THREATENED ABORTION

RISK FACTORS – advanced maternal age, bacterial or viral infection during pregnancy, inadequate
prenatal care, trauma to the abdomen

PATHOPHYSIOLOGY – uterine abnormalities; vaginal bleeding without cervical dilation

NURSING MANAGEMENT:

- Monitor vital signs, fetal heart rate and uterine contractions.

- Provide health teaching about avoiding stress, sexual interaction or strenuous activity.

MEDICAL MANAGEMENT:

- Administration of progesterone
- Administration of acetaminophen

HEALTH TEACHING:

- Educate the patient about the importance of bed rest.

ASSESSMENT

- Assess pain scale and amount of bleeding.

- Assess for any vaginal discharge.

DIAGNOSIS

- FEAR RELATED TO RISK OF PREGNANCY LOSS

- ACUTE PAIN RELATED TO ABDOMINAL CRAMPING AND VAGINAL SPOTTING OR BLEEDING AS
EVIDENCED BY BLANK ABORTION
- ANTICIPATORY GRIEVING RELATED TO EXPECTED LOSS OF UNBORN CHILD

STO – After 24 hours of nursing intervention, the patient will verbalize decrease level of pain

LTO – After a week of nursing intervention, the patient will verbalize relief and determine ways to
manage pain.

IMMINENT OR INEVITABLE ABORTION

– impending miscarriage indicated with bleeding with pain and effaced cervix.

RSIK FACTORS: Uterine or immunologic abnormalities and Major trauma

MEDICAL MANAGEMENT: D AND C / ACEMATINOPHEN

ASSESSMENT:

- Assess for vital signs

- Assess for vaginal bleeding and uterine contractions

NURSING INTERVENTIONS:

- Perform sonogram
 - Monitor uterine contractions and fetal heart rate

HEALTH TEACHING

- Educate the patient about the importance of bed rest.

COMPLETE ABORTION

- Fetus parts have been expelled or removed from the uterus completely.

INCOMPLETE ABORTION

- Miscarriage in which some fetal or placental tissue remains in the uterus

MISSED ABORTION

- Dead embryo or fetus is retained in the womb for a period of time, which symptom of
miscarriage may not occur

SEPTIC ABORTION

- Spontaneous or induced abortion associated with bacterial infection

ECTOPIC PREGNANCY

RISK FACTORS – tubal damage – pid, previous tubal surgery, congenital anomalies of the tube,
endometriosis, previous ectopic pregnancy, presence of iud, des, vitro fertilization.

NURSING DIAG

- Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy.

- Anticipatory grieving related to the loss of pregnancy.
- Pain related to abdominal bleeding secondary to tubal rupture

NURSING MANAGEMENT

- Monitor vital signs, fetal heart rate and uterine contractions.

- Perform pelvic exam, blood test and ultrasound.

MEDICAL MANAGEMENT:

- Administer methotrexate or misoprostol.

- Perform SALPINGECTOMY

ASSESSEMENT

- Assess for vital signs

- Assess for vaginal discharge or bleeding.

HEALTH TEACHING

- Educate the patient of the importance of bed rest.

PLANNING
STO – After 24 hours of nursing intervention, the patient will verbalize decrease level of pain

LTO – After a week of nursing intervention, the patient will verbalize relief and determine ways to
manage pain.

HYDATIDIFORM MOLE

- Trophoblastic villi cells located in the outer ring of the blastocyst rapidly increase in size, begin to
deteriorate, and fill with fluid

RISK FACTORS – women with low protein intake, advanced maternal age older than 35 years old, asian
heritage.

NURSING DIAG

- Deficient fluid volume related to heavy vaginal bleeding secondary to hydatidiform mole as
evidenced by bp.
- Grieving related to loss of pregnancy as evidenced by anger and social detachment.

NURSING INTERVENTIONS

- Perform suction curettage to evacuate the mole

- Monitor vital signs, vaginal discharge or any bleeding, fetal heart tone.

MEDICAL MANAGEMENT

- Methotrexate
- Perform hysterectomy

ASSESSEMENT

- Assess for expansion of uterus than normal

- Assess for absent fetal heart sound

HEALTH TEACHING

- Educate patient about the importance of avoiding strenuous activity.

