OB TEST THREE SG - REAL (6).docx - 1 OB TEST THREE Chapter 18 Gestational Onset Bleeding during pregnancy(care Nursing interventions o Obtain accurate

OB TEST THREE SG - REAL (6).docx - 1 OB TEST THREE Chapter...

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OB TEST THREE Chapter 18: Gestational Onset Bleeding during pregnancy (care) Nursing interventions o Obtain accurate patient history o Assess vital signs, s+s of shock, amount of bleeding, FHR, support system, coping mechanisms o Intervene with IV fluids/blood, type and cross for blood, give oxygen Bleeding disorders (many causes) o Causes: Exercise/sex – most common cause of bleeding Miscarriage S+S: pelvic cramping, back ache, spotting, vaginal bleeding (25% of the time) o *Cramping on sides/groin = round ligament pain Causes: o Early (1 st trimester) 4-8w: chromosomal 10w: hormonal 12w: infections or environmental o Late (2 nd trimester up to 20 weeks/500g) Maternal factors Reproductive structure Cervical insufficiency (14-18w cervix cannot handle increased weight and premature dilation causes bleeding) Maternal disease (HTN, DM) Medical/Nursing Care o Emotional support, grieving guidance o Teach about physical pain management o Assess vaginal bleeding, and where it is coming from o Suction D+C – if its incomplete (outpatient) o RhoGam – if Rh(-) Teach o Report any foul smelling discharge, bleeding, tenderness, fever, chills o Should have support person for 12-24 hours at least o Support groups/grief counseling Ectopic pregnancy – attaches somewhere besides uterus Often attaches in ampulla of fallopian tube Risk Factors o PID (pelvic inflamm disease) o IUD (intrauterine device) alters the lining of the uterus 1
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o Endometriosis o Tubal damage (previous surgery, congenital problem) o Previous ectopic pregnancy o Hormones or fertility drugs with increased progesterone or estrogen High levels of progesterone alters motility of egg in tube o Smoking paralyzes cilia o Advanced maternal age S+S: o Normal symptoms of pregnancy like amenorrhea, breast tenderness, n/v, chadwicks (blue discoloration), hegars (softening of isthmus), hCG is in blood and urine o Fainting and dizziness o One sided lower abdominal pain o Diffuse lower abdominal pain between 4-7 weeks o Referred right shoulder pain from blood on nerve o Physical exams Tenderness of fallopian tube and ovaries (adnexal tenderness and adnexal mass) Bleeding is slow and chronic –abdomen becomes rigid and tender Pelvic exam is painful Mass of blood can be palpated H+H decrease, WBCs increase Clinical therapy o Rule out appendicitis, UTI, PID, ruptured cyst, inflamm of fallopian tube o Menstrual history –LMP, cramps o hCG – gradual decrease o Pelvic exam, transvaginal ultrasound (FHR) Medical tx o Methotrexate (Folic acid antagonist): End life of baby, given when tube is in tact to save mom’s tube. Used if the woman wants to have future pregnancy Surgical tx o Laparoscopic linear salpingectomy – evacuates pregnancy and saves the tube (if ruptured then tube will be removed – ectomy) Pt. education o Report s+s of infection o Know future risk of ectopic pregnancy is increased Gestational trophoblastic disease (GTD), Hydatidiform mole, molar Abnormal placental development proliferation of trophoblastic cells 2
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