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1230 Unit 2 Part 2
| Question | Answer |
|---|---|
| painless cervical dilation with bulging of fetal membranes and parts through the external os in the second trimester; pregnancy loss is frequently inevitable | cervical insufficiency |
| standard treatment for cervical insufficiency; performed between 14 and 26 weeks gestation | cervical cerclage (stitch the cervix) |
| hydatidiform mole or molar pregancy (benign), and gestational trophoblastic neoplasia (malignant) | gestational trophoblastic disease |
| two types of molar pregnancies; both involve errors in chromosomal duplicationd uring fertilization; some features of a malignancy | partial and complete |
| risk factors of molar pregnancy: | history of previous gestational trophoblastic disease; extremees of age; young women in early teens and older women near the end of reproductive lives are at highest risk |
| clinical manifestations of molar pregnancy | most common signe - vaginal bleeding; hCG level is usually higher than expected for gestational age; transvaginal ultrasound to confirm |
| treatment of molar pregnancy | evacuation of the uterus; continued follow-up care for 1 year (may develop cancer) |
| nursing care for molar pregnancy | woman at risk for several complications; monitor frequently for vag bleeding; check condition of uterine fundus; administer oxytocin as ordered; DIC (no clotting from any vessels); trophoblastic embolus or pulmonary edema secondary to fluid overload |
| condition in which the placenta is implanted close to or covers the cervical os; exact cause is not known | placenta previa |
| things that increase risk for placenta previa | history of elective abortions, multiparity (multiple deliveries), advanced maternal age (older than 35), previous cesarean birth or uterine incisions, maternal smoking, prior placenta previa |
| Placenta previa is classified according to the degree to which the placenta covers the cervix. | total (rarely resolves - completely covers cervix); partial (sometimes resolves); marginal (sometimes resolves) |
| clinical manifestations of placenta previa | painless, bright red bleeding (1st episode usually between 27 and 32 weeks gestation); transvaginal ultrasound |
| Total placenta previa is associated with: | atypical fetal presentations (breech or transverse) |
| treatment for placenta previa | imediate cesarean deliver is a life-saving measure for the woman and the baby (if massive bleeding occurs); Kleihauer-Betke test; RhoGam; NSTs |
| A ____________ delivery is necessary in all cases of total placenta previa. | cesarean |
| nursing care for placenta previa | careful observation; IV access at all times; assess for signs of shock (from bleeding); LISTEN TO FETAL HEART RATE AT LEASE EVERY 4 HOURS) |
| Postpartum care for placenta previa | normal postpartum care; assess for signs of infection and mehorrhage (pad count) |
| prematue separation of a normally implated placenta; cause is unknown | abruptio placentae |
| risk factors for abruptio placentae | elevated blood pressure; preeclampsia and pre-existing chronic hypertension; advanced maternal age (>35); multiparity; history of cesarean delivery; trauma; smoking; alcohol; cocaine; preterm premature rupture of membranes |
| abruptio placentea classified by: | whether bleeding is concealed (more dangerous) or apparent; whether degree of abruption is partial or complete |
| maternal complications with abruptio placentea: | hemorrhagic shock, DIC, uterine rupture, renal failure, death |
| fetal complications with abruptio placentea | relate to the degree of placental separation and maturity of fetus; hypoxia, anemia, growth retardation, death |
| clinical manifestations of abruptio placentea | abdomen will harden and not release; based on s/s of patient; pain has sudden onset and is constant; ultrasound |
| treatment of abruptio placentea | vaginal delivery is preferred for small abruptions |
| nursing care for abruptio placentea | careful monitoring; watch for signs of shock; continuous EFM; prepare for emergency cesarean if ordered; monitor for postpartum hemorrhage and condinue to observe for signs of DIC after the birth |
| abrutpio placentea assessment | though OB history; acut bleeding episode; obtain fetal heart rate and apply the EFM; evaluate the woman's pain |
| second leading cuase of maternal morbidity and mortality; not only dangerous for the woman, but also puts the fetus at risk | hypertensive disorders in pregnancy (gestational HTN, preeclampsia/eclampsia; chronic HTN; preeclampsia superimposed on chronic HTN) |
| term used to describe elevated blood pressure (>140/90) that develops for the first time during pregnancy; can be transient or chronic | gestational hypertension |
| serious condition in which the blood pressure rises to 140/90 or higher accompanied by proteinuria; may develop into eclampsia; may have presence of seizure activity or coma; exposure to trophoblastic tissue appears to be the triggering factor | preeclampsia |
| tests for preeclampsia | there are no diagnostic tests available |
| more likely to develop preeclampsia and are 2-3 times more likely to die from it or eclampsia | African-American women |
| Primary problem underlying development of preeclampsia is generalized : | vasospasm |
| categorized as mild or sever, seizures are tonic-clonic and only rarely progress to status epilepticus; edema is significant if it is nondependent or if it involves the face and hands | preeclampsia |
| severe form of preeclampsia; greatly increases the mortality associated with preeclampsia | HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) |
| treatment of preeclampsia | primary goal - to deliver baby and restore the woman to a healthy state; preventing maternal seizures; magnesium sulfate (ther. level is 4-8 mg/dL) |
| When giving magnesium sulfate, monitor the reflexes and respiratory rate of the woman receiving it at frequent intervals; high risk for antepartum complications 24-48 hours after deliver; antidote for magnesium sulfate: | Calcium gluconate |
| nursing care for HELLP | frequent monitoring of woman of fetus; auscultate lungs evry 2 hours; weigh woman daily; report HA, visual changes, epigastric pain; assess deep tendon reflexes; implement seizure precautions; woman on bed rest; adequate nutrition; phychosocial needs; NST |
| high blood pressure present before the woman becomes pregnant | chronic hypertension |
| chronic hypertension and experiencing proteinuria | preeclampsia superimposed on chronic hypertension |
| treatment and nursing care with preeclampsia superimposed with chronic hypertension | prenatal visits at more frequent intervals; fetal surveillance is an area of intense focus; methyldopa (Aldomet) is the drug of choice for maintenance therapy |
| refers to a pregnacy in which the woman is carrying more than one fetus | multiple gestation |
| twins are at risk for: | twin-to-twin transfusion syndrom (TTTS); conjoined; experience growth restriction; be born prematurely |
| woman's risk with multifetal pregnancy | postpartum hemorrhage; increases fetal nutrient demands; maternal anemia |
| nursing care with multifetal pregnancy | increased emphasis on woman's diet, multivitamin and iron supplements, rest; teach symptoms of preterm labor; perform fetal movement counts daily after 32 weeks gestation |
| incompatibilities between the woman's blood and the fetus' blood can cause problems for the fetus - the two types are: | Rh imcompatibility and ABO incompatibility |
| Rh incompatibility | isoimmunization; fetus develops hemolytic anemia; anti-D immunoglobulin (RhoGam); woman will have no symptoms; fetus may be severely affected (miscarriage); treatment is RhoGam |
| To give RhoGam, woman must be: | Rh negative; must not have anti-D antibodies; infant must be Rh-positive; direct Coomb's test must be weakly reactie or negative |
| ABO incompatibility | another cause of hemolytic disease of newborn; most frequently arises when the woman's blood type is O and the baby's is A, B, or AB; much less severe form than Rh incompatibility; fetus rarely requires exchange transfusion |
Created by:
akgalyean
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