6860411
Description
Flashcards by Allie Winningham, updated more than 1 year ago
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Created by Allie Winningham
about 8 years ago
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| Question | Answer |
| MAP: mean arterial pressure | Normal is 70-110 mmHg. Is an indicator of perfusion of Oxygen and nutrients to vital organs. NEED > 60 mmHg to adequately perfuse vital organs! |
| MAP is affected by…. | Volume of blood ejected from heart/minute, heart rate, blood pressure, and vascular resistance. |
| MAP = | [(2xDiastolic) + systolic] / 3 |
| Antepartum causes of bleeding (before birth) | 1st/2nd Trimester: abortion, ectopic pregnancy, gestational trophoblastic disease 3rd: Placenta previa and abruptio placentae |
| Intrapartum causes of bleeding (during labor) | Uterine inversion/rupture, abnormal cord insertions, placental abnormalities. |
| Postpartum causes of bleeding | hemorrhage, retained placental tissue, lacerations, hematomas |
| Causes of Spontaneous Abortion | Chromosomal defects is most common! Teratogens, faulty implantation/fertilization, maternal infection, endocrine disorders (DM and hypothyroidism), anatomic defects (bicornate uterus or incompetent/weak cervix) |
| Symptoms of Spontaneous Abortion | Spotting, light bleeding, uterine cramping, back ache, pelvic pressure (most common before week 12) |
| DX tests for Spontaneous Abortion | Cervical exam, ultrasound, Hematocrit and Hgb, low B-hCG for gestational age, serum progesterone |
| Treatment of Spontaneous Abortion | Abstinence for at least 2 weeks! Sedation, blood transfusion, IV fluids, D&C, Rhogam! |
| Dilation and Curettage | Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion. |
| Ectopic Pregnancy | The fertilized ovum implants in the fallopian tube and development occurs there, pregnancy cannot be sustained. Ampullary ectopic pregnancy is most common. |
| Causes of Ectopic Pregnancy | Fallopian tube scarring or surgery prior, congenital tube defects, endometriosis, previous EP, exposure to DES (diethylstilbestrol-estrogen) |
| Symptoms of Ectopic Pregnancy | Lower abdominal pain (one-sided, dull then sharp), delayed menses, abnormal vaginal bleeding, breast tenderness, nausea, positive pregnancy test, syncope, low Hct and Hgb, >12,000 WBC count |
| DX of Ectopic Pregnancy | Pelvic Exam, Ultrasound (no uterine sac), B-hCG< 1500-2000. Serum progesterone <5 ng/dL, or serial serum B-hCG that is decreasing or at nonviable level. |
| Beta Human Chorionic Gonadotropin (B-hCG) | EP is suspected if B-hCG is present at lower levels than expected for gestation. B-hCG peaks around week 8-10 of pregnancy. |
| TX of Ectopic Pregnancy | Methotrexate if tube is not ruptured, pregnancy is 3.5 cm or less, no fetal heart movement, woman is stable. Follow up with B-hCG levels. OR Surgery: Salpingostomy *Give Rhogam for Rh- women |
| Methotrexate | Used for TX ectopic pregnancy. MOA: inhibits cell division in embryo. SE: N/V, abdominal pain Educations: no alcohol or folic acids for a while after TX, monitor B-hCG levels, avoid intercourse till levels drop |
| Salpingostomy | Surgery for treatment of EP. May be via laparoscopy. Fallopian tube is lacerated and maintained if viable, but may need to be removed. |
| Nursing Care for Ectopic Pregnancy | Prevent hypovolemia, manage pain, support the woman and validate loss, screen high risk women, educate about safe sex practices to decrease incidence STI's, treat complications. |
| Gestational Trophoblastic Disease | Abnormal proliferation of trophoblastic cells (outermost layer) of developing blastula |
| 3 Types of GTD | 1) Complete/Partial Hydatiform Mole 2) Invasive Mole 3)Choriocarcinoma |
| Molar Pregnancy | Abnormal proliferation of placental tissue- chorionic villi and edema. Results in pregnancy loss, increased chances of choriocarcinoma. |
| Complete Hydatiform Mole | Ovum develops with NO genetic material and becomes fertilized by sperm. Low chance of development of choriocarcinoma. |
| Partial Hydatiform Mole | 69 Chromosomes in cell due to doubling of paternal chromosomes. Fetal tissue membranes are present. Can be extremely dangerous for mother, uterine rupture may occur. |
