Bleeding and Pain
First Trimester blood loss range: spotting to hemorrhage
Pain: lower abdominal cramping
Spontaneous Abortion (Miscarriage)
Fertility Treatments and STD's
Ectopic - scarring of a tube can cause blockage
Medical management: Methotrexate X2 doses
Surgical management: Salpingectomy
What are medical/surgical managements for ectopic pregnancy?
Hemoglobin
Hematocrit
Platelet Count
What are part's of the CBC that are important for assessing blood loss?
Avoid foods with folic acid
Avoids gas forming foods and sun exposure
Tylenol only for pain
Double flush toliet/ use seperate toilet
What is included in the education for a patient taking Methotrexate for ectopic pregnancy?
Pain: Unilateral abdominal pain/ possibly referred shoulder pain
Ectopic Pregnancy
Genetic problem
Older paternal age
Spontaneous Abortion (Miscarrage) - either no mom dna or two of dad's dna
Older paternal age may have old dna that is not as good.
Large Bore IV and fluid bolus
What are interventions for the hemorrhaging patient?
Ultrasound: no fetus in the uterus
What would be the ultrasound results for Ectopic Pregnancy?
Follow up care: frequent and essential
Birth Control: reliable and for at least one year
What is the patient teaching for Complete Molar Pregnancy?
Second Trimester bleeding: prune colored
Pain: None really associated with this condition
Low Beta Carotene diet or low animal fat diet
Asian, Native American, and Hispanic descent
Complete Molar Pregnancy (Gestational Trophoblastic Disease)
Medical Management: Misoprostol (Cytotec)
Surgical Management: Dilation and Curettage (D&C) or Dilation and Evacuation (D&E)
What are managment options for spontaneous abortion (Miscarriage)?
Ultrasound: snowstorm effect noted
What is the ultrasound result for a Complete Molar Pregnancy?
Larger baby size than expected for due date
Hyperemesis
BP problems prior to 20 weeks of pregnancy
What are Complete Molar Pregnancy S/S?
Third Trimester bleeding: Bright red
Pain: none
Abdomen: soft
Placenta Previa
Trauma
Drug use (cocaine)
Smoking or hypertension
Placenta Abruption - vasoconstriction is not good and can cause this problem
Witness Consent Foley
Clip pubic hair O2 to keep sat 95%
keep warm
IV bolus
Antibiotic prophylaxis
What are nursing interventions prior to Cesarean Section?
HCG level: below 5 mIU/mL at 9 weeks
(nl: 9 weeks: 59,109–135,901 mIU/mL)
Spontaneous abortion
Post delivery education on complications include:
Hemorrhage and Infection
All!
Third Trimester bleeding: dark red
Pain: intense
Abdomen: board like and areas of tenderness
Scarred Uterus
Grand Multiparity
Placenta Previa
Ectopic
Miscarriage
Complete Molar Pregnancy
When is grief support needed?
Ultrasound: placenta location is over the internal os of the cervix
Bed rest
NST and BPP every other day
Fetal monitoring
Pad count
Wait and see approach
What are nursing interventions and assessments for Placenta Previa.