Page 684 - Saunders Comprehensive Review For NCLEX-RN

choriocarcinoma.

B. Assessment

1. Fetal heart rate not detectable
2. Vaginal bleeding, which may occur by the fourth week
or not until the second trimester; may be bright red or
dark brown in color and may be slight, profuse, or
intermittent
3. Signs of preeclampsia (progressive blood pressure
elevations) before the 20th week of gestation; note
that preeclampsia usually occurs after 20 weeks of
pregnancy, typically in the third trimester.
4. Fundal height greater than expected for gestational
date
5. Elevated human chorionic gonadotropin levels
6. Characteristic snowstorm pattern shown on
ultrasound
C. Interventions
1. Prepare the client for uterine evacuation (before
evacuation, diagnostic tests are done to detect
metastatic disease).
2. Evacuation of the mole is done by vacuum aspiration;
oxytocin may be administered after evacuation to
contract the uterus.
3. Monitor for postprocedure hemorrhage and infection.

4. Tissue is sent to the laboratory for evaluation,

and follow-up is important to detect changes
suggestive of malignancy.
5. Human chorionic gonadotropin levels are monitored
every 1 to 2 weeks until normal prepregnancy levels
are attained; levels are checked every 1 to 2 months
for 1 year.
6. Instruct the client and her partner about birth control
measures so that pregnancy can be prevented during
the 1-year follow-up period.
XIII. Hyperemesis Gravidarum
A. Description: Intractable nausea and vomiting during the first
trimester that causes disturbances in nutrition and fluid and
electrolyte balance
B. Assessment

1. Nausea most pronounced on arising; may

occur at other times during the day
2. Persistent vomiting
3. Weight loss
4. Signs of dehydration

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