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Reproduction:Antepartal Client -Complications/High Risk
Learning OutcomesDiscuss the nursing and collaborativemanagement of the antepartal client withcomplications of pregnancy.Develop and implement a plan of care forthe antepartal client experiencingcomplications including nursing,interdisciplinary care and educationalneeds.
High Risk PregnancyCan relate to the pregnancy itselfCan occur because the woman has amedical condition or injury thatcomplicates the pregnancyCan result from environmental hazardsthat affect the mother or her fetusCan arise from maternal behaviors orlifestyles that have a negative effect on themother or fetus
Hyperemesis GravidarumManifestations:Excessive nausea andvomitingDehydrationReduced delivery ofblood, oxygen, andnutrients to the fetusCan affect fetal growth?? Is Tx different frommorning sickness?? etiologyTreatmentCorrectdehydrationandelectrolyteoracid-base imbalanceAntiemetic drugs maybe prescribedIn extreme cases:TPN may berequiredHospitalization
Bleeding in Pregnancy: AbortionSpontaneous(nonintentional)ThreatenedInevitableIncompleteCompleteMissedRecurrentInducedTherapeuticElectiveLoss of pregnancy beforefetus is viableDenotes termination ofpregnancyMost occur1st12wksMost common: severecongenital abnormalitiesAlso see with infection,maternal endocrinedisorders, abnormalitiesof reproductive tract
AbortionThretened AbortionVaginal bleeding (25%spotting)Uterine crampingPersistent backachePelvic pressureCervix is closedReport all bleedingNote: bleeding, clots,tissue, foul odorUltrasound (fetalpresence and viability)Consult: sexual activityInevitable abortionROMCervix dilatedActive heavy bleedingDilation and curettage(D&C) if tissue remains orheavy bleedingNo treatment with naturalexpulsion
Incomplete AbortionManagement:Cardiovascular statusstabilizationIV, bloodD&C,followed by IVPitocin or IMMethergineD&C not usually after14 wks 2° excessive bleeding potential;  Pitocin or prostaglandinSevere abdominalcrampingActive uterinebleedingCervix dilatedPassing placental andfetal tissueSome products ofconception expelled,some remain
Recurrent Abortion3 or more consecutivespontaneous abortionsMost 2° genetic, chromosomal abnormalities, or reproductive tract problemsEndocrine, immunologic factors, systemic disease (lupus), STD’s (syphilis).Management:ID causeIf incompetent cervix,do cerclageIs removed prior tolaborCall immediately iflabor starts, orROM (Rupture ofmembranes)
Nursing Care/Assessmentfor AbortionCollaborative careAssessment of CV statusIdentify Rh factor;labsTeach measures toinfectionDiet/nutrition needs:mayneed

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Term
Spring
Professor
Espindola
Tags
Obstetrics, Ectopic pregnancy, vaginal bleeding

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