T4 - Hemorrhagic Disorders (Josh) Flashcards by Josh Miller

Symptoms of Shock

Rapid thready pulse

Pallor

Hypotension

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What is an Incompetent Cervix?

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

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When does an Incompetent Cervix usually occur?

2nd Trimester

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What is the usual result of an Incompetent Cervix?

Spontaneous Abortion or Preterm Birth

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Which clients are at risk for an Incompetent Cervix?

PID (or previous cervical trauma)

Maternal exposure to DES (Diethylstilestrol)

Congenital Uterine Anomalies

History of unexplained 2nd TRIMESTER loss

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How would an Incompetent Cervix be assessed?

Cervical dilation w/out contractions or pain

Client presents w/ completely dilated and bulging membranes

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What are methods for Cerclage?

Shirodkar (ligated submucosa around cervix)

McDonald Procedure (purse string suture)

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Which clients are candidates for Cerclage?

Membranes Intact

History of abortions/miscarriages in 2nd Trimester

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When would a prophylactic Cerclage be placed on a client?

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

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Nursing Responsibilities r/t Cerclage Procedure.

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

tocolytics (anti-contraction meds)

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Risk factors for Ectopic Pregnancy

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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Preventing Symptoms of Ectopic Pregnancy

Positive Pregnancy Test

Vaginal Spotting

Sharp, UNILATERAL abdominal pain

SHOULDER pain from bleeding irritating the phrenic nerve

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How is Ectopic Pregnancy confirmed?

transvaginal U/S

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

Ectopic Pregnancy

***not necessarily on side of ectopic pregnancy

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Interventions for Ectopic Pregnancy

Goal is to preserve tube for future pregnancies

Medication mgmt

Laparoscopic surgery possible

Linear salpingectomy (removal of tube)

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— is an abnormal growth of trophoblastic tissue

Hydatidiform Mole

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What is a partial Hydatidiform Mole?

abnormal embryo that usually aborts in the 1st Trimester

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Complications from Gestational Hydatidiform Mole.

Predisposes to Cancer (Choriocarcinoma)

***develops in 20% of clients

***invasive and usually metastatic

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Indications of Hydatidiform Mole

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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Complications of Hydatidiform Mole

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

Severe Preeclampsia during 1st Half of Pregnancy

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How is Hydatidiform Mole removed?

suction evacuation

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Follow up care for Non-malignant Hydatidiform Mole

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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How is a Placental Abruption classified?

Amount of Bleeding

Mild
Moderate
Severe

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When do Placental Abruptions normally happen?

late 3rd Trimester ***even can happen in labor

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

1 year

Risk Factors for Placental Abruption

HTN disorders Cocain (vasoconstriction) High gravidity or Previous abruption Abdominal Trauma Cig smoking Premature ROM Multips (Twins)

What is the most frequent cause of Placental Abruption?

Cocaine use

S/S of Placental Abruption

Bleeding (apparent or concealed) Abdominal Pain Uterine Tenderness and Contractions ****50% of abruptions can be identified by U/S

Maternal Complications from Placental Abruption

Hemorrhage (Hypovolemic Shock) Hypofibrinogemia Thrombocytopenia Renal Failure

Prognosis of Placental Abruption depends on ...

Extent of blood loss Time b/t placental detachment and birth Degree of DIC

--- fetal mortality rate with abruption.

20-30% ***if 50% of placenta involved, fetal death is likely

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

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

Management of Abruption

Monitor Blood Loss IV Fluids Monitor for coagulation probs (DIC) Blood and Blood products Rhogam

What is goal of IV fluids with Abruption?

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

When would they do a C-section for Abruption?

Only if baby is alive and distressed ***if fetal demise, will be vaginal delivery

With placental abruption, what ultimately leads to fetal demise?

hypoxia

What rate would O2 be for treatment of Abruption

8-12 L/min

-- is a late sign of hypovolemia.

BP decreasing

What can an Abruption lead to?

DIC

How many types of Placenta Previa are there?

Complete (Total) Partial Marginal Low-lying

Predisposing factors to Placenta Previa

Multiple gestation Closely spaced pregnancies Maternal age > 35 High parity African/Asian Previous Placenta Previa Previous C/S or Suction (endometrial scarring)

S/S of Placenta Previa

Painless Bright red vaginal bleeding in 3rd trimester Fundal height greater than expected for gestational age

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

placenta being below baby pushes baby up higher than should be

Why would Placenta Previa bleeding happen in 3rd Trimester?

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

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

Placenta Previa

--- is painless --- is painful

Placenta Previa Placental Abruption

Nursing interventions for Placenta Previa

Bedrest IV fluids CBC, clotting studies, Rh factor EXTERNAL Uterine and fetal monitors U/S (external)

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

Complete Placenta Previa

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

extend period of gestation long enough for lungs to mature

Maternal Complicatoins r/t Placenta Previa

Premature ROM Preterm labor/birth Precursor to PP Hemorrhage Thrombophlebitis Anemia Infection

Fetal / Neonatal Risks r/t Placenta Previa

Preterm birth Malpresentation Congenital Anomalies r/t poor perfusion IUGR r/t poor perfusion

What is Conservative Mgmt of Placenta Previa

Bedrest and Observation Pad counts (for bleeding) Serial HCTs Fetal Surveillance (NST, BPP) NO VAG EXAMS

With Placenta Previa, what should we be prepared for?

emergency C/S

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

Placenta Previa Placental Abruption

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

Placenta Previa Placental Abruption

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

Placenta Previa Placental Abruption

With -- --, there is fetal distress if a lot of blood is lost. With -- --, there typically is always fetal distress associated w/ late decels.

Placenta Previa Placental Abruption

With --- ---, fetus will be breech or transverse and cannot engage. With -- --, there is no relationship b/t fetal presentation.

Placenta Previa Placental Abruption

Related Factors to Placental Abruption

HTN and Vascular Disease Previous Abruption High Parity Poor Nutrition (esp. Folic Acid deficiency) Cigs Cocaine Trauma (sudden loss of lots of AF)

What can trigger DIC

Placental Abruption Retained Dead Fetus AF Embolus Severe Pre-eclampsia HELLP Syndrome Gram Negative Sepsis

Symptoms of DIC

Bleeding from gums or injection sites Epistaxis Petechiae on skin

Treatment for DIC

Treat underlying problem Monitor VS for Hypovolemic Shock Be prepared to administer lots of Blood Monitor Urine Output

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 -- --

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)

Pregnancy loss before 20 wks is --- Pregnancy loss after 20 wks is ---

abortion miscarriage

S/S of Shock

HR elevation Weak, thready pulse Pallor Cool, clammy skin Hypotension

Meds for Ectopic Preg

Methotrexate to dissolve the prenancy

Treatment for H. Mole

Dilation and Curettage (D and C)

What is a Vasa Previa?

vessels are implanted into the fetal membranes instead of placenta vessels will cross over internal OS ****requires C/S

T4 - Hemorrhagic Disorders (Josh) Flashcards

(69 cards)