NUR 265 EXAM 2/NUR 265 EXAM 2 LATEST
UPDATED AND REVISED IN 2024-2025 DECEMBER
What is the definition of Hyperemesis Gravidarum?
persistent, uncontrollable vomiting of UNKNOWN etiology- begins in the
first weeks of pregnancy and may CONTINUE THROUGHOUT
PREGNANCY
What is Hyperemesis Gravidarum associated with?
unmarried white women during first pregnancies
multifetal pregnancies
allergy to fetal protein
high estrogen & hCG
maternal thyroid disfunction
multiple gestation
trophoblastic disease
What is associated with hyperemesis gravidarum?
unmarried white women during first pregnancies, multifetal pregnancies,
allergy to fetal protein, high estrogen and hCG, maternal thyroid
dysfunction, multiple gestation and trophoblastic disease
What are the clinical manifestations of hyperemesis gravidarum?
weight loss of more than 5%, dehydration (elevated H&H, dry mucous
membranes, decreased urine output, with higher specific gravity),
ketonuria, alkalosis, acidosis, elevated liver dysfunction, vitamin K
deficiency
Nursing Management of Hyperemesis gravidarum?
,rule out other causes of N/V, monitor electrolytes, eliminate strong odors,
BRAT diet with frequent meals, LIQUID between meals, sit upright after
meals, ginger, iron supplements, Maintain adequate nutrition and fluid
balance, emotional support. Medications like Benadryl, Pepcid, Priolsec,
Metoclopramide (emptying gastric contents) and Zofran
What is Hydatidiform mole pregnancy?
A type of gestational trophoblastic disease where trophoblasts develop
abnormally. The cluster can grow rapidly and are large enough to fill the
uterus to the size of an advance pregnancy
What is the different between complete and partial Hydatidiform mole
pregnancy?
Complete: no embryonic or fetal parts, maternal DNA/ paternal duplicates
Partial: often has embryonic or fetal parts and an amniotic sac- but not an
organized fetus. Maternal DNA/ Paternal duplicates (69 chromosomes)
What are the clinical manifestations of Hydatidiform mole pregnancy?
Bleeding: DARK BROWN to hemorrhage
uterine size larger than expected for gestational age
Excessive N/V from high hCG
HTN: early development of preeclampsia before 24 weeks gestation-->
increased body volume bc the body believes you are having a fetus
What are the diagnostics for Hydatidiform mole pregnancy?
Ultrasound: SNOWSTORM PATTERN
elevated hCG: higher than expected for gestational age
On a ultrasound test what is the difference between partial and
complete molar pregnancy?
Partial: will have placenta but no fetus
complete: vesicles and the absence of a fetal sac or fetal heart activity
,Nursing Management for Molar pregnancy?
Evacuation of the trophoblastic tissue
continuous follow-ups to detect malignant changes to trophoblastic tissue
risk for hemorrhage
management of comorbidities
IV Oxytocin to contract the uterus after removal
send tissue to lab for evaluation
follow up care 6 weeks post removal for hCG levels; if still high something
was left or carcinoma has developed
reliable contraception for at least 1 years will be essential because
pregnancy could mask a carcinoma
What is DIC and its complications?
defect in coagulation that occurs with severe complications of pregnancy,
inappropriate coagulation also taking place in the microcirculation
Complications: missed spontaneous abortions, placental abruption, HTN;
preeclampsia, HELLP syndrome, amniotic fluid embolism
What are the results of DIC?
results in excessive bleeding and the formation of tiny clots in the tiny blood
vessels, blocking blood flow to organs and causing ischemia
bleeding to occur from any vulnerable area such as IV sites, incisions,
gums, or the nose and from expected sites such as the site of placental
attachment during the postpartum period
D-Dimer is positive also monitor clotting labs
Nursing Management of DIC
treat the cause
replace blood and blood components
apply O2- 10L via facemask
, weight blood loss, monitor for signs of shock
additional IV for additional products
What are the different types of abortions?
threatened, inevitable, incomplete, complete, and missed
Describe threaten abortion
vaginal bleeding during the first half of pregnancy
women should be advised to notify their physician if brownish or red vaginal
bleeding is noted
monitor labs like progesterone and B-hCG
teach pt to limit sexual activity
NO STERNOUS ACTIVITY
count the pads and note the color
Describe Inevitable abortion
membranes rupture/ cervix dilates, uterine contractions, active bleeding
Incomplete abortion
some fetal/ placental tissue, active bleeding, severe uterine cramping,
cervix is open and risk for infection is a huge concern
Nursing management of inevitable and incomplete abortion
Pitocin to contract the uterus and methergine to control the bleeding
surgical management: dilation and curettage, need an IV access, may not
be done after 14 weeks, risk for excessive bleeding (give oxytocin/
prostaglandin for contractions)
Describe complete abortion
bleeding, cramping, contractions, cervix closes, ALL products of conception
are expelled
refrain from sexual activity until follow up, watch for infection, monitor
bleeding, may give Pitocin to help expel
UPDATED AND REVISED IN 2024-2025 DECEMBER
What is the definition of Hyperemesis Gravidarum?