| S/S of Hydatiform Mole | DARK brown spotting, profuse hemorrhage, uterus larger than expected, severe nausea, precclampsia prior to 24 weeks, greater than normal B-hCG, absent FHT's. US reveals grape-like clusters. |
| TX of Hydatiform Mole | D&C. Follow with Chest X-ray, pelvic exam, B-hCG levels every 1-2 weeks x3 and every 1-2 months x 1 year. Avoid pregnancy! |
| Placenta Previa | Placenta in the lower segment of the uterus, may cover cervical os. Unknown origin, occurs in about 1/200-300 pregnancies |
| Three types placenta previa | 1)Total (complete) 2) partial 3) marginal (not covering cervix) |
| Risk Factors for Placenta Previa | >35 years of age, smoking or Rx use, large placenta, previous C-section, close pregnancies |
| Management of Placenta Previa | DX by ultrasound, C-section for complete placenta pre via, NO vaginal exams!!!!! (could lead to rupture of placenta). May labor if marginal. Frequent EFM, if non-reassuring need emergent C-section. |
| Symptoms of Placenta Previa | Usually painless, FRANK red blood, fetal malpresentation (not engaged, relaxed, soft-nontender uterus |
| Nursing Intervention: Placenta Previa | Monitor maternal VS frequently, document bleeding characteristics, pain if present, contractions (look for preterm labor), continuous EFM |
| Abruptio Placenta | Placenta detaches from the uterine wall before fetus is born. Is a medical EMERGENCY! Occurs in 1/100 births, primary cause is unknown. |
| Risk factors for Abruptio Placenta | Abdominal trauma, HTN, smoking, Cocaine abuse, History of previous abruption |
| Maternal Risks Associated with Placental Abruption | Hemorrhage, shock, D&C, anemia, infection, hysterectomy, death |
| Fetal Risks after placental abruption | HYPOXIA, brain damage, prematurity, anemia, Intrauterine growth restriction (IUGR) d/t inadequate nutrition, death |
| Most common symptoms of abruptio placenta | Vaginal bleeding that's DARK red, dull aching pain in low back that can be SEVERE, uterine tenderness, decreased resting tone between contractions, rigid board-like abdomen, low intensity contractions |
| Nursing Assessment for Abruptio Placenta | Maternal VS (oxygen, pain, and BP), EFM, abdominal assessment- resting tone between contractions, symptoms of shock, peri-pads to measure amount of blood, |
| Nursing Interventions for Abruptio Placenta | IV start (>18 gauge for blood products), insert foley catheter, continuous EFM, oxygen administration (8-10L/min), prep for delivery or C-section, Type and Cross blood (at least 4 units!), measure abdominal girth, monitor DIC labs (fibrinogen, platelets, PT and aPTT, fibrin degradation product) |
| Disseminated Intravascular Coagulation (DIC) | pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body. |
| Uterine Inversion | Cause of Intrapartum bleeding due to prolapse of the uterus during 3rd stage of labor (delivery of placenta) that occurs in 1/2000 births. Results in massive hemorrhage, maternal shock, and pain. |
| Risk factors for Uterine Inversion | Pulling on the umbilical cord, fundal pressure during birth, increased abdominal pressure during birth, weak uterine wall and increased uterine relaxation, administration of Mg Sulfate |
| Uterine Rupture | Tear in the uterine wall d/t increased uterine pressure during labor. Full rupture is rare but dehiscence is not. |
| Risk Factors for Uterine Rupture | Previous C-section (increased risk with classic incision versus low-transverse), thin uterus wall, blunt trauma, and excessively strong contractions |
| S/S of Uterine Rupture | May have no S/S. Pain between scapula (blood pools below diaphragm), a feeling that something "ripped", abdominal tenderness, chest/shoulder pain, hypovolemic shock, non-reassuring EFM, absent uterine contractions! |
| TX of Uterine Rupture | Emergency operation to repair, emergent delivery of fetus, about 1/3 women require emergent hysterectomy |
| Postpartum Hemorrhage | IS most common cause of maternal mortality/morbidity in the U.S. |
| Priorities during PPH | 1) massage fundus 2) empty bladder 3) Administer oxytocic Rx's |
