Term
|
Definition
| Implantation of a fertilized ovum outside the uterine cavity |
|
|
Term
| Where do 95% of ectopic pregnancies occur |
|
Definition
|
|
Term
| Risk factors of ectopic pregnancy |
|
Definition
hx of std or pid
previous hx of ectopic pregnancy
failed tubal ligation
IUD
multiple induced abortions
maternal age over 35 years
cigarette smoking
vaginal douching |
|
|
Term
| S/sx of ectopic pregnancy initally |
|
Definition
normal sx of pregnancy are present like
amenorrhea
breast tenderness
nausea
etc |
|
|
Term
| later signs of ectopic pregnancy |
|
Definition
vaginal spotting or light bleeding
one sided or diffuse lower abdominal or pelvic pain
vasomotor disturbances: fainting, dizziness
shoulder or neck pain that is worse on inspiration |
|
|
Term
| if a woman used assisted reproductive techniques what is she at risk for |
|
Definition
|
|
Term
| if implantation occurs in the distal fallopian tube what later signs may she exibit, and what may it be mistaken for |
|
Definition
intermittent abdominal pain
small amounts of vaginal bleeding
may be mistaken for a threatened abortion |
|
|
Term
| if an embryo dies early what may happen to it? |
|
Definition
| reabsorption into the womans body |
|
|
Term
| if implantation occurs in the proximal end of the tube, what may happen and what are the signs and symptoms |
|
Definition
rupture within 2-3 weeks
sudden severe pain in one of the lower quadrants of the abdomen
intraabdominal hemmorhage
irritation of the diaphram which manifests by shoulder or neck pain that is worse on inspiration
signs of hypovolemic shock with no or minimal external bleeding |
|
|
Term
| Signs of hypovolemic shock |
|
Definition
tachycardia (early)
Decrease in bp late)
cool clammy pale skin
confusion or restlessness
rigid tender abdomen
lightheadedness
syncope |
|
|
Term
| Diagnosis of ectopic pregnancy |
|
Definition
ultrasound: 28 days
Serum BhCG, and progesterone:
and Laparoscopy |
|
|
Term
| What is the normal for the serum B-hCG and include the what the lows mean |
|
Definition
at 3 weeks 5-50
if low, can indicate an abnormal pregnancy |
|
|
Term
| If progesterone is low during a pregnancy, what does that suggest? |
|
Definition
| pregnancy is unlikely to be viable |
|
|
Term
| What does management of ectopic pregnancy depend upon> |
|
Definition
| whether the tube is intact or ruptured |
|
|
Term
| Medical managemt may allow what? |
|
Definition
| preservation of the tube and allows for future fertility |
|
|
Term
| When is medical management most sucessful? |
|
Definition
tube is intact,
lize of pregnancy is less than 3.5
early in the pregnancy,
fetus is not living |
|
|
Term
| what does methotrexate (amethopterin, MTX) do? |
|
Definition
| interfers with cell reproduction and inhibits cell division in the embryo |
|
|
Term
| Nursing Considerations for methotrexate |
|
Definition
destroys rapidly growing tissue
administered im
single dose or multi dose
requires serial B-hCG testing for at least 2 weeks
avoid alcohol or vitimans wth FOLIC ACID |
|
|
Term
| If a woman is started on methotrexate, what should she d/c? |
|
Definition
Prenatal vitamins,
no food with folic acid |
|
|
Term
|
Definition
green veggies
citrius fruits
beans peas lentils
avocado
okra
asparagus
dark leafy greens
broccli
brussel sprouts
seeds and nuts
cauliflower
beets
corn
celery
carrots
squash |
|
|
Term
| What surgical management options are there for those with an ectopic pregnancy |
|
Definition
| laproscopic linear salpingostomy: |
|
|
Term
|
Definition
may salvage the tube for later pregnancies
tube opened with fine linear incision
POC removed
to reduce scarring tubal incision is left to heal withough suturing
may be attempetd if tube is minimally ruptured and slightly greater opening is needed for removal of POC |
|
|
Term
| What options are available for a ruptured fallopian tube? |
|
Definition
control bleeding and prevent hypovolemic shock
salpingectomy: removal of fallopian tube and ligation of blood vessels
liklihood of fertility decreases |
|
|
Term
| What to consider about the tubes in an ectopic pregnancy? |
|
Definition
| the same condition that was present in one side, may be present in another. |
|
|
Term
|
Definition
preventing hypovolemic swhock
control pain
psychological support
explain temporary side effects like N/V with methotrexate
importance of communicating bothersome drug effects of worsening symptoms that indicate rupture like pelvec shoulder or neck pain, dizziness or faintness, increased vaginal bleeding |
|
|
Term
|
Definition
no alcohol or folic acid
no ingercourse until h-bCG are absent within 2-3 weeks
