

Severe Preeclampsia during 1st Half of Pregnancy

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22
Q

How is Hydatidiform Mole removed?

A

suction evacuation

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23
Q

Follow up care for Non-malignant Hydatidiform Mole

A

Weekly hCG levels initially (ensure any remaining tissue does not turn malignant)

hCG levels MONTHLY for ONE YEAR

Prophylactic Chemo

Don’t get pregnant for 1 year

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24
Q

How is a Placental Abruption classified?

A

Amount of Bleeding

  • Mild
  • Moderate
  • Severe
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25
Q

When do Placental Abruptions normally happen?

A

late 3rd Trimester

***even can happen in labor

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26
Q

How long should a client w/ a Hydatidiform Mole wait to get pregnant again?

A

1 year

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27
Q

Risk Factors for Placental Abruption

A

HTN disorders

Cocain (vasoconstriction)

High gravidity or Previous abruption

Abdominal Trauma

Cig smoking

Premature ROM

Multips (Twins)

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28
Q

What is the most frequent cause of Placental Abruption?

A

Cocaine use

29
Q

S/S of Placental Abruption

A

Bleeding (apparent or concealed)

Abdominal Pain

Uterine Tenderness and Contractions

**50% of abruptions can be identified by U/S

30
Q

Maternal Complications from Placental Abruption

A

Hemorrhage (Hypovolemic Shock)

Hypofibrinogemia

Thrombocytopenia

Renal Failure

31
Q

Prognosis of Placental Abruption depends on …

A

Extent of blood loss

Time b/t placental detachment and birth

Degree of DIC

32
Q

— fetal mortality rate with abruption.

A

20-30%

***if 50% of placenta involved, fetal death is likely

33
Q

What is difference b/t Placenta Previa and Placental Abruption?

A

Placental Abruption is accompanied by abdominal pain while Placenta Previa has no pain

34
Q

Management of Abruption

A

Monitor Blood Loss

IV Fluids

Monitor for coagulation probs (DIC)

Blood and Blood products

Rhogam

35
Q

What is goal of IV fluids with Abruption?

A

maintain a HCT of 30 and Urine output of 30 mL/hr

36
Q

When would they do a C-section for Abruption?

A

Only if baby is alive and distressed

***if fetal demise, will be vaginal delivery

37
Q

With placental abruption, what ultimately leads to fetal demise?

38
Q

What rate would O2 be for treatment of Abruption

A

8-12 L/min

39
Q

– is a late sign of hypovolemia.

A

BP decreasing

40
Q

What can an Abruption lead to?

41
Q

How many types of Placenta Previa are there?

A

Complete (Total)

Partial

Marginal

Low-lying

42
Q

Predisposing factors to Placenta Previa

A

Multiple gestation

Closely spaced pregnancies

Maternal age > 35

High parity

African/Asian

Previous Placenta Previa

Previous C/S or Suction (endometrial scarring)

43
Q

S/S of Placenta Previa

A

Painless

Bright red vaginal bleeding in 3rd trimester

Fundal height greater than expected for gestational age

44
Q

Why would fundal height be greater than expected for Placenta Previa?

A

placenta being below baby pushes baby up higher than should be

45
Q

Why would Placenta Previa bleeding happen in 3rd Trimester?

A

stretching and thinning of lower uterine segment that occurs during 3rd Trimester

46
Q

If bleeding occurs after 20th week gestation, what would we suspect?

A

Placenta Previa

47
Q

— is painless

— is painful

A

Placenta Previa

Placental Abruption

48
Q

Nursing interventions for Placenta Previa

A

Bedrest

IV fluids

CBC, clotting studies, Rh factor

EXTERNAL Uterine and fetal monitors

U/S (external)

49
Q

Which type of placenta previa always requires a c-section?

A

Complete Placenta Previa

50
Q

What will the doctors try to do w/ placenta previa?

A

extend period of gestation long enough for lungs to mature

51
Q

Maternal Complicatoins r/t Placenta Previa

A

Premature ROM

Preterm labor/birth

Precursor to PP Hemorrhage

Thrombophlebitis

Anemia

Infection

52
Q

Fetal / Neonatal Risks r/t Placenta Previa

A

Preterm birth

Malpresentation

Congenital Anomalies r/t poor perfusion

IUGR r/t poor perfusion

53
Q

What is Conservative Mgmt of Placenta Previa

A

Bedrest and Observation

Pad counts (for bleeding)

Serial HCTs

Fetal Surveillance (NST, BPP)

NO VAG EXAMS

54
Q

With Placenta Previa, what should we be prepared for?

A

emergency C/S

55
Q

With — —, bleeding is always visible while a — – can have concealed bleeding.

A

Placenta Previa

Placental Abruption

56
Q

— is painless while — will have constant pain and tenderness to palpation.

A

Placenta Previa

Placental Abruption

57
Q

With — —, the uterus is not in labor while with — — there is continuous UC and abdomen will be stiff as a board.

A

Placenta Previa

Placental Abruption

58
Q

With – –, there is fetal distress if a lot of blood is lost.

With – –, there typically is always fetal distress associated w/ late decels.

A

Placenta Previa

Placental Abruption

59
Q

With — —, fetus will be breech or transverse and cannot engage.

With – –, there is no relationship b/t fetal presentation.

A

Placenta Previa

Placental Abruption

60
Q

Related Factors to Placental Abruption

A

HTN and Vascular Disease

Previous Abruption

High Parity

Poor Nutrition (esp. Folic Acid deficiency)

Cigs

Cocaine

Trauma (sudden loss of lots of AF)

61
Q

What can trigger DIC

A

Placental Abruption

Retained Dead Fetus

AF Embolus

Severe Pre-eclampsia

HELLP Syndrome

Gram Negative Sepsis

62
Q

Symptoms of DIC

A

Bleeding from gums or injection sites

Epistaxis

Petechiae on skin

63
Q

Treatment for DIC

A

Treat underlying problem

Monitor VS for Hypovolemic Shock

Be prepared to administer lots of Blood

Monitor Urine Output

64
Q

A client at 9 weeks gestation is admitted to the ER complaining of a sharp pain in her right side, vaginal spotting and N/V.

This assessment data would lead the nurse to suspect – –

A

Ectopic Pregnancy

***key is the sharp, unilateral pain in right side with vaginal spotting and n/v

***also, Placental Abruption happens later in preg (30-34 wks)

65
Q

Pregnancy loss before 20 wks is —

Pregnancy loss after 20 wks is —

A

abortion

miscarriage

66
Q

S/S of Shock

A

HR elevation

Weak, thready pulse

Pallor

Cool, clammy skin

Hypotension

67
Q

Meds for Ectopic Preg

A

Methotrexate to dissolve the prenancy

68
Q

Treatment for H. Mole

A

Dilation and Curettage (D and C)

69
Q

What is a Vasa Previa?

A

vessels are implanted into the fetal membranes instead of placenta

vessels will cross over internal OS

**requires C/S

Maternal-Newborn (Josh) (29 decks)

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