GROUP_1__Module_1M_Antenatal_Complications.pdf.pdf

Cebu Doctors’ University
College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclamation, 6014 Mandaue City, Cebu, Philippines
Tel. No. +63 (32) 238-8746 loc. 8191-8192 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudoctorsuniversity.edu
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NCM 109:
THEORY MODULE 1M
ANTENATAL COMPLICATIONS
Group F1:
Aguilar, Justine Anne
Alerta, Jary Eve Dwiezl
Asunto, Daryl Ann
Bolofer, Daphne Angie
Caballes, Mary Jeneibe
Cania, Sunny Jr
Chan, Bea Francesca
Corciega, Khiel
Cordovez, Crystal
Cuyos, Yori Nicole Martine
Enor, Ma. Christine
Estur, Froilan
Facilitator: Mrs. Dolores M.Saldivia
Date Submitted: February 05, 2022

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NCM 109
Midterm Reporting Guide
General Instructions:
1. Each section will be divided into 4 groups.
(Midterm-3 Modules/Finals-2 Modules)
2. Each group will have an assigned topic to prepare. The report will have the following
contents:
2.1. Definition/Description of the disease or complication
2.2 Etiology/Cause
2.3 Types if Applicable
2.4 Signs and Symptoms
2.5 Management
*Nursing, Medical, Pharmacologic, Surgical
2.6 Relevant Pictures/Videos
2.7 One (1) priority Nursing Care Plan for each complication
3. Submit an initial draft, final output and prerecorded reports in the assignment tab and
coordinate with the assigned facilitator.
4. Reports will be presented by each group during virtual class for critiquing.
Antenatal Complications

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ABORTION
Definition/Description of the disease or complication
- Any interruption of a pregnancy before a fetus is viable
- spontaneous miscarriages
Etiology/Cause
- Abnormal fetal development due either to a teratogenic factor or to a
chromosomal aberration
- Immunologic factors may be present or rejection of the embryo through an
immune response
- Implantation abnormalities
- Up to 50% of zygotes never implant securely because of inadequate
endometrial formation. The placental circulation does not develop
adequate enough to support the pregnancy.
- The zygote was implanted on an inappropriate site
- Corpus luteum fails to produce enough progesterone to maintain the decidua
basalis
- Urinary Tract Infection
- Said to cause preterm birth
- Ingestion of alcohol at the time of conception or during early pregnancy
- Systemic infections such as rubella, syphilis, poliomyelitis, cytomegalovirus, and
toxoplasmosis readily cross the placenta
- An infection can hinder the growth of a fetus which then leads to the fall
of the production of estrogen and progesterone, resulting in endometrial
sloughing.
- With the sloughing, prostaglandins are released leading to uterine
contractions and cervical dilations to expel the products of pregnancy

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Types if Applicable
- Threatened Miscarriage
- A woman may notice slight cramping but no cervical dilation upon vaginal
examination but bleeding is present.
- Imminent (Inevitable) Miscarriage
- There are uterine contractions and dilations with the loss of the products
of conception.
- Complete Miscarriage
- The entire products, fetus, membranes, and placenta, are expelled
spontaneously without assistance. Bleeding is present but usually slows
within 2 hours and then halts within a few days after passage of
pregnancy products.
- Incomplete Miscarriage
- A part of the conceptus, usually the fetus, is expelled but the membranes
or placenta are still in the uterus. There is a danger for maternal
hemorrhage as long as the other parts of conception are still retained in
the uterus due to ineffective contraction under this condition.
- Missed Miscarriage
- The fetus expires in the uterus but it is not expelled. Painless vaginal
bleeding may occur.
- Recurrent/Habitual Pregnancy Loss
- When a woman experiences three spontaneous miscarriages that occured
at the same gestational age.
- Septic Miscarriage
- Abortion accomplanied by infection
- Results from the same pregnancy tissue retained inside the uterus and
has not been removed

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Signs and Symptoms
Threatened Abortion
- Persistent low backache with pelvic pressure
- Dull and midline suprapubic discomfort
- Bleeding (minimal, painless)
- Clearly rhythmic cramps
Inevitable Abortion
- Cervical dilation
- Rupture of the membranes
- Vaginal bleeding (painful)
- Associated with cramping pain at lower abdomen
Incomplete Abortion
- Vaginal bleeding (heavy, fleshy masses)
- Associated with colicky pain at lower abdomen
Complete Abortion
- History of pain and passage of product of conception
- Absent of pain, minimal bleeding
Missed Abortion
- Decreased in pregnancy symptoms
- Vaginal bleeding (absent, minimal)
Septic Abortion
- Pelvic and abdominal pain
- Fever
- Malodorous vaginal discharge

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Management (*Nursing, Medical, Pharmacologic, Surgical)
● Nursing Management
○ Assessment
■ Presenting symptom of spontaneous miscarriages is almost always
vaginal spotting. Once noticed, the woman must contact her
healthcare provider.
■ Nurses should be aware of the guidelines of assessing vaginal
bleeding during pregnancy.
■ Important to know the actions of the woman to ensure she did
not attempt an illegal abortion.
■ Ask what she had done to stop the bleeding.
■ Report the amount of blood loss and whether bleeding might be
heavier than she first reported.
○ Nursing Intervention
■ If bleeding is heavy, lay the woman flat in her bed on her side and
monitor uterine contractions as well as fetal heart rate.
■ Measure the intake and output to establish renal function and
assess the vital signs of the mother to establish the maternal
response to the blood loss.
■ Measure maternal blood loss by saving and weighing the used
pads.
■ Save any tissue found in the pads as this might be part of the
products of pregnancy.
○ Evaluation
■ Aim is to restore maternal blood volume and stopping the source
of bleeding.
■ Pulse rate should be below 100 bpm and fetal heart rate must be
at normal level of 120-160 bpm

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■ Client’s urine output should be 30 mL/hr and with minimal
bleeding for not more than 24 hours.
● Medical Management
○ Administration of intravenous fluids as well as oxygen to replace
intravascular fluid loss and provide adequate fetal oxygenation.
○ Avoid vaginal examinations to avoid disturbing the products of pregnancy
or trigger cervical dilation.
○ Physicians might order an ultrasound examination for more information
on the well-being of the mother and fetus.
● Pharmacologic Management
○ Premedication of mifepristone 200 mg orally to be followed by
misoprostol 800 mcg vaginally with a repeated dose if needed 3 hours to
seven days after the first dose.
● Surgical Management
○ Dilation and evacuation is done to make sure that all the products of
pregnancy are removed from the uterus.
○ Dilation and curettage is commonly performed for incomplete
miscarriages to remove the retained products of pregnancy from the
uterus to prevent maternal hemorrhage and infection.

