Term
| Placenta Previa and statistics |
|
Definition
implantation of the placenta in the lower uterine segment near the presenting part
1/200 |
|
|
Term
|
Definition
previous hx
multiparity
increasing maternal age
c-section or uterine surgery
smoking or drug use
recent spontaneous or induced abortion
asian or african
male fetus |
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|
Term
| placenta completely covers the internal cervical os |
|
Definition
|
|
Term
|
Definition
| internal os is partially covered by the placenta |
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|
Term
| edge of the placenta is at the margin of the internal os |
|
Definition
|
|
Term
|
Definition
| placents is implanted in the lower uterine segment but does not reach the os although in close proximity |
|
|
Term
|
Definition
(classic) painless bright red bleeding
can be scanty or diffuse |
|
|
Term
| how are many diagnosed before s/sx occur |
|
Definition
|
|
Term
| what may the bleeding do? |
|
Definition
| stop spontaneously but returns later |
|
|
Term
| when may the bleeding start |
|
Definition
| any time but may occur during labor |
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|
Term
| The nurse is about to persorm a digital examination on a patient with suspected placenta previa, what should she do? |
|
Definition
| STOP! It may cause further seperation or a tear which can lead to severe maternal and fetal bleeding |
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|
Term
| when can a digital examination be performed on a patient with suspected placenta previa |
|
Definition
| when the location and position are verified by ultrasount. |
|
|
Term
| what else should be avoided? |
|
Definition
| ADMINISTRATION OF OXYTOCIN |
|
|
Term
| what are medical interventions based on |
|
Definition
| condition of mother and fetus |
|
|
Term
| if the condition is stable and there is no active bleeding |
|
Definition
bed rest, close to hospital
strict monitoring of vaginal discharge or bleeding
no sex
administer corticosteriods (for lungs) |
|
|
Term
|
Definition
prepare for cesarean delivery
IV therapy
large bore needle because they WILL NEED BLOOD
type and cross match |
|
|
Term
| During home care nurses should emphasize |
|
Definition
assessing vaginal discharge or bleeding after each BM or urination
fetal movements daily
asseing uterine activity daily
NO SEX CAN CAUSE DISRUPTION OF THE PLACENTA |
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|
Term
| The care at the hospital is the same except: |
|
Definition
| nonstress tests, and biophysical profiles |
|
|
Term
| what the nurse should report |
|
Definition
significant change in fetal heart activity
increased vaginal bleeding
signs of preterm labor
rupture of the membranes |
|
|
Term
| when should rupture of the membranes be reported? |
|
Definition
| at home or at the hospital |
|
|
Term
| if a mother has had her membranes ruptured, and does not stop bleeding, but the fetus is premature, what is done |
|
Definition
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|
Term
| What is abruptio placentae |
|
Definition
seperation of a normally implanted placenta before the fetus is born
0.5-1% |
|
|
Term
|
Definition
maternal hypertension
multigravida
short umbilical cord
prior hx
smoking
abdominal trauma
COCAINE USE IS THE LEADING CAUSE |
|
|
Term
| what is the factors that contribute to the severity |
|
Definition
| amount of bleeding and size of hematoma |
|
|
Term
| major danger of abruptio placentae |
|
Definition
| hemorrhage and hypovolemic shock and DIC |
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|
Term
| s/sx of abruptio placentae |
|
Definition
dark red vaginal bleeding
sudden low back or abdominal pain, aching or dull to severe
rigid boardlike tender uterus
uterine irritability with frequent contractions, high resting tone with internal monitoring |
|
|
Term
|
Definition
| margins of the placenta remain intact and it bleeds into this space |
|
|
Term
|
Definition
| bleeding separates or dissects the membranes from the endometrium and blood flows out throught the vagina |
|
|
Term
| what color is the amniotic fluid often |
|
Definition
|
|
Term
| why does the uterus become boardlike? |
