WEEK 3-ATI Flashcards
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1
Q
corpus luteum
A
A structure that develops in an ovary where ovulation took place that secretes estrogen and progesterone until the placenta takes over.
2
Q
how long is the cervix
A
slightly over 2 cm
3
Q
internal cervical os
A
opening of the cervix at the uterus
4
Q
external cervical os
A
Also known as endocervical canal, it is the passage that connects the vagina to the uterus.
5
Q
what state is pregnancy in
A
prothrombotic state:
A blood condition that increases the risk of clots to form in blood vessels.
6
Q
why does a prothrombotic state occur
A
pregnant clients have an increase in some coagulation factors, reduced fibrinolysis, and increased platelet reactivity.
7
Q
fibrinolysis
A
A process that prevents clots from forming or breaks down clots that formed.
8
Q
spontaneous abortion
A
Spontaneous pregnancy loss that occurs prior to 20 weeks gestation.
9
Q
what are the 6 types of spontaneous abortions
A
threatened
inevitable
incomplete
complete
septic
missed
10
Q
threatened abortion
A
The products of conception are threatened with expulsion through uterine cramping and bleeding. The embryo continues to be viable, and the cervix remains closed.
11
Q
inevitable abortion
A
The products of conception have not passed through the client’s dilated cervix; abortion is unavoidable.
12
Q
incomplete abortion
A
A partial passing of the products of conception from the cervical os.
some contents remain in the uterus
13
Q
complete abortion
A
all products of conception have been completely expelled
14
Q
septic abortion
A
Occurs when products of conception are retained and become infected.
15
Q
missed abortion
A
Passage of some products of conception. The cervix is closed, but there is no fetal cardiac activity.
16
Q
can spontaneous abortions happen prior to a client knowing they were pregnant?
A
yes
17
Q
A nurse is caring for a client who has had a spontaneous abortion. Which of the following is a possible cause of spontaneous abortions?
A
chromosomal instability
18
Q
cause of spontaneous abortions
A
varies and is not always known
19
Q
what causes about 50% of spontaneous abortions
A
fetal chromosomal anomalies
20
Q
spontaneous abortion and age relation
A
chance of having one DECREASES as the gestational age INCREASES
21
Q
modifiable risk factors for a spontaneous abortion
A
hypertension
large amounts of caffeine
alcohol use
malnutrition
physical trauma
22
Q
level of alcohol shown to cause spontaneous abortions
A
250 mL
although no level is considered safe of course
23
Q
risk factors
A
for spontaneous abortion that cannot be modified are thrombophilia and antiphospholipid syndrome (APS)
24
Q
thrombophilia
A
Blood disorder that causes blood clots.
25
antiphospholipid syndrome (APS)
A condition in which the immune system creates antibodies that attack tissues in the body.
26
rates with spontaneous abortions rise?
with maternal age
27
clinical presentation of spontaneous abortions
uterine cramping or light vaginal bleeding
not always
can also mean ectopic preg
vaginal bleeding may or may not be with passage of tissue too
28
septic spontaneous abortion clinical presentation
fever
purulent
foul-smelling vaginal discharge
tachycardia
29
most common medication for spontaneous abortion
misoprostol
800 mcg vaginally once PRN 3 hr up to 7 days after first dose
30
molar pregnancy
Unexpected chromosomes can cause a molar pregnancy, also known as a hydatidiform mole. Molar pregnancy is a premalignant condition and occurs after improper fertilization
31
most common type of molar pregnancy
gestational trophoblastic disease
32
gestational trophoblastic disease
Lesions or tumors, which include placental site nodule, exaggerated placental site, and molar pregnancy, that demonstrate unexpected growth of trophoblast of the placenta; usually non neoplastic, but can become cancerous; highly curable if treated early.
33
molar pregnancies are benign but can develop into a malignancy called?
gestational trophoblastic neoplasia (GTN)
34
gestational trophoblastic neoplasia (GTN)
A malignancy that includes invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. All GTN have the ability to metastasize and may be fatal without treatment.
35
how are molar pregnancies classified
complete
partial
invasive
36
complete molar pregnancy
the sperm fertilizes an egg, but there is no genetic material in the egg, so no embryo (fetal tissue) is formed.
most commonly has all paternal chromosomes because the sperm fertilizes an empty egg that lacks maternal chromosomes
37
partial molar pregnancy
embryo in which two sperm fertilize one egg
more dad genes than mom (BAD)
excessive amount of placental or trophoblastic growth and extra set of chromosomes
38
invasive molar pregnancy
tumor that grows where the placenta attaches to the uterus
enlarged and attach through the myometrium and possibly into vascular spaces
39
myometrium
middle layer of uterine wall
M for middle
40
A nurse is caring for a client who has a molar pregnancy that contains no genetic material and no fetal tissue. Which of the following types of molar pregnancies does the client have?
complete molar pregnancy
41
complete mole vs partial mole
complete: 46 xx (all dad)
partial: 69xx (all dad)
42
A nurse is caring for a client who has an invasive mole. Which of the following areas do invasive moles grow into?
myometrium
vascular sites
extrauterine spaces
43
An invasive mole has enlarged
hydropic villi that were retained in the uterus after a partial or complete molar pregnanc
44
hydropic villi
Small projections that connect the placenta to the uterus.
45
risk factors for a molar pregnancy
extremes of maternal ages (under 15 and over 35)
history of spontaneous abortion or infertility
history of molar preg
46
vaginal bleeding in molar pregnancies
prune juice
46
complications of molar pregnancy
hyperemesis gravidarum, vaginal bleeding, and pelvic discomfort.
missed period, positive pregnancy test
47
what can be seen also in a molar pregnancy
preeclampsia
48
A nurse is caring for a client who has a molar pregnancy. Which of the following are manifestations of a molar pregnancy?
missed period
pelvic pain
vaginal bleeding
49
treatments for molar pregnancies
For most molar pregnancies, either a uterine evacuation or hysterectomy to surgically remove the mole is recommended.
50
A nurse is caring for a client who is in their second trimester of pregnancy and has a suspected molar pregnancy. Which of the following conditions may develop related to the molar pregnancy in the second trimester?
preeclampsia
51
oxytocin
control postpartum bleeding (and induction of labor as well)
52
risk factors for GTN
manifestations of trophoblastic proliferation (uterine size larger than expected for the gestational age, hCG levels greater than 100,000 mIU/mL, and lutein cysts greater than 6 cm) and age greater than 40 years old.
53
how long to modify hCG after molar pregnancy
3 months
54
caring for client with molar pregnancy
hCG assessed
BP for preeclampsia
hypovolemia due to vaginal bleeding
55
hyperemesis gravidarum
Nausea and vomiting in pregnancy that is severe and persistent.
56
hCG level that indicates molar pregnancy
greater than 100,000 mIU/mL
57
cervical insufficiency
occurs when painless cervical dilation leads to a second-trimester pregnancy loss
58
ultrasound finding for cervical insufficiency
less than 25 mm cervical length
58
risk factors for cervical insufficiency
history of mid-trimester pregnancy loss
preterm birth
uterine surgery that req cervical diliatation
induced abortion
cervical trauma
cervical laceration
59
clinical presentation of cervical insufficiency
pelvic pressure
Braxton-Hicks
cramping
backache
changes in vaginal discharge
60
cerclage
A medical procedure in which a stitch is placed around the cervix to prevent dilation.
61
ectopic pregnancy
embryo implants elsewhere other than the uterus
62
locations of ectopic pregnancy
abdomen
interstitial
fallopian tube
ovary
cervix
hysterotomy scar
63
hysterotomy
An incision made into the uterus during a medical procedure.
64
IUD and ectopic pregnancies
increased by 53% chance
unknown as to why
65
risk factors for ectopic pregnancy
AMA
endometriosis
infertility
PID
cigarette smoking
clients pregnant while on oral contraceptives and IUD in place
66
Which of the following clients has the highest risk of ectopic pregnancy?
client who got pregnant with IUD in place
67
syncope
fainting
68
clinical presentation of ectopic pregnancy
vaginal bleeding
abdominal pain
are the most common
other include...
syncope
vomiting
diarrhea
lower urinary tract infections
urinary freq
painful urination
69
A nurse is caring for a client who is suspected of having an ectopic pregnancy. Which of the following manifestations should the nurse anticipate with this client?
abd pain
vaginal bleeding
urinary freq
70
three options for ectopic preg treatment
expectant management
medical management
surgical management
71
expectant management for ectopic pregnancy
monitoring the client while waiting for the ectopic pregnancy to resolve on its own
only appropriate for asymptomatic clients who have an ectopic preg in an unknown location and who have an hCG serum level that is low (less than 200 mIU/mL) and declining
72
medical management for ectopic pregnancy
methotrexate for stable clients with confirmed ectopic pregnancy and who are not allergic
for stable vital signs
73
surgical management for ectopic pregnancy
salpingectomy and salpingostomy
unstable, suspected tubal rupture, allergic to methotrexate, failed methotrexate treatment
74
salpingectomy
Surgical removal of the fallopian tube.
75
salpingostomy
Incision into the fallopian tube without removing the tube.
76
modifiable risk factors for ectopic pregnancies
smoking and vaginal douching
77
monitor what vital signs for ectopic pregnancy
HR for tachycardia
BP for hypotension due to hypovolemia
78
manifestations of tubal rupture
sharp ABD pain
severe, sharp pelvic pain
syncope
rectal pressure
hypotension
vaginal bleeding
79
what to avoid on methotrexate
folic acid supplements
foods that contain folic acid
NSAIDs
narcotics
alcohol
gas-producing foods (can mimic ruptured ectopic preg)
avoid sunlight to prevent dermatitis
80
what can methotrexate cause
fetal death
don't get pregnant on this medication and for at least one ovulatory cycle after completion
81
placenta previa
placenta does not migrate up by the third trimester and is located near or covering the cervix
82
where does placenta usually attach to
upper, posterior uterine wall
83
anterior vs posterior placenta
anterior: placenta placement in the front of the uterus
posterior: placenta placement in the back of the uterus
posterior placenta previas are more likely to persist than anterior.