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Relevant Pictures

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One (1) priority Nursing Care Plan for each complication
Needs/ Problems/
Cues
Nursing Diagnosis Scientific Basis Objectives of Care Nursing Actions Rationale
I. Physiologic
Deficit
Fluid Volume Deficit
Objective Cues:
● Weight loss
(depending
on the
severity of
fluid volume
deficit)
● Concentrated
urine,
decreased
urine output
● Dry mucous
membranes,
sunken
eyeballs
● Weak pulse,
tachycardia
● Decreased
skin turgor
● Decreased
Fluid volume deficit r/t
profuse vaginal
bleeding secondary to
incomplete abortion
Deficient Fluid Volume
(also known as Fluid
Volume Deficit (FVD),
hypovolemia) is a state
or condition where the
fluid output exceeds
the fluid intake. It
occurs when the body
loses both water and
electrolytes from the
ECF in similar
proportions. Common
sources of fluid loss
are the gastrointestinal
tract, polyuria, and
increased perspiration.
Risk factors for
deficient fluid volume
are as follows:
vomiting, diarrhea, GI
suctioning, sweating,
decreased intake,
nausea, inability to
gain access to fluids,
adrenal insufficiency,
osmotic diuresis,
General Objective:
After 1 week of nursing
intervention, the patient
will regain normal state of
health with decreased
signs and symptoms of
fluid volume deficit.
Specific Objectives:
After 1-3 hours of
nurse-client interaction,
the patient will be able to:
1. verbalize
awareness of
causative factors
and behaviors
essential to correct
fluid deficit
2. explain measures
that can be taken
to treat or prevent
fluid volume loss
3. demonstrate
lifestyle changes to
avoid progression
Measures to manage
fluid volume deficit:
1. Obtain thorough
gynecological and
obstetric history.
2. Perform pelvic exam
in post-abortion
patient.
3. Monitor and
1. To avoid mistakes in
identifying causative
factors.
2. The rate and amount
of bleeding can be
easily underestimated
especially when the
patient is in the supine
position. Thus,
clinicians should
always perform a
pelvic exam in a
post-abortion patient
to determine that no
blood has collected in
the vagina or uterus.
The nurse should
check the vaginal area
for blood.
3. A decrease in

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blood
pressure,
hemoconcent
ration
● Postural
hypotension
Subjective Cues:
● Alterations in
mental state
● Patient
complaints of
weakness
and thirst
that may or
may not be
accompanied
by
tachycardia
or weak
pulse
hemorrhage, coma,
third-space fluid shifts,
burns, ascites, and
liver dysfunction. Fluid
volume deficit may be
an acute or chronic
condition managed in
the hospital, outpatient
center, or home
setting.
Appropriate
management is vital to
prevent potentially
life-threatening
hypovolemic shock.
The management
goals are to treat the
underlying disorder
and return the
extracellular fluid
compartment to
normal, restore fluid
volume, and correct
any electrolyte
imbalances.
Reference:
Wayne, G. (2021,
of dehydration
4. describe
symptoms that
indicate the need
to consult with
health care
provider
document vital signs,
especially BP and HR.
4. Assess skin turgor
and oral mucous
membranes for signs
of dehydration.
5. Monitor and
document
circulating blood
volume can cause
hypotension and
tachycardia. Alteration
in HR is a
compensatory
mechanism to
maintain cardiac
output. Usually, the
pulse is weak and
irregular if electrolyte
imbalance also occurs.
Hypotension is evident
in hypovolemia.
4. Signs of dehydration
are also detected
through the skin. The
skin of elderly patients
loses elasticity; hence
skin turgor should be
assessed over the
sternum or on the
inner thighs.
Longitudinal furrows
may be noted around
the tongue.
5. Febrile states decrease
body fluids by

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October 03). Deficient
fluid volume
(dehydration) nursing
care plan. Nurselabs.
Retrieved from
https://nurseslabs.com
/deficient-fluid-volume/
temperature.
6. Review the patient’s
medications,
including
prescription, OTC
drugs, herbs, and
nutritional
supplements.
7. Review laboratory
data.
8. Administer
medications as
ordered.
9. Discuss individual risk
factors, potential
problems, and
specific interventions.
10. Provide psychological
support and
confidentiality.
perspiration and
increased respiration.
This is known as
insensible water loss.
6. To identify medications
that can alter fluid and
electrolyte balance.
7. To evaluate fluid and
electrolyte status.
8. To stop or limit fluid
losses.
9. To reduce risk of injury
and dehydration.
10. Because some patients
may experience
anxiety.

