Unit 6 - Childbearing Risks (exam 3)

NSG222 Exam 3 Study Guide Pt. 1 (Bleeding Problems)

Also known as spontaneous abortion, it refers to the loss of a pregnancy BEFORE 20 weeks.

Miscarriage

A condition where the fertilized egg implants outside the uterus, posing risk to a mothers life.

Ectopic Pregnancy

Medication given to prevent rupture in ectopic pregnancy by stopping the fetus from developing.

Methotrexate

A patient presents with abdominal pain and spotting, the nurse is concerned for an ectopic pregnancy, what is the primary method to confirm this diagnosis?

Transvaginal ultrasound

How many weeks after missed menses could a patient begin spotting with an ectopic pregnancy?

6 to 8 weeks

Given to women experiencing pain in ectopic pregnancy to manage discomfort.

Opioid analgesics

Condition where trophoblastic cells proliferate and produce HCG.

Gestational Trophoblastic Disease

What is the clinical marker for Gestational Trophoblastic Disease?

A positive HCG test

EX: A patient presents to the clinic complaining of abnormal vaginal bleeding, breast tenderness, fatigue, nausea, vomiting, and that a pregnancy test she took was positive. After assessment no fetal heartbeat is found and her HCG levels were high. What could this be indicative of?

Gestational Trophoblastic Disease ***Will mimic the s/s of a spontaneous abortion at 12 weeks’ gestation, but there will be ABSCENSE of a fetal heartbeat

On an ultrasound, what is likely to be seen in a patient with GTD?

Molar pattern

What is likely to be initiated in a patient with GTD as a prophylactic measure?

Chemotherapy (Methotrexate)

When GTD is ruled malignant, what is this called?

Choriocarcinoma

A patient was just diagnosed with gestational trophoblastic disease, what should be done to manage this disease?

Uterine content evacuation ***AS SOON AS DIAGNOSIS IS MADE

EX: A patient that had gestational trophoblastic disease and uterine content evacuation a few months ago presents to the clinic today for a follow up. What is the priority nursing intervention?

Obtain a serial HCG Test

For how long will a patient who experienced gestational trophoblastic disease need to have follow up serial HCG tests?

1 Year

Management for gestational trophoblastic disease involves removing uterine contents promptly after diagnosis, what is this called?

Uterine content evacuation

What are LATE bleeding problems in pregnancy?

• Placenta previa

• Placental Abruption

Condition where the placenta implants over the cervical os

Placenta Previa

Around how many weeks gestation would you expect to begin seeing bleeding in a patient with placenta previa?

20 weeks’ gestation

EX: A patient presents to the clinic and has been diagnosed with placenta previa. What are the expected signs and symptoms you would expect to see?

• PAINLESS bleeding

• Bright red blood

• Bleeding that is continuous or intermittent

  ***Patient could bleed more in labor

EX: You are caring for a patient with placenta previa. What finding should be reported to the HCP right away?

The patient has soaked through a pad within the past 30 minutes

• The patient should NOT be soaking through more than one pad an hour

What should be done for a patient with placenta previa experiencing SEVERE bleeding?

Immediate Cesarean Birth

EX: You are reviewing orders for your patient that was admitted with placental previa. What order would you question?

Vaginal exam

Placenta Previa - Complete

Completely covering the OS

Placenta Previa- Partial

Partially covering the OS

Placenta Previa- Marginal

Within 2 cm of the OS

What order should be given to a patient with placenta previa that is experiencing MINOR bleeding?

Bed Rest

What should be ordered for a patient with placenta previa that is experiencing MAJOR bleeding?

Blood products and IV fluids

Early separation of the placenta from the uterine wall

Placental Abruption

Immediate intervention in placental abruption involving IV fluids to manage hemorrhage and maintain maternal stability.

Fluid resuscitation

EX: You are receiving a new patient who is having a placental abruption, what is the primary nursing intervention?

Begin Fluid resuscitation and IV fluids

What is the most common cause of placental abruption?

Cocaine use

What assessment findings would you expect to see on a patient with placental abruption?

• Hard abdomen (feels solid)

• Pain

• Blood loss **Dark red

What will decrease during placental abruption?

• Fetal blood supply

• Fetal movement

What are the causes of miscarriage in the FIRST trimester?

Genetic abnormalities

What can a miscarriage in the FIRST trimester provide?

While still upsetting, this can provide a sense of relief

What is the main cause of miscarriage in the SECOND trimester?

Maternal Conditions

EX: A patient presents to the clinic complaining that she may be experiencing a miscarriage. What should the nurse question and assess?

• How many weeks pregnant is the patient?

• Does she have any other medical conditions that could have contributed to this?

• Is she experiencing any vaginal bleeding

If the mother is experiencing vaginal bleeding during a miscarriage, what should the nurse include in the plan of care?

Monitor closely. ***Excessive bleeding can indicate hemorrhage

What is the term for fetal demise after 20 weeks’ gestation?

Stillbirth

What is the most common place for an ectopic pregnancy to occur?

The fallopian tubes

Other places an ovum can implant, causing ectopic pregnancy?

• Cervix

• Abdominal cavity

• Ovaries

What is the most common cause of ectopic pregnancy?

Pelvic Inflammatory Disease (PID)

Other causes for ectopic pregnancy?

• Smoking

• IUD

• Previous tubal

• Douching

EX: You are caring for a patient that is Rh-Negative that is experiencing an ectopic pregnancy. What order would you expect to see?

Rhogam (Rh immunoglobin)

EX: A patient is admitted to the hospital for an ectopic pregnancy that has NOT ruptured, is clinically stable, and has no signs of bleeding in the uterine cavity. What are the priority nursing interventions for this patient?

Give methotrexate (Usually IM single dose)

• These are indications for MEDICAL treatment, not surgical don’t get tricked!

What nursing management would be indicated for a patient experiencing an ectopic pregnancy and needing surgical intervention?

• #1 Priority - Preparing the women for treatment

• Provide support

• Patient education

What should you provide to a patient who has just experienced an ectopic pregnancy?

• Emotional support **allow her to express herself to you

• Referral to support groups

• Education

What patient education should you provide to a patient being discharged following an ectopic pregnancy?

• No smoking during childbearing years

• PROMT Treatment, in the event an STI is contracted

• Wear protection for intercourse

• Limit the amount of sexual partners

EX: A woman is at the clinic for an appointment following an ectopic pregnancy, what would you expect to be ordered (what is the primary intervention) (what would you need to collect)?

Serial HCG test (this will be routine at every follow up visit)

How much blood can a pregnant loose before showing signs of shock?

40%