A patient is diagnosed with a hydatidiform mole and is scheduled for a dilation and curettage (D&C) to remove the molar tissue. Which nursing intervention is most important to perform immediately before the procedure?

A) Obtain a signed informed consent

B) Ensure the patient has an empty bladder

C) Administer prescribed antibiotics

D) Educate the patient on the importance of follow-up hCG monitoring

A patient with a confirmed diagnosis of a hydatidiform mole presents with elevated blood pressure, tachycardia, persistent vomiting, and significant uterine enlargement. After stabilization, what is the nurse's priority intervention to prepare for the patient's immediate procedure?

B) Prepare the patient for dilation and curettage (D&C)

A) Administer antiemetics to control vomiting

B) Prepare the patient for dilation and curettage (D&C)

C) Educate the patient on the risk of gestational trophoblastic neoplasia

D) Monitor the patient's blood pressure every hour

A patient who recently underwent a dilation and curettage for a molar pregnancy is exhibiting increased abdominal tenderness and spotting post-procedure. Her lab results show a further drop in hemoglobin and high beta-hCG levels. What is the priority nursing intervention based on these findings?

C) Administer a blood transfusion as ordered.

A) Monitor the patient's vital signs every 4 hours.

B) Prepare the patient for a possible repeat surgical intervention.

C) Administer a blood transfusion as ordered.

D) Educate the patient on signs of infection to report.

A patient who recently underwent a dilation and curettage for a molar pregnancy is experiencing increased abdominal tenderness, spotting, and persistent dizziness. Her lab results indicate anemia and mild hyponatremia. The medical team is considering a blood transfusion and prophylactic antibiotics. Which nursing intervention is most critical at this time to prevent further complications?

A) Perform continuous monitoring of vital signs and watch for signs of hemodynamic instability.

B) Educate the patient on the importance of follow-up beta-hCG testing.

C) Encourage the patient to increase oral fluid intake to correct hyponatremia.

D) Assist the patient with ambulation to prevent dizziness and promote circulation.

A patient is undergoing treatment for persistent gestational trophoblastic disease after a dilation and curettage procedure. Her beta-hCG levels have decreased slightly but remain significantly elevated. Which nursing action is most appropriate to prioritize at this time?

B) Initiating methotrexate therapy as prescribed by the healthcare provider.

A) Educating the patient about the signs and symptoms of potential infection.

B) Initiating methotrexate therapy as prescribed by the healthcare provider.

C) Monitoring the patient's blood pressure and heart rate every 4 hours.

D) Scheduling the patient for weekly beta-hCG level testing.

A patient with persistent gestational trophoblastic disease is being closely monitored after a blood transfusion and repeat dilation and curettage. Despite a slight decrease in beta-hCG levels, the team is considering methotrexate therapy. Which of the following nursing actions is most critical in preparing the patient for potential methotrexate treatment?

B) Assess the patient's kidney and liver function tests prior to initiating methotrexate therapy.

A) Educate the patient on the importance of frequent blood draws to monitor beta-hCG levels.

B) Assess the patient's kidney and liver function tests prior to initiating methotrexate therapy.

C) Discuss dietary modifications to enhance iron absorption following the blood transfusion.

D) Reinforce the need for increased hydration to prevent complications from retained tissue.

A patient underwent a repeat dilation and curettage and is being monitored for potential complications. Two days post-procedure, her beta-hCG levels show a modest decrease but remain elevated at 120,000 mIU/mL. The team is considering methotrexate therapy. What is the priority nursing intervention based on this clinical scenario?

B) Educate the patient about the side effects of methotrexate therapy.

A) Monitor the patient's vital signs closely for signs of infection.

B) Educate the patient about the side effects of methotrexate therapy.

C) Assess the patient's understanding of the importance of follow-up appointments.

D) Prepare the patient for immediate surgical intervention.

A patient is two days post dilation and curettage for the treatment of gestational trophoblastic disease. Beta-hCG levels have decreased modestly, and a pelvic ultrasound shows a persistent mild fluid accumulation. Which nursing action is most appropriate at this time?

C) Educate the patient on the importance of follow-up appointments and start prescribed broad-spectrum antibiotics.

A) Monitor the patient's vital signs and wait for further decrease in beta-hCG levels.

B) Administer methotrexate as prescribed to treat elevated beta-hCG levels.

C) Educate the patient on the importance of follow-up appointments and start prescribed broad-spectrum antibiotics.

D) Encourage increased fluid intake to help reduce pelvic fluid accumulation.

A patient with suspected persistent gestational trophoblastic disease is being monitored closely for infection and possible malignant transformation. Which nursing intervention is most critical in managing this patient's care plan?

B) Educate the patient on the importance of adhering to scheduled beta-hCG tests to monitor treatment effectiveness.

A) Encourage the patient to avoid all physical activity to prevent exacerbation of symptoms.

