NCLEX Review & Nursing School

Preeclampsia

Ectopic Pregnancy
Ectopic pregnancy is the condition in which the ovum implants in area other than the endometrial lining of the uterus. This pregnancy is not commonly successful since the areas outside of the uterus cannot sustain for a full-term pregnancy. It’s studied that it usually happens when there is a tubal blockage that prevents the fertilized ovum from passing through the fallopian tubes.
Ectopic pregnancy can be happened at abdominal, tubal, myometrial or cervical.
Ectopic pregnancy at abdomen:
The abdomen is usually unable to sustain for embryo growth
Ectopic pregnancy at tubal:
This is the most common site of ectopic pregnancy. It can causes mother at risk for tubal rupture that can be a life threatening condition.
Ectopic pregnancy at myometrial:
We cannot recognize it until delivery that usually requires a hysterectomy to stop bleeding. Sometime it is called as placenta accrete.
Ectopic pregnancy at cervical:
It has relation with placenta previa
Precipitating Factors:

1. PELVIC INFLAMMATORY DISEASE
2. PREVIOUS TUBAL SURGERY OR TUBAL PREGNANCY
3. ENDOMETRIOSIS, AND
4. CONGENITAL ANOMALIES OF THE FALLOPIAN TUBES

Sign and Symptoms:

1. SHARP ONE-SIDED PAIN
2. TENDERNESS OF ADNEXAL, AREA OVER OVARY AND TUBE
3. VAGINAL BLEEDING (MAY OR MAY NOT SEEN)
4. HARD AND RIGID ABDOMEN AND SIGNS OF CIRCULATORY COLLAPSE WHEN TUBAL IS RUPTURED.

How to care patient with ectopic pregnancy:

• PROVIDE EMOTIONAL SUPPORT FOR WHOM UNDERGOING SURGICAL OR MEDICAL TREATMENT
• PROVIDE EMERGENCY RESUSCITATION AND EMERGENCY SURGERY
• TEACH MOTHER ABOUT PRE AND POST OPERATIVE SELF CARE
• CONSIDER TO REFER MOTHER TO A FETAL DEMISE SUPPORT GROUP

Placenta previa

Placenta usually implanted in lower uterine segment near/over cervical opening; placenta may partially/totally cover cervical os

    S/Sx

        1st and 2nd trimester spotting

        3rd trimester

        ->blding SUDDEN, BRIGHT RED and PAINLES!!!!

    Dx

        US- degree obs

    NI

        Hosp

            BR- side lying, tendelenberg for 72hr

            US – locate placenta

            No vaginal/rectal exam unless delivery not a prob

            Amniocentesis – lung maturity(changes blding and fetal status)

        Home

            Blding cease and preg maintained

            Limited act

            No douching, enemas, coitus

            Monitor fetal mvmt

            NST q 1-2wks

            Monitor comp

Abruptio placentae “premature separation of placenta”

    R/T

Inc maternal HTN

Gestational Trophoblastic Disease

    Hydratiform mole

    Degenerative anomaly of chorionic villi

    S/Sx

        Inc HCG lvl

        Uterine size>expected dates

        No FHR, fetus by US

        Min dark red/brown vaginal blding w/ passage of grapelike clusters

        Inc NV and assoc PIH

    NI

        Curettage to completely remove all molar tissue that can become malignant

        No preg for 1yr

        Monitor hcg lvl 1yr

            ->if inc hcg lvl = HYSTERECTOMY and CHEMO