Ch. 19 Nx Mg. Preg Risks

What does the blood look like in placenta previa?

Bright red

Should a vaginal exam be done with placental previa?

no

Type of bleeding for abruptio placentae?

Can be concealed or visible

Incomplete abortion: tx?

Client stabilization Evacuation of uterus via D&C or prostaglandin analog p. 689

PP. 19 placenta previa therapeutic mgmt?

Dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labor signs and symptoms

Habitual abortion: assess findings?

Hx of three or more consecutive spontaneous abortions Not carrying pregnancy to viability or term p. 689

Sx intervention for ectopic?

Linear salpingostomy p. 692

Implantation sites other than fallopian?

Ovaries, intestine, cervix, or abdominal cavity p. 690-691

PP. 16 gestational trophoblastic: education to provide?

Tx, serial hCG monitoring, prophylactic chemotherapy

How is the FHR in placenta previa?

Within normal range

PP. 16 gestational trophoblastic nx ass.?

-Clinical manifestations similar to spontaneous abortion at 12 w -US visualization -High hCG levels

PP. 5 Conditions associated w/ early bleeding during preg?

-Spontaneous abortion -Ectopic pregnancy -Gestational trophoblastic disease -Cervical insufficiency

Most common implantation site for ectopic preg?

Fallopian tubes p. 690

PP. 21 Placenta previa support and education?

Fetal movement counts, effects of prolonged bed rest (if necessary) Prepare for Csec

How is the uterine tone in abruptio placentae?

Firm and rigid

Inevitable abortion: assess. findings?

Great vaginal bleeding Membrane rupture Cervical dilation Strong abdominal cramping Possible passage of products of conception p. 689

What is the single dose IM tx for ectopic?

Methotrexate, (abort med, gets fetus or preg to stop) p. 691

Risk factors from ectopic preg include?

PID, GC/CT, tubal scarring, previous tubal sx, infertility, intrauterine contraceptive devices, previous ectopic preg, uterine fibroids, sterilization, smoking, multiple sexual partners, progestine-only oral contraceptives, douching, diethylstilbestrol exposure p. 691

Conditions with late bleeding that usually occur after 20th week?

Placenta previa Abruptio placentae Placenta accreta p. 687

Inevitable abortion: dx tests?

US hCG levels p. 689

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? high number of pregnancies multiple gestation pregnancy use of oral contraceptives history of endometriosis

history of endometriosis Explanation: The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple abortions (elective terminations of pregnancy). Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 665

Incomplete abortion (passage of some conception products): assess. findings?

Intense abdominal cramping Heavy vaginal bleeding Cervical dilation p. 689

A nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess? painless bright red vaginal bleeding increased fetal movement "knife-like" abdominal pain with vaginal bleeding generalized vasospasm

"knife-like" abdominal pain with vaginal bleeding Explanation: The classic manifestations of abruption placenta are painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement. Painless bright red vaginal bleeding is the clinical manifestation of placenta previa. Generalized vasospasm is the clinical manifestation of preeclampsia and not of abruptio placentae. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 677

PP. 3&4 Preg complications?

-Bleeding during preg -Hyperemesis gravidarum -Gestational hypertension -HELLP syndrome -Gestational diabetes -Blood incompatibility -Amniotic fluid imbalances -Multiple gestation -Premature rupture of membranes

Maternal disease condition examples?

-Cervical insufficiencies -Congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids) -hypothyroidism -DM -Chronic nephritis -Cocaine use -Thrombophilias -Lupus -Polycystic ovary syndrome -Severe HTN -Acute infection (Rubella, cytomegalovirus, herpes simplex virus, bacterial vaginosis, toxoplasmosis) p. 688

Ectopic onset signs?

6th or 8th week of gestation after the missed menstrual period would show adnexal fullness and tenderness on the unruptured fallopian tube and spotting p. 692

PP. 13 ectopic preg hallmark sign?

Abdominal pain with spotting within 6-8w after missed period

Classic clinical triad for ectopic preg?

Abdominal pain, amenorrhea and vaginal bleeding p. 691

High risk pregnancy?

Jeopardizes health of mother, or fetus or both p. 686

Missed abortion (nonviable embryo retained in utero for at least 6 weeks): assess. findings?

Absent uterine contractions Irregular spotting Possible progression to inevitable abortion p. 689

Mifepristone (RU-486): action?

Acts as progesterone antagonist, helps prostaglandins to stimulate uterine contractions; causes endometrium to slough, may be followed by administration of misoprostol within 48h p. 690

Stillbirth is lost when?

