Nursing 211

N211: Health Differences Across the Lifespan I swelling or hematoma at the puncture site, fever of 101.4° F, urinary retention or abnormal vaginal discharge (foul odor, brown color, and tissue). 3.7 Gestational Trophoblastic Disease Gestational trophoblastic Disease (Hydatidiform Mole) occurs when the chorionic villi degenerate into a bunch of clear vesicles in grape-like clusters. Hydatidiform mole is a developmental anomaly; an embryo is rarely present. An abnormal growth of trophoblastic tissue with three types: hydatidiform mole (Molar pregnancy), invasive mole (chorioadenoma destruens) and choriocarcinoma (form of cancer). A complete mole may lead to the development of choriocarcinoma, a rapidly growing malignant neoplasm. Nursing Assessment Includes variable vaginal bleeding during the first trimester (may be brown and may contain some grapelike clusters; unusual uterine growth measured by fundal height (uterus larger than expected for gestational date); no fetal parts can be palpated and no fetal heart rate is heard; “snowstorm” pattern on ultrasound. Abnormal labs include a very high hCG levels and very low maternal AFP levels. Client may have severe hypertension that occurs during the first half of the pregnancy. Other common findings are anemia, excessive nausea and vomiting, abdominal cramping and early symptoms of preeclampsia. Nursing Diagnosis • Grieving related to loss of pregnancy • Anxiety related to fear of secondary surgical procedure • Risk for fluid volume deficit related to hemorrhage Nursing Inte ventions Include providing preoperative and postoperative D&C care. Assess vital signs, vaginal bleeding, and uterine cramping. Provide RhoGAM to appropriate client (Rh-negative with Rh positive partners) post procedure. Reinforce need for frequent follow up care during the next year to rule out the development of choriocarcinoma. Weekly hCG levels are done initially with other testing to rule out cancer; reinforce need for diligent follow up care because one out of five women develops cancer. Client should not become pregnant for one year following molar pregnancy in case chemotherapy is indicated; provide contraceptive counseling. Provide emotional support for client and family who are grieving pregnancy loss and living with fear of developing a malignancy. Teach client signs of complications to be reported immediately are bright red frank, vaginal bleeding, and temperature spike over 100.4°F and foul-smelling vaginal discharge.

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