NURS 368 - High Risk Antepartum (INCLUDES PLACENTA PREVIA/ABRUPTIO, VIRUSES, INFECTIONS) - Exam 2

How do you treat hyperemesis gravidarum?

hospitalizations, NPO, IV therapy until after 48 hrs after vomiting stops, gradually increase diet

What are the causes of hyperemesis gravidarum?

unknown - may be related to high hCG levels (twins, molar pregnancy)

What are nursing actions for treating hyperemesis gravidarum?

antiemetics, encourage oral hygiene, daily weight, monitor lab values, TPN and steroids, small frequent meals, nutrition/dietary consults

What are the 3 most common reasons for bleeding in the first half of pregnancy?

abortion, ectopic pregnancy, gestational trophoblastic disease (including hydatiform mole)

What is hyperemesis gravidarum?

severe n/a resulting in weight loss, dehydration, and electrolyte imbalances

What is an abortion?

loss of pregnancy prior to 20 weeks gestation

What is a spontaneous abortion?

occurs w/o action of the mother or provider (a.k.a. miscarriage)

What is an induced abortion?

elective termination of the pregnancy

What are the causes of spontaneous abortion?

severe congenital abnormalities (50-60%), maternal infections, endocrine disorders (hypothyroidism and IDDM), anatomic defects of the uterus or cervix

What are the 6 types of spontaneous abortions?

threatened, imminent/inevitable, incomplete, complete, missed, and recurrent

What is a threatened abortion?

Bleeding is first sign. cervix remains closed, hCG levels rise, uterine size increases.

How do you manage a threatened abortion?

notify physician, detailed hx, comfort measures, assess FHR, beta hCG levels, no intercourse until bleeding stops, instruct pt to count pads and note the quantity of blood

What is an imminent/inevitable abortion?

inevitable abortion. membranes often rupture and cervix dilates. active bleeding that may be present and heavy.

How do you manage an imminent/inevitable abortion?

supportive care, ensure all products of conception (POC) are expelled, potential D&C performed

What is an incomplete abortion?

some, but not all of the POC are expelled. cervix is open

How do you manage an incomplete abortion?

ensure cardiovascular stability, type and screen, IV fluids, D&C, consider uterotonics

What is a complete abortion?

all POCs expelled, ctxs and bleeding stop, cervix is closed

How do you manage a complete abortion?

no medical intervention is needed unless excessive bleeding or infections

What is a missed abortion?

the fetus dies in the first half of pregnancy, but remains in the uterus. symptoms of pregnancy disappear. D&C or labor induction can be done

What are the complications of a missed abortion?

infection and/or disseminated intravascular coagulation (DIC; bleeding from every orifice)

What is a recurrent abortion?

habitual abortions (3 or more consecutive)

What are the causes of recurrent abortions?

genetics, anomalies of repro tract, lupus, diabetes, infections, STDs, insufficient progesterone

Nursing considerations of abortions?

monitor for hypovolemic shock, fluid and blood volume replacement, emotional support

What is ectopic pregnancy?

implantation of a fertilized ovum in an area outside of the uterine cavity (95% in the fallopian tube)

What are the risk factors for an ectopic pregnancy?

STDs, PID, IUD, tobacco use, douching, multiple abortions, failed tubal ligation, previous ectopic pregnancies

s/s of ectopic pregnancy?

missed period, vaginal bleeding, positive urine test, abdominal and pelvic pain

what are the s/s of a ruptured fallopian tube?

sudden and severe pain, intraabdominal hemorrhage, irritation of the diaphragm that might radiate to the neck and shoulder, signs of hypovolemic shock

How can you assess for a ruptured fallopian tube?

transvaginal ultrasound and serum hCG

How do you treat a ruptured fallopian tube?

methotrexate and surgery if ruptured

what is gestational trophoblastic diseases?

a spectrum of diseases that include a benign hydatidiform mole and gestational trophoblastic tumors, such as invasive moles and choriocarcinoma

What is a hydatidiform mole?

molar pregnancy. occurs when the trophoblast attaches to the uterine wall and the cells develop abnormally and form only the placenta and not the fetus. the chorionic villi develop into cystic, vascular vesicles

What is a complete mole?

no fetus is present

What is a partial mole?

fetal tissue or membranes present

What is placenta previa?

implantation of the placenta in the lower segment of the uterus. painless, bright red bleeding

How do you diagnose placenta previa?

ultrasound

How do you treat placenta previa?

bedrest, no vaginal exams, c-sections common

What are the s/s of placenta previa?

sudden onset of painless bleeding in latter half of pregnancy

How do you manage placenta previa?

stabilize cardiovasc system, delay birth to increase maturity, administer steroids, no intercourse, daily kick counts, bedrest, assess vaginal discharge

What is abruptio placentae?

separation of the placenta before the baby is born

S/s of abruptio placentae?

bleeding and formation of a hematoma on the maternal side. the hematoma can expand and affect gas and nutrient exchange.

Risk factors for abruptio placentae?

HTN, smoking, cocaine usage, multigravida, abdominal trauma, hx of previous abruption, autoimmune and coagulopathies

5 classic signs of abruptio placentae?

vaginal bleeding, abdominal and low back pain, uterine irritability w/frequent and low intensity ctxs, high uterine resting tone identified with IUPC, uterine tenderness that may be localized to the site of the abruption

nursing care for abruption

assess bleeding and pain, maternal VS, EFM, labs, ultrasound, bed rest, tocolytics, rhogam if rh-

What are the effects of cytomegalovirus?

20-30% chance of infant mortality at birth, 10% of fetuses are severely retarded, SGA, learning disabilities. can cause hearing loss

How can a pregnant woman reduce her exposure to CMV?

wash hands frequently, not sharing cups/plates/utensils/food/toothbrushes, not sharing towels/washcloths, cleaning toys, pacifiers, countertops, and anything that comes into contact w/children's urine or saliva

How is rubella transmitted?

droplets and direct contact

What are the fetal complications of rubella?

congenital rubella syndrome (90%), hearing loss, intellectual disabilities, cataracts, cardiac defects, growth restrictions, microcephaly

How do you manage rubella?

prevention (vaccine BEFORE pregnancy), immunity testing

How can herpes be transmitted vertically to the fetus?

ROM and birth

When does a herpes+ pregnant woman need a c-section instead of a vaginal delivery?

when lesions are visible within 30 days of EDB

What drug is given to suppress the outbreak of herpes lesions?

acyclovir

what are the fetal affects of herpes?

skin, mouth, and eye infections. encephalitis, disseminated HSV, high mortality rate

What are the fetal effects of hep B?

prematurity, LBW, and neonatal death

What drug is commonly used to treat maternal HIV?

zidovudine

What are some interventions for HIV during pregnancy?

c/s at 38 weeks, no breastfeeding, limit invasive procedures during labor

What is toxoplasmosis?

a protozoal infection transmitted through organisms in raw/undercooked meat, contact w/cat feces