| Definition of PPH | More than 500 mL blood loss after vaginal delivery or more than 1000 mL blood loss after C-section. *1g= 1mL S/S of shock don't appear until 1000-2000 mL have already been lost (30-40% total blood volume) |
| Symptoms of Hypovolemic Shock | Shaking, pallor, tachycardia, increased Respiratory rate, restlessness and anxiety, cool, clammy skin, decreased blood pressure |
| Late PPH | Begins later than 24 hours after birth and may continue for up to 6 to 12 weeks after. Usually not greater than 1 to 2 weeks after. |
| Causes of late PPH | Sub-involution of uterus, infection with chlamydia, retained placental fragments |
| SX of Late PPH | Lower abdominal tenderness, may have fever, lochia rubra beyond 1 week, foul discharge, fundal height greater than expected |
| TX of Late PPH | Methergine 0.2 mg PO every 4 hours x 2days, antibiotics, D&C |
| Early Postpartum Hemorrhage | Occurs within the first 24 hours after delivery. |
| Causes of early PPH | UTERINE ATONY, genital trauma, and retained placental fragments. Hematoma, uterine inversion, and coagulation disorders. |
| Uterine Atony / Risk Factors for PPH | Over-worked muscle from rapid or long lasting labor, use of oxytocin or uterine relaxing Rx's (Mg Sulfate), multiparous women (> 5 births), use of forceps or vacuum extraction, precclampsia |
| Recognition of PPH | Identify risk factors early on, boggy enlarged uterus after delivery, large gush of blood, increased lochia flow (1 pad in 1 hr is bad!), clots, increased HR and RR, decreased BP, MAP, and urine output (are later signs!) Altered level of consciousness |
| Colloid IV Fluids | Volume expanders, remain in the vascular space. They are expensive and need refrigeration. Examples: Dextrans and hetastarches |
| Crystalloid IV Fluids | Don't stay in Intravascular space for long, used for hydration and calories. Examples: NS, LR, Dextrose (D5W). Are cheap and can be stored at room temperature. |
| Oxytocic Drugs | Drugs used that have similar effects of oxytocin: promote uterine contraction and cease bleeding. |
| Oxytocin | Given IM or IV, causes smooth muscle contraction. |
| Methergine | NOT for use in Hypertensive clients. Given IM or PO. Causes uterine and vascular smooth muscle contraction |
| Hemabate | Do not use for those with renal or liver impairments, glaucoma, asthma, or HTN. Injected into the uterus or given IM, causes myometrial contraction |
| Cytotec [Misopristol] | POWERFUL myometrial contractions. Given rectally, not for use in those sensitive to prostaglandins. |
| Medical Intervention of PPH | Bimanual compression, embolization of pelvic vessels, vessel ligation, or hysterectomy as last resort |
| Hematomas | Cause of bleeding after delivery. Blood collects in connective or soft tissue under skin. Causes include trauma or injury to blood vessels, inadequate hemostasis at an incision or laceration site. |
| Risk Factors for Hematomas | Episiotomies, laceration, nulliparity, operative vaginal delivery (forceps or vacuum), impaired coagulation |
| Nursing Intervention for Hematomas | Frequently inspect site, observe for S/S of shock and report immediately, manage pain |
| TX of hematomas | 3-5 cm hematomas only require palliative treatment such as Ice and analgesia. >5 cm hematomas may require incision, drainage, vessel ligation in the OR with sedation. ICE for 24 hours! |
| Lacerations | Tear in the perineum, vagina, or cervix. Can include 1 large laceration or several small lacerations. |
| Risk factors for Laceration | Younger maternal age, nulliparity, epidural anesthesia, fast childbirth, forceps or vacuum delivery, macrosomia, use of oxytocin |
| SX of Lacerations | PERSISTENT BLEEDING DESPITE FIRM FUNDUS, symptoms of hypovolemic shock, pain |
| Nursing Management of Lacerations | Notify MD ro CNM immediately. May require immediate repair to stop bleeding. |
| Ongoing care for PPH | I/O, IV access with > 18 gauge, rest, pain management, help care for baby, Iron supplement with vitamin C, education, communication with health staff, and report symptoms of infection |
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