INCOMPLETE ABORTION

Signs and Symptoms Medication

- Vaginal spotting - Paracervical anesthetic
- Cramping block or analgesia
- Cervical dilation but incomplete expulsion of - Oxytocin
uterine content - IV fluid
- Bleeding: Heavy, profuse - Blood transfusion
- Uterine cramping: Severe
- Passage of tissue: Yes
- Cervical dilation: Yes, with tissue in cervix
Nursing Diagnosis
- Risk for deficient fluid volume related to bleeding during pregnancy
- Risk for infection
Intervention
- Assess vital signs
- Assess amount of bleeding
- Perineal care (Sanitary pads, do not use tampons)
- Provide healthy diet for fast recovery and to make up for lost volume
- Massage the uterine fundus to aid contractions
- D&C or suction curettage to prevent hemorrhage and infection

For hemorrhage:
- 1 sanitary pad per hour
- Monitor vital signs to detect hypovolemic shock
- Suction curettage
- Blood transfusion
Evaluation
- Blood pressure is maintained above 100/60 mmHg
- Pulse rate below 100 bpm
- Urine output more than 30 mL/hr.
- Minimal bleeding for not more than 24 hours

Pathophysiology:
 ECTOPIC PREGNANCY

Signs and Symptoms Medication

- Increased pulse rate and Before the rupture:
respiratory rate - Methotrexate
- Cold, clammy skin (↓ Blood volume) - Mifepristone
- Nausea and vomiting
- Sudden unilateral lower abdominal During the rupture:
quadrant pain - IV therapy
- Scant vaginal spotting - Pain medications
- Dizziness or lightheadedness - Blood transfusion
- Peritoneal irritation
- Cullen’s sign
- Tender mass palpated in cul-de-sac
Nursing Diagnosis
- Risk for deficient fluid volume related to bleeding from a ruptured ectopic
pregnancy.
- Powerlessness related to early loss of pregnancy secondary to ectopic
pregnancy
Intervention
- Place patient flat in bed
- Assess vital signs to establish baseline data and determine if the patient is
under shock
- Maintain accurate intake and output to establish the patient’s renal function
- Monitor skin turgor
- Prepare the patient for surgical procedure (Laparoscopy or Salpingectomy)
- Assist in ligation or reparation of fallopian tube.
Evaluation
- Maternal bleeding has been reduced and/or stopped
- Patient maintains adequate fluid volume
- Stable vital signs
- Good skin turgor, adequate capillary refill, and free of dehydration

Pathophysiology:
 PREGNANCY INDUCED HYPERTENSION (PRE-ECLAMPSIA)

Signs and Symptoms Medication

- Edema - Hydralazine or labetalol
- Shortness of breath (antihypertensive drugs)
- Sudden weight gain - Methyldopa (↓ peripheral
- Nausea or vomiting vascular resistance)
- Making small amounts of urine - Nifedipine (relax heart
- Headache that doesn’t go away muscle and blood vessels)
- Blurred vision or double vision - Magnesium sulfate
- Pain in the upper right side of the belly or - Diazepam
pain around the stomach - Calcium gluconate
- HELLP syndrome (severe form of pre- (antidote for magnesium
eclampsia) toxicity)
Nursing Diagnosis
- Deficiency fluid volume
- Decreased cardia output
- Altered uteroplacental tissue perfusion
- Risk for maternal injury to tissue edema
- Acute pain
- Risk for imbalanced nutrition: less than body requirements
- Activity intolerance
Intervention
Without severe features: With severe features:
- Monitor antiplatelet therapy - Support bed rest
- Promote bed rest - Monitor maternal and fetal well being
- Promote good nutrition - Support nutrition intake
- Promote emotional support - Administer medication to prevent pre-
eclampsia
Evaluation
- Patient’s blood pressure is within normal range
- Patient’s protein in urine is over 300mg indicates pre-eclampsia

