Prenatal Hemorrhage - PrenatalHemorrhage

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Prenatal Hemorrhage Hemorrhage may occur early or late in pregnancy, owing to certain physiological problems, each with its own  signs and symptoms, which help in establishing a differential diagnosis and in creating the plan of care. This general  guide for care is meant to treat hemorrhage in the antepartal client. Where appropriate, interventions specific to each  physiological problem are identified. CLIENT ASSESSMENT DATA BASE: GENERAL FINDINGS Circulation Hypertension or hypotension may be present. Pallor. Dizziness. Ego Integrity Anxious, fearful, apprehensive Food/Fluid Nausea/vomiting Safety Pelvic inflammatory disease; repeated episodes of gonorrhea Sexuality Multiparity and advanced maternal age (>35). Previous cesarean sections. Repeated second- or third-trimester abortions. Specific conditions with appropriate signs and symptoms are listed in the prenatal time sequence in which they might  appear. Ectopic Pregnancy Timing of rupture depends on location of fetus; i.e., isthmus of fallopian tube may rupture after 4–5 wk; an  interstitial implantation may not rupture until the beginning of the second trimester. (Note: Enhanced diagnostic  techniques are helping to identify the anomaly prior to tubal rupture.) Circulation Hypotension Tachycardia Delayed capillary refill Cold, clammy skin Faintness, syncope Food/Fluid Abdomen may be tender.
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Pain/Discomfort Colicky abdominal pain. Referred shoulder pain may be noted as abdomen fills with blood. Severe one-sided pain may occur in presence of tubal rupture. Safety Normal or subnormal temperature Sexuality Abdominal tenderness. Uterine enlargement may be noted. Adnexal mass is palpable on pelvic examination. History of infertility/assisted reproductive techniques; use of progestin as only contraceptive/intrauterine device; prior  tubal surgery. Abortion: can occur at any time prior to 20 weeks’ gestation. (Refer to CP: Spontaneous Termination.) Hydatidiform Mole (Gestational Trophoblastic Disease) May occur as early as the 4th week or as late as the second trimester Circulation Hypertensive symptoms and/or edema may have developed before 20 weeks’ gestation (PIH). Food/Fluid Severe nausea/vomiting (hyperemesis gravidarum). Urine may be positive for protein. Sexuality Uterus may be enlarged out of proportion to gestation or may be smaller than anticipated; bilateral ovarian  enlargement. No FHTs or fetal outline palpable; no fetal activity noted.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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Prenatal Hemorrhage - PrenatalHemorrhage

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