Early Bleeding
Cramping and bleeding with a CLOSED cervix and a still-viable embryo describes this type of spontaneous abortion.
What is a threatened abortion?
Painless, bright red bleeding after 20 weeks with a soft, non-tender uterus.
What is placenta previa?
New-onset seizures after 20 weeks with no other cause.
What is eclampsia?
The antidote the nurse keeps at the bedside for magnesium sulfate toxicity.
What is calcium gluconate?
The 1-hour glucose challenge test for gestational diabetes is routinely done between these weeks of pregnancy.
What is 24–28 weeks?
Intractable nausea and vomiting, ketones in the urine, and more than 5% weight loss.
What is hyperemesis gravidarum?
"Prune-juice" bleeding, a uterus large for dates, and an hCG over 100,000.
What is a molar pregnancy (hydatidiform mole)?
Painful bleeding with a rigid, board-like, tender uterus and frequent contractions.
What is placental abruption?
A new BP of 140/90 or higher after 20 weeks (2 readings, 4 hours apart) with NO proteinuria or organ involvement.
What is gestational hypertension?
The therapeutic serum range for magnesium sulfate.
What is 4–7 mEq/L?
First-line medication for diabetes in pregnancy, chosen because it does not cross the placenta.
What is insulin?
Teach the client on levothyroxine to take her prenatal vitamin at least this many hours later.
What is 4 hours?
Painless cervical dilation leading to a second-trimester loss; often treated with a cerclage at 13–14 weeks.
What is cervical insufficiency?
This assessment is NEVER performed on a client with placenta previa.
What is a digital vaginal (cervical) exam?
BP of 160/110 or higher, platelets under 100,000, and a headache unrelieved by meds are each examples of these.
What are severe features of preeclampsia?
A client on a mag infusion has RR 10, absent DTRs, and is hard to arouse. This is the nurse's FIRST action.
What is stop the magnesium infusion (then call the provider and give calcium gluconate per protocol)?
This placental hormone increases insulin resistance in the 2nd and 3rd trimesters, so insulin needs go up.
What is human placental lactogen (hPL)?
This autoimmune disease is the most common cause of hyperthyroidism in pregnancy.
What is Graves' disease?
A stable client with an unruptured tubal ectopic is treated with this folic acid antagonist, and must avoid folic acid supplements while taking it.
What is methotrexate?
A persistent placenta previa on the 36-week ultrasound means the client will most likely be scheduled for this at 36–37 weeks.
What is a cesarean birth?
A client has RUQ pain, nausea, and malaise. Her BP is 128/80 and her urine protein is normal, but her platelets are 68,000 and her AST/ALT are rising.
What is HELLP syndrome? (BP may be normal!)
Given to an Rh-negative client with bleeding at 12 weeks or later to prevent sensitization.
What is Rho(D) immune globulin?
Gestational diabetes is diagnosed when this many values on the 3-hour GTT are out of range.
What is 2 of 4?
When diet changes aren't enough for hyperemesis, first-line medication is vitamin B6 combined with this antihistamine.
What is doxylamine?
A client with a known tubal ectopic suddenly reports sharp pelvic pain, rectal pressure, and dizziness. HR 128, BP 84/50. Name what is happening and what the nurse prepares for.
What is ectopic rupture (hemorrhagic shock); prepare for emergency surgery?
After a severe abruption, the client is oozing from her IV site and gums. Platelets and fibrinogen are low, PT/PTT is prolonged, and D-dimer is elevated.
What is DIC (disseminated intravascular coagulation)?
During an eclamptic seizure, the nurse positions the client this way and documents these two details.
What is left side-lying; the time and duration of the seizure?
This first-line antihypertensive should be held if the diastolic BP is under 80 and avoided in clients with asthma or heart block.
What is labetalol?
The LGA newborn of a mother with GDM is closely watched for this in the first hours of life, and the mother needs this test 4–12 weeks postpartum.
What is neonatal hypoglycemia; a 75-g oral glucose tolerance test (OGTT)?
The client is switched from PTU to methimazole after week 16 because PTU carries this risk.
What is hepatotoxicity (liver damage)?