|
Definition
| uterus is filling up with blood |
|
|
Term
| s/sx of a concealed hemorrhage |
|
Definition
bleeding may not be present
increase in fundal height
maternal and fetal tachycardia
decrease in maternal bp
restlessness |
|
|
Term
| management of abruptio placentae |
|
Definition
complete assessment with FHR eval
bedrest if it is a small abruption
tocolytics to decrease uterine activity |
|
|
Term
|
Definition
Serial Kleihauer-Betke (K-B) test
coagulation studies
cbc
drug screen |
|
|
Term
| what does the k-b test look for |
|
Definition
| fetal cells in maternal circulation |
|
|
Term
| what does the drug screen look for specifically |
|
Definition
|
|
Term
| if a woman is in a MVA or domestic violence, how long are they observed? |
|
Definition
|
|
Term
| if no contractions are present, and FHR and lab studies are WDL, bbut the mother was involved in a MVA, how long is she going to be observed? |
|
Definition
|
|
Term
| There are signs of fetal compromise and excessive bleeding is apparent after the mother was hit by her partner, what is to be done? |
|
Definition
prompt delivery of the fetus
followed by intensive monitoring
1+ large bore needles and IV lines for fluid and blood replacement. |
|
|
Term
| Assessment for the woman of a hemorrhagic condition of late pregnancy: bleeding |
|
Definition
| amount, time, estimated loss, description of tissue or clots passed, peripads and underpads saved |
|
|
Term
|
Definition
sonstant, intermittent, sharp, dull, severe, onset, and location.
is uterus tender or irritable when palpated gently |
|
|
Term
|
Definition
| hypertension/hypotension and tachycardia that occur with shock |
|
|
Term
|
Definition
| electronic monitor for FHR, baseline variability, and fetal response to uterine activity |
|
|
Term
| Assessment: Uterine Contractions |
|
Definition
| Membranes ruptures: IU pressure catheter |
|
|
Term
| Assessment: OB hx, and length of gestation |
|
Definition
gravida, para, previous abortions, preterm infants, previous pregnancy outcomes
LMP, fundal height, correlation of height with estimated gestation, ultrasound.
can use piece of tape to mark bleeding |
|
|
Term
| Interventions for monitoring for signs of hypovolemic shock |
|
Definition
increased rate and effort of heart and lungs
fetal and maternal tachycardia
weak peripheral pulses
normal or slightly decreased maternal bp
low o sat
cool pale skin and mucous membranes
pallor of skin and mm
cold clammy skin
urine output less athan 30ml/hr
restlessness agigation and decreased mentation |
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|
Term
| Interventions for monitoring the fetus |
|
Definition
electronic fetal monitoring
late decels
call hcp for new labs that suggest increasing abruption like ^K-B levels |
|
|
Term
| Interventions for tissue oxygenation |
|
Definition
place in lateral position hob flat
restrict maternal movements
provide simple explanations, reasurrance and emotional support to reduce anxiety |
|
|
Term
| Collaboritaing with HCP for fluid replacement intervention |
|
Definition
insert IV lines large bore or central line
order for typing and crossmatching
administer fluids as directed |
|
|
Term
| the patient has cool pale skin and tachycardia and weak peripheral pulses, what does this indicate? |
|
Definition
|
|
Term
| The patient's urine output is 25ml/hr, she has a falling blood pressure and her o2 sats are steadily falling, what is this and what should be initated? |
|
Definition
late hypovolemic shock
type and cross match
central/2 large bore ivs
fluid replacement |
|
|
Term
| Interventions for providing emotional support |
|
Definition
explain what is happing
reassure about pain relief measures
provide accurate and timely information to woman and her family
no false reassurances |
|
|
Term
| Interventions for c-section: |
|
Definition
prepare quickly
remain with her and her family to provide as much information as possible |
|
|
Term
| after birth interventions |
|
Definition
assess for bleeding from the vagina and any surgical sites or puncture wounds (DIC)
all postpartum assessments and those associated with surgery and hemmorhagic complication |
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