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INCOMPETENT CERVIX
- Premature cervical dilation or Cervical insufficiency, previously termed an
incompetent cervix, is defined by the American College of Obstetricians and
Gynecologists (ACOG) as the inability of the uterine cervix to retain a pregnancy
in the second trimester, in the absence of uterine contractions.
- Meaning, their cervix begins to shorten or dilate before the baby is ready to be
born. Putting the pregnancy at risk for miscarriage or premature birth.
- Cervix is a long, narrow passage at the lower end of the uterus and normally
remains closed until the third trimester.
Etiology/Cause
- It is associated with increased maternal age. Depending on the severity of the
insufficiency, it usually occurs in the middle of the second or early third trimester.
- Infection/Inflammation induces early activation of the final pathway of
parturition, resulting in cervical changes.
- May be congenital or acquired structural defects
- The most common congenital cause is a defect in the embryological development
of Mullerian ducts.
- The most common acquired cause is trauma to the cervix, such cervical
conization, LEEP (loop electrosurgical excision procedure), cervical lacerations
during childbirth, or forced cervical dilatation during the uterine evacuation in the
first or second trimester of pregnancy
Types if Applicable
- N/A
Signs and Symptoms
- Cervical dilation is shown upon inspection of the physician.
- Show of a pink-tinged vaginal fluid discharge from the vaginal opening as a
sign that the cervix has dilated.
- Increased pelvic pressure is felt by the mother due to the fetus already
descending.

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- Backache
- Nursing Management
- Nursing Assessment
- Ask the woman who is experiencing painless bleeding if she is
feeling an intense pressure on her pelvis.
- Inspect and save pads used by the woman during bleeding to
determine any clots or tissues that already passed out.
- Determine if the woman is experiencing true contractions to
prepare for the birth of the fetus.
- Nursing Interventions
- Obtain history about prenatal screening and amount and timing of
care.
- Investigate current home situation.
- Facilitate positive adaptation to situations through active listening,
acceptance and problem solving.

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- Evaluation
- Provide prenatal care plan. Lack of prenatal care can place both
mother and fetus at risk.
- May have a history of unstable relationships or inadequate/lack of
housing that affects safety as well as general well being.
- Helps in successful accomplishments of the psychological tasks of
pregnancy.
- Medical Management
- Physicians would exclude any medications that could prevent the cervix
from dilation.
- To avoid jeopardizing the pregnancy, surgical procedures are immediately
enforced.
- Pharmacologic Management
- Progesterone Treatment. Administration of hydroxyprogesterone caproate
prophylaxis against preterm delivery is given to majority of women with
suspected cervical insufficiency who do not meet criteria for a
history-based diagnosis of cervical insufficiency and, in turn, a
history-indicated cerclage.
- Surgical Management
- McDonald’s Cervical Cerclage wherein the cervix is sutured
horizontally and vertically with nylon sutures. They are pulled back
together until the cervical canal is only a few millimeters in diameter.
- Shirodkar Cervical Cerclage is a procedure which involves threading
sterile tape in a purse-string manner under the submucosal layer on the
cervix. It is then sutured into place to close the cervix.
- Transabdominal Cerclage wherein a mersilene tape is placed at the
level of the isthmus between the uterine wall and the uterine vessels. The
tape is tied anteriorly. This is done between 11 weeks and 13 weeks
following laparotomy.

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- Transvaginal Cerclage is a surgical procedure that is done through the
vagina. Stitches are used to close the cervix during pregnancy to help
prevent a premature birth.
- The fetus will be able to be born vaginally when the sutures are removed
in the 37th or 38th week of pregnancy.
Relevant Pictures/Videos

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https://youtu.be/YIo_cUKBO8k
https://youtu.be/AfvrvAYi9E0

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Needs/ Problems/
Cues
Nursing
Diagnosis
Scientific Basis Objectives of Care Nursing Actions Rationale
I. Physiologic
Problem
Objective Cues:
● Blood Urine
● Vital signs as
follows:
T: 36.7
P: 110
R: 21
BP: 110/60
Subjective Cues:
“Nakikkita ko
may kasamang
dugo sa napkin
ko pag-ihi ko”
as verbalized
by the client.
Risk for maternal
injury related to
premature
cervical dilation
as manifested by
threatened
abortion.
Cervical insufficiency
(also called
incompetent cervix)
means your cervix
opens (dilated) too
early during
pregnancy, usually
without pain or
contractions.
Contractions are
when the muscles of
your uterus get tight
and then relax. They
help push your baby
out of your uterus
during labor and
birth. Premature
birth and miscarriage
are both possible
outcomes of cervical
insufficiency. When a
baby is born too
early, before the
General Objective:
After 5 days of holistic
nursing care, the client
will be able to:
1. Experience no
vaginal bleeding
Specific Objectives:
After 8 hours of
student-nurse
interaction, the client
will be able to:
1. Patient will
verbalize
understanding
of individual risk
factors or
conditions that
may impact
pregnancy.
2. Patient will
Independent:
1. Encourage modified or
complete bed rest.
2. Discuss implications of
preexisting conditions
and possible impact on
pregnancy.
Dependent:
3. Monitor signs closely.
1. Depending on the
symptoms of uterine
activity and cervical
changes, the degree
of activity may need
to be adjusted.
2. Pregnancy may have
no effect, or may
reduce or exacerbate
severity of symptoms
of chronic conditions.
3. Changes in vital signs
(e.g., elevated
temperature or pulse,
decreasing BP) may
indicate infection or
shock.

