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Nova Southeastern University Maternal-Child Nursing And Families NUR 4130 CH 19, 20

James Moore
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Nova Southeastern University Concepts Of Maternal-Child Nursing And Families (NUR 4130) 3. CH 19, 20 – High Risk Pregnancy Maternity and Pediatric Nursing Antepartum. These notes are based on the information from the book and class, and it’s everything to know about high risk pregnancy

CH 19 – Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications High Risk Pregnancy • Jeopardy to mother, fetus, or both • Condition due to pregnancy or result of condition present before pregnancy • Higher morbidity and mortality • Risk assessment with first antepartal visit; ongoing • Diverse factors

Pregnancy complications
Conditions Associated with Early Bleeding During Pregnancy

Spontaneous Abortion • Cause unknown and highly variable – First trimester commonly due to fetal genetic abnormalities – Second trimester more likely related to maternal conditions • Most common complication of early pregnancy • Abortion: Loss of an early pregnancy, usually before week 20th of gestation. Can be spontaneous (loss of fetus d/t natural causes) or induced. • Nursing assessment – Vaginal bleeding à women complaining of vaginal bleeding must be seen immediately to determine the cause/reason why she’s bleeding – ask about color of bleeding (bright red is significant), amount (saturating a pad/hr. is significant), and any passage of clots or tissue – assess pain level, cramping or contractions – Vital signs, pain level – Client’s understanding • Types of Spontaneous Abortion – Threatened: The cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs, not passage of fetal tissue – Inevitable: The placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased, possible passage of products – Incomplete: The embryo or fetus has passed out of the uterus, but the placenta remains inside – Complete: embryo or fetus and placenta are out – Missed: non-viable embryo retained in uterus for at least 6 weeks, without s/s (in other words when mom doesn’t know the fetus is dead inside) – Habitual: > 3 consecutives spontaneous abortions • Nursing Management: – Continued monitoring: vaginal bleeding, pad count – Observe for passage of products of conception – Pain level and management of pain to address cramping discomfort – Preparation for procedures (most of the time after abortion, a D&C is done) – If spontaneous abortion happened out of the hospital, and passage of products of conception occurred, pt. should bring everything to the hospital with her – Medications § meds such as misoprostol or PGE2 (intravaginal suppository) to empty the uterus or retained tissue or fragments that were not completely passed in the abortion w/o surgical intervention § If mother Rh negative and abortion occurs, administer RhoGAM within 72 hrs. – Support: physical and emotional support; emphasis that the woman is not the cause of the loss; verbalization of feelings, grief support, referral to community support group
Ovum implantation outside the uterus • d/t obstruction or slowing passage of ovum from tube to uterus • As the embryo enlarges, it causes the potential for organ rupture because only the uterine cavity is designed to expand and accommodates fetal development à leading to massive hemorrhage, infertility or death • Many women are asymptomatic before tubal rupture • Classic clinical triad: abdominal pain, amenorrhea, and vaginal bleeding • Therapeutic management – Determine the existence of an ectopic pregnancy: urine pregnancy test to detect pregnancy, hCG concentrations to exclude a false positive urine test, transvaginal ultrasound to visualize the misplaced pregnancy – Medical: drug therapy (methotrexate –if it hasn’t rupture yet, prostaglandins, misoprostol, and actinomycin) – Surgery if rupture – RhoGAM if woman.


Nova Southeastern University Maternal-Child Nursing And Families NUR 4130 CH 19, 20

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