NCMA219 High Risk Pregnancy I (Bleeding Disorders) PDF

NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 & 4 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ...

NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 & 4 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL SPONTANEOUS MISCARRIAGE/ABORTION BLEEDING DISORDERS Abortion First Trimester ○ Medical term for interruption of a pregnancy ○ Abortion/Miscarriage before the fetus is viable. ○ Ectopic Pregnancy ○ ELECTIVE ABORTION – planned medical Second Trimester termination of a pregnancy. ○ Hydatidiform Mole Miscarriage ○ Incompetent Cervix ○ Interruption of a pregnancy occurs Third Trimester spontaneously. ○ Placenta Previa CAUSES ○ Abruptio Placenta Abnormal fetal development (teratogenic factor or ○ Preterm Labor chromosomal aberration). Immunologic factor (rejection of embryo through immune response). Implantation abnormalities Inadequate progesterone Systemic infection (Rubella, syphilis, poliomyelitis, cytomegalovirus, toxoplasmosis) Ingestion of teratogenic drug EMERGENCY INTERVENTIONS TYPES Alert health care team of emergency situation. Place wman flat in bed on her side. Begging IVF as ordered (LR using G16 or G18) needle). Administer O2 (6-10 LPM) via face mask. Monitor uterine contractions and FHR by external monitor. Avoid vaginal examination. Withold oral fluid. Blood typing and crossmatching of 2 units whole blood as ordered. Measure input (I) and output (O). Assess vital signs (VS) q 15 mins; apply pulse oximeter and automatic BP cuff as necessary. Assist with placement of central venous pressure or pulmonary arter catheter and blood determinations. Measure maternal blood loss by weighing perineal pads; save any tissue passed. Set aside 5 mL of blood drawn intravenously in a clean test tube; observe in 5 mins for clot formation. Assist with ultrasound examination. Maintain positive attitude about fetal outcome. Provide emotional support. NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 1  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL MANAGEMENT Rectal pressure Positive pregnancy test (50%) Sharp localized pain when cervix is touched Signs of shock/ciculatory collapse DIAGNOSTICS Ultrasonography Culdocentesis ECTOPIC PREGNANCY Implantation occurs outside the uterine cavity. Types: ○ Tubal (Fallopian tube – interstitial, isthmic, Laparoscopy infundibulum and fibrial portior) ○ Cervical ○ Abdominal ○ Ovarian PREDISPOSING FACTORS Fallopian tube narrowing or constriction Serial testing of HCG beta-subunit Pelvic Inflammatory Disease (PID) Puerperal and postpartal sepsis Surgery of the fallopian tubes Congenital anomalies of the fallopian tubes Adhesions, spasms, tumors IUD usage ASSESSMENT FINDINGS Amenorrhea or abnormal menstrual period/spotting TREATMENT Early signs or pregnancy Methotexate , Leucovorin (Unruptured) ○ Tubal rupture signs – sudden, acute low ○ Methotexate – prevents the zygote from abdominal pain radiating to the shoulder (Kehr’s growing by blocking enzymes in the body that sign) or neck pain. maintain the pregnancy thus preventing Nausea and vomiting rupturing of the fallopian tube (Imperial College Bluish navel (Cullen’s sign) Healthcare, 2023). NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 2  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL ○ Leucovorin – used to protect cells from effects DIAGNOSIS of methotrexate and decrease its side effects Passage of vesicles – 1st sign that aids to diagnosis (Bachman & Banhart, 2012). TRIAD Signs Management of profound shock if ruptured (Blood ○ Big uterus replacement) ○ Vaginal bleeding Surgical removal of the ruptured tube (Salphingectomy). ○ HCG greater than 1 million Antibiotics Ultrasound NURSING MANAGEMENT PROGNOSIS Carry out an ongoing assessment for shock 80% remission after D&C; may progress to cancer of Implement promptly shock treatment chorion – Choriocarcinoma Position on modified