Question

Chapters 28-29 & 31 Hemorrhagic Disorders Endocrine & Metabolic Disorders Mental Health Disorders & Substance Abuse Rena is a 29-year-old woman who was brought to the Emergency Deperteent by ombulonce after she fainted, She states she is senually active but has not been consistent with contraceptive use. Her last menstrual period was 6 weeks ago, and it was delayed for several weeks then very light. This morning, Reno experienced moderate dark brown vaginal bleeding and later became lightheaded and fainted. Her vitel signs are WNL. She complains of a dull pain on the right side of her lower abdomen What is an ectopic pregnancy? 2. What are the risk factors for an ectopic pregnancy? 3. Reng has a quantitative 8-hCG level drawn. The results are 2100 milli-International Units/ml. The physicion orders a transvaginal ultrasound examination. Why 4. The ultrasound shows an unruptured tubal pregnancy in the right uterine tube that is 3 cm in diometer without any cardiac activity. Methotrexate 50 mg IM is ordered. Why was the Methotrexate ordered? 5. Rena is being discharged from the emergency department. She mode a follow-up appointment with her gynecologist for the next day, What information should you include as part of discharge teaching? was the ultrasound ordered? Susan is a 26-year-old G1PO at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin Au is 9. She uses glyburide 10 mg po daily. The physician has switched her to insulin at this time, 1, What is the nursing priority at this time? 2, What should Susan be taught obout insulin needs in pregnancy? 3. What additional risk foctor does Susan have? 4, How should Susan be counseled regarding weight gain in pregnancy? 5, What advice can be given to Suscn regarding exercise? Jane is a 33-year-old 64 P3, She has just found out that she is pregnant and is alarmed because she was using a selective serotonin reuptake inhibitor (SSRI) for depression. She was also using oral contraceptives. She acknowledges she may have forgotten to take some of the oral contraceptive pills. Jane's last menstrual period was January 8. Today is February 20. What can you tell Jane about her exposure to the 5SRI? 2. Jane has an ultrasound, which reveals she is 5 weeks pregnant. She then cansults a genetic counselor for information about the medication exposure. Becouse of the timing of her exposure, the counselor informs 1 her there would likely be an "all or nothing" effect. What does this mean? 3. Jane has stopped taking her SSRI but is having trouble coping with symptoms of depression She attends therapy but feels she needs the medication also. What are the principles of medication use during pregnancy that must be considered?

Answer 1

1.Ectopic pregnancy

It refers to implantation of the fertilized egg outside the uterus.

2.The main risk factors of ectopic pregnancy are

• Abdominal surgery
• Surgery of uterus (fallopian tube)
• A women with intrauterine device if conceived
• Previous ectopic pregnancy
• Tubal ligation
• Abortion
• Pelvic inflammatory disease
• Congenital birth defect of uterus
• Age above 35 years
• Endometriosis
• Smoking

3.The Beta HCG levels are low in ectopic pregnancy but a range of 2100miu indicates multiple gestation. The transvaginal scan is done to visualize gestation sac in the uterine cavity ,absence of it is the confirmatory test for ruling out ectopic pregnancy

4.The drug methotrexate stops the pregnancy by inhibiting the growth of fertilized egg and causing it to shrink and expel out.This is a best way if the implanted egg is in the tube to prevent rupture and surgery

5.The following discharge informations can be provided

• Adequate rest
• Observe for the quantity of bleeding
• Report immediately in case of light headedness,chest pain or shoulder pain,fever,severe pain.