TABLE 4-8 Emergency Conditions
First Trimester
Assessment/Observations Possible Problem Nursing Care Plan/Implementation
Fluid-Gas Transport
  1. Cramping - with or without bleeding or passage of tissue
Abortion (before 24 weeks)
Threatened
Imminent, incomplete, septic 		Bed rest, sedation, avoid coitus - if threatened; bed rest, start IV fluids and draw blood for laboratory work: CBC, type/crossmatch, electrolytes, platelets, HCG levels
  1. Passage of tissue (products of conception; grapelike vesicles) or brown spotting; fundus too high for gestational age; blood pressure elevated. Often associated with hyperemesis gravidarum and preeclampsia
Hydatidiform mole (trophoblastic disease) Vital signs q5 - 15 min, prn
  1. Severe pain, shock out of proportion to amount of overt blood; shoulder-strap pain (Kehr's sign), a “referred pain” that indicates intraabdominal bleeding (or rupture of ovarian cyst); amenorrhea of 6-12 weeks
Ectopic pregnancy Save all pads or tissue passed through vagina for physician evaluation
No rectal or vaginal examination until physician is present
  1. Malodorous discharge; hyperthermia and chills; tender abdomen
Septic abortion (self-induced or “criminal”) Take complete history, if possible
Convulsion precautions if hypertensive
  1. Ecchytnosis or bleeding - with a history that includes any or all of the following: had symptoms of pregnancy, but they subsided; pregnancy test negative; uterine size diminishing; no EHR
Missed abortion with possible DIC (retained dead fetus syndrome) Emotional support for loss of pregnancy (through nurse’s manner, tone of voice, touch, use of woman’s name, keep her informed of what is happening); oxygen, prn
Second Trimester
Fluid-Gas Transport
  1. Cramping; passage of products of conception
Late abortion Same as for first semester
  1. Labor - cervical changes, "show"
Incompetent cervical os See physician immediately for possible cerclage
  1. Prolonged nausea and vomiting; unexplained hypertension or preeclampsia; passage of dark blood or grapelike vesicles; absent Fl I Rs; excessive fundal height for gestation
Hydatidiform mole Maintain hydration; assess for dehydration; refer to physician
Sensory-Perceptual
  1. Preeclampsia/eclampsia Assessment: hypertension first noted after 24 weeks; followed by increased proteinuria Symptoms: blurred or double vision; pain: headache, epigastric (late sign) Signs: BP 160/110; 3* proteinuria Edema: facial, digital; pulmonary Oliguria Hyperreflexia
With increased severity: renal failure, circulatory collapse, CVA, coagulation defects (DIC); abruptio placentae; convulsions Pharmacological management of hypertension

Convulsion precautions:
  1. Emergency tray at bedside
  2. Oxygen/suction
  3. Start IV
  4. Padded siderails
  5. Limit environmental stimulation
  6. Constant observation
  7. Deep-tendon reflexes
  8. Daily weight
  9. I&O - strict
  10. Note any complaints and changes
  11. Prepare for lab work (type and crossmatch, CBC, platelets, BUN, and creatinine, uric acid, SGOT, SGPT)
  1. Convulsions in absence of hypertension, proteinuria, or facial edema
CVA, epilepsy, drug toxicity; intracranial injury; diabetic complications; encephalopathy Convulsion care:
  1. Oxygen/mask; drugs (Valium, magnesium sulfate IV)
  2. Observe
    • Uterine tone, FHR, fetal activity
    • Signs of labor
  3. Emotional support for woman and family
Third Trimester
Fluid-Gas Transport
  1. Bleeding: painless, bright red, vaginal Contractions or uterine tone normal
Placenta previa No vaginal exam
Apply fetal monitor; assess for labor; position: semi- to high Fowlers; ultrasound to verify placental location
  1. Pain: abdomen rigid and tender to touch Increased uterine tone; signs of shock disproportionate to visible blood loss; may have loss of FHTs; associated with: preeclampsia, multiparity, precipitous labor, oxytocin induction trauma, cocaine use
Abruptio placentae As for placenta previa; position: Sims’
Prepare for possible emergency Cesarean delivery