84
three types of placenta previas
marginal
partial
complete
85
marginal placenta previa
Placenta lies near the cervix but does not cover the opening.
86
partial placenta previa
The placenta covers a portion of the cervix.
87
complete placenta previa
Placenta completely covers the cervical opening.
88
what do C sections increase the risk of
placenta previas
89
Persistence of a previa as gestational age increases indicates
that it will not likely resolve.
90
risk factors for placenta previa
major ones are...
previous placenta previa
previous cesarean sections
multiple gestation
other ones are...
Other risk factors include previous uterine surgery, such as a myomectomy, increasing number of pregnancies, increasing maternal age greater than 35, fertility treatment (due to hormones or implantation), previous pregnancy termination, maternal smoking or cocaine use, male fetuses, endometriosis, and prior uterine artery embolization.
91
myomectomy
Surgical removal of fibroids.
92
when is the previa most commonly found
ultrasound exam at 18-20 weeks of gestation
93
A nurse is caring for a client who has placenta previa. Which of the following assessment findings should the nurse anticipate with this condition?
painless vaginal bleeding
94
clinical presentation of placenta previa
painless vaginal bleeding in the SECOND HALF of pregnancy
95
Medication Management for placenta previa
antenatal corticosteroids (Betamethasone)
96
A nurse is caring for a client who has placenta previa. Which of the following conditions can occur in a client who has placenta previa?
ptsd
anxiety
hemorrhage
difficulty sleeping
97
why should clients with placenta previa not get digital vaginal exam
prevent palpation of the placenta, which can lead to hemorrhage.
98
vitals to watch during placenta previa
mom's BP for hypovolemia
fetal HR that might show signs of hypoxia or anemia
99
indications for urgent C section with placenta previa
active labor
non-reassuring fetal heart tracing
severe or persistent bleeding
significant bleeding after 34 weeks gestation
100
placental abruption
occurs when the placenta prematurely separates from the uterine wall at or after 20 weeks gestation
101
cause of placental abruption
rupture of maternal vessels from the placenta
rupture of maternal vessels away from the placenta causes bleeding between the lining of the uterus and the maternal side of the placenta. As the blood accumulates, it pushes the placenta away from the uterine wall.
102
acute vs chronic placental abruption
acute: medical emergency, high-pressure hemorrhage cause by arteries in the placenta
chronic: low pressure hemorrhage, here is an unexpected development of the spiral arteries in the placenta, which leads to decidual necrosis and placental inflammation.
103
factors that increase risk for placental abruption
history of an abruption, cocaine use, cigarette smoking, maternal age greater than 35 years, and hypertension.
104
Risk factors that can be caused by the pregnancy for placental abruption
multiple gestation pregnancy, polyhydramnios, preeclampsia, sudden uterine decompression from delivery of a twin or rupture of membranes with polyhydramnios, submucosal myomas, and a short umbilical cord
105
A nurse is caring for a client who has a placental abruption. Which of the following are risk factors for placental abruption?
cocaine use
preeclampsia
polyhydramnios
cigarette smoking
short umbilical cord
106
clinical presentation of placental abruption
sudden onset vaginal bleeding
mild to moderate abd pain
uterine contractions
107
A nurse is caring for a client who has placental abruption. Which of the following findings should the nurse understand is a manifestation of hypovolemia?
tachycardia
108
condition where the uterus is stretched due to blood that has collected in the uterus due to placental abruption?
Couvelaire uterus
109
clotting disorders during pregnancy that one may be at risk for
DVT and PE
110
two types of clotting disorders
inherited and aquired
111
inherited thrombophilia
genetic condition that increases the risk for thromboembolic disease in pregnant clients
increased during pregnancy because of the hypercoagulable state caused by pregnancy-associated physiologic changes.
112
acquired thrombophilia
most commonly seen is antiphospholipid syndrome (APS).
113
antiphospholipid syndrome (APS)
causes arterial or venous thrombosis and may cause poor pregnancy outcomes due to antiphospholipid antibodies in the client’s blood
clinical autoimmune disorder that can cause recurrent early pregnancy loss
114
gestational thrombocytopenia (GT)
acquired condition that can occur in pregnant clients and causes low platelets
aka incidental thrombocytopenia and responsible for almost all thrombocytopenia noted in uncomplicated pregnancies.
115
thrombocytopenia
Low level of platelets in the blood.
diagnosed at less than 150,000/microL
116
A nurse is teaching a group of students about thrombophilia. Which of the following should the nurse include in the teaching?
Factor V Leiden is the most common type.
117
cause for inherited thrombophilia
gene mutations
118
risk factors for thrombocytopenia include
pregnancy
preeclampsia/HELLP syndrome
DIC
thrombotic thrombocytopenia purpura
SLE
119
APS manifestations
venous and arterial thrombosis in any organ system
120
