Pregnancy Complications - Medical Conditions ATI CH 9

Pregnancy Complications - Medical Conditions ATI CH 9 What are some unexpected medical conditions that can occur during pregnancy? - Recurrent premature dilation of the cervix Hyperemesis gravidarum Anemia Gestational diabetes mellitus Gestational hypertension What are the crucial components of unexpected medical conditions in pregnancy in order to ensure fetal well-being and maternal health? - Awareness Early detection Interventions Recurrent premature dilation of the cervix: Cervical Insufficiency (Incompetent Cervix) - Recurrent premature dilation of the cervix or cervical insufficiency is a variable condition whereby expulsion of the products of conception occurs. It is thought to be related to tissue changes and alterations in the length of the cervix. What are the risk factors for Cervical Insufficiency? - History of cervical trauma (previous lacerations, excessive dilations, and curettage for biopsy) Short labors Pregnancy loss in early gestation Advanced cervical dilation at earlier weeks of gestation In utero, exposure to diethylstilbestrol (ingested by the client's mother during pregnancy) Congenital structural defects of the uterus or cervix What signs and symptoms should the nurse be aware of for Cervical Insufficiency? - Increase in pelvic pressure or urge to push Pink-stained vaginal discharge or bleeding Possible gush of fluid (rupture of membranes) Uterine contractions with the expulsion of the fetus Postoperative (cerclage) monitoring for uterine contractions, rupture of membranes, and signs of infection Which diagnostic procedures are used for Cervical Insufficiency? - Ultrasound Cervical Cerclage ■ An ultrasound showing a short cervix (less than 25 mm in length), the presence of cervical funneling (beaking), or effacement of the cervical os indicates reduced cervical competence. ■ Prophylactic cervical cerclage is the surgical reinforcement of the cervix with a heavy ligature that is placed submucosally around the cervix to strengthen it and prevent premature cervical dilation. Best results occur if this is done before 23 to 24 weeks of gestation. The cerclage is removed at 37 weeks of gestation or when spontaneous labor occurs. What types of nursing care should the RN implement for a patent with incompetent cervix? - Evaluate the client's support systems and availability of assistance if activity restrictions and/or bed rest are prescribed. Assess vaginal discharge. Monitor client reports of pressure and contractions. Check vital signs. Which medications are used for a patient with an incompetent cervix? - Administer tocolytics prophylactically to inhibit uterine contractions. What are the discharge instructions that should be included for a patient with an incompetent cervix? - Place the client on activity restriction/bed rest. Encourage hydration to promote a relaxed uterus. (Dehydration stimulates uterine contractions.) Advise the client to refrain from intercourse and to monitor for cervical/uterine changes. What information should the nurse plan to teach the client regarding an incompetent cervix? - Teach the patient about signs and symptoms to report to the provider for preterm labor: rupture of membranes, infection, strong contractions less than 5 min apart, severe perineal pressure, and an urge to push. Instruct the client about using the home uterine activity monitor to evaluate uterine contractions. Arrange for the client to follow up with a home health agency for close observation and supervision. Plan for removal of the cerclage around 37 weeks of gestation. Hyperemesis gravidarum - Excessive nausea and vomiting (possibly related to elevated hCG levels) that is prolonged past 12 weeks of gestation and results in a 5% weight loss from prepregnancy weight, electrolyte imbalance, acetonuria, and ketosis. Hyperemesis gravidarum may be associated with altered thyroid function. There is a risk to the fetus for intrauterine growth restriction (IUGR) or preterm birth if the condition persists. ............