Part VI Flashcards
(26 cards)
What is a Molar Pregnancy or Gestational Trophoblastic Disease (GTD)
· Cancerious - There is abnormal hyperproliferation of trophoblastic cells that would normally develop into the placenta.
- hCG is produced from the cancer tissue. (Tumor develops from gestational tissue rather than from maternal tissue)
· Women must be tracked for a year for malignancies of the chorion and are asked not to attempt to conceive during this period of time. May need Chemo!
· Lung metastasis is most common site when metastasis occurs!
· Rate of this in Asian countries is 5-10x higher.
· _________ metastasis is most common site when metastasis occurs in Gestational Trophoblastic Disease (GTD) or Molar Pregnancy!
lung
The rate of Gestational Trophoblastic Disease (GTD) or Molar Pregnancy is higher in _________ countries
Asian - Rate of this in Asian countries is 5-10x higher.
What is the function of amniotic fluid?
- a cushion for the baby
- The baby swallows it in and pees it out
- It keeps the baby at an appropriate temperature
- It helps keep pressure off the baby’s limbs and keeps the chord from getting pinched.
What is the function of the placenta?
separates the mom and baby (kinda like a filter)
- It is how waste is removed from baby.
Do mother and baby share circulation?
No; the placenta is the barrier
What is the function of the cord?
The cord contains 2 arteries and 1 vein (veins carry away the waste; arteries bring oxygen – backward from mother)
*The Cord is supposed to be attached to the middle of the smooth side of the placenta
Average length of a cord is normally the length of what
newborn baby (19-21 inches)
true or false - Too much amniotic fluid can increase the hemorrhage risk or make one think they are more pregnant then they are
true
if a woman thinks her water has broken, what should the nurse teach her to do?
*if a woman thinks her water broke, she needs to come in immediately to make sure the cord is not pinched.
What is Hydramnios (also called polyhydramnios)?
more than 2000 mL fluid at 32-36 weeks’ gestation
· Can be acute or chronic
· Associated with fetal malformations that affect swallowing, neural tube defects (AFP increased), anencephaly (incomplete brain development - not survivable), twins, and diabetes
· Can cause preterm labor, shortness of breath, cord prolapse, and edema of the lower extremities
What is Oligohydramnios?
less than 500 mL amniotic fluid at 32-36 weeks’ gestation
· Associated with post-maturity, maternal HTN, IUGR (placental insufficiency), renal malformations
· Possible skeletal malformations and less ability for pulmonary development earlier in pregnancy. Labor- cord compression & increased hypoxia risk
true or false - If a pregnant woman with an unknown Hx comes in, put an IV and external monitors on them (Don’t do cervical/digital exam if unknown Hx)
true
What is known to cause a placental abruption (placenta coming off uterine wall)?
- Out-of-control hypertension (#1 cause)
- trauma to belly
- old placentas.
Cocaine spikes BP - causing abruptions
What are some Symptoms of Placental Abruption?
Symptoms of Placental Abruption
· ⬆️ Uterine resting tone and ⬆️ abdominal girth
· Possible vaginal bleeding-may be very heavy
· Rigid, board-like abdomen
· Extreme abdominal tenderness/pain
· S/S Shock
· Non-reassuring FHT pattern or loss of fetal heart tones
What is the Treatment and Nursing Care for a Placental Abruption? (Mild)
If mild separation, may be able to deliver vaginally
· Monitor resting uterine tone, contraction effectiveness, and abdominal girth frequently
· Continuous fetal monitoring
· Large gauge IV
What is the Treatment and Nursing Care for a Placental Abruption? (Moderate to Severe)
If moderate to severe separation
· Emergency Cesarean (maybe even hysterectomy with severe bleeding)
· Whole Blood
· IV fluids
· Monitor for DIC-fibrinogen and platelets are decreased; PT & PTT are prolonged
true or false - DIC (disseminated intravascular coagulation) is possible with 10% of placental abruption patients.
true! monitor for this
Explain key things about an Ectopic Pregnancy.
Ectopic Pregnancy
· Pregnancy cannot be saved
o Can be in the fallopian tube, cervix, ovary, or abdominal cavity
o Pregnancy in fallopian tube (tubal pregnancy)
· Symptoms often begin at 7-8 weeks’ gestation (evaluated with vaginal probe ultrasound)
· Presents with: Vaginal bleeding, pelvic and/or side pain, referred shoulder pain, symptoms of shock, positive hCG pregnancy test, syncope
What is the priority with an Ectopic Pregnancy?
PRIORITY- Assess mother for stability-could be a hemorrhage!
Serious medical emergency if tube ruptures - requires surgery, life threatening!
How is an ectopic pregnancy diagnosed and how is it treated?
Diagnosed with transvaginal ultrasound (absence of a gestational sac) but a positive pregnancy test
· Medical treatment-IM methotrexate most common, but no meds are approved by FDA for ectopic pregnancy treatment
· Methotrexate is given IM once with an hCG test repeated between days 0-4 after the medication is administered. A decreasing hCG level is highly predictive of treatment success.
What is Hyperemesis Gravidarum?
· Excessive vomiting that leads to a weight loss of 5% of pre-pregnancy weight
· Cause is unclear-some theories are ⬆️ hCG, ⬆️ estrogen, genetic factors, Vitamin B6 deficiency, displacement of GI, and psychologic factors such as stress increase symptoms.
What is the biggest worry with Hyperemesis Gravidarum?
Biggest worry is Dehydration & fluid-electrolyte imbalance risks (first worry is not food, it’s fluid and electrolytes)
What is the Treatment & Nursing Care for Hyperemesis?
· IV fluids (normal saline) often with K+ added if hospitalized, NPO 1st 24-36 hours initially with IV only, no hurry to force them to eat!!!