Trendelenburg Infuse D5LR for plasma administration, blood transfusion, or drug administration as ordered Monitor VS, bleeding, I & O Provide physical and psychological support HYDATIDIFORM MOLE Abnormal proliferation and degeneration of the trophoblastic villi. As the cells degenerate, they become filled with fuid and appear as clear fluid-filled, grape-sized vesicles. Gestational Trphoblastic Disease Cause: unknown TREATMENT Evacuation by suction dilatation and currettage (D&C) or hysterectomy if no spontaneous evacuation. Hysterectomy if above 45 years old and no future pregnancy is desired. RISK FACTORS HCG titer monitoring for one year (no pregnancy for one Low protein intake year). Women older than 35 years old Medical replacement: blood, fluid, plasma Asian women Chemotherapy for malignancy: Methotrexate is drug of Women with a blood group of A who marry men with choice blood group O. Chest X-ray ASSESSMENT FINDINGS Brownish or reddish, intermitted or profuse vaginal bleeding by 12 weeks. Spontaneous expulsion of molar cyst usually occurs between the 16th to 18th weeks of pregnancy. Rapid uterine enlargement inconsistent with the age of gestations. Symptoms of PIH before 20 weeks. Excessive nausea and vomiting because of excessive HCG (1-2 million IU/L/24 hours). Positive pregnancy test No fetal signs – heart tones, parts, movements Abdominal pain NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 3  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL NURSING MANAGEMENT Relaxed cervical os on pelvic examination Advise bed rest Montior VS, blood loss, molar/tissue passafe, I&O Maintain fluid and electrolyte balance, plasma, and blood volume through replacements as ordered. Prepare for suction D&C or hysterectomy as ordered. Provide psychological support. Prepare for discharge TREATMENT ○ Emphasize need for follow-up HCG titer CONSERVATIVE MANAGEMENT determination for 1 year. ○ Bed rest ○ Reinforce instructions on NO PREGNANCY FOR ○ Avoindance of heavy lifting ONE YEAR; give instructions related to ○ No coitus contraceptions. FOR WOMEN WITH PREVIOUS LOSSES: elective cervical COMPLICATIONS cerclage (late first trimester or early second trimester) Choriocarcinoma ○ Shirkodar procedure Hemorrhage ○ McDonald procedure Uterine Perforation Infection PREMATURE CERVICAL DILATATION (INCOMPETENT CERVIX) A condition characterized by a mechanical defect in the NURSING MANAGEMENT cervice causing cervical effecament and dilatation and Provide psychological support to client who may have expulsion of the product of conception (POC). negative feelings. Associated with: Provide post-cerclage procedure care. ○ Increased maternal age Advise limitation of physical activities within 2 weeks after ○ Congenital structural defects treatment. ○ Trauma to the cervix Matrnal and fetal growth monitoring. Instruct to report promptly signs of labor. Assessment of signs of labor, infection, or premature rupture of membranes. In labor – prepare STITCH REMOVAL SET in addition to delivery set (post-McDonalds surgery). ABRUPTIO PLACENTA Premature separation of the implanted placenta before the birth of the fetus. ASSESSMENT FINDINGS Painless contractions resulting in delivery of a dead or non-viable fetus. History of abortions NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 4  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL PREDISPOSING FACTORS NURSING MANAGEMENT Maintain bed rest, Left Lateral Recumbent (LLR) Careful monitoring: ○ Maternal VS ○ FHT TYPES OF ABRUPTIO PLACENTA ○ Labor onset/progress ○ I&O ○ Oliguira/anuria ○ Uterine pain ○ Bleeding Administer IV fluids, plasma, or blood as ordered Prepare for diagnostic examination Provide psychological support Prepare for emergency birth Observe for associated problems after delivery: TYPES OF PLACENTAL SEPARATION ○ Poorly contracting uterus 1. Marginal/Low Separation ○ Disseminated Intravascular Coagulation 2. Moderate/High Separation ○ Hyperfibrinogenemia 3. Severe/Complete Separation ○ Prematurity, neonatal distress PRETERM LABOR Labor that occurs after the 20th week and before the 37th week of gestation. In >30% cases, exact cause of preterm labor is unknown. Occurs approximately 9-11% of all pregnancies. Any woman having persistent uterine contraction (4 q 20 ASSESSMENT FINDINGS mins). Painful, vaginal bleeding ASSOCIATED WITH: Rigid, board-like, and painful abdomen Dehydration Enlarged uterus due to concealed bleeding Urinary Tract Infection If in labor: tetanic contractions with the absence of Periodontal disease alternating contraction and relaxation of the uterus Chorioamnionitis COMPLICATIONS Strenous job or extreme fatigue Hemorrhagic shock COMPLICATIONS Couvelaire uterus Prematurity Disseminated Intravascular Coagulation (DIC) Fetal death Cerebrovascular Accident (CVA) from DIC Small-for-gestational age (SGA) / Intrauterine Growth Hypofibrinogenemia Restriction IUGR Renal failure Increased perinatal morbidity and mortality Infection TREATMENT (HOSPITALIZATION) Prematurity Fetal Distress/Deminse (IUFD) Bed rest on Left Lateral Recumbent (LLR) Adequate hydration NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 5  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL Monitoring: ASSESSMENT FINDINGS ○ Uterine contractions and irritability (q 1-2 hrs). Maternal report of passage of fluid per vagina ○ VS Determination of alkaline amniotic fluid and not acidic ○ I&O urine or vaginal discharge. ○ Signs of infection DIAGNOSIS ○ Cardiac and respiratory status and distress signs ○ Cervical consistency, dilatation, and effacement Nitrazine Test ○ Fetal well being ○ Change in color of nitrazine paper from yellow ○ Early signs of edema (acidic vaginal pH = 4-6) to blue color because of Promotion of physical and emotional comfort neutral to slightly alkaline amniotic fluid (pH = Administration of tocolytics (MgSO4, Terbutaline, 7-7.5). Ritodrine) Ferning Test ○ Contraindications: ○ Amniotic fluid, high in sodium content, will Advanced pregnancy assume a ferning pattern when dried on the Ruptured of bag of waters slide. Maternal distress (bleeding Sterile Speculum Examination complication, PIH, cardiovascular ○ Direct visualization of fluid from cervical os is disease) the most reliable diagnosis. Fetal distress Presence of fetal problems (Rh isoimmunization) Administration of corticosteroids ○ Betamethasone (12 mg IM q 24 hrs x 2 doses) ○ Dexamethasone (6 mg IM q 12 hrs x 4 doses) ○ Nursing Managements Assess effects of drugs on labor and fetus COMPLICATIONS Monitor for side effect Maternal infection or chorioamnionitis DISCHARGE (PREMATURE LABOR STOPPED) Cord prolapse Maintain bed rest, LLR preferred Premature labor Well-balanced diet (high in iron, vitamins, and important minerals) Continuation of oral medications Frequent prenatal visit every week Activity/lifestyle evaluated and restricted as necessary Illnesses: ○ Chronic – monitored ○ Acute – treated stat Provide client teaching MANAGEMENT OF PROM ○ Symptom of preterm labor Initial Assessment ○ Prompt reporting to physician ○ Confirm the diagnosis of PROM PREMATURE RUPTURE OF MEMBRANE (PROM) ○ To determine the gestation of the fetus ○ To identify the woman who need to deliver Spontaneous rupture of fetal membrane any time after If pregnancy is >37 weeks and with presence of the ff, the the peiod of viability byt before the onset of labor. deliver Cause: UNKNOWN ○ Congenital anomalies Associated with the infection of the membrane ○ Fetal distress, cord prolapse (Chorioamnionitis). ○ Signs of chorioamnionitis Occurs in 5-10% of pregnancies Induction of labor – if no contraindication NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) 6  NCMA219 LESSON 4: HIGH RISK PREGANANCY I (BLEEDING DISORDERS) WEEK 3 I SECOND YEAR, SECOND SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y2-6 I OLFU - VAL If pregnancy is