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37th week of
pregnancy, it is
referred to as a
premature birth.
When a baby dies in
the womb before the
20th week of
pregnancy, it is
known as a
miscarriage.
Reference:
Incompetent Cervix |
Cleveland Clinic.
(n.d.).
Retrived from
https://my.cleveland
clinic.org/health/dise
ases/17912-incompe
tent-cervix
make essential
changes to her
lifestyle and
everyday
activities to
manage risks.
3. Patient will
identify signs
and symptoms
that require
medical
attention and
evaluation.
4. Patient’s fetus
will grow
normally and
carry the
pregnancy to
term.
4. Notify physicians of
abnormal findings or
signs of labor.
5. Note presence of
vaginal bleeding,
leaking amniotic fluid,
or uterine contraction.
6. Assess the presence of
contraindications for
cerclage procedure.
4. Prompt intervention
lessens likelihood of
complications.
5. Aside from a little
spotting, vaginal
bleeding could be a
symptom of cervical
dilation. Leaking
membranes could
signal the upcoming
birth and put the
client at a higher risk
of infection.
6. If vagianl bleeding or
cramping is present,
membranes are
ruptured, cervical
dilations exceeds 3
cm, or the diagnosis
of cervical
dysfunction is in
question, the
treatment is not
performed since the
situation is

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Interdependent:
7. Referral to a reliable
support system and
programs.
progressed and
spontaneous abortion
is inevitable.
7. Increase the chances
of successfully
managing, treating,
and overcoming the
challenge.
References:
Belleza, M. (2019). 3 Premature Dilation of the Cervix Nursing
Care Plans. Nurseslabs. Retrieved from
https://nurseslabs.com/premature-dilation-cervix-nursing-care-
plans/
Ross, M. G. (2021). Preterm Labor. Medscape. Retrieved from
https://emedicine.medscape.com/article/260998-overview

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ECTOPIC PREGNANCY
- A fertilized egg implants outside of the uterus, most commonly in the fallopian
tube.
- Fallopian tubes are not made to hold a growing embryo and can’t stretch like a
uterus. This condition can lead to bleeding in the mother.
- Life-threatening condition that requires emergency treatment.
Etiology/Cause
- The fertilized egg was unable to migrate swiftly enough through the fallopian
tube. A tube might become partially or blocked as a result of an infection or
inflammation. Inflammatory disease (PID) is a common cause of this.
- Endometriosis. This occurs when cells from the uterine lining grow outside the
uterus. The cells can grow and cause blockage into the fallopian tube. The tube
can be blocked by scar tissue from previous abdominal surgery or fallopian tube
surgery.
Types if Applicable
● Tubal pregnancy
○ When the egg implants in the fallopian tube, it is called a tubal
pregnancy. Tubal pregnancies are the majority of ectopic pregnancies
and the most common type of ectopic pregnancy. The type of tubal
pregnancy can be further classified based on where the pregnancy
develops inside the fallopian tube.
■ A pregnancy grows in the fimbrial end in around five percent of all
cases.
■ A pregnancy grows in the ampullary section in around 80% of all
cases.
■ In about 12% of all cases, pregnancy occurs in the isthmus of the
fallopian tube. Because of the increased vasculature in this area,
bleeding is more likely to occur, and hence pregnancy mortality is
more likely.

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■ A pregnancy in the cornual and interstitial region of the fallopian
tube occurs in about 2% of cases and is more likely to result in
pregnancy death due to increased vasculature in this area.
● Non-tubal ectopic pregnancy
○ Nearly two percent of all ectopic pregnancies become established in other
areas including the ovary, the cervix, or the intra-abdominal region.
● Heterotopic pregnancy
○ In some rare circumstances, one fertilized egg implants inside the uterus
while the other implants outside. Because of the painful nature of ectopic
pregnancy, it is frequently identified before intrauterine pregnancy. The
pregnancy inside the womb may still be viable if human chorionic
gonadotropin levels continue to rise after the ectopic pregnancy has been
removed.
Signs and Symptoms
- One-sided abdominal pain. Typically on one side of your abdomen (tummy),
which can be persistent and severe.
- Vaginal bleeding.Vaginal bleeding is not the same as typical menstrual
bleeding. It might be bright or dark red, and it frequently starts and stops. Some
women mistake this bleeding for menstruation and don't know they're pregnant
until it's too late.
- Shoulder tip pain. Shoulder tip pain is felt at the point where your shoulder
meets your arm. Although the cause of shoulder tip pain is unknown, it
frequently occurs while lying down and is a sign that an ectopic pregnancy is
causing internal bleeding. The phrenic nerve, which is positioned in your
diaphragm (the muscle used during breathing that separates your chest cavity
from your abdomen), is thought to be irritated by the bleeding. Referred pain
(pain felt elsewhere) in the shoulder blade is caused by irritation to the phrenic
nerve.
- Bowel pain. You may experience pain when passing urine or stools.

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- Diarrhea and vomiting. An ectopic pregnancy can cause similar symptoms to
gastrointestinal disease and is often associated with diarrhea and vomiting.
- Nursing Management
- Assessment
● No unusual symptoms are usually present at the time of implantation of an
ectopic pregnancy.
● The usual signs of pregnancy would occur, such as a positive pregnancy test,
nausea and vomiting, and amenorrhea.
● At 6-12 weeks of pregnancy, the trophoblast would be large enough to rupture
the fallopian tube.
● Bleeding would follow, and it would depend on the number and size of the
affected blood vessels the amount of bleeding that would occur.
● Sharp, stabbing pain in the lower quadrant is likely to be felt by the we woman
once a rupture has occurred, followed by scant vaginal bleeding.
● Upon arrival at the hospital, a woman who has a ruptured ectopic pregnancy
might present signs of shock such as rapid, thread pulse, rapid respirations, and
decreased blood pressure.
● There would be a decreased hCg levels or progesterone levels that would
indicate that the pregnancy has ended.
-Nursing intervention
● Upon arrival at the emergency room, place the woman flat in bed.
● Assess the 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.