After 20th week p. 687

Type of bleeding in placenta previa?

Always visible, slight, more profuse

Ectopic preg means?

An ovum is implanted out of the uterine cavity p. 689

Bleeding during pregnancy?

Anytime during pregnancy is life threatening. Experienced in 20% during the first trimester. p. 686

What type of delivery should be done with placenta previa?

C-section

Labs and dx testing for placental abruption?

CBC, fibrinogen levels, PT/aPTT, type and cross match, nonstress test, BPP

PP. 12 ectopic preg therapeutic mgmt?

Medical: Methotrexate, prostaglandins, misoprostol, and actinomycin Sx if there is a rupture Rh immunoglobulin if woman is Rh-negative

Sx methods for preg bleeding?

Balloon tamponade Compression sutures Arterial ligation p. 687

PP. 17 cervical insufficiency tx mgmt?

Bed rest, pelvic rest, avoidance of heavy lifting, cervical cerclage

Miscarriage is lost when?

Before 20th week p. 687

Most likely the causes of spontaneous abortion in 1st trimester?

Chromosomal abnormalities p. 688

Threatened abortion: Therapeutic mgmt?

Conservative supportive tx Reduction in activity in conjunction with nutritious diet and adequate hydration p. 689

Is there discomfort or pain with abruptio placentae?

Constant; uterine tenderness on palpation

PP. 18 cervical insufficiency nx mgmt?

Continue monitoring, especially w/ preterm labor, emotional support, education

PP. 8 Nx mgmt for spontaneous abortion, continue monitoring what?

Continue monitoring: -vaginal bleeding -pad count -passage of products of conception -pain level -preparation for procedures -medications

Blood description for abruptio placentae?

Dark

What color is the bleeding with placenta abruption?

Dark red

Fetal movement w/ placental abruption?

Decreased

Therapeutic mgmt of placenta previa?

Dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labor signs and symptoms

Mgmt of obstetric hemorrhage?

Early recognition, assessment, resuscitation p. 686

Sx to prepare for with vag bleeding?

Evacuating uterus, misoprostol or PGE2, Rhogam if they are Rh negative p. 688

Beta-hCG doubles how often?

Every 2-4 days until peak values are reached 60-90 days after cnception p. 692

Type of pain w/ placental abruption?

Knife like, uterine tenderness, contractions

What to be monitored with preg bleeding?

Low back pain, abdominal cramps, conception tissue passage, hourly pad saturation p. 688

PP. 6 spontaneous abortion is unknown however during 2nd trimester can be due to?

Maternal conditions

Most likely the causes of spontaneous abortion in 2nd trimester?

Maternal disease p. 688

Fetal presentation for placenta previa?

May be breech or transverse lie; engagement is absent

Complete abortion: tx?

No medical or sx intervention needed F/U appointment to discuss family planning p. 689

Fetal presentation with abruptio placentae?

No relationship

Is there discomfort or pain with placenta previa?

None (painless)

Assessment findings of a threatened abortion?

Often slight vaginal bleeding No cervical dilation or change in cervical consistency Mild abdominal cramping Closed cervical os No passage of fetal tissue p. 689

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? Onset of vaginal bleeding was sudden and painful Fetus is in a breech position Sonogram shows the placenta covering the cervical os Uterus is soft between contractions

Onset of vaginal bleeding was sudden and painful Explanation: Sudden onset of abdominal pain and vaginal bleeding with a rigid uterus that does not relax are signs of a placental abruption (abruptio placentae). The other findings are consistent with a diagnosis of placenta previa. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 675

PP. 12 Ectopic preg is ovum placed where?

Outside of uterus

PP. 17 Cervical insufficiency can be caused by premature or postmature dilation of cervix?

Premature

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Premature separation of the placenta Preterm labor that was undiagnosed Placenta previa obstructing the cervix Possible fetal death or injury

Premature separation of the placenta Explanation: Premature separation of the placenta begins with sharp fundal pain, usually followed by dark red vaginal bleeding. Placenta previa usually produces painless bright red bleeding. Preterm labor contractions are more often described as cramping. Possible fetal death or injury does not present with sharp fundal pain. It is usually painless. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 675

Ectopic contributing factors?

