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28 Cards in this Set
- Front
- Back
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Discuss the most common cause of bleeding during the 1st and 2nd half of pregnancy
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ectopic pregnancy
abortion hydatiform mole |
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identify pregnancy complications
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thret
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threatened abortion S/S
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vaginal bleeding
cramping backache cervix is closed partial/complete expulsion of embryo or fetus, placenta, and membranes |
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inevitable abortion S/S
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bleeding
cramping cervix dilates membranes may rupture |
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complete abortion S/S
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products of conception expelled
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incomplete abortion S/S
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some products of conception expelled
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missed abortion S/S
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embryo or fetus dies in utero but not expelled
brownish vaginal discharge cervix closed DIC |
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recurrent/habitual abortion S/S
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abortion occurs consecutive in > 3 pregnancies
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physical findings of ectopic pregnancy
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amenorrhea
breast tenderness nausea decrease HCG/progesterone unilateral pain in lower abdominal area dull aching/cramping leads to sharp stabbing pain in lower abdomen referred shoulder pain bleeding, may/my not be visible tender abdomen |
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physical findings of hydatidiform mole
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excessive N/V (increase B-HCG)
enlarged unporptional uterus vag bleeding and cramps pre-eclampsia before 24 weeks gestation hyperthyroidism no fetal movement or FHR snowy pattern on US increase HCG titer (1-2 million) |
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physical findings of placenta previa
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painless bright red bleeding
cardinal sign depending on placental placement fetal distress |
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physical findings of abruption placenta
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vaginal bleeding
uterine irritability low-intensity contractions abdominal/lower back pain increase uterine resting tone (ICP) uterine tenderness non-reassuring FHT fetal death |
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abortion NI
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assess vag bleeding
VS educate on appropriate activity level give emotional support after abortion: advise to rest administer iron supplement as needed no sex until after next menses admin. Rhogam if RH - within 72h |
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ectopic pregnancy NI
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Assess patient history for risk factors, and slight vaginal bleeding with abdominal tenderness
Assess for S/S of infection and anemia Assess for S/S of shock Administer antibiotics as ordered Administer Rhogam to Rh negative client Give emotional support. Inform her she is still fertile with one tube. Instruct about contraceptives. She should wait at least 3 cycles before initiating another pregnancy Instruct about S/S of ectopic implantation because of increased risk of recurrence |
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hydatidiform mole NI
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Observe for S/S
b. Emotional support - referral to support groups c. Client teaching: importance of follow-up importance of contraception for at least one year |
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placenta previa NI
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• Assess vaginal bleeding. Differentiate symptoms of placental abruption.
• No vaginal exams • IV therapy (Lactated Ringers) and blood replacement therapy if ordered (have two units of crossmatched blood available). • Monitor FHR • Emotional support • After delivery, check for postpartal hemorrhage (monitor H&H, Rh factor, and urinalysis). • Observe for S/S of infection |
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abruption placentae NI
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• Evaluate blood loss
• Start IV • Monitor VS • Measure urine output • Administer oxygen prn • Evaluate fetal staus • No vaginal exam until placenta previa has been ruled out • Emotional support |
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megaloblastic anemia
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A hematologic disorder characterized by the production of immature, dysfunctional RBCs
With the absence of folic acid, immature RBCs fail to divide, and become enlarged (megaloblastic) and fewer in number |
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anemia causes
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o inadequate dietary intake of iron
o mal-absorption o blood loss |
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anemia S/S
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o fatigue
o headache o tachycardia o pallor of skin and conjunctiva o anorexia o inability to concentrate o listlessness o irritability |
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anemia treatment
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o PO iron supplements (even with good nutrition)
o Imferon injections if PO iron not tolerated |
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affect of anemia on the mother
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- more susceptible to postpartal infection and hemorrhage
- tires easily - tolerates even minimal blood loss poorly during delivery - delayed wound healing - increased C.O. to compensate = increased workload on heart |
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effects of anemia on the fetus
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- low Hgb levels associated with spontaneous abortions, stillbirths, perinatal death, low birth weight, and preterm birth
- may be hypoxic during labor due to impaired uteroplacental oxygenation - folic acid deficiency at conception or early pregnancy associated with neural tube defects, cleft lip and palate — Important to begin supplements pre-conception to prevent these effects |
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Hyperemesis gravidarm etiology
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unknown, several theories proposed
- increased estrogen, or increased HCG (multiple gestation or mole) - liver dysfunction - possible allergies to fetal proteins - esophageal reflux - vitamin B deficiency - Has been associated with Helicobaceter pylori (H. pylori ) which is the organism that causes peptic ulcer disease) - psychological factors – may be more of a response to the condition than a cause |
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hyperemesis gravidarm NI
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o NPO to rest GI system. Oral feedings begun as tolerated
o Hydration -- IV therapy o Administer as ordered: vitamin supplements, antiemetics ( Zofran, Phenergan), o Administration of vitamin B-6 and Reglan. Also the administration of methylprednisolone (steroid), and ginger. o Tube feedings or parenteral nutrition may be necessary o Encourage oral hygiene o Assess character of emesis, FHR, I&O, evidence of bleeding or jaundice, and emotional state o Provide diversional activities o Psychologic counseling may be ordered o Avoid narcotics !! |
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Sulfonamides in treating UTI's
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safe early pregnancy
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Tetracyclines in treating UTI's
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rarely used in pregnancy
crosses placenta after 4 months |
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Nitrofurantoin, Ampicillin and cephalosporins in UTI's
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effective and safe for the fetus
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