STO – After 24 hours of nursing intervention, the patient will verbalize decrease level of pain

LTO – After a week of nursing intervention, the patient will verbalize relief and determine ways to
manage pain.

PREMATURE CERVICAL DILATATION (INCOMPETENT CERVIX)

- cervix open too early during pregnancy

NURSING DIAG

- Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the

cervix.

RISK FACTORS: smoking, history of cervical incompetence

STO – Patient will verbalize understanding of individual risk factors or conditions that may impact
pregnancy.

Patient will appear relaxed and report anxiety is reduced to manageable level.

LTO – Patient will display fetal growth within normal limits and carry pregnancy to term.

Patient will identify healthy ways to deal with and express anxiety.

ASSESSMENT

- Assess for vital signs

- Assess for uterine contractions and vaginal bleeding

NURSING INTERVENTIONS

- Provide information and assist in ultrasonography as indicated.

- Review history of previous pregnancies.

HEALTH TEACHING

- Educate the patient about the importance of complete bed rest

MEDICAL INTERVENTIONS

- Administer progesterone
- Perform cervical cerclage

PLACENTA PREVIA

- Placenta is located over or near the cervix, in the lower part of the fetus

NURSING DIAGNOSIS

- FEAR OR ANXIETY RELATED TO RISK OF PREGNANCY LOSS AEB PLACENTA PREVIA

- DEFICIENT FLUID VOLUME RELATED TO INSUFFICIENT FLUID INTAKE AS EVIDENCED BY
WEAKNESS
- ACUTE PAIN R/R ABDOMINAL CRAMPING AEB VAGINAL SPOTTING

RIKS FACTORS: previous c section delivery, has placenta previa in previous delivery, multiple pregnancy,
smoking

PLANNING

STO – patient will have a normal fluid volume / patient will reduce anxiety attacks

LTO - patient will maintain fluid volume at a functional level / patient will be free from anxiety attacks

ASSESSMENT

- Assess for amount and character of bleeding

- Assess for vital signs

NURSING MANAGEMENT
 - Monitor for continued bleeding and onset of labor
- Monitor fetal heart rate and fetal activity continuously

HEALTH TEACHING

- Instruct the patient to avoid enemas or sexual intercourse

MEDICAL MANAGEMENT

- Tocolytic and betamethasone

ABRUPTIO PLACENTA

- Placenta is partially or completely detached from the uterine wall before delivery

NURSING DIAGNOSIS

- FEAR OR ANXIETY RELATED TO RISK OF PREGNANCY LOSS AEB PLACENTA PREVIA

- DEFICIENT FLUID VOLUME RELATED TO INSUFFICIENT FLUID INTAKE AS EVIDENCED BY
WEAKNESS
- ACUTE PAIN R/R ABDOMINAL CRAMPING AEB VAGINAL SPOTTING
- INEEFECTIVE TISSUE PERFUSION RELATED TO EXCESSIVE BLOOD LOSS

RISK FACTORS: drug abuse, previous abruption, smoking, pih,

STO – the patient will verbalize decrease level of pain

LTO – After a week of nursing intervention, the patient will verbalize relief and determine ways to
manage pain.

ASSESSMENT

- Assess for vital signs

- Assess for vaginal bleeding and uterine contractions

NURSING MANAGEMENT

- Monitor uterine contractions

- Weigh perineal pads used during bleeding

HEALTH TEACHING

- Educate patients about reversible risk factors, especially smoking, before further pregnancies.

MEDICAL MANAGAMENT:

- Corticosteroid and analgesics

PRETERM LABOR

- Labor that starts before 37 complete weeks of pregnancy

NURSING DIAG

- FEAR OR ANXIETY RELATED TO RISK OF PREGNANCY LOSS AEB PLACENTA PREVIA

 - ACUTE PAIN R/R ABDOMINAL CRAMPING AEB VAGINAL SPOTTING
- RISK FOR INJURY (MATERNAL AND FETAL) RELATED TO DELIVERY OF PRETEMR INFANT AEB

RISK FACTORS: previous preterm labor, multiple pregnancy, smoking or drug abuse

STO - will maintain pregnancy at least to the point of fetal maturity

LTO – will deliver a preterm but complication- free neonate

ASSESSMENT

- Assess for uterine contractions (pain or painless)

- Assess for rupture of amniotic membranes

NURSING INTERVENTIONS

- Monitor fetal status

- Administer fluids

HEALTH TEACHING

- Educate patient about the importance of bed rest.

PROM

- Rupture of the amniotic sac before labor begins

NURSING DIAG

- FEAR OR ANXIETY RELATED TO RISK OF PREGNANCY LOSS AEB PLACENTA PREVIA

- ACUTE PAIN R/R ABDOMINAL CRAMPING AEB VAGINAL SPOTTING

- RISK FOR INJURY (MATERNAL AND FETAL) RELATED TO DELIVERY OF PRETEMR INFANT AEB

RISK FACTORS: prior preterm birth, smoking, polyhydramnios, sti, low economic status

STO – will maintain pregnancy at least to the point of fetal maturity

LTO – will deliver a preterm but complication- free neonate

ASSESSMENT

- Assess for vital signs

- Assess for vaginal bleeding and uterine cramping

NURSING MANAGEMENT

- Monitor signs of infection

- Evaluate uterine activity and fetal response to the labor

HEALTH TEACHING

- Inform the patient that frequent are necessary to ensure maternal safety

MEDICAL MANAGEMENT
 - Corticosteroid and tocolytic

GESTATIONAL HYPERTENSION - 140/90 systolic 30mmgh diastolic 15 mmhg no proteinuria or edema,

goes back to normal

- High blood pressure that is present before pregnancy begins

NURSING DIAG

- DECREASED CARDIAC OUTPUT RT BLANK AEB EDEMA/TACHYCARDIA

- RISK FOR INJURY RT EDEMA / ABNORMAL CLOTTING FACTORS AEB
- DEFICIENT KNOWLEDGE RT INFORMATION MISINTERPETATION AEB INACCURATE FOLLOW UP
CHECK UP

RISK FACTORS: preexisting hypertension, diabetes, kidney disease, mothers age is younger than 20 and
older than 40

STO – will return to normal vital signs

LTO - will remains normotensive throughout the remainder of the pregnancy.

ASSESSMENT

- Assess vital signs especially blood pressure

- Assess for edema

NURSING MANAGEMENT

- Monitor urine testing – to rule out pre-eclampsia

- Instruct the patient to drink fluids more frequently

HEALTH TEACHING

- Educate the patient in the importance of monitoring the blood pressure at home

MEDICAL MANAGEMENT

- Administer iv labetalol and hydralazine

PREECLAMPSIA WI/O SEVERE FEATURES

- The patient’s high blood pressure reduces the blood supply to the fetus which may get less
oxygen and fewer nutrient

NURSING DIAG

- DECREASED CARDIAC OUTPUT RT BLANK AEB EDEMA/TACHYCARDIA

- RISK FOR INJURY RT EDEMA / ABNORMAL CLOTTING FACTORS AEB
- DEFICIENT KNOWLEDGE RT INFORMATION MISINTERPETATION AEB INACCURATE FOLLOW UP
CHECK UP

RISK FACTORS – pre-eclampsia in previous pregnancy, multiple pregnancy, chronic high blood pressure

STO - will return to normal vital signs

LTO - will remains normotensive throughout the remainder of the pregnancy.

ASSESSMENT

- Assess vital signs especially the pulse rate and bp

- Assess for edema

NURSING MANAGEMENT

- Monitor fetal activity and fetal heart rate

- Instruct the patient to drink fluids more frequently

HEALTH TEACHING

MEDICAL MANAGEMENT

- Administer corticosteroid lung maturity and labetalol used to treat high blood pressure

PREECLMAPSIA WITH SEVERE FEATURES

- The patient’s high blood pressure reduces the blood supply to the fetus which may get less
oxygen and fewer nutrient

NURSING DIAG

- DECREASED CARDIAC OUTPUT RT BLANK AEB EDEMA/TACHYCARDIA

- RISK FOR INJURY RT EDEMA / ABNORMAL CLOTTING FACTORS AEB
- DEFICIENT KNOWLEDGE RT INFORMATION MISINTERPETATION AEB INACCURATE FOLLOW UP
CHECK UP

RISK FACTORS – pre-eclampsia in previous pregnancy, multiple pregnancy, chronic high blood pressure

STO - will return to normal vital signs

LTO - will remains normotensive throughout the remainder of the pregnancy.

ASSESSMENT

- Assess vital signs especially the pulse rate and bp

- Assess for edema

NURSING MANAGEMENT

- Monitor fetal activity and fetal heart rate

- Instruct the patient to drink fluids more frequently

HEALTH TEACHING

MEDICAL MANAGEMENT

- Administer corticosteroid lung maturity and labetalol used to treat high blood pressure

ECLAMPISA

- Serious conditions were high blood pressure results in seizures during pregnancy
NURSING DIAG

- DECREASED CARDIAC OUTPUT RT BLANK AEB EDEMA/TACHYCARDIA

- RISK FOR INJURY RT EDEMA / ABNORMAL CLOTTING FACTORS AEB
- DEFICIENT KNOWLEDGE RT INFORMATION MISINTERPETATION AEB INACCURATE FOLLOW UP
CHECK UP

RISK FACTORS: chronic hypertension, maternal age, mutliple pregnancy

STO - will return to normal vital signs

LTO - will remains normotensive throughout the remainder of the pregnancy.

ASSESSMENT

- Assess vital signs especially the pulse rate and bp

- Assess urine output

NURSING MANAGEMENT

- Perform physical examination

- Monitor fetal heart rate and fetal activity

HEALTH MANAGEMENT

- Educate the importance of prenatal visits

MEDICAL MANAGEMENT

- Administer magnesium sulfate to prevent seizures and corticosteroid for lung maturity

GESTATIONAL DIABETES MELLITUS

- Condition in which a hormone made by the placenta prevents the body from using insulin
effectively.

NURISING DIAG

- RISK FOR INJURY (MATERNAL AND FETAL) RT CHANGES IN BLOOD GLUCOSE CONTROL/
INCREASE BLOOD PRESSURE/REDUCED BLOOD FLOW AEB
- DEFICIENT KNOWLEGDE RT MISINFORMATION AEB INACCURATE FOLLOW THROUGH OF
INSTRUCTIONS
- RISK FOR INFECTION RT HYPERGLYCEMIA/OBESITY AEB

RISK FACTORS: obese, have diabetes, family history of diabetes

STO - Acknowledge factors that lead to unstable blood glucose.

LTO - Identify interventions to prevent or reduce Risk for Infection.

ASSESSMENT

- Assess glucose level

- Assess urine output
NURSING MANAGEMENT

- Monitor vital signs

- Encourage patients to read labels

HEALTH EDUCATION

- Educate about home glucose monitoring

MEDICAL MANAGEMENT

- Administer insulin injections and normalize insulin activity

HYPERTONIC – not adequate relaxation of muscle tone between contractions, cramps that results in
ischemia or reduced blood flow to the fetus

HYPOTONIC LABOR DYSFUNCTION – poor and inadequate uterine contractions that may lead to
prolonged delivery

UNCOORDINATED -

UTERINE ATONY – failure of the uterus to contract sufficiently during and after childbirth

TRAUMA -

RETAINED PLACENTAL FRAGMENTS – delayed postpartum hemorrhage or prolonged postpartum

spotting

- OXYTOCIN
- MANUAL MASSAGE TO STIMULATE CONNTRACTIONS
- D&C OR D&E
- EXAMINATION OF THE UTERUS

ENDOMITRITIS – inflammation of the endometrial lining of the uterus

- AMPICILLIN
- GENTAMICIN
- METRONIDAZOLE
- DOXYCYCILINE

PERITONITIS – redness or swelling of lines of belly or abdomen

- PENICILIN
- CIPROFLOXACIN

THROMBOPHLEBITIS – inflammatory process that causes a blood clot to form and block one or more
veins, usually in legs

- HEAT TO THE PAINFUL AREA/ELEVATING THE LEGS/NSAID/COMPRESSION STOCKINGS