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Maternal Newborn - Cher > Test 4 Hemorrhagic Disorders > Flashcards

Test 4 Hemorrhagic Disorders Flashcards

1
Q

Symptoms of shock

A

rapid thready pulse
pallor
hypotension

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2
Q

Painless cervical effacement and dilation that is not associated with contractions

A

Incompetent cervix

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3
Q

Incompetent cervix usually occurs…

A

2nd trimester

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4
Q

What is the usual result of incompetent cervix?

A

spontaneous abortion or preterm birth

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5
Q

Late sign of shock

A

low BP

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6
Q

Who is at risk for incompetent cervix?

A
  • previous cervical trauma
  • maternal exposure to DES
  • congenital uterine anomalies
  • history of previous unexplained loss
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7
Q

What is DES?

A

Diethylstilestrol

Not used since 1970s. Synthetic form of estrogen used 1938 to 1971 to prevent miscarriages

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8
Q

What is cerclage?

A

?

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9
Q

what is BPP?

A

Biophysical profile

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10
Q

What is NST?

A

Non stress test

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11
Q

Previa or abruption?
A.Hypertensive and vascular diseases can cause?
B.Multiple pregnancies, close together, previous c section?

A

A. abruption

B. Previa

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12
Q

Blood that is not clotting because they have coagulation problems

A

DIC

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13
Q

Purse String Cerclage

A

McDonald

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14
Q

petechiae

A

little blood spots on the surface

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15
Q

Fertilized ovum implanted outside the uterine cavity.

A

ectopic pregnancy

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16
Q

Most common site for ectopic pregnancy?

A

fallopian tube

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17
Q

What can ectopic pregnancy lead to?

A

hemorrhage, collapse and death

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18
Q

Risk factors for ectopic pregnancy

A
  • History of STDs
  • previous tubal pregnancy
  • failed tubal ligation
  • IUD
  • multiple induced abortions
  • maternal age >35
  • assistive reproductive techniques
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19
Q

Symptoms of Ectopic pregnancy

A
  • Positive pregnancy test
  • Vaginal spotting or severe bleeding
  • Sharp abdominal pain, unilateral
  • Classic sign of ruptured site is shoulder pain as a result of internal bleeding irritating the diaphragm and phrenic nerve.
  • Diagnosis confirmed by transvaginal ultrasound
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20
Q

Intervention for ectopic pregnancy ruptured tube

A

salpingectomy

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21
Q

Tubal pregnancy without rupture may give __________ – destroys rapid dividing cells

A

methotrexate

22
Q

2nd step in ectopic pregnancy

A

teasing out the ectopic pregnancy intact, and then irrigating the incision to make sure it is free of any ectopic tissue

23
Q

Nursing interventions for Ectopic pregnancy

A 
rh immune globulin
fluids
T&C
Monitor for symptoms of shock
emotional care
follow up
24
Q

What is GTD?

A

Gestational Trophoblastic Disease (Hydatiform Mole)

25
Q

Abnormal growth of trophoblastic tissue

A

Hydatidiform Mole

26
Q

What are the 2 types of GTD

A

Complete mole : develops from empty ovum

Partial Mole : abnormal embryo that usually aborts in the 1st trimester

27
Q

Complications of GTD

A
  • predisposes client to choriocarcinoma
  • Cancer develops following evacuation in 20% of clients
  • Cancer is invasive and usually metastatic
28
Q

Vaginal bleeding of hydatidiform mole looks like:

A

brown “prune juice” containing grape like vesicles.

29
Q

Complications associated with GTD

A
  • Hyperemesis

- preeclampsia

30
Q

If baby’s HR goes up check mom’s:

A

temp

31
Q

Follow up care for Non-malignant GTD

A
  • Weekly HcG levels initially to ensure that any remaining tissue does not turn malignant.
  • hCG levels monthly for one year
  • Chemotherapy prophylactic or as treatment
  • Encourage client to prevent pregnancy for one year
32
Q

Premature detachment of all or part of a normally implanted placenta.

A

placental abruption

33
Q

Is placental perfusion interrupted with placental abruption

A

yes

34
Q

How is classification of placental abruption determined?

A

Level of bleeding

Mild, moderate, severe

35
Q

Apparent placental abruption = (___-___%)

Concealed = (____-____%)

A

70-80%

10-20%

36
Q

When does placental abruption occur?

A

Usually late 3rd trimester or even in labor

37
Q

What is the most frequent cause of placental abruption?

A

Cocaine use

38
Q

Risk factors for Abruption

A 
Hypertensive disorders
Cocaine abuse – vasoconstriction
High gravity or Previous abruption
Abdominal trauma
Maternal cigarette smoking
PROM
Twin gestation
39
Q

Signs and symptoms of Abruption

A
  • Bleeding (apparent or concealed)
  • Abdominal Pain
  • Uterine Tenderness and contractions
  • 50% abruptions can be identified on uterine screen
40
Q

3 types of placental abruption

A

partial concealed
partial apparent
complete separation

41
Q

Maternal complications of Placental Abruption

A
  • Hemorrhage Hypovolemic shock
  • Hypofibrinogemia
  • Thrombocytopenia
  • Renal failure (due to ischemia)
42
Q

___-____% fetal/neonatal mortality with abruption

A

20-30

43
Q

Abruption: If 50% of placenta involved, fetal _____ is likely to occur (due to hypoxia)

A

death

44
Q

Medical management of abrupt placenta

A 
monitor blood loss
IV fluids
Monitor Coagulation Problems
Blood and/or Blood products
Rhogam
45
Q

If mild case of abruption give to mom to help with fetal lung maturity if less than 36 weeks

A

steroids

46
Q

Care for Abruption?

A
  • External monitoring FHR/Toco…
  • Monitor BP, HR, and R for impending shock
  • O2 via face mask at 8-12L/min
  • Start and maintain IV fluids with 18g needle
  • Review lab to estimate blood loss (hct and hgb)
  • Review coagulation studies for potential development of DIC
  • Prepare for emergency CS

-NO VAGINAL EXAMS

47
Q

Vaginal Exams for Placenta Abruptio?

A

No

48
Q

Placenta implanted in lower uterine segment, near or over the internal cervical os

A

placenta previa

49
Q

Types of placenta previa

A

Complete
Partial
Marginal
Low Lying

50
Q

Previa types:
-internal os is entirely covered by placenta when the cervix is completely dilated

  • Incomplete coverage of internal os
  • Only an edge of the placenta extends to the internal os, but ma extend onto the os as the cervix dilates during labor
  • Placenta is implanted in the lower uterine segment but does not reach the os
A

Complete or total –

Partial –

Marginal –

Low-lying –

51
Q

predisposing factors

A
  • multiple gestation
  • closely spaced pregnancies
  • maternal age >35
  • high parity
  • asian or african
  • previous placenta previa
  • previous c/s or suction
52
Q

sharp pain radiating toward shoulder =

A

ectopic

Maternal Newborn - Cher (6 decks)

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