persistent, uncontrollable vomiting of UNKNOWN etiology- begins in the
first weeks of pregnancy and may CONTINUE THROUGHOUT
PREGNANCY
What is Hyperemesis Gravidarum associated with?
unmarried white women during first pregnancies
multifetal pregnancies
allergy to fetal protein
high estrogen & hCG
maternal thyroid disfunction
multiple gestation
trophoblastic disease
What is associated with hyperemesis gravidarum?
unmarried white women during first pregnancies, multifetal pregnancies,
allergy to fetal protein, high estrogen and hCG, maternal thyroid
dysfunction, multiple gestation and trophoblastic disease
What are the clinical manifestations of hyperemesis gravidarum?
weight loss of more than 5%, dehydration (elevated H&H, dry mucous
membranes, decreased urine output, with higher specific gravity),
ketonuria, alkalosis, acidosis, elevated liver dysfunction, vitamin K
deficiency
Nursing Management of Hyperemesis gravidarum?
,rule out other causes of N/V, monitor electrolytes, eliminate strong odors,
BRAT diet with frequent meals, LIQUID between meals, sit upright after
meals, ginger, iron supplements, Maintain adequate nutrition and fluid
balance, emotional support. Medications like Benadryl, Pepcid, Priolsec,
Metoclopramide (emptying gastric contents) and Zofran
What is Hydatidiform mole pregnancy?
A type of gestational trophoblastic disease where trophoblasts develop
abnormally. The cluster can grow rapidly and are large enough to fill the
uterus to the size of an advance pregnancy
What is the different between complete and partial Hydatidiform mole
pregnancy?
Complete: no embryonic or fetal parts, maternal DNA/ paternal duplicates
Partial: often has embryonic or fetal parts and an amniotic sac- but not an
organized fetus. Maternal DNA/ Paternal duplicates (69 chromosomes)
What are the clinical manifestations of Hydatidiform mole pregnancy?
Bleeding: DARK BROWN to hemorrhage
uterine size larger than expected for gestational age
Excessive N/V from high hCG
HTN: early development of preeclampsia before 24 weeks gestation-->
increased body volume bc the body believes you are having a fetus
What are the diagnostics for Hydatidiform mole pregnancy?
Ultrasound: SNOWSTORM PATTERN
elevated hCG: higher than expected for gestational age
On a ultrasound test what is the difference between partial and
complete molar pregnancy?
Partial: will have placenta but no fetus
complete: vesicles and the absence of a fetal sac or fetal heart activity
,Nursing Management for Molar pregnancy?
Evacuation of the trophoblastic tissue
continuous follow-ups to detect malignant changes to trophoblastic tissue
risk for hemorrhage
management of comorbidities
IV Oxytocin to contract the uterus after removal
send tissue to lab for evaluation
follow up care 6 weeks post removal for hCG levels; if still high something
was left or carcinoma has developed
reliable contraception for at least 1 years will be essential because
pregnancy could mask a carcinoma
What is DIC and its complications?
defect in coagulation that occurs with severe complications of pregnancy,
inappropriate coagulation also taking place in the microcirculation
Complications: missed spontaneous abortions, placental abruption, HTN;
preeclampsia, HELLP syndrome, amniotic fluid embolism
What are the results of DIC?
results in excessive bleeding and the formation of tiny clots in the tiny blood
vessels, blocking blood flow to organs and causing ischemia
bleeding to occur from any vulnerable area such as IV sites, incisions,
gums, or the nose and from expected sites such as the site of placental
attachment during the postpartum period
D-Dimer is positive also monitor clotting labs
Nursing Management of DIC
treat the cause
replace blood and blood components
apply O2- 10L via facemask
, weight blood loss, monitor for signs of shock
additional IV for additional products
What are the different types of abortions?
threatened, inevitable, incomplete, complete, and missed
Describe threaten abortion
vaginal bleeding during the first half of pregnancy
women should be advised to notify their physician if brownish or red vaginal
bleeding is noted
monitor labs like progesterone and B-hCG
teach pt to limit sexual activity
NO STERNOUS ACTIVITY
count the pads and note the color
Describe Inevitable abortion
membranes rupture/ cervix dilates, uterine contractions, active bleeding
Incomplete abortion
some fetal/ placental tissue, active bleeding, severe uterine cramping,
cervix is open and risk for infection is a huge concern
Nursing management of inevitable and incomplete abortion
Pitocin to contract the uterus and methergine to control the bleeding
surgical management: dilation and curettage, need an IV access, may not
be done after 14 weeks, risk for excessive bleeding (give oxytocin/
prostaglandin for contractions)
Describe complete abortion
bleeding, cramping, contractions, cervix closes, ALL products of conception
are expelled
refrain from sexual activity until follow up, watch for infection, monitor
bleeding, may give Pitocin to help expel