Previous ectopic pregnancy Hx of sexually transmitted infections (STI's) Fallopian tube scarring from PID In utero exposure to DES Endometriosis Previous tubal or pelvic sx Infertility and tx for infertility Uterine abnormalities (fibroids) Intrauterine contraception Progestin-only mini pills that slows ovum transport Postpartum or postabortion infection Altered estrogen and progesterone levels (interferes w/ tubal motility) Increasing age (older than 35) Smoking p. 692

Complete abortion: dx tests?

US showing complete empty uterus p. 689

Placental abruption?

Separation of placenta leading to compromised fetal blood supply

If rupture/hemorrhage occurs before tx for ectopic what are the sx?

Severe, sharp and sudden pain in lower abdomen as tube tears open and embryo is expelled into the pelvic cavity. There will be: referred pain to the shoulder area Bleeding into abdomen Phrenic nerve irritation Hypotension Marked abdominal tenderness and distension hypovolemic shock p. 692

Threatened abortion: Dx test?

US to confirm empty sac Maternal serum that tests declining hCG and progesterone levels p. 689

What is the uterine tone for placenta previa?

Soft and relaxed

Conditions associated w/ preg bleeding that is early within the 1st trimester?

Spontaneous abortion Uterine fibroids Ectopic preg GTD Cervical insufficiency p. 687

Misoprostol (Cytotec): action?

Stimulates uterine contractions to terminate a pregnancy, evacuate the uterus after abortion to ensure passage of all products of conception p. 690

Lecture: Cervical Cerclage?

Stitch on cervix

Onset of placenta abruption?

Sudden

Incomplete abortion: dx tests?

US to confirm products of conception still in the uterus p. 689

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? Ectopic pregnancy Habitual abortion Cervical insufficiency Threatened abortion

Threatened abortion Spontaneous abortion (miscarriage) occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.

PP. 13 ectopic preg lab and dx testing?

Transvaginal US, serum beta hCG, additional testing to rule out other conditions

PP. 15 Gestational trophoblastic cause?

Unknown

Placenta previa cause?

Unknown

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? cord compression fetal distress related to hypoxia infection central nervous system (CNS) involvement

fetal distress related to hypoxia Explanation: When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 697

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate

methotrexate Explanation: Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 663

A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? referred shoulder pain vaginal spotting nausea breast tenderness

referred shoulder pain Explanation: Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 663

In placenta previa where does the placental implant?

Over the cervical os

What is the vaginal bleeding like with the placental previa?

Painless, bright red in second or third trimester, spontaneous cessation then recurrence

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? Check deep tendon reflexes. Measure fundal height. Palpate the fundus and check fetal heart rate. Obtain a voided urine specimen and determine blood type.

Palpate the fundus and check fetal heart rate. Explanation: The classic signs of placental abruption (abruptio placentae) are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 675

PP. 12 Ectopic preg obstruction or slowing to what?

Passage of ovum through tube to uterus

A client at 36 weeks' gestation experiences vaginal bleeding. Which conditions might be the cause of the client's bleeding? Select all that apply. Placenta previa Placental abruption (abruptio placentae) Bloody show Ectopic pregnancy Spontaneous abortion (miscarriage)

Placenta previa Placental abruption (abruptio placentae) Bloody show Explanation: In the third trimester, placenta previa, placental abruption, and bloody show are potential causes of vaginal bleeding. Spontaneous abortion (miscarriage) and ectopic pregnancy are causes of vaginal bleeding in the first trimester and would not be seen in the third trimester. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 671

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption results in painless, bright red vaginal bleeding during labor. Placental abruption requires "watchful waiting" during labor and birth.

Placenta previa is an abnormally implanted placenta that is too close to the cervix. Explanation: Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. Immediate intervention is required for placental abruption. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 672

PP. 14 ectopic preg nx mgmt?

Preparation for tx, analgesics for pain, medications, teaching about signs and sx of rupture, sx, emotional support, education

Inevitable abortion: tx?

Vacuum curettage if conception products do not pass Prostaglandin analogs such as misoprostol to empty uterus of retained tissue p. 689

PP. 19 Placenta previa nx mgmt: risk factors?

Vaginal bleeding, painless, bright red in 2nd or 3rd trimester, spontaneous cessation then recurrence

Habitual abortion: dx tests?

Validation via clients hx p. 689

Transvaginal US detects what?