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-Evaluation
● The goal of the evaluation is to ensure that maternal blood loss is replaced and the
bleeding would stop.
● The patient must maintain adequate fluid volume at a functional level as evidenced by
normal urine output at 30-60mL/hr and a normal specific gravity between the ranges of
1.010 to 1.021.
● Vital signs, especially the blood pressure and pulse rate, should be stable and within the
normal range.
● Patient must exhibit moist mucous membranes, good skin turgor, and adequate capillary
refill.
- Medical Management
The medical management of a woman with an ectopic pregnancy should be initiated the
moment she is brought to the emergency room. Just a few moments of interval for action would
cause a big difference in the safety of the patient.
- Surgical Management
Surgical interventions would be performed after the rupture of the ectopic pregnancy to ensure
that the reproductive system would still be functional and no complications would arise.
Laparoscopy. This will be performed to ligate the bleeding blood vessels and repair or remove
the damaged fallopian tube.
Salpingectomy. This intervention would be performed if the fallopian tube is completely
damaged. The affected tube would be removed and what would be left would be sutured
appropriately.
- Pharmacologic Management
The standard medical treatment for unruptured ectopic pregnancy is methotrexate therapy.
Methotrexate is an antineoplastic agent that inhibits cell proliferation by destroying rapidly
dividing cells. It acts as a folate antagonist. The decision to use this agent should be made in
conjunction with, if not by, the consulting obstetric specialist.

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Relevant pictures/ videos
https://m.youtube.com/watch?v=EeZ2YJ4ZYPs

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Needs/Problems/Cues Nursing Diagnosis Scientific basis Objectives of Care Nursing Actions Rationale
I. Physiologic
deficit
Objective cues:
● Facial mask of pain
● Guarding behavior
● Vital signs taken as
follows:
● Temp: 36.4
● Pulse rate: 85
● RR: 22
● BP: 110/90
Subjective:
● “Masakit yung likod
ko tapos papunta sa
tiyan ko, parang
feeling ko
manganganak na
ako”, as verbalized
by the mother.
Acute pain related to
distention or rupture
of the fallopian tube.
The fallopian tube,
which transports eggs
from the ovaries to
the uterus, is the most
common site of an
ectopic pregnancy. A
tubal pregnancy is a
term used to describe
this type of ectopic
pregnancy. The ovary,
abdominal cavity, or
the lower part of the
uterus (cervix), which
connects to the
vaginal canal, can all
be affected by an
ectopic pregnancy.
It is impossible for an
ectopic pregnancy to
go on normally. If left
untreated, the
fertilized egg will die,
and the growing tissue
will cause
life-threatening
bleeding.
General objective:
After 4 days of
nursing interventions,
the patient will be
relieved or controlled.
Specific
Objectives:
After 8 hours of
nurse-client
interaction, the
patient will be able
to:
1. Appear
relaxed, able
to sleep/rest
and
participate in
activities
appropriately.
2. Patient will
Independent:
1. Encourage bed rest
with patient in side
lying position.
2. Apply external
uterine and fetal
monitoring.
3. Instruct patient to
report any feelings
of difficulty
breathing or chest
pain, dizziness,
nervousness and
irregular heart
beats.
Dependent:
4. Monitor maternal
vital signs
1. Best rest relieves
pressure of the
fetus on the
cervix.
2. Uterine and fetal
monitoring
provides
evidence of
maternal and
fetal well being.
3. Early recognition
of possible
adverse effects
allows for prompt
intervention.
4. to determine
presence of
hypotension and

College of Nursing
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Reference:
Ectopic Pregnancy.
(2020). Mayo Clinic.
Retrieved from
https://www.mayoclini
c.org/diseases-conditi
ons/ectopic-pregnancy
/symptoms-causes/syc
-20372088
demonstrate
relaxation
techniques
and deep
breathing
exercises.
3. Patient will
exhibit a
decreased
level of pain.
5. Monitor for
presence and
amount of vaginal
bleeding.
6. Monitor for
increased pain and
abdominal
distention and
rigidity.
Interdependent:
7. Notify the
practitioner of the
abnormal
assessment
findings.
8. Discuss individual
risk or potential
problems and
specific
tachycardia
caused by
rupture of
hemorrhage.
5. Increased pain
and abdominal
distention
indicates intra
abdominal
hemorrhage
6. Evidence of
hypovolemic
shock
7. This prevents
harm and to be
aware of the
client’s condition
and feeling.
8. To prevent and
limit the
occurrence of
pain.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
interventions to the
client.
Reference:
Ectopic Pregnancy. (2020). Mayo Clinic. Retrieved
from
https://www.mayoclinic.org/diseases-conditions/ectop
ic-pregnancy/symptoms-causes/syc-20372088

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HYPEREMESIS GRAVIDARUM
- Hyperemesis gravidarum is severe and excessive nausea and vomiting during
pregnancy, which leads to electrolyte, metabolic, and nutritional imbalances in
the absence of medical problems.
Etiology/Cause
- The condition might be caused by rapidly rising serum levels of hormones such
as HCG (human chorionic gonadotropin) and estrogen. Extreme nausea and
vomiting during pregnancy might indicate a multiple pregnancy (you’re carrying
more than one baby) or hydatidiform mole (abnormal tissue growth that is not a
true pregnancy).
-
Types if Applicable
-
Signs and Symptoms
- Being dehydrated. Symptoms of dehydration include, feeling thirsty, tired, dizzy
or lightheaded, not peeing very much, and having dark yellow and
strong-smelling pee
- Weight loss. It's not uncommon for women in their first trimester to lose a little
bit of weight due to bad nausea and vomiting that precludes them from eating in
a normal way
- Low blood pressure (hypotension) when standing. Unlike regular
pregnancy sickness, HG may not get better by 16 to 20 weeks. It may not clear
up completely until the baby is born, although some symptoms may improve at
around 20 weeks.
- Nausea accompanied by severe vomiting. It is unknown what causes severe
morning sickness. However, it could be linked to the hormonal changes that
occur during pregnancy.
- Nutritional disorders. Vitamin B1 (Thiamine) deficiency, Vitamin B6 deficiency
or Vitamin B12 deficiency

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
● Nursing Management
Assessment
- Perform a full clinical examination
- Assess for clinical signs of dehydration
- Measure lying and standing blood pressure, pulse rate and character
Check urine for ketones
- Keep a chart of the patient's temperature
More specifically assess for:
Signs of hypokalemia (muscle weakness), hypercalcaemia, hypocalcaemia (Chvostek's or
Trousseau's sign) or thyrotoxicosis
Nursing Intervention
● IV therapy with replacement of electrolytes and possible total parenteral nutrition.
● Maintain NPO status for 24-28 hour vomiting has stopped
● Facilitate the client’s environment- quiet, stress free, and odor free
● Measure and record fluid intake and output.
● Encourage small frequent meals and snacks once vomiting has subsided.
● Administer antiemetics as prescribed.
Evaluation
● Aims to help the patient hydrated in order to avoid possible cases like constipation or
ketosis
● After volume repletion, the patient should have no persistent electrolyte or ketone
imbalances
● Ensure proper weight maintenance in order to avoid loss of 5% or more body weight.
● Ensures a certain diagnosis with their current condition.
Medical Management
● Small frequent meals: Nausea and vomiting might be treated with dry foods
(such as crackers) and small, frequent meals.
● Intravenous fluids: It is important for a pregnant woman to maintain her fluid
intake. Intravenous (IV) fluids might be needed if a woman continues to vomit

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throughout pregnancy. In severe cases, the woman might require hospitalization
and given IV fluids. IV fluids might be discontinued when a woman is able to
take in fluids by mouth.
● Total parenteral nutrition: The most severe cases of hyperemesis gravidarum
might require that complex, balanced solutions of nutrients be given through an
IV throughout pregnancy. This is called total parenteral nutrition (TPN).
Pharmacologic Management
● treatment may be initiated by giving vitamin B-6 10-25 mg 3-4 times daily;
doxylamine 12.5 mg 3-4 times daily can be used in addition.
● Promethazine, 25 mg every 8 h for 24 h, Reduces nausea and vomiting
Surgical Management
Tube feeding - Nasogastric tube seems to be effective in relieving intractable nausea and
vomiting and in providing adequate nutritional support. Enteral nutrition should be considered
as an alternative to total parenteral nutrition in the management of hyperemesis gravidarum.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
Needs/ Problems/
Cues
I. Physiologic
problem
Objective Data:
Temperature: 37.5
Pulse Rate: 88
Respiratory Rate: 20
Blood Pressure: 110/80
● Sweating
● Facial flushing
● Restlessness
Subjective Data:
- Patient
complaints of
feeling thirst and
having no
appetite.
- “Permi nako
isuka ang akong
Nutritional imbalance
r/t nausea and
vomiting
An inability of the
body to absorb
certain nutrients or
a poor diet might
result in nutritional
imbalance.
Depending on the
nutrients in short or
excess supply,
imbalances generate
unpleasant side
effects and illnesses
that could lead to
serious disease
Source: What Is
Nutritional
Imbalance & What
Forms Are There?,
(2021, January 11)
Healthfully.
Retrieved from
General Objective:
After 1 week of nursing
intervention, the patient
will maintain nutrition
and hydration and will
be avoiding any
complications and injury
to the patient and to
the fetus/.
Specific Objective:
After 8 hours of
nurse-client interaction,
the patient will be able
to:
1. Exhibit a
decrease in
behavioral signs,
such as
restlessness and
Independent
1. Assess for signs
of dehydration
2. Monitor FHR and
fetal activity.
3. Provide nutrition in
small but frequent
portions.
1. Improve fluid
balance, and
maintain a
homeostatic
mechanism, is the
basis for the
mother and fetus
to maintain
balance.
2. FHR and fetal
movement is an
indication that the
fetal/fetus is in a
good condition.
3. Feeding gradually
or slowly may
help.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
gipang kaon” https://healthfully.co
m/547230-what-is-n
utritional-imbalance-
what-forms-are-ther
e.html
irritability.
2. To know deep
breathing
exercise
3. Verbalize the
purpose of the
medication and
intervention
4. Monitor the
provision of fluids
and food in 24
hours as well as
expenditures and
recorded fluid
intake.
Dependent
5. Give parenteral
fluids such as
electrolytes,
glucose and
vitamins according
to the program.
4. The provision of
fluids and
electrolytes is a
way to deal with
persistent
vomiting, this
recording will be
able to assess the
balance of
electrolytes given,
while the number
of how many
calories can
already be given.
5. This fluid will
provide or meet
the needs of the
body’s acid-base
balance,
electrolytes and
hypovitaminosis.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
Interdependent
6. Monitor blood urea
nitrogen, protein,
Prealbumin,
glucose, nitrogen
balance as
indicated.
7. Do collaborations
with other teams
for the
administration of
antiemetic drugs.
6. Reflects organ
function and
nutritional status
and needs.
7. To cope with
vomiting.
Source: Wayne, G. (2021, October 03). Deficient fluid
volume (dehydration) nursing care plan. Nurselabs.
Retrieved from
https://nurseslabs.com/deficient-fluid-volume/
Wayne, G. B. (2017, September 24). Imbalanced
Nutrition: Less Than Body Requirements Nursing
Care Plan. Nurseslabs.
https://nurseslabs.com/imbalanced-nutrition-less-
body-requirements/

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
HYDATIDIFORM MOLE
- Also known as molar pregnancy. This is a rare complication of pregnancy
characterized by an abnormal growth of trophoblasts, the cells that normally
develop into the placenta. The rare mass forms inside the womb (uterus) at the
beginning of the pregnancy. It is a type of gestational trophoblastic disease
(GTD).
Etiology/Cause
- Hydatidiform mole or molar pregnancy results from the abnormal fertilization of
the oocyte (egg).
- In a complete molar pregnancy, the chromosomes from the mother’s eggs are
lost or inactivated and the father’s chromosomes are duplicated. This is the result
of an empty egg being fertilized by one or two sperm, and all of the genetic
material is from the father.
- In a partial or incomplete molar pregnancy, the mother’s chromosomes remain
but the father provides two sets of chromosomes, resulting to the embryo having
69 chromosomes instead of 46. This often occurs when two sperm fertilize an
egg which results to an extra copy of the father’s genetic material.
Types if Applicable
● Complete Molar Pregnancy
- The placental tissue is abnormal and swollen and it appears to form
fluid-filled cysts. In this type, there is no formation of fetal tissue.
● Partial Molar Pregnancy
- There may be normal placental tissue along with abnormally forming
placental tissue. There may also be fatal formation, but misscariage
occurs during the early period in pregnancy because the fetus is not able
to survive,
Signs and Symptoms
- Dark brown to bright red vaginal bleeding during the first trimester
- Severe nausea and vomiting

College of Nursing
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- Sometimes vaginal passage of grape like cysts
- Pelvic pressure or pain
- Rapid uterine growth - the uterus is too long large for the state of pregnancy
- High blood pressure
- Preeclampsia - a condition that causes high blood pressure and protein in the
urine after 20 weeks of pregnancy
- Ovarian cysts
- Anemia
- Overactive thyroid (hypothyroidism)
Nursing Management
- Assess the patient's blood pressure, see whether she is bleeding severely, and
make sure to notify the doctor immediately.
- Assess for signs and symptoms of pregnancy induced hypertension, because for
a woman with H-mole, they occur earlier than the 20th week of pregnancy.
- Monitor for evidence of hemorrhage such as vital signs, abdominal pain, uterine
status, and vaginal bleeding.
- Teach deep breathing techniques to alleviate the pain. Use diversional activities if
possible.
- Assess the abdominal girth and fundal height to establish baseline data regarding
the growth of the uterus.
- Assess the abdomen area for indicators of internal bleeding (e.g. Cullen’s). and
check for abdominal pain.
- If the patient is experiencing nausea and vomiting, make sure that she does not
aspirate it.
- Keep in mind that the patient may find this difficult to accept, so make sure to
provide emotional assistance and explain to the patient that it is not her fault this
happened.
- Monitoring the HCG level and follow-ups.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
- Discuss the family planning methods available for her.
Medical Management
- Quantitative Beta HCG Test (BHCG) - this is a blood test to check if there is HCG
present in the blood serum. It reflects levels of HCG usually results over 25
MIU/ML means you are pregnant, anything extremely higher than that needs
further evaluation. Remember that this is not the definitive test for H. Mole but
this test is important to monitor any recurrence after the management.
- Urine Test or Serum for HCG - a very high result for HCG might indicate the
presence of an H. Mole.
- Ultrasound - if no fetal heart tones are heard, an ultrasound will be ordered.
Transvaginal or pelvic results will show a grape like vesicle or a classic snowstorm
like appearance.
- Chest X-ray or Lung CT (Computed Tomography) - these tests will be ordered if
H. Mole pregnancy is already confirmed and metastasis is a big concern since
choriocarcinoma and other GTD spreads really fast.
- Pregnancy Test - this may not be able to detect specifically the H. Mole, but this
will confirm if the woman is pregnant or not.
Pharmacologic Management
- Dactinomycin - used to treat different types of cancers that affect the kidneys,
uterus, testicles, bones, muscles, joint, and soft tissues and also used to treat
solid tumors. The physician orders this medication once metastasis occurs.
- Chemotherapy - will be done if the HCG levels are not decreasing even though
there is no conceptus left in the uterus. The most commonly used drug is
Methotrexate but the drug Dactinomycin is also used. The chemotherapy also
depends on the staging done by the pathologist. In some institutions, whether or
not the HCG levels decrease, they would still give a prophylactic chemotherapy
- Methotrexate - a prophylactic course of methotrexate may order by the
physician, which attacks rapidly growing cells like the abnormal growing
trophoblastic cells

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
Surgical Management
- Suction curettage - This is the ideal management of gestational trophoblastic
disease, to evacuate the mole inside the woman’s uterus and avoid any further
complications if it stays longer inside the reproductive system.
Relevant Pictures/Videos

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
Needs/ Problems/
Cues
I. Physiologic
problem
Objective Cues:
V/S:
T = 37.2°C
PR = 112 bpm
RR = 22/min
BP = 140/90mmHg
Subjective:
“Sakita sa akong tiyan
og luyo maglisod ko
og lihok” as verbalized
by the patient
- 1 is the lowest
and 10 is the
pain scale; Pain
scale is 8/10
Acute pain related to
hydatidiform mole as
evidence by
verbalization of pelvic
pain, restlessness and
vaginal bleeding
A hydatidiform mole is
growth of an abnormal
fertilized egg or an
overgrowth of tissue
from the placenta. The
fast growth can also
cause pressure and pain.
Most women have
severe nausea and
vomiting, vaginal
bleeding, and very high
blood pressure which
results in pain that the
tissues in a molar
pregnancy grow faster
than they do, especially
in the second trimester.
Your stomach may look
too large for that early
stage in pregnancy.
Source:
Ramirez, P. T., &
Salvo, G. (2022,
General Objective:
After 2 days of
holistic nursing care,
the client will be able
to:
1. Report pain as
either relieved
or controlled
Specific Objective:
After 8 hours of
student-nurse
interaction, the client
will be able to
1. Reduced pain
score of 7/10
to a lower
number,
ideally 3/10
2. Display a
reduced BP
Measures to manage
acute pain related to
hydatidiform mole:
Independent
1.Asses the patient’s vital
signs
2. Measure abdominal
girth and fundal height
3. Assess the
characteristics of pain at
least 30 minutes after
administering the pain
medication
1.Measuring the vital signs
of a pregnant patient is the
first step to pregnancy
abnormalities in order to
initiate timely treatments.
2. To establish a baseline
data pertaining to the
growth of the uterus.
3. To monitor the
effectiveness of the
medical treatment provided
for pelvic pain relief.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
January 24).
Hydatidiform
Mole. MSD
Manual.
Retrieved
February 4, 2022,
from
https://www.msd
manuals.com/ho
me/women-s-hea
lth-issues/cancers
-of-the-female-re
productive-syste
m/hydatidiform-
mole
Pillitteri, A. (2018).
Maternal and Child
Health Nursing (Vol. 1).
Wolters Kluwer.
within a
normal range
of
<120/80mmH
g
3. Explain
measures that
can be taken
to prevent
further
complications
4. Elevate the head of
the bed and position the
patient in semi Fowler’s.
5. . Save all pads used by
the patient during vaginal
bleeding
Dependent
6. Administer prescribed
pain medications.
7. During severe episodes
of pain, Place the patient
in complete bed rest.
Perform
non-pharmacologic
measures such as guided
imagery, provision of
distraction (tv or radio),
and relaxation techniques
like deep breathing
exercises.
Interdependent
4. For optimal lung
expansion and to increase
oxygen level.
5. To check for clots and
tissues the patient may
have discharged.
6. To alleviate the
symptoms of acute pelvic
pain
7. Allows optimal patient
comfort.

