Hemorrhagic Disorders
Clinical manifestations of Cervical insufficiency and treatment
None, Braxton Hick, pelvic pressure, cramping, backache, or change in vaginal discharge
Treatment: Cerclage & progesterone
Signs/Symptoms of Pre-Clampsia:
Edema, Headaches, N/V, epigastric pain, blurry vision, oliguria, hyperreflexia
Considerations for fetus and mother
Fetus: Risk for Large gestational Age, Birth injuries, hypoglycemia and jaundice postpartum, preterm birth
Mother: Risk for HTN or Pre-eclampsia, preterm labor, birth injuries (tearing), Type 2 diabetes mellitus
Risk factor and diagnostic test for Premature Pre-labor rupture of membranes
Low-pregnancy BMI, Tobacco use, history of PPROM, infection short cervical length, amniocentesis,
Fern test: fluid under microscope
Nitrazine Test: sample fluid on swab that changes color based on if membrane was ruptured or not
What is a muskuskeletal change that happens postpartum for mom?
Diastasis Recti - Line or space between abdomen muscles due to enlarged uterus
Clinical Manifestations and Treatment of Molar Pregnancy (Hydatidiform Mole)
Hyperemesis Gravidarum, Enlarged uterus, preeclampsia
Treatment includes Uterine evacuation (Curettage), Hysterectomy (for those done having kids), Chemotherapy (to prevent progression for complete molar pregnancies)
What is HELLP syndrome? Signs/Symptoms
Pregnancy related hypertension with signs of, Hemolysis; Elevated liver enzymes; Low Platelets
Nausea, vomiting, right upper quadrant abdominal pain; general malaise
Gestational diabetes Treatment
Moderate exercise: 30 minutes 5-7 times per week; Diet: <40% carbs, 20% protein, 40% fat; Medications - glyburide, metformin, insulin
Blood sugar monitoring
Eclampsia is classifed as
Pregnancy related hypertension with onset of seizures
What is a prolapsed umbilical cord? S/S and treatment
What is Ectopic Pregnancy and how do you treat it?
Abnormal plantation of an embryo; Methotrexate, Salpingectomy (removal of the tube) or Salpingostomy (incision into the tube).
Decreased blood pressure; decreased urine output; respirations <12/min; absent patella reflex
Stop infusion, administer calcium gluconate
Diagnostic test for Hyperemsis Gravidarum
CBC: Increased Hgb/Hct; CMP: low potassium, sodium, calcium; BUN/Creatine: elevated; UA: ketones in urine
What lab is usually associated with Pre-Clampsia?
Elevated Proteinuria
Types of Lochia and when should each be seen during the postpartum period
Rubra - Dark red, first 3-4 days postpartum
Serosa - Pink to brown, days 4-10 postpartum
Alba - White or yellow, 10 - 14 days postpartum
Difference from Placenta Previa and Placenta abruptio (Risk factors, S/S, diagnostic testing, treatment)
Placenta Previa is when placenta is located near or covering the uterus; previous placenta previa, Previous C sections, multiple gestations; Painless, bright red bleeding; ultrasound; close follow ups (since now at high risk), no vaginal exams
Placenta Abruptio is when the placenta prematurely separates from the uterine wall at or after 20 weeks' gestation; History of abruption, smoking or cocaine use, maternal age greater then 35 years, hypertension; Dark red bleeding with abdominal pain and/or back pain, uterine contractions; Monitor, emergent delivery
Medication for Gestational Hypertension
Low dose aspirin; Oral antihypertensives (methyldopa, labetalol, nifedipine); IV antihypertensives (hydralazine, labetalol); IV magnesium sulfate; betamethasone
Treatment for hyperemsis Garvidum and patient education
Medication: Zofran(ondansetron), Diclegis
Non-Pharmacological: Avoiding triggers, Ginger, Acupressure, frequent snacks/ small meals
Client education: Start with clear liquids, then bland diet, then small frequent meals; severe cases may need enteral nutrition or TPN
Risk factors of hyperemesis gravidarum
Nulliparity, Age <30, Multifetal gestation, Molar pregnancy, Hyperthyroid disorders, diabetes, GI disorders, Family history of HG, high levels of emotional stress.
Risk to fetus: Small for gestational age, preterm birth, intrauterine growth restriction (IUGR)
What are the components of a BUBBLE assessment what is each letter assessing?
Breast, soft, filing, engorged, cracks in nipples, bleeding, latching; Uterine tones, firm fundus, midline at or below umbilicus; Bladder, frequent urination (3L a day); Bowel, passing gas, stool softener; Lochia, discharge, color, odor, consistency, amount; Episiotomy, or any incision (REEDA, Redness, edema, ecchymosis, drainage, approximation)
The 5 types of spontaneous abortions and descriptions for each:
Threatened: cervix is closed, embryo may still be viable, although mother is experiencing warning signs like cramping and bleeding; Inevitable: cervix is dilated, the loss is now "unavoidable" or inevitable, even though the tissues haven't passed yet; Incomplete: the cervix is open and some tissues has passed, but some is still left inside the uterus; Complete: All products of conception have been entirely expelled, and the uterus is empty; Missed: the fetus has passed away (no cardiac activity), but nothing has been expelled yet and cervix remains closed.
Nursing considerations for patients with Gestational Hypertension
Bedrest; Home blood pressure monitoring; close fetal monitoring; seizure precautions; psychosocial precautions
Diagnostic test for Gestational diabetes
Glucose tolerance test: 1hr, patient drinks 50g of oral glucose solution, glucose labs are drawn in 1hr, if >140mg/dL, Oral glucose tolerance test will need to be done; additional fasting done, 100g of oral glucose liquid solution, 3 blood glucose tests drawn in 3hrs, if two readings (out of four) are elevated, gestational diabetes is diagnosed.
S/S of Preterm labor and treatments for it
Dull back ache, pelvic pressure, feeling that fetus ball up; SQ terbutaline (relax uterus and reduces contractions), oral nifedipine (lower BP), IV magnesium sulfate (neuroprotectant), cerclage (prevents preterm labor up to 24 weeks)
Lochia consistency and amount
scant <2.5cm; Light <10cm; Moderate 15cm; heavy saturated pad <1hr