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Flashcards in T4 - Hemorrhagic Disorders (Josh) Deck (69):
1

Symptoms of Shock

Rapid thready pulse

Pallor

Hypotension

2

What is an Incompetent Cervix?

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

3

When does an Incompetent Cervix usually occur?

2nd Trimester

4

What is the usual result of an Incompetent Cervix?

Spontaneous Abortion or Preterm Birth

5

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

6

How would an Incompetent Cervix be assessed?

Cervical dilation w/out contractions or pain

Client presents w/ completely dilated and bulging membranes

7

What are methods for Cerclage?

Shirodkar (ligated submucosa around cervix)

McDonald Procedure (purse string suture)

8

Which clients are candidates for Cerclage?

Membranes Intact

History of abortions/miscarriages in 2nd Trimester

9

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

10

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

11

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

tocolytics (anti-contraction meds)

12

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

13

Preventing Symptoms of Ectopic Pregnancy

Positive Pregnancy Test

Vaginal Spotting

Sharp, UNILATERAL abdominal pain

SHOULDER pain from bleeding irritating the phrenic nerve

14

How is Ectopic Pregnancy confirmed?

transvaginal U/S

15

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

Ectopic Pregnancy

***not necessarily on side of ectopic pregnancy

16

Interventions for Ectopic Pregnancy

Goal is to preserve tube for future pregnancies

Medication mgmt

Laparoscopic surgery possible

Linear salpingectomy (removal of tube)

17

--- is an abnormal growth of trophoblastic tissue

Hydatidiform Mole

18

What is a partial Hydatidiform Mole?

abnormal embryo that usually aborts in the 1st Trimester

19

Complications from Gestational Hydatidiform Mole.

Predisposes to Cancer (Choriocarcinoma)

***develops in 20% of clients

***invasive and usually metastatic

20

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

21

Complications of Hydatidiform Mole

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

Severe Preeclampsia during 1st Half of Pregnancy

22

How is Hydatidiform Mole removed?

suction evacuation

23

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

24

How is a Placental Abruption classified?

Amount of Bleeding

- Mild
- Moderate
- Severe

25

When do Placental Abruptions normally happen?

late 3rd Trimester

***even can happen in labor

26

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

1 year

27

Risk Factors for Placental Abruption

HTN disorders

Cocain (vasoconstriction)

High gravidity or Previous abruption

Abdominal Trauma

Cig smoking

Premature ROM

Multips (Twins)

28

What is the most frequent cause of Placental Abruption?

Cocaine use

29

S/S of Placental Abruption

Bleeding (apparent or concealed)

Abdominal Pain

Uterine Tenderness and Contractions

****50% of abruptions can be identified by U/S

30

Maternal Complications from Placental Abruption

Hemorrhage (Hypovolemic Shock)

Hypofibrinogemia

Thrombocytopenia

Renal Failure

31

Prognosis of Placental Abruption depends on ...

Extent of blood loss

Time b/t placental detachment and birth

Degree of DIC

32

--- fetal mortality rate with abruption.

20-30%

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

33

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

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

34

Management of Abruption

Monitor Blood Loss

IV Fluids

Monitor for coagulation probs (DIC)

Blood and Blood products

Rhogam

35

What is goal of IV fluids with Abruption?

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

36

When would they do a C-section for Abruption?

Only if baby is alive and distressed

***if fetal demise, will be vaginal delivery

37

With placental abruption, what ultimately leads to fetal demise?

hypoxia

38

What rate would O2 be for treatment of Abruption

8-12 L/min

39

-- is a late sign of hypovolemia.

BP decreasing

40

What can an Abruption lead to?

DIC

41

How many types of Placenta Previa are there?

Complete (Total)

Partial

Marginal

Low-lying

42

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)

43

S/S of Placenta Previa

Painless

Bright red vaginal bleeding in 3rd trimester

Fundal height greater than expected for gestational age

44

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

placenta being below baby pushes baby up higher than should be

45

Why would Placenta Previa bleeding happen in 3rd Trimester?

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

46

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

Placenta Previa

47

--- is painless

--- is painful

Placenta Previa

Placental Abruption

48

Nursing interventions for Placenta Previa

Bedrest

IV fluids

CBC, clotting studies, Rh factor

EXTERNAL Uterine and fetal monitors

U/S (external)

49

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

Complete Placenta Previa

50

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

extend period of gestation long enough for lungs to mature

51

Maternal Complicatoins r/t Placenta Previa

Premature ROM

Preterm labor/birth

Precursor to PP Hemorrhage

Thrombophlebitis

Anemia

Infection

52

Fetal / Neonatal Risks r/t Placenta Previa

Preterm birth

Malpresentation

Congenital Anomalies r/t poor perfusion

IUGR r/t poor perfusion

53

What is Conservative Mgmt of Placenta Previa

Bedrest and Observation

Pad counts (for bleeding)

Serial HCTs

Fetal Surveillance (NST, BPP)

NO VAG EXAMS

54

With Placenta Previa, what should we be prepared for?

emergency C/S

55

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

Placenta Previa

Placental Abruption

56

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

Placenta Previa

Placental Abruption

57

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

58

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

59

With --- ---, fetus will be breech or transverse and cannot engage.

With -- --, there is no relationship b/t fetal presentation.

Placenta Previa

Placental Abruption

60

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)

61

What can trigger DIC

Placental Abruption

Retained Dead Fetus

AF Embolus

Severe Pre-eclampsia

HELLP Syndrome

Gram Negative Sepsis

62

Symptoms of DIC

Bleeding from gums or injection sites

Epistaxis

Petechiae on skin

63

Treatment for DIC

Treat underlying problem

Monitor VS for Hypovolemic Shock

Be prepared to administer lots of Blood

Monitor Urine Output

64

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)

65

Pregnancy loss before 20 wks is ---

Pregnancy loss after 20 wks is ---

abortion

miscarriage

66

S/S of Shock

HR elevation

Weak, thready pulse

Pallor

Cool, clammy skin

Hypotension

67

Meds for Ectopic Preg

Methotrexate to dissolve the prenancy

68

Treatment for H. Mole

Dilation and Curettage (D and C)

69

What is a Vasa Previa?

vessels are implanted into the fetal membranes instead of placenta

vessels will cross over internal OS

****requires C/S