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
8. Prepare the patient for
surgery
9. Give post-surgery
advise to the patient
such as preventing
strenuous activity for a
few weeks or as ordered.
If the pain medications
are not working, inform
the health care team.
8. Dilatation and
Curettage, Hysterectomy;
are the two surgical
interventions for molar
pregnancy.
9. To reduce the surgical
pain felt by the patient and
to allow full recovery and
healing.
References:
Belleza, R. M. N. (2016, December 21). Gestational
Trophoblastic Disease. Nurseslabs. Retrieved February
4, 2022, from
https://nurseslabs.com/gestational-trophoblastic-diseas
e/
C. Rn, A. B. (2021, March 15). Hydatidiform Mole
Nursing Diagnosis Interventions and Care Plans.
NurseStudy.Net. Retrieved February 4, 2022, from

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
https://nursestudy.net/hydatidiform-mole-nursing-care-
plans/
Nursing Care Plan: Nursing Interventions for
Hyperemesis Gravidarum. (n.d.). Nursing Care Plan.
https://nanda-nursing-care-plan.blogspot.com/2012/07
/nursing-interventions-for-hyperemesis.html
Vousden, N. (2018, June 22). Innovations in vital signs
measurement for the detection of hypertension and
shock in pregnancy - Reproductive Health. BioMed
Central. Retrieved February 4, 2022, from
https://reproductive-health-journal.biomedcentral.com/
articles/10.1186/s12978-018-0533-4#:
Wayne, G. B. (2017, September 24). Imbalanced
Nutrition: Less Than Body Requirements Nursing Care
Plan. Nurseslabs.
https://nurseslabs.com/imbalanced-nutrition-less-body-
requirements/

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
List of References:
Alves, C. (2021, July 20). Spontaneous abortion. StatPearls [Internet]. Retrieved February 2,
2022, from https://www.ncbi.nlm.nih.gov/books/NBK560521/
Belleza, R. M. N. (2019, June 1). 3 Premature Dilation of the Cervix Nursing Care Plans.
Nurseslabs. https://nurseslabs.com/premature-dilation-cervix-nursing-care-plans/
Belleza, M. (2017, January 19). Abortion: Nursing management and care. Nurseslabs. Retrieved
February 2, 2022, from https://nurseslabs.com/abortion/
Belleza, R. M. N. (2016, December 30). Incompetent Cervix. Nurseslabs.
https://nurseslabs.com/incompetent-cervix/
Belleza, R. M. N. (2016, December 21). Gestational Trophoblastic Disease. Nurseslabs. Retrieved
February 4, 2022, from https://nurseslabs.com/gestational-trophoblastic-disease/
Cafasso, J. (2019, May 01). Everything you need to know about miscarriage. Healthline.
Retrieved from https://www.healthline.com/health/miscarriage
Ectopic pregnancy. (2020, April). Pregnancy Birth and Baby.
https://www.pregnancybirthbaby.org.au/ectopic-pregnancy
Ectopic Pregnancy: Symptoms, Causes, Treatments & Tests. (2020, June 2). Cleveland
Clinic. https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy
Familydoctor.org editorial staff. (2020, October 5). What Is Ectopic Pregnancy? Tubal
Pregnancy. Familydoctor.Org. https://familydoctor.org/condition/ectopic-pregnancy/
Flagg. (2017). Maternal and child health nursing (8th ed.). Lippincott Williams and Wilkins.
Incompetent Cervix | FindATopDoc. (n.d.). Findatopdoctor.Com.
https://www.findatopdoc.com/Medical-Library/Diseases-and-Conditions/Incompetent-Cervix

College of Nursing
_________________________________________________________________________________________________________________________________________________________________________
Mandal, A., MD. (2019, February 27). Types of Ectopic Pregnancy. News-Medical.Net.
https://www.news-medical.net/health/Types-of-Ectopic-Pregnancy.aspx
Nursing Care Plan: Nursing Interventions for Hyperemesis Gravidarum. (n.d.). Nursing Care
Plan.
https://nanda-nursing-care-plan.blogspot.com/2012/07/nursing-interventions-for-hyperemesis.h
tml
Ramirez, P. T., & Salvo, G. (2022, January 24). Hydatidiform Mole. MSD Manual. Retrieved
February 4, 2022, from
https://www.msdmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductiv
e-system/hydatidiform-mole
Recurrent hydatidiform mole: MedlinePlus Genetics. (n.d.). Medlineplus. Retrieved February 4,
2022, from https://medlineplus.gov/genetics/condition/recurrent-hydatidiform-mole/
Sajadi-Ernazarova, K.R., Martinez, C.L., & Sapkota, R. (2021, May 24). Abortion complications.
StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK568800/
Thakur, M. (2021, September 06). Cervical Incompetence. StatPearls [Internet]. Retrieved
February 3, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK525954/

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