1550: NURS mgmt of Preg @ Risk, ch19

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  1. Common alterations that place a Preg @ risk.

    Spontaneous Abortion:
    Definition, occurrence (which trimester), risk?
    Spon. Abortion (miscarriage):loss of fetus due to natural causes.

    80% occur in 1st trimester.

    Cause: RT fetal genetic abnormalities not RT mother.
  2. Nursing assessment of "spontaneous abortion" (miscarriage)

    Passage of any  clots or tissue?
    Bleeding: color, amount, frequency of pad replacement.

    Clots: save any tissue/clots & bring to clinic.

    Any s/sx, severity, duration.

    Pain assessment, cramping, contractions.

    Knowledge of pregnancy.

    Knows blood type & Rh?
  3. Nursing mgmt "spontaneous abortion" (miscarriage)

    What might you explain to the woman?
    Actions for managing s. abortions?
    Explain to the woman that it is usually due to physio process unrelated to her action & that she is not responsible.


  4. Medical (therapeutic) mgmt of "spontaneous abortion".

    Dilation & curettage: how is this procedure done?
    Removes tissue from the inside of the uterus.

    Physician opens cervix, curette (an instrument) is used to remove tissue.
  5. Common alterations that place a Preg @ risk.

    Ectopic Preg. (ectopic: displaced)

    Where is the fertilized ovum implanted?

    What happens when the gestation gets bigger?

    What can ectopic prego lead to?
    Outside the uterine cavity.

    May rupture since the uterus is the only organ designed for fetal development.

    May lead to hemorrhage, infertility, death.
  6. Common alterations that place a Preg @ risk.

    Ectopic Preg.

    What is usually the cause of an ectopic p?
    • Due to obstruction of the Fallopian tube:
    • tubal scarring/surgery
    • infertility
    • hx of preg loss or hx of ectopic
    • use of an IUD
    • uterine fibroids
  7. Common alterations that place a Preg @ risk.

    Ectopic Preg: nursing management.

    What should you focus on?
    Focus on treatment & support.

    Administer analgesics as ordered, explain med and possible side effects.
  8. Unruptured Fallopian Tube Assessment.

    When do s/sx begin?

    What are some s/sx?

    What happens when the gestation grows?

    (what is the mother's Rh? Blood type? Rh negative? RhoGAM candidate?
    S/sx begin around 7-8 weeks gestation.

    • S/SX include:
    • Adnexal fullness.
    • Vaginal spotting: 6-8 wks after missed menses.
    • When gestation grows, pain increases
    • (unilateral, bi, or all over abdoment)
  9. Unruptured fallopian tube: Lab&testing.

    What is performed and what does it confirm?

    What is diagnostic of an "ectopic preg"?
    Transuterine ultrasound confirms intrauterine pregnancy. 

    Ectopic preg: presence of adnexal mass and absence of intrauterine gestational sac.

    Assesses the size of uterus and provides evidence of fetal viability (life).
  10. Unruptured fallopian tube: Lab&testing.

    Beta-human chorionic gonadotropin (B-hCG)

    What information can the level of B-hCG provide?

    Do B-hCGs decrease or increase in 50% of all ectopic pregnancies?
    In ectopic pregnancies, b-hCG decreases, however, in normal pregnancies b-hCG level increase every 48-72 hrs until it reaches 10k-20k mIU/mL.

    In 2 days if B-hCG is <66% increase, there is a 90% chance the pregnancy is abnormal.

  11. Unruptured fallopian tube: Medical (therapeutic) Management:

    How does Methotrexate work? What is it also used to treat?

    What are the advantages?
    • Metho: most common med used.
    • Dissolves the embryo.
    • Treats cancer, psoriasis, & RA.

    • Ad:
    • Avoids surgery
    • Allows continuation of function for f. tubes.
    • Lower cost
  12. Ruptured Fallopian Tube Assessment:

    How should you assess a ruptured tube?

    What are some s/sx?
    • Begin the same as an unruptured tube.
    • faintedness
    • Referred pain to the shoulder-indicates bleeding to the abdomen causing phrenic nerve irritation.
    • HYPOtn
    • Hypovolemic Shock (from shoulder pain)
    • Mother's blood type and Rh? Rh -? Rhogam candidate?
  13. Ruptured: medical management:

    What is the only option for a ruptured fallopian tube?
    Emergency surgery is the only option.

    Laparotomy w/ the removal of the tube (salpingectomy) is indicated.
  14. Cervical Insufficiency (Premature dilation of the cervix)

    What is indicative of a weak or defective structure of the cervix?
    A cervix that is weak and structurally defective spontaneously dilates w/o contractions during the 4th/5th month of gestation before fetal viability.
  15. Cervical Insufficiency (Premature dilation of the cervix)
    • Cervical trauma
    • Previous:
    • PTL and Delivery
    • Prego loss near or <20 wks
    • Surgeries or procedures involving the cervix
  16. Cervical Insufficiency (Premature dilation of the cervix).

    Nursing Management: What should you do?
    • Educate s/sx of PTL, activity restrictions
    • Encourage rest
    • Monitor for PTL
    • Backage
    • Increase in vag discharge
    • ROM uterine contractions
    • Provide emotional support
    • Pre/Post op care if having cerclage
  17. When (gestational week) is a cervical cerclage placement indicated?

    What is a cerclage and why is it used?
    If <20 weeks gestation.

    A cerclage is a nonabsorbant suture used to close a malfunctioning cervix.

    It is used to prevent premature birth.
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1550: NURS mgmt of Preg @ Risk, ch19
2015-04-01 01:30:47

common alterations EXAM 2
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