[ppt]nursing care of the client who is having an · web viewtitle nursing care of the client...
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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-482OxytocinProstaglandins-ProstinE2Misoprotol (Cytotec)
Post –procedure care Administer RhoGam if the client is Rh-negative Discharge Instructions
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 anomaliesDiethylstilbestrol (DES) exposureCervical operationsCervical TraumaCervical Inflammation
Clinical manifestations:Lower abdominal pain Urinary frequency in the second trimesterEffacement and Dilation of the cervixProtrusion of membranes through the cervix Rupture of the membranes in second
trimester
Treatment:Bedrest- Position client so there is pressure
off cervix Initially the Trendelenburg position may be used until after surgery
Serial cervical ultrasound assessmentNo vaginal examsAdminister tocolytic agentsSurgical intervention- Cerclage is a band of
nonabsorbable suture placed around the cervix.
Monitor for uterine contractions, fetal well being, and vital signs
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
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-layingMarginalPartialComplete or Total
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
Clinical Manifestations:Episodic painless vaginal bleeding after 20 weeks
gestationBright Red Bleeding without uterine contractionsUltrasound:
Reveals the malpositioned placenta Complications of placenta previa:
Preterm deliveryHypovolemiaAltered tissue perfusionDeterioration in fetal status
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
Nurse Care:Obtain laboratory specimens:
CBC, Type & Rh, Type & CrossmatchBe 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 supportStrict Bedrest- Position client so pressure is not on
the placenta If client is stable and has diet order make sure it
is well balancePrenatal vitamins and iron will be continue
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
RISK FACTORS:PreeclampsiaEclampsiaChronic HypertensionMultipartyAbdominal Trauma Uterine AnomaliesSmokingCocaine AbusePremature Rupture Of Membranes-PROM
Complications of Abruptio Placenta:Risk of depleting clotting factorsDICHypovolemiaMultiorgan failureMaternal DeathUterine Placenta insuffiencyFetal HypoxiaFetal Death
Clinical manifestations:Sudden Dark Red Vaginal BleedingUnremitting painFirm-to boardlike uterineShock greater than blood lossUltrasound will show abruptionEFM:
Uterine irritability Nonreassuring Fetal Heart pattern- Loss of
variability and late decelerations
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 problemsReview lab values:
CBC, Coagulation studies, PT,PTT
Nursing Care: Insert large IV Catheter(18-gauge or
bigger) and maintain IV infusion Provide O@ at 8-12L/min Anticipate Transfusion Therapy:
RBC’sFFPPLT’sCrypopreciateAlbumin
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
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)
Complications:HypovolemiaAlt. Tissue PerfusionMultiorgan failureMaternal deathFetal death
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 HctProlonged PTT and PTDecreased fibrinogenDecrease PLT’sD-Dimer
NURSING CARE:Care for this client is for the critically ill
client. Identify Risk factors predisposing to DIC.
Early detection is extremely importantMaintain 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
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
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