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 Nursing Care:  Counseling about the procedures and alternatives  Provide nonjudgmental care  Allow the client to express her feelings  Preparation.

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Presentation on theme: " Nursing Care:  Counseling about the procedures and alternatives  Provide nonjudgmental care  Allow the client to express her feelings  Preparation."— Presentation transcript:

1  Nursing Care:  Counseling about the procedures and alternatives  Provide nonjudgmental care  Allow the client to express her feelings  Preparation for the procedures: Surgery-D&C or hysterotomy (rarely used) Medications: “Morning –after pill” –RU-482 Oxytocin Prostaglandins-ProstinE2 Misoprotol (Cytotec)  Post –procedure care  Administer RhoGam if the client is Rh-negative  Discharge Instructions

2  INCOMPETENT CERVIX is where there is painless effacement and dilation of the cervical os that is not associated with contractions  It often occurs in the second trimester  Risk Factor:  Congenital uterine anomalies  Diethylstilbestrol (DES) exposure  Cervical operations  Cervical Trauma  Cervical Inflammation


4  Clinical manifestations:  Lower abdominal pain  Urinary frequency in the second trimester  Effacement and Dilation of the cervix  Protrusion of membranes through the cervix  Rupture of the membranes in second trimester

5  Treatment:  Bedrest- Position client so there is pressure off cervix Initially the Trendelenburg position may be used until after surgery  Serial cervical ultrasound assessment  No vaginal exams  Administer tocolytic agents  Surgical intervention- Cerclage is a band of nonabsorbable suture placed around the cervix.  Monitor for uterine contractions, fetal well being, and vital signs


7  Discharge planning:  Teach the client the clinical manifestations of preterm labor, rupture of membranes, and infection. And to report them to health care provider immediately.  Teach the client to return(to hospital) if uterine contraction begin, because the suture will need to be removed to prevent damage to cervix and allow birth  Keep follow up visits with the health care provider  Do Fetal Movement Counts

8  PLACENTA PREVIA is the improper implantation of the placenta in the lower uterine segment.  It is classified according to the degree to which the placenta covers the cervical os.:  Low-laying  Marginal  Partial  Complete or Total


10  Risk factors:  Endometrial scarring  Impede Endometrial vasculation related to: Hypertension Diabetes mellitus Uterine tumor Drug abuse Smoking  Increase placenta mass  Closely spaced pregnancies  Multiple gestation  Multiparity

11  Clinical Manifestations:  Episodic painless vaginal bleeding after 20 weeks gestation  Bright Red Bleeding without uterine contractions  Ultrasound: Reveals the malpositioned placenta  Complications of placenta previa:  Preterm delivery  Hypovolemia  Altered tissue perfusion  Deterioration in fetal status


13  NURSING CARE:  Perform a complete assessment on any pregnant client that presents with painless bright red vaginal bleeding except:  NO VAGINAL EXAMS  Insert large bore catheter(18 or greater) and maintain IV infusion  Monitor: Vital signs Continuous Fetal monitoring I&O-pad count/weight them  Notify: Physician, charge nurse, ICN, and anesthesia personnel

14  Nurse Care:  Obtain laboratory specimens: CBC, Type & Rh, Type & Crossmatch  Be prepared to deliver client: Vaginally for the low-lying placenta-have Double set up in the Delivery room Cesarean section for partial and complete placenta previa- have Hysterectomy tray in the delivery room  Provide emotional support  Strict Bedrest- Position client so pressure is not on the placenta  If client is stable and has diet order make sure it is well balance  Prenatal vitamins and iron will be continue

15  ABRUPTIO PLACENTA is a premature separation, either partial or total of a normally implanted placenta from the decidual lining of the uterus after 20 weeks’ gestation.  Classifications of Abruptio Placenta:  Types: See next slide Marginal-A Central/Concealed/Covert-B Complete-C  Degrees of placental separation: Grades-0-3


17  RISK FACTORS:  Preeclampsia  Eclampsia  Chronic Hypertension  Multiparty  Abdominal Trauma  Uterine Anomalies  Smoking  Cocaine Abuse  Premature Rupture Of Membranes-PROM


19  Complications of Abruptio Placenta:  Risk of depleting clotting factors  DIC  Hypovolemia  Multiorgan failure  Maternal Death  Uterine Placenta insuffiency  Fetal Hypoxia  Fetal Death

20  Clinical manifestations:  Sudden Dark Red Vaginal Bleeding  Unremitting pain  Firm-to boardlike uterine  Shock greater than blood loss  Ultrasound will show abruption  EFM: Uterine irritability Nonreassuring Fetal Heart pattern- Loss of variability and late decelerations

21  NURSING CARE:  Assess and Monitor: Amount of Vaginal Bleeding Vital Signs I&O Measure abdominal girth Uterine characteristics and activity EFM-Continuously For development of coagulation problems Review lab values: CBC, Coagulation studies, PT,PTT

22  Nursing Care:  Insert large IV Catheter(18-gauge or bigger) and maintain IV infusion  Provide O@ at 8-12L/min  Anticipate Transfusion Therapy:  RBC’s  FFP  PLT’s  Crypopreciate  Albumin

23  Nursing Care:  Anticipate Expedited Delivery: Vaginally Cesarean section Have Hysterectomy Tray in room  Provide emotional support  Instruct client and family on disease process and procedures and possible surgery  Contact-Physician, Charge nurse, Anesthesia personnel, ICN unit

24  DISSEMINATED INTRAVASCULAR COAGULATION (DIC) is a complex coagulopathy condition which occurs secondary to another underlying disease process  Risk Factor:  Preeclampsia/Eclampsia  Sepsis  Abruptio Placenta  Prolonged IUFD  Excessive Blood  Uterine inversion or rupture  Amniotic Fluid embolism (AFE)


26  Complications:  Hypovolemia  Alt. Tissue Perfusion  Multiorgan failure  Maternal death  Fetal death

27  Clinical Manifestations:  Shocklike state  Overwhelming and diffuse hemorrhage: Petechia, ecchymosis, hematomas Oozing of blood from puncture sites, IV sites, and /or surgery incisions. Bleeding gums. Blood in urine Laboratory valves: Decreased Hg and Hct Prolonged PTT and PT Decreased fibrinogen Decrease PLT’s D-Dimer

28  NURSING CARE:  Care for this client is for the critically ill client.  Identify Risk factors predisposing to DIC. Early detection is extremely important  Maintain IV site- Central line maybe placed.  Anticipated Transfusion therapy: Fresh Whole Blood Fresh Frozen plasma Cryoprecipate  Monitor VS, I&O, perfusion status*,bleeding, cardiopulmonary status

29  Nursing Care:  Educate the client and family concerning disease process, procedures.  Provide support to the client and family.  No Heparin is given to the client who has DIC and who is pregnant or has been delivered

30  HYPEREMESIS GRAVIDARUM is a disorder with intractable vomiting associated with pregnancy with significant electrolyte imbalance and fluid deficit and possible starvation.  Etiology is unknown/PREGNANCY  Risk Factors:  High levels of hCG  Gestational Trophoblastic Disease  Multigestation  Psychopathologic and emotional factors  Stress  Other pathophysiology

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