B) Educate the patient on the importance of adhering to scheduled beta-hCG tests to monitor treatment effectiveness.

C) Advise the patient to self-medicate with over-the-counter pain relievers for pelvic discomfort without consulting the healthcare team.

D) Instruct the patient to increase fluid intake to promote renal clearance of medications.

A patient, three days post-initiation of broad-spectrum antibiotics, reports a new onset of mild fever and increasing pelvic discomfort. Her white blood cell count is slightly elevated, and beta-hCG levels are decreasing slower than expected. What should be the nurse's primary focus in addressing the patient's current condition?

A) Monitor for signs of antibiotic-resistant infection and report to the physician.

B) Educate the patient on the potential side effects of methotrexate therapy.

C) Encourage increased fluid intake to help reduce fever and discomfort.

D) Prepare the patient for immediate surgical intervention.

hydatiform mole - Nursing Case Study

Pathophysiology

• Primary mechanism: A hydatidiform mole forms due to abnormal fertilization, often involving an empty ovum fertilized by one or two sperm, leading to a gestational trophoblastic disease characterized by the proliferation of abnormal trophoblastic tissue in the uterus.

• Secondary mechanism: The resulting tissue lacks normal fetal development and instead forms cystic, fluid-filled clusters resembling a "bunch of grapes," driven by excessive proliferation of trophoblastic cells and abnormal villous edema.

• Key complication: If untreated, this can lead to persistent gestational trophoblastic neoplasia, where the invasive mole continues to grow and may metastasize, necessitating prompt intervention to prevent significant morbidity.

Patient Profile

Demographics:

28-year-old female, office administrator

History:

• Key past medical history: Previous miscarriage at 10 weeks gestation

• Current medications: Prenatal vitamins, folic acid

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Vaginal bleeding and abdominal pain

• Key symptoms: Excessive nausea and vomiting, uterine size larger than expected for gestational age, passing of grape-like vesicles

• Vital signs: Blood pressure 150/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 99.1°F

Section 1

As the medical team conducts an initial assessment, they note the patient's vital signs and symptoms suggest a significant development in her condition. The patient's blood pressure has increased to 160/100 mmHg, and her heart rate remains elevated at 115 bpm. She continues to experience persistent vomiting and reports increasing abdominal pain. Upon physical examination, the uterus is palpated to be significantly larger than expected for the gestational age, consistent with the suspected diagnosis of a hydatidiform mole. Additionally, the patient is visibly pale and reports feeling dizzy upon standing, indicating potential anemia or hypovolemia due to blood loss.

The obstetrician orders an ultrasound and lab tests, including a complete blood count (CBC) and quantitative beta-hCG levels. The ultrasound results confirm the presence of a molar pregnancy, showing a "snowstorm" pattern with no identifiable fetus. The beta-hCG levels are markedly elevated at 200,000 mIU/mL, significantly higher than expected for a normal pregnancy at this stage, affirming the diagnosis. The CBC reveals a hemoglobin level of 9.0 g/dL, pointing towards anemia likely due to ongoing bleeding. These findings indicate the patient is at risk for further complications, including potential progression to gestational trophoblastic neoplasia if not addressed promptly.

The medical team discusses the urgent need for intervention. The priority is to stabilize the patient's hemodynamic status and plan for the evacuation of the molar tissue to prevent further complications. The patient is counseled about the importance of the procedure, which carries both diagnostic and therapeutic benefits. This step is crucial in preventing the potential for invasive disease and alleviating her current symptoms. The team prepares for a dilation and curettage (D&C) to remove the molar tissue, with plans for close follow-up to monitor hCG levels post-procedure, ensuring complete resolution of the disease and preventing malignancy.

Section 2

Following the dilation and curettage procedure, the medical team closely monitors the patient in the recovery unit. Initially, her vital signs show promising improvement; her blood pressure decreases to 140/90 mmHg, and her heart rate stabilizes at 95 bpm. However, shortly after the procedure, she begins to experience increased abdominal tenderness and a new onset of spotting. Her dizziness persists, and she continues to appear pale. Concerned about these developments, the team orders a repeat complete blood count and checks her electrolytes to assess for ongoing blood loss or electrolyte imbalances.

The lab results reveal a further drop in hemoglobin to 8.5 g/dL, indicating continued anemia. The electrolytes show mild hyponatremia with a sodium level of 133 mEq/L, which could contribute to her dizziness and overall weakness. Despite the successful evacuation of the molar tissue, these findings suggest potential complications such as retained products of conception or secondary infection. Additionally, the patient's beta-hCG levels, although expected to decrease, still remain high at 180,000 mIU/mL, raising concerns about persistent gestational trophoblastic disease.

In response to these new complications, the medical team deliberates on further management strategies. They consider administering a blood transfusion to address the anemia and stabilize the patient's hemodynamic status. Furthermore, they plan to initiate prophylactic antibiotics to mitigate the risk of infection and schedule follow-up beta-hCG tests to ensure a downward trend, indicating effective resolution of the trophoblastic disease. The patient is counseled on the necessity of these interventions and the importance of continued monitoring, emphasizing the critical role of follow-up in preventing progression to more severe conditions, such as gestational trophoblastic neoplasia. This vigilant approach aims to navigate the patient safely through this complex phase of her care journey.

Section 3

The medical team decides to proceed with a blood transfusion to address the patient's anemia and stabilize her hemodynamic status. Following the transfusion, her hemoglobin levels increase to 10.5 g/dL, and she begins to feel slightly more energetic. Her blood pressure stabilizes at 130/85 mmHg, and her heart rate decreases to 88 bpm, both indicating a positive response to the intervention. Despite these improvements, the patient continues to report persistent abdominal discomfort and an increase in spotting, prompting further evaluation.

An ultrasound is conducted to assess for any retained products of conception or other abnormalities. The imaging reveals a small amount of retained tissue, suggesting incomplete evacuation during the initial procedure. Additionally, there is mild fluid accumulation in the pelvic cavity, raising concerns about a possible secondary infection. Given these findings, the medical team decides to perform a repeat dilation and curettage to ensure complete removal of any remaining molar tissue.

In parallel, the patient's beta-hCG levels are closely monitored. Although there is a slight decrease to 150,000 mIU/mL, the levels remain significantly elevated, reinforcing the suspicion of persistent gestational trophoblastic disease. The team discusses the possibility of initiating methotrexate therapy if the repeat procedure does not yield the expected decrease in beta-hCG levels. The patient is informed about the potential need for additional treatment and the importance of continued surveillance, emphasizing the goal of preventing progression to gestational trophoblastic neoplasia. This comprehensive approach underscores the necessity of integrating clinical reasoning with vigilant monitoring to navigate potential complications effectively.

Section 4

Following the repeat dilation and curettage, the medical team closely monitors the patient's recovery, particularly her vital signs and laboratory results. Initially, the patient reports a reduction in abdominal discomfort and a decrease in bleeding, suggesting a positive response to the procedure. Her vital signs remain stable, with a blood pressure of 125/80 mmHg and a heart rate of 85 bpm. However, the team remains vigilant, aware of the potential for new complications to arise.

A follow-up beta-hCG test is conducted two days post-procedure. The results show a modest decrease to 120,000 mIU/mL, which, although in the right direction, still indicates persistently elevated levels. This finding elevates the concern for persistent gestational trophoblastic disease, necessitating careful clinical reasoning to determine the next steps. The team considers the patient's overall clinical picture, including the slight improvement in symptoms and the gradual decline in beta-hCG levels, to decide if methotrexate therapy should be initiated.

Meanwhile, a repeat ultrasound is performed to ensure there are no new developments. The imaging confirms successful removal of the retained tissue, but also reveals a persistent mild fluid accumulation in the pelvic cavity. This raises suspicion for a low-grade infection, prompting the initiation of broad-spectrum antibiotics as a precautionary measure. The medical team discusses the findings with the patient, emphasizing the importance of adherence to follow-up appointments and the need for ongoing surveillance. This comprehensive approach not only addresses immediate complications but also anticipates potential future challenges in the patient's journey towards recovery.

Section 5

Three days post-initiation of broad-spectrum antibiotics, the patient's clinical status begins to shift, necessitating a reassessment of the treatment strategy. Although her vital signs remain largely stable, with a blood pressure of 122/78 mmHg and a heart rate of 88 bpm, the patient reports experiencing new onset of mild fever and increasing pelvic discomfort. A repeat complete blood count reveals a white blood cell count of 12,500/mm³, slightly elevated from previous levels, suggesting a possible infectious process. Moreover, the patient's beta-hCG levels, retested on the same day, show a further decrease to 100,000 mIU/mL, yet the rate of decline is slower than anticipated, reinforcing concerns about persistent gestational trophoblastic disease.

In light of these developments, the medical team opts to intensify their focus on both infection control and monitoring for malignant transformation. They decide to broaden the antibiotic coverage, considering the possibility of antibiotic-resistant organisms, and request a pelvic culture to identify the specific pathogen responsible for the suspected infection. Additionally, the potential need for methotrexate therapy becomes more pressing, prompting a thorough discussion with the patient about the benefits and risks associated with chemotherapy. The team emphasizes the importance of adherence to the treatment regimen and close monitoring of symptoms, as well as the necessity for regular beta-hCG testing to assess the effectiveness of the interventions.

As the patient processes this information, the interdisciplinary team works collaboratively to ensure a comprehensive care plan. They stress the importance of maintaining regular follow-ups and encourage the patient to report any new symptoms promptly. By staying vigilant and responsive to the evolving clinical picture, the team aims to address both immediate and long-term concerns, guiding the patient towards a stable recovery while preparing for potential future challenges in her treatment journey.