OB study guide 1 Chapter 20 o Hyperemesis Gravidarum Definition - Severe vomiting due to increase levels of HCG and carbohydrate metabolism (must carry around a pack of crackers) Increased risk for dehydration (electrolyte imbalance) -Will be hospitalized (she cant eat or drink ANYTHING) Make NPO for the first 24 hour and give IV fluids -Dehydration = cramping (of the uterus) = preterm labor Cant keep anything down, DEHYDRATED ; caused by HcG, estrogen, carbs Treatment - IV Fluids 3000 mL in 24 hours, hospital, NPO, antiemetic, Phenergan, dramamine, introduce foods slowly after at least 48 hours, electrolytes Nursing Care -monitor I&O, decrease odors , good environment (opposite end of the hall where it is quiet) o Bleeding Disorders Can be r/t many possible causes is bleeding coming from rectal or vaginal area. Is it bright red, brown, and how much? Small on underwear, turn water red, had you just had a bowel movement Exercise/intercourse -benign, can stop these things that are causing bleeding Spontaneous abortion - threatened abortion; do not know if will loss pregnancy Miscarriage – bright red vaginal bleeding; cramping; lower back ache S/S - bright red vaginal bleeding, not a lot, can start pink-brownish and then turns bright red, spotting to much more, starts with lower back ache, heaviness in pelvis, like with a period. Not all come together Tx .- increase fluids, get off of feet and bed rest for 24 hrs, if she does miscarry bring in for D&C –dilation and curettage- may chose to go home and wait it out, if 10-12 weeks will need D&C Causes - chromosome abnormalities, infection, or exposure to teratogen, sometimes placenta problem, hormonal problem. Late abortions- incompetent cervix that dilates, Hypertension pre=pregnancy, disease MOM has like blood disease. Nursing Care - allow her to verbalize, allow to grieve, do not give blame because we do not know; don’t blame yourself, can have testing done on tissues; support groups o Ectopic Pregnancy - another reason for bleeding, baby implants somewhere else other than uterus; usually tubes-ampulla of fallopian tube; must rule out gall bladder problems, appendicitis, and tubal twist Associated causes - Pelvis Inflammation Disease (PID), STDs, IUD in place, HX endometriosis, surgical scars, hormonally related S/S - ED with one sided abdomen pain then whole abdomen sensitive to touch, dizziness, irritation on right shoulder, sub diaphragmatic nerve, rule out gallbladder, appendicitis, cyst, UTI, kidney infection Treatment - rule out other things, if tubal pregnancy may give methotrexate to dissolve egg to save fallopian tube; baby cannot survive Methotrexate – drug to give if tube is still there, will cause egg to dissolve; will spare tube
OB study guide 2 Nursing care - rupture of tube, hypovolemic shock, Vital signs, emotional status, if didn’t know she was pregnant tends to be less emotions o Gestational Trophoblastic Disease/Hydatiform Mole/Molar Pregnancy
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