Flashcards in T4 - Hemorrhagic Disorders (Josh) Deck (69):
Symptoms of Shock
Rapid thready pulse
What is an Incompetent Cervix?
PAINLESS cervical effacement and dilation that is NOT associated w/ contractions
When does an Incompetent Cervix usually occur?
What is the usual result of an Incompetent Cervix?
Spontaneous Abortion or Preterm Birth
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
How would an Incompetent Cervix be assessed?
Cervical dilation w/out contractions or pain
Client presents w/ completely dilated and bulging membranes
What are methods for Cerclage?
Shirodkar (ligated submucosa around cervix)
McDonald Procedure (purse string suture)
Which clients are candidates for Cerclage?
History of abortions/miscarriages in 2nd Trimester
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
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
With Cerclage, what type of drugs may be administered if labor begins?
tocolytics (anti-contraction meds)
Risk factors for Ectopic Pregnancy
History of STDs or PID (scarring)
***Chlamydia and Gonorrhea
Previous Tubal Pregnancy
Failed Tubal Ligation
Multiple induced abortions (scarring)
Maternal age > 35
Preventing Symptoms of Ectopic Pregnancy
Positive Pregnancy Test
Sharp, UNILATERAL abdominal pain
SHOULDER pain from bleeding irritating the phrenic nerve
How is Ectopic Pregnancy confirmed?
Client presents w/ unilateral abdominal pain that radiates to shoulder.
***not necessarily on side of ectopic pregnancy
Interventions for Ectopic Pregnancy
Goal is to preserve tube for future pregnancies
Laparoscopic surgery possible
Linear salpingectomy (removal of tube)
--- is an abnormal growth of trophoblastic tissue
What is a partial Hydatidiform Mole?
abnormal embryo that usually aborts in the 1st Trimester
Complications from Gestational Hydatidiform Mole.
Predisposes to Cancer (Choriocarcinoma)
***develops in 20% of clients
***invasive and usually metastatic
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)
Elevated hCG levels
Complications of Hydatidiform Mole
Excessive N/V (Hyperemesis Gravidarum r/t high hCG levels)
Severe Preeclampsia during 1st Half of Pregnancy
How is Hydatidiform Mole removed?
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
Don't get pregnant for 1 year
How is a Placental Abruption classified?
Amount of Bleeding
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?
Risk Factors for Placental Abruption
High gravidity or Previous abruption
What is the most frequent cause of Placental Abruption?
S/S of Placental Abruption
Bleeding (apparent or concealed)
Uterine Tenderness and Contractions
****50% of abruptions can be identified by U/S
Maternal Complications from Placental Abruption
Hemorrhage (Hypovolemic Shock)
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.
***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
Monitor for coagulation probs (DIC)
Blood and Blood products
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?
What rate would O2 be for treatment of Abruption
-- is a late sign of hypovolemia.
What can an Abruption lead to?
How many types of Placenta Previa are there?
Predisposing factors to Placenta Previa
Closely spaced pregnancies
Maternal age > 35
Previous Placenta Previa
Previous C/S or Suction (endometrial scarring)
S/S of Placenta Previa
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?
--- is painless
--- is painful
Nursing interventions for Placenta Previa
CBC, clotting studies, Rh factor
EXTERNAL Uterine and fetal monitors
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
Precursor to PP Hemorrhage
Fetal / Neonatal Risks r/t Placenta Previa
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)
Fetal Surveillance (NST, BPP)
NO VAG EXAMS
With Placenta Previa, what should we be prepared for?
With --- ---, bleeding is always visible while a --- -- can have concealed bleeding.
--- is painless while --- will have constant pain and tenderness to palpation.
With --- ---, the uterus is not in labor while with --- --- there is continuous UC and abdomen will be stiff as a board.
With -- --, there is fetal distress if a lot of blood is lost.
With -- --, there typically is always fetal distress associated w/ late decels.
With --- ---, fetus will be breech or transverse and cannot engage.
With -- --, there is no relationship b/t fetal presentation.
Related Factors to Placental Abruption
HTN and Vascular Disease
Poor Nutrition (esp. Folic Acid deficiency)
Trauma (sudden loss of lots of AF)
What can trigger DIC
Retained Dead Fetus
Gram Negative Sepsis
Symptoms of DIC
Bleeding from gums or injection sites
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 -- --
***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 ---
S/S of Shock
Weak, thready pulse
Cool, clammy skin
Meds for Ectopic Preg
Methotrexate to dissolve the prenancy
Treatment for H. Mole
Dilation and Curettage (D and C)