Pathophysiology:
 IRON DEFICIENCY ANEMIA

Signs and Symptoms Medication

- Below average body weight - Iron supplements
- Pale skin and mucous membranes - Parenteral iron
- Anorexia
- Growth retardation
- Listlessness
- Frequent infection
- Nail brittleness
- Sore muscles
Nursing Diagnosis
- Risk for bleeding
- Risk for infection
- Fatigue related to decreased hemoglobin and diminished oxygen-carrying
capacity of the blood.
- Knowledge deficit related to the complexity of treatment, lack of resources, or
unfamiliarity with the disease condition
Intervention
- Advise patient to take iron supplements an hour before meals
- Educate about foods high in iron
- Encourage client to have diet rich in vitamin C
- Educate patient and family members about IDA
- Administer prescribed medications
Evaluation
- Patient verbalizes the reduction of fatigue, as evidenced by reports of increased
energy and ability to perform desired activity
- Patient verbalizes understanding of own disease and treatment plan
- Reduced risk for bleeding, as evidences by normal or adequate platelet
- Normal vital signs

Pathophysiology:
 HYDATIDIFORM MOLE

Signs and Symptoms Medication

- Overgrowth of uterus high positive - Methotrexate (stops rapid growth of
human chorionic gonadotrophin H. mole)
(hCG) test - Dactinomycin (once metastasis
- No fetus presented in the occurs)
ultrasound - Pain medications
- Bleeding from vagina of old and
fresh blood accompanied by cyst
formation
Nursing Diagnosis
- Risk for infection
- Risk for injury
- Acute pain
- Deficient fluid volume
Intervention
- Dilation and curettage procedure to remove abnormal tissue growth
- Assess vital signs and measure abdominal girth and fundal height
- Assist patient in obtaining urine specimen for hCG
- Prepare patient for surgical intervention
Evaluation
- Vaginal bleeding is reduced
- Pelvic pressure and pain are reduced
- Patient was able to express feeling effectively

Pathophysiology:
 GESTATIONAL DIABETES MELLITUS

Signs and Symptoms Medication

- Glucose in urine - Insulin or insulin therapy
- Hyperglycemia - Metformin (500mg OD or BID)
- Warm and very dry skin
- Fruity odor breath
- Rapid breathing
- Fatigue
- Polydipsia (thirst)
- Polyuria (urination)
- Polyphagia (hunger)
Nursing Diagnosis
- Risk for ineffective tissue perfusion related to reduced vascular flow
- Risk for infection related to impaired healing accompanying condition
- Imbalanced nutrition less than body requirements related to inability to use
glucose
- Risk for the ineffective coping related to required change in lifestyle
- Deficient fluid volume deficit related to polyuria accompanying disorder
- Knowledge deficit related to difficult and complex health problems
Intervention
- Provide patient with appropriate diet
- Educate patient with proper exercise
- Assess patient vital signs
- Administer medication if ordered
Evaluation
- Patient’s blood glucose level is normal
- Patient’s BMI is normal

Pathophysiology:
 PLACENTA PREVIA

Signs and Symptoms Medication

- Sudden, painless vaginal bleeding - Administer IV fluid
during 2nd trimester - Administer tocolytic agents
- Blood transfusion
Nursing Diagnosis
- Decreased cardiac output
- Ineffective tissue perfusion
- Risk for infection
- Deficient fluid volume
Intervention
- Monitor vital signs
- Observe level of consciousness
- Monitor FHR
- Assess abdomen for tenderness and rigidity
- Provide calm and quite environment
- Side lying position
- Encourage patient to drink adequate amounts of fluids
Evaluation
- Patient maintains fluid volume
- Patient manifests hemodynamic stability
- Patient demonstrated behaviors to improve circulation
- Patient remains calm
- Patient effectively performs perineal care

Pathophysiology:
 ABRUPTIO PLACENTA

Signs and Symptoms Medication

- Abdominal pain - Administer IV fluids
- Longer and intense uterine - Administer tocolytic agents
contractions - Blood transfusion
- Uterine tenderness
- Back pain
- Decreased fetal movement
- External dark red blood in
hemorrhage
Nursing Diagnosis
- Deficient fluid volume related to bleeding during premature placental separation
- Risk for infection
- Ineffective tissue perfusion
- Acute pain
Intervention
- Maintain bed rest
- Assist with early delivery
- Monitor vital signs, FHR, and movement
- Observe level of consciousness
- Assess abdomen for tenderness or rigidity
- Encourage proper fluid intake

For infection:
- Avoid douching
- Maintain aseptic technique

Upon delivery:
- Perform APGAR scoring every five minutes after birth
- Monitor neonate for signs of shock
Evaluation
- Maintains fluid volume
- Demonstrated behaviors to improve circulation
- Effectively performs perineal care

Pathophysiology: