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Terms in this set (10)
Three types of placental abruption
1: Marginal= separates at the edges= blood vaginally
2: Central= blood is trapped b/n placenta and uterine wall= concealed bleeding
3: Complete= massive vaginal bleeding= total separation.
Signs and Symptoms
Onset is sudden and stormy
Bleeding can be external or concealed
Color of blood = dark venous
Anemia is greater than apparent blood loss
Shock is greater than apparent blood loss
Pain= severe and steady
Uterine tone = firm to stony hard
Uterine countour= may enlarge and change shape
Fetal heart tones = present or absent
Engagement= may be present
In active hemorrhage monitor vital signs every 5 minutes and compare to maternal baseline
VS indicate how the mom is responding to blood loss. Hypotension BP <90/60 indicates loss of large amounts of body fluid and the need for whole blood admin. A large gauge cannula is needed to allow IV fluids to be administered quickly and can be used for the admin of whole blood or blood products
1: Inspect skin color, temperature, and capillary refill
2: Count and weigh pads hourly. Record pad saturation amount using a specific amount of time (50mL of dark red blood on pad in 20 min.)
1 g = 1mL of blood. Skin should not exhibit signs of pallor or cyanosis and should not be cold or clammy.
1: Evaluate LOC frequently
2: Monitor urinary output via urinary catheter and urine-specific gravities
1: moderate to severe hemorrhage from abruptio placentae may lead to hypovolemia = cerebral hypoxia. Changes in LOC = decrease in blood flow to the brain.
2: If urine output is decreased below 30 mL/hr this may indicate a sign of shock. Inability to concentrate urine may = renal damage from vasoconstriction and decreased blood perfusion.
Monitor for signs of DIC
disseminated intravascular coagulopathy leads to the formation of small blood clots inside the blood vessels throughout the body. As the small clots consume coagulation proteins and platelets, normal coagulation is stopped and abnormal bleeding occurs from the skin, IV, IM injection sites, nose, mouth. Petechiae around BP cuff site, maternal tachycardia and diaphoresis. FIBRINOGEN LEVELS (ELEVATED in PREGNANCY) DROP IN MIN TO THE POINT AT WHICH BLOOD WILL NO LONGER COAGULATE. Large amounts of thromboplastin = DIC resulting in hypofibrinogenemia.
Evaluate biophysical prophile results.
Evaluates fetal breathing, fetal movement of body or limbs, & fetal tone.
1: Assess fetal heart rate pattern every 15 min.
2: Encourage client ot rest in the left lateral recumbent position
Decrease pressure on the vena cava= blood flow increased to the fetus = low risk for hypoxia.
Prepare client for possible C-section
After treatment of hypofibrinogenemia
2: Assess uterine resting tone every 15 min and abdominal girth hourly
3: Monitor uterine contractions and resting tone every 15 min
There is an increase in uterine resting tone with this disorder= hypoxemia in fetus. Uterine size increases as bleeding occurs at the separation site. Measure abdominal girth hourly by placing a tape, measure around the maternal abdomen at the level of the umbilicus or place a mark at the top of the uterine fundus.
THIS SET IS OFTEN IN FOLDERS WITH...
Medical Coding -Surgery
H I T chapter # 6
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