Visualizes misplaced pregnancy and low levels of serum beta-hCG p. 692

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? high number of pregnancies multiple gestation pregnancy use of oral contraceptives history of endometriosis

history of endometriosis Explanation: The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple abortions (elective terminations of pregnancy). Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 665

A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? Select all that apply. infertility treatment smoking advancing maternal age previous induced abortion (medical abortion) hypotension

infertility treatment smoking advancing maternal age previous induced abortion (medical abortion) Research has identified certain risk factors for placenta previa. They include advancing maternal age (more than 35 years), previous cesarean birth, multiparity, uterine insult or injury, cocaine use, prior placenta previa, infertility treatment, Asian ethnic background, multiple gestations, previous induced abortion (medical abortion), smoking, previous myomectomy to remove fibroids (leiomyomas), short interval between pregnancies, and hypertension or diabetes.

A client is seeking advice for his pregnant wife who is experiencing mild elevations in blood pressure. In which position should a nurse recommend the pregnant client rest? supine position lateral recumbent position left lateral lying position head of the bed slightly elevated

lateral recumbent position Explanation: The nurse should encourage a client with mild elevations in blood pressure to rest as much as possible in the lateral recumbent position to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis. The nurse should maintain the client with severe preeclampsia on complete bed rest in the left lateral lying position. Keeping the head of the bed slightly elevated will not help to improve the condition of the client with mild elevations in blood pressure. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 684

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with preterm premature rupture of membranes (PPROM) has completed how many weeks of gestation? less than 37 weeks less than 38 weeks less than 39 weeks less than 40 weeks

less than 37 weeks Explanation: Preterm premature rupture of membranes (PPROM) is defined as the rupture of the membranes prior to the onset of labor in a woman who is less than 37 weeks' gestation. PROM (premature rupture of membranes) refers to a woman who is beyond 37 weeks' gestation, has presented with spontaneous rupture of the membranes, and is not in labor. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 696-697

What would be the physiologic basis for a placenta previa? a loose placental implantation low placental implantation a placenta with multiple lobes a uterus with a midseptum

low placental implantation Explanation: The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 671

Biological factors that place a woman at risk for pregnancy?

-Genetic conditions -Chromosomal abnormalities -Multiple pregnancies -Defective genes -Inherited disorders -ABO incompatibility -Large fetal size -Medical and obstetric conditions -Preterm labor and birth -Cardiovascular disease -Chronic hypertension -Cervical insufficiencies -Placental abnormalities -Infection -Diabetes -Maternal collagen diseases -Thyroid diseases -Asthma -Postterm pregnancy -Hemoglobinopathies -Nutritional status -Inadequate dietary intake -Food fads -Excessive food intake -Under- overweight status -Hematocrit value less than 33% -Eating disorder p. 687

PP. 15 Gestational trophoblastic disease: two types?

-Hydatidiform -Choriocarcinoma

PP. 15 gestational trophoblastic tx management?

-Immediate evacuation of uterine contents (D&C) -Long-term f/u and monitoring of serial hCG levels

Environmental factors placing a woman at risk during pregnancy?

-Infections -Radiation -Pesticides -Illicit drugs -Industrial pollutants -Second-hand cig smoke -Personal stress p. 687

PP. 2 High risk pregnancy?

-Jeopardy to mother, fetus, or both -Condition due to pregnancy or result of condition present before pregnancy -Higher morbidity and mortality -Risk assessment w/ first antepartal visit; ongoing -Diverse factors

PP 21 Placenta previa Nx mgmt?

-Monitoring of maternal-fetal status -Vaginal bleeding; pad count -Avoidance of vaginal exams -FHR

Pharm measures for preg bleeding?

-Oxytocin, ergometrine, prostaglandins p. 687

PP. 8 Nx mgmt spontaneous abortion, support?

-Physical/emotional -Remind the women it is not her fault -Verbalize feelings -Grief support -Referral to community support group

PP. 18 cervical insufficiency nx assess?

-Pink tinged vaginal discharge or pelvic pressure -Cervical shortening via transvaginal US

Sociodemographic factors placing a woman at risk during pregnancy?

-Poverty status -Lack of prenatal care -Age of younger than 15 years or older than 35 yrs -Parity-all first pregnancies and more than 5 pregnancies -Marital status-increased risk for unmarried women -Accessibility to health care -Ethnicity-increased risk in non-white women p. 687

PP. 16 gestational trophoblastic nx mgmt?

-Preoperative preparation -Emotional support

Psychosocial factors placing a woman at risk during pregnancy?

-Smoking -Caffeine -Alcohol/substance abuse -Maternal obesity -Inadequate support system -Situational crisis -Hx of violence -Emotional distress -Unsafe cultural practices p. 687

PP. 7 Types of spontaneous abortion?

-Threatened -Inevitable -Incomplete -Complete -Missed -Habitual

PP. 19 Placenta previa cause?

-Unknown, placental implants over cervical os -Classification (Fig 19.4)

PP. 6 spontaneous abortions nx assessment?

-Vaginal bleeding -Cramping or contractions -Vital signs, pain level -Clients understanding

At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. What should the nurse do next? Assess fetal heart rate Administer oxygen by face mask Insert a Foley catheter Prepare the client for an epidural

Assess fetal heart rate Explanation: The presence of intense, knife-like abdominal pain with a sudden onset, a rigid and board-like abdomen, and no vaginal bleeding is evidence of a placental abruption (abruptio placentae). The next action by the nurse is to assess the fetal heart rate to determine the fetus's status. The priority is saving the life of the fetus and the mother. Inserting a urinary catheter and administering oxygen can be done once the status of the fetus is known. This client is not an appropriate candidate for an epidural at this time. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 677

A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints? Healthy pregnancy Ectopic pregnancy Molar pregnancy Placenta previa

Ectopic pregnancy Explanation: The most commonly reported symptoms of ectopic pregnancy are pelvic pain and/or vaginal spotting. Other symptoms of early pregnancy, such as breast tenderness, nausea, and vomiting, may also be present. The diagnosis is not always immediately apparent because many women present with complaints of diffuse abdominal pain and minimal to no vaginal bleeding. Steps are taken to diagnose the disorder and rule out other causes of abdominal pain. Given the history of the client and the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the client were term and she was in labor. With a molar pregnancy the woman typically presents between 8 to 16 weeks' gestation reporting painless (usually) brown to bright red vaginal bleeding. Placenta previa typically presents with painless, bright red bleeding that begins with no warning. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 662

Missed abortion: tx?

Evacuation of uterus (if inevitable abortion does not occur): suction curettage during first trimester, dilation and evacuation during second trimester Induction of labor with intravaginal PGE2 suppository to empty uterus without surgical intervention p. 689

How is the FHR in abruptio placentae?

Fetal distress or absent

PP. 6 spontaneous abortion is unknown however during 1st trimester can be due to?

Fetal genetic abnormalities

Complete abortion (passage of ALL conception products): assess. findings?

Hx of vaginal bleeding and abdominal pain Passage of tissue w/ subsequent decrease in pain and significant decrease in vaginal bleeding p. 689

Habitual abortion: tx?

Id & treat underlying cause (genetic, chromosomal, reproductive, chronic disease, immunologic problems) Cervical cerclage in 2nd trimester if incompetant cervux is the cause p. 689

A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant? Bed rest for the next 4 weeks Intravenous administration of a tocolytic Immediate surgery Internal uterine monitoring

Immediate surgery Explanation: The client presents with the signs and symptoms of an ectopic pregnancy, which is confirmed by the transvaginal ultrasound. Ectopic pregnancy means an embryo has implanted outside the uterus. Surgery is necessary to remove the growing structure before damage can occur to the woman's internal organs. Bed rest, a tocolytic, and internal uterine monitoring will not correct the situation. The growing structure must be removed surgically. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 665

In placenta previa is the onset insidious or sudden?

Insidious

Placenta previa manifestations?

Insidious onset Always visible, slightly profuse Bright red blood No pain Soft and relaxed uterus FHR in normal range Fetal presentation may be breech, transverse lie; engagement is absent p. 702 ch.

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the client's beta-hCG level. Monitor the mass with transvaginal ultrasound. Monitor the client's vital signs and bleeding. Monitor the fetal heart rate (FHR).

Monitor the client's vital signs and bleeding. Explanation: A nurse should closely monitor the client's vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture. Beta-hCG level is monitored to diagnose an ectopic pregnancy or impending spontaneous abortion (miscarriage). Monitoring the mass with transvaginal ultrasound and determining the size of the mass are done for diagnosing an ectopic pregnancy. Monitoring the FHR does not help to identify hypovolemic shock. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 666

PGE2, dinoprostone (Cervidil, Prepidil Gel, Prostin E2): action?

Stimulates uterine contractions, causing expulsion of uterine contents; expel uterine contents in fetal death or missed abortion during 2nd trimester, can dilate cervix in pregnancy at term p. 690

Abruptio placentae manifestations?

Sudden onset Bleeding can be concealed or visible Blood can be dark Discomfort or pain can be constant with uterine tenderness on palpation Uterine tone is firm to rigid Fetal heart rate is distressed or absent Fetal presentation has no relationship p. 702

Rh(D) immunoglobulin (Gamulin, HydroRho-D, Rho-GAM, MICRhoGAM): action?

Suppress immune response of non-sensitized Rh-negative moms exposed to Rh (+) blood; prevents isoimmunization in Rh-negative women exposed to Rh-positive blood after abortions, miscarriages, and pregnancies p. 690

Missed abortion: dx tests?

US to identify all conception products p. 689

PP. 17 cervical insufficiency cause?

Unknown, possibly cervical damage

A nurse is providing care to a pregnant woman with preterm prelabor rupture of membranes (PPROM). On admission, the client's baseline information was as follows: temperature, 97.6°F (36.5°C); pulse, 76 beats/minute; fetal heart rate, 136 beats/minute; white blood cell count, 7 x 103cells/mm3 (7.0 x 109/L). Now, 8 hours later, assessment reveals the following: temperature, 99.6°F (37.7°C); pulse, 82 beats/minute; fetal heart rate, 180 beats/minute; white blood cell count, 8.5 x 103 cells/mm3 (8.5 X 109/L). The nurse suspects a possible infection based on the change in which parameter? temperature pulse rate fetal heart rate white blood cell count

fetal heart rate Explanation: Nursing management for the woman with prelabor rupture of membranes (PROM) or preterm prelabor rupture of membranes (PPROM) focuses on preventing infection and identifying uterine contractions. The risk for infection is great because of the break in the amniotic fluid membrane and its proximity to vaginal bacteria. Therefore, maternal vital signs must be monitored closely. The nurse should be alert for a temperature elevation or an increase in pulse, which could indicate infection. Also the nurse will monitor the fetal heart rate continuously, reporting any fetal tachycardia (which could indicate a maternal infection). The nurse will evaluate the results of laboratory tests such as a complete blood count (CBC). An elevation in white blood cells would suggest infection. For this woman, the change in fetal heart rate is significant and suggests a possible infection. Although the temperature, pulse rate, and white blood cell count are slightly increased, they are still within acceptable limits. Concern would grow if the client's temperature increased above100.4°F (38°C), pulse rate rose significantly from baseline, or the white blood cell count rose above 10 x 103 cells/mm3 (10 x 109/L). Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 696

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? firm, rigid uterus on palpation gradual onset of symptoms fetal heart rate within normal range absence of pain

firm, rigid uterus on palpation Explanation: The uterus is firm-to-rigid to the touch with abruptio placentae. It is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. A gradual onset of symptoms is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 675

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? placenta previa hyperemesis gravidarum gestational trophoblastic disease pregnancy-induced depression

gestational trophoblastic disease Explanation: This client has risk factors of a "molar" pregnancy: nausea and vomiting at an early gestational week and dark brown vaginal discharge. The early nausea/vomiting can be due to a high hCG level, which is a sign of gestational trophoblastic disease. There is only one sign/symptom of hyperemesis gravidarum. Placenta previa is marked by bright red bleeding and tends to happen later in gestation. There are no data to support any psychosis at this stage. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 667

A 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? tissue sensitivity to insulin increases using too much insulin at this stage of the pregnancy normal response to the pregnancy insulin resistance is starting to decrease

normal response to the pregnancy Explanation: This is a normal response to the pregnancy. During pregnancy, tissues become resistant to insulin to provide sufficient levels of glucose for the growing fetus. This can result in three normally occurring responses: blood glucose levels are lower than normal when fasting; blood glucose levels are higher than normal after meals; and insulin levels are increased after meals. The various hormones will prevent the mother from using most of the insulin produced to allow the extra glucose to get to the growing fetus.

The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? morbidly obese maternal age more than 30 years living in coastal areas previous cesarean birth

previous cesarean birth Explanation: The risk of placenta previa is greatly increased when a woman has had a previous cesarean delivery due to the scarring of the endometrial lining. Maternal age over 35 years, and not just more than 30 years, is considered another risk factor. Placenta previa is more common among those living in high altitudes not among those living in coastal areas. Obesity is not recognized as a potential risk for this condition. Other risk factors can include uterine insult or injury, cocaine use, prior placenta previa, infertility treatment, multiple gestations, previous induced abortion (medical abortion), smoking, previous myomectomy to remove fibroids, short interval between pregnancies, hypertension, or diabetes. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 672

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)? strong abdominal cramping slight vaginal bleeding closed cervical os no passage of fetal tissue

strong abdominal cramping Explanation: Strong abdominal cramping is associated with an inevitable spontaneous abortion (miscarriage). Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion. Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications - Page 663