emphasize follow up appointments b/c may need surgical intervention |
|
|
Term
| Emotional support for ectopic pregnancy |
|
Definition
accept anger grief guilt self blame and anxiety
may be anxious about future pregnancies
may feel acute sense of loss
clarify explanations
therapeutic communication |
|
|
Term
| Gestational Trophoblastic Disease or Hydatidiform mole |
|
Definition
| patholocic proliferation of trophoblastic cells where the placenta not the fetus grows |
|
|
Term
|
Definition
| ovum with no genetic material, sperm fertilizes the egg and divides forming the hydropic vesicles |
|
|
Term
|
Definition
| normal ovum fertilized by two sperm. |
|
|
Term
| what complication may arise from this |
|
Definition
| acute respiratory distress if the vesicles enter the circulation and embolize to her lungs |
|
|
Term
| S/sx of hydatidiform mole |
|
Definition
vaginal bleeding browninsh like prune juice but can be bright red'
hyperthyroidism
uterine enlargement greater than expected gestational age classic)
passage of hydropic vessels
preeclampsia
MARKED elevation of hCG
hyperemesis gravidarium |
|
|
Term
| What is used for diagnosis |
|
Definition
|
|
Term
|
Definition
anemia
DIC
infection (if late diagnosis and spontaneous abortion of mole)
embolization of the lung
Malignant gestational trophoblastic disease
usually choriocarcinoma |
|
|
Term
| What does manaement include |
|
Definition
evacuation of the mole
follow up |
|
|
Term
| What is done before evacuation? |
|
Definition
chest xray
metabolic and blood chemistry tests
baseline B-hCG
CBC
clotting factors
blood typing and cross match
treatment for hypertension or hyepremesis |
|
|
Term
| what is usually used to extract the mole |
|
Definition
vaccum aspiration
after done: IV oxytocin to contract |
|
|
Term
| What follows the evacuation |
|
Definition
|
|
Term
| What is the follow up protocol for choriocarcinoma |
|
Definition
evaluation of BhCG every 1-2 weeks until three normal prepregnancy levels
then 1-2 months for up to a year |
|
|
Term
| what should be avoided during follow up |
|
Definition
| pregnancy because it could obscure the evidence of choriocarcinoma |
|
|
Term
| what is done if the bhcg does not fall? |
|
Definition
| ct of the brain, chest abdomen and pelvis to help identify metastases of the cancer |
|
|
Term
| what is the primary treatment for choriocarcinoma |
|
Definition
| chemotherapy and has a high cure rate |
|
|
Term
| emotional considerations after tx |
|
Definition
| may experience the same emotions as any other pregnancy loss plus anxious about the possibility of cancer and the need to delay pregnancy |
|
|
Term
| assessment of the woman with a hemorrhagic condition of early pregnancy |
|
Definition
confirm pregnancy and length of gestation
physical assessment: amount and character of bleeding, pain characteristics, examine linen and peripads (may weigh them)
vs for cardio status
H&H
rh factor for RhoGAM
fever, malaise, and prolonged or odours vaginal discharge
knowledge |
|
|
Term
| what does uterine cramping accompy |
|
Definition
|
|
Term
| what is associated with deep severe pelvic pain |
|
Definition
|
|
Term
| if a women has a ruptured tube, what may be the only symptom? |
|
Definition
| pain because it can also bleed into the abdomen |
|
|
Term
| Interventions for providing information about tests and procedures |
|
Definition
explain diagnostic procedures like transvaginal or abd ultrasound
tell the purpose, duration, and any discomfort accompanied by it
reinforce explanations for surgery
administer anesthetic
reason for blood test: BhCG, H&H, coagulation, blood type and screen |
|
|
Term
| Interventions for teaching measures to prevent infection: |
|
Definition
greatest during first 72 hours after spontaneous and surgery
perineal pads instead of tampons until bleeding stopped
wash hands before and after changing
talk to hcp before resuming sex |
|
|
Term
| Interventions for dietary information |
|
Definition
nutrition and adequate fluid intake for infection and correct anemia
high in iron
vitamin c
possible iron supplements |
|
|
Term
|
Definition
liver
red meat
spinach
eggyolks
carrots
rasins |
|
|
Term
|
Definition
broccli
citrus
strawberries
cantaloupe
cabbage
green peppers |
|
|
Term
| nursing care for iron supplements |
|
Definition
take with meals
high in fiber and fluid 2,500ml/day to reduce constipation |
|
|
Term
| Interventions for teaching signs of infection |
|
Definition
can buy a thermometer
take temp q8hrs for first 3 days att home
med help if above 100f
report vaginal discharge with foul odor, pelvic tenderness or general malaise |
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