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Maternal and Child Nursing > Complications during Pregnancy: Bleeding > Flashcards

Complications during Pregnancy: Bleeding Flashcards

1
Q

True or false: Vaginal bleeding during pregnancy may be normal.

A

False

Vaginal bleeding during pregnancy is always abnormal and must be carefully investigated to determine the cause.

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2
Q

Causes of bleeding during the first trimester of pregnancy (2 answers)

A
  • Spontaneous abortion

- Ectopic pregnancy

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3
Q

Causes of bleeding during the second trimester of pregnancy (2 answers)

A
  • Gestational trophoblastic disease

- Incompetent cervix

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4
Q

Causes of bleeding during the third trimester of pregnancy (3 answers)

A
  • Placenta previa
  • Abruptio placenta
  • Preterm labor
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5
Q

Spontaneous abortion is when a pregnancy is terminated when? (2 answers)

A
  • Before 20 weeks gestation (point of fetal viability)

- Fetal weight is less than 500 g

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6
Q

Risk factors for spontaneous abortion (8 answers)

A

S.A.T.C.C.A.M.M.

  • Substance abuse
  • Advancing maternal age
  • Trauma or injury
  • Chromosomal abnormalities (most common cause; 50% of cases)
  • Chronic maternal infections
  • Anomalies in the fetus or placenta
  • Maternal illness (e.g., insulin-dependent DM)
  • Maternal malnutrition
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7
Q

Diagnostic procedures for spontaneous abortion (5 answers)

A

C.W.U.S.H.

  • Clotting factors (monitor for disseminated intravascular coagulopathy)
  • WBC (check for infection)
  • Ultrasound of cervix (to check if opened or closed)
  • Serum human chorionic gonadotropin (hCG)
  • Hgb, Hct if considerable blood loss
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8
Q

Types of miscarriages (6 answers)

A
  • Threatened
  • Inevitable
  • Incomplete
  • Complete
  • Missed
  • Recurrent
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9
Q

Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter. Char!

Threatened miscarriage

a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix

A

a. Slight cramps
b. Spotting - moderate
c. None
d. Closed

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10
Q

Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.

Inevitable miscarriage

a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix

A

a. Moderate
b. Mild to severe
c. None
d. Dilated

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11
Q

Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.

Incomplete miscarriage

a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix

A

a. Severe
b. Continuous and severe
c. Partial fetal tissue or placenta
d. Dilated

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12
Q

Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.

Complete miscarriage

a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix

A

a. None
b. Minimal
c. Complete expulsion of uterine contents
d. Open then closes after passage of tissues

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13
Q

Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.

Missed miscarriage

a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix

A

a. None
b. Brownish discharge
c. None
d. Closed

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14
Q

Spontaneous abortion / Miscarriage assessment

Recurrent miscarriage

A

Habitual abortion; three consecutive miscarriages

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15
Q

Nursing interventions for clients with spontaneous abortion

a. Immediate management (3 answers)
b. Medications (3 answers)

A

a.

  • Perform pregnancy test
  • Bed rest with sedation for threatened, inevitable, and incomplete abortions
  • Determine how much tissue has passed; save passed tissue for examination

b.

  • Administer:
    • blood products as prescribed
    • IV oxytocin as prescribed to expulse products of conception
    • broad spectrum antibiotics
    • RhoGRAM to Rh-negative clients
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16
Q

Nursing interventions for clients with spontaneous abortion

c. Procedures (2 answers)
d. Health teaching (3 answers)

A

c.

  • Assist with termination of pregnancy (e.g., D&C, D&E) as indicated
  • Avoid vaginal exam

d.

  • Use lay term for miscarriage with clients
  • Advise clients with threatened abortion to avoid coitus
  • Provide client education and support
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17
Q

Defined as the abnormal implantation of the fertilized ovum outside of the uterine cavity

A

Ectopic pregnancy

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18
Q

Where does implantation usually occur during ectopic pregnancy?

A

Fallopian tube (this results in a fatal hemorrhage)

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19
Q

Risk factors for ectopic pregnancy (8 answers; from quizlet + SLRC)

A

E.C.T.O.P.I.C.S.

  • Endometriosis
  • Contraceptives (IUD)
  • Tubal surgery
  • Other abdominal surgery
  • Pelvic inflammatory disease (PID)
  • Infertility treatment
  • Can’t find a reason (idiopathic)
  • Smoking/STD
20
Q

Diagnostic procedures for ectopic pregnancy (3 answers)

A
  • Transabdominal ultrasound
  • Culdocentesis (if utz not available)
  • WBC count elevated to 15,000 mm^3
21
Q

Nursing assessment for ectopic pregnancy

A

N.O.U.R.S.S. ,,, naurrrr saurri

  • Nausea and vomiting
  • One or two missed menses
  • Unilateral stabbing pain and tenderness in lower abdominal quadrant
  • Referred shoulder pain
  • Scant, dark red, or brown vaginal spotting
  • Symptoms of hemorrhage and shock (e.g., hypotension, tachycardia, pallor)
22
Q

Medication used to inhibit cell division and enlargement of embryo; also prevents rupture of fallopian tube; used in ectopic pregnancy

A

Methotrexate

23
Q

Surgical management for ectopic pregnancy

This procedure is done to salvage the fallopian tube if not ruptured

A

Linear salpingostomy

24
Q

Surgical management for ectopic pregnancy

This procedure is done when the fallopian tube has ruptured

A

Laparoscopic salpingostomy (removal of the tube)

25
Q

Nursing management for ectopic pregnancy

A
  • Replacement fo fluids and electrolytes
  • Provide client education and support
  • Prepare client for surgery and postoperative nursing care
26
Q

The proliferation and degeneration of trophoblastic villi in the placenta which takes on the appearance of grape-like clusters

A

Gestational trophoblastic disease (H-mole)

27
Q

Nursing assessment for GTD (4 answers)

A

R.E.V.S.

  • Rapid uterine growth larger than expected
  • Excessive vomiting
  • Vaginal bleeding at approx 16 weeks gestation
  • Symptoms of pregnancy-induced hypertension that occur prior to 20 weeks gestation (e.g., hpn, edema, proteinuria)
28
Q

Nursing interventions for GTD (4 answers)

A
  • Advise client to bring any passed clots or tissue for examination
  • Administer RhoGAM to RH-negative clients
  • Instruct client to use reliable contraception for 6-12 months
  • Emphasize importance of follow-up because of risk of choriocarcinoma
29
Q

The painless passive dilation of the cervix in the absence of uterine contractions, occurs around week 20 of gestation

A

Incompetent cervix

30
Q

Risk factors of incompetent cervix (4 answers)

A

I.C.H.I.

  • Increased maternal age
  • Congenital structural defects
  • History of cervical trauma
  • In utero exposure to diethylstilbestrol
31
Q

Nursing assessment for incompetent cervix (4 answers)

A
  • Pink-stained vaginal discharge or bleeding
  • Increase in pelvic pressure
  • Possible gush of fluid
  • Uterine contractions with expulsion of fetus
32
Q

Nursing interventions (6 answers)

A
  • Activity restrictions/bed rest
  • Hydration
  • Administer tocolytic prophylactically to inhibit uterine contractions
  • No intercourse
  • No standing for more than 90 mins
  • No heavy lifting
33
Q

Condition in which the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus.

A

Placenta previa

34
Q

Three types of placenta previa (with descriptions)

A
  1. Complete or total - cervical os is completely covered by placental attachment
  2. Incomplete or partial - cervical os is only partially covered by placental attachment
  3. Marginal - placenta is attached in the lower uterine segment but does not reach cervical os
35
Q

Nursing assessments for placenta previa (5 answers)

A
  • Palpable placenta
  • Painless, bright red vaginal bleeding
  • Fundal height greater than expected
  • Soft, relaxed, nontender uterus
  • Breech or transverse position of fetus

may pagka rude ako na think na mnemonics ani,,, placenta previa fookin sooks bools BAHAHAHA

36
Q

Nursing interventions for placenta previa (5 answers)

A
  • IV fluids
  • Corticosteroids for fetal lung maturity
  • Nothing inserted vaginally
  • Bed rest
  • Blood replacement as prescribed

in case no baby born…

37
Q

The premature separation of the placenta from the uterus (can be partial or complete detachment)

A

Abruptio placenta

38
Q

Nursing assessment for abruptio placenta (6 answers)

A
  • Sudden onset of intense localized uterine pain
  • Vaginal bleeding (bright or dark red)
  • Tender, board-like abdomen
  • Firm rigid uterus with contractions (uterine hypertonicity)
  • Fetal distress
  • Symptoms of hypovolemic shock

svt, ffs!!!!! char haixt another not wholesome mnemonic

39
Q

Nursing interventions for abruptio placenta

A
  • Avoid vaginal exams (may exacerbate bleeding)
  • Blood products administration
  • Rh-negative clients should be given immune globulin
  • Provide emotional support
  • Corticosteroids for fetal lung maturity
  • Deliver fetus (treatment of choice)
  • Fluid volume replacement

ABRPCDF
ABRP from abruptio, then CDF nlang dayon kay wla ko ma think memomik

40
Q

Group of conditions wherein the placenta attaches itself too deeplt into the wall of the uterus

A

Placenta accerta spectrum

41
Q

This occurs when the placenta attaches too deep into the uterine wall but does not penetrate the uterine muscle; most common of the three, occuring in 75% of all cases

A

Placenta accreta

42
Q

This occurs when the placenta attaches even deeper into the uterine wall and penetrates into the uterine muscle; accounts for 15% of the cases

A

Placenta increta

43
Q

This occurs when the palcena penetrates through the entire uterine wall and attaches to another organ such as the bladder; accounting for 5% of the cases

A

Placenta percreta

44
Q

Risk factors of placenta accreta (2 answers)

A
  • Placenta previa

- Previous cesarean deliveries

45
Q

Surgical management of placenta accreta (2 answers)

A
  • Premature delivery of fetus

- Hysterectomy to prevent damage to neighboring organs

46
Q

Nursing interventions for placenta accreta (7 answers)

A
  • Blood product administration
  • Immune globulin for Rh-negative clients
  • Fluid volume replacement
  • Corticosteroids for fetal lung maturity
  • Avoid vaginal exams
  • Schedule for C section before 37 weeks
  • Emotional support

BIFCASE… :(

Maternal and Child Nursing (9 decks)

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