Introduction to Maternity and Pediatric Nursing, Fourth Edition

Nursing Care of Women with Complications During Pregnancy

High Risk Pregnancy Causes Relate to the pregnancy itself Occurs because the woman has a medical condition Results from environmental hazards Arise from maternal behavior or lifestyle

Relate to the pregnancy itself

Occurs because the woman has a medical condition

Results from environmental hazards

Arise from maternal behavior or lifestyle

Assessment of Fetal Health Nurses responsibility Preparing patient properly for test Explaining reason for test Clarifying and interpreting results in collaboration with other HCPs Providing support to patient

Nurses responsibility

Preparing patient properly for test

Explaining reason for test

Clarifying and interpreting results in collaboration with other HCPs

Providing support to patient

US Images

4D US Images

AFI

Kick Count Assessment Tool

Doppler Ultrasound Blood Flow Assessment

AFP

Amniocentesis

NST

Percutaneous Blood Sampling

Danger Signs in Pregnancy Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Persistent vomiting Epigastric pain Swelling of face and hands Severe, persistent headache

Sudden gush of fluid from vagina

Vaginal bleeding

Abdominal pain

Persistent vomiting

Epigastric pain

Swelling of face and hands

Severe, persistent headache

Danger Signs in Pregnancy – Cont’d Blurred vision or dizziness Chills with fever > 100.4 degrees Painful urination or reduced urine output

Blurred vision or dizziness

Chills with fever > 100.4 degrees

Painful urination or reduced urine output

Pregnancy-Related Complications Hyperemesis Gravidarum Manifestations Persisitent N/V Significant weight loss Dehydration: dry tongue and mucous membranes, decreased turgor, scant concentrated urine, high hematocrit Electrolyte and acid-base imbalance Unusual stress, emotional immaturity, passivity, ambivalence

Hyperemesis Gravidarum

Manifestations

Persisitent N/V

Significant weight loss

Dehydration: dry tongue and mucous membranes, decreased turgor, scant concentrated urine, high hematocrit

Electrolyte and acid-base imbalance

Unusual stress, emotional immaturity, passivity, ambivalence

Treatment Correct electrolyte imbalances and acid-base imbalances with oral or IV fluids Antiemetic drugs Possibly parenteral nutrition Pregnancy-Related Complications

Treatment

Correct electrolyte imbalances and acid-base imbalances with oral or IV fluids

Antiemetic drugs

Possibly parenteral nutrition

Nursing Care Focus is on teaching Avoid foods that trigger N/V Eat small, frequent meals Teach about intake and output Provide support to the mother Pregnancy-Related Complications

Nursing Care

Focus is on teaching

Avoid foods that trigger N/V

Eat small, frequent meals

Teach about intake and output

Provide support to the mother

Bleeding Disorders of Early Pregnancy Abortion Specific care depends on whether abortion induced or spontaneous Treatment Cervical cerclage Suturing of cervix – to help maintain threatened pregnancy Counseling Administration of oxytocin to help control blood loss Rhogam given if mother Rh negative

Abortion

Specific care depends on whether abortion induced or spontaneous

Treatment

Cervical cerclage

Suturing of cervix – to help maintain threatened pregnancy

Counseling

Administration of oxytocin to help control blood loss

Rhogam given if mother Rh negative

Bleeding Disorders of Early Pregnancy Nursing Care for Abortion Physical care Documents amount of bleeding Pad count Vital signs Instruct pt. To remain NPO if actively bleeding Instructions Report increased bleeding Monitor temp every 8 hours x 3 days Take iron supplement Resume sex as prescribed by HCP Appointment with HCP at assigned date and time

Nursing Care for Abortion

Physical care

Documents amount of bleeding

Pad count

Vital signs

Instruct pt. To remain NPO if actively bleeding

Instructions

Report increased bleeding

Monitor temp every 8 hours x 3 days

Take iron supplement

Resume sex as prescribed by HCP

Appointment with HCP at assigned date and time

Bleeding Disorders of Early Pregnancy Emotional Care for Abortion Acknowledge grief Provide for spiritual support

Emotional Care for Abortion

Acknowledge grief

Provide for spiritual support

Bleeding Disorders of Early Pregnancy Ectopic Pregnancy Occurs when fertilized egg is implanted outside uterine cavity 95% in fallopian tube May result from Hormonal abnormalities Inflammation Infection Adhesions Congenital defects Endometriosis Use of intrauterine contraception – due to inflammation Failed tubal ligation

Ectopic Pregnancy

Occurs when fertilized egg is implanted outside uterine cavity

95% in fallopian tube

May result from

Hormonal abnormalities

Inflammation

Infection

Adhesions

Congenital defects

Endometriosis

Use of intrauterine contraception – due to inflammation

Failed tubal ligation

Bleeding Disorders of Early Pregnancy Zygote cannot survive for long May die and be reabsorbed May rupture tube creating a surgical emergency Manifestations Lower abdominal pain Light vaginal bleeding If rupture occurs Sudden, severe abdominal pain, vaginal bleeding and hypovolemic shock Referred shoulder pain

Zygote cannot survive for long

May die and be reabsorbed

May rupture tube creating a surgical emergency

Manifestations

Lower abdominal pain

Light vaginal bleeding

If rupture occurs

Sudden, severe abdominal pain, vaginal bleeding and hypovolemic shock

Referred shoulder pain

Bleeding Disorders of Early Pregnancy Treatment for Ectopic Pregnancy Test for hCG Transvaginal US Laparoscopic exam Medical treatment No action if being reabsorbed Methotrexate (if tube not ruptured) – inhibits cell division Sugery to remove pregnancy from tube or entire tube if damage is severe

Treatment for Ectopic Pregnancy

Test for hCG

Transvaginal US

Laparoscopic exam

Medical treatment

No action if being reabsorbed

Methotrexate (if tube not ruptured) – inhibits cell division

Sugery to remove pregnancy from tube or entire tube if damage is severe

Bleeding Disorders of Early Pregnancy Nursing Care for Ectopic Pregnancy Vital signs Assessment of lung and bowel sounds IV fluids Blood replacement as necessary Antibiotics Pain management NPO Indwelling catheter Bed rest Emotional support

Nursing Care for Ectopic Pregnancy

Vital signs

Assessment of lung and bowel sounds

IV fluids

Blood replacement as necessary

Antibiotics

Pain management

NPO

Indwelling catheter

Bed rest

Emotional support

Bleeding Disorders of Early Pregnancy Hydatidiform Mole Molar pregnancy Occurs when the chorionic villi abnormally increase and form vesicles May be complete (no fetus) or partial (only part of the placenta has vesicles) May cause Hemorrhage Clotting abnormalities Hypertension Later development of choriocarcinoma

Hydatidiform Mole

Molar pregnancy

Occurs when the chorionic villi abnormally increase and form vesicles

May be complete (no fetus) or partial (only part of the placenta has vesicles)

May cause

Hemorrhage

Clotting abnormalities

Hypertension

Later development of choriocarcinoma

Bleeding Disorders of Early Pregnancy Chromosome abnormalities are common May occur in women at ages of extreme reproductive life Manifestations Bleeding Rapid uterine growth Failure to detect FHR activity Signs of hyperemesis gravidarum Unusually early PIH Snowstorm pattern on US with no evidence of fetus

Chromosome abnormalities are common

May occur in women at ages of extreme reproductive life

Manifestations

Bleeding

Rapid uterine growth

Failure to detect FHR activity

Signs of hyperemesis gravidarum

Unusually early PIH

Snowstorm pattern on US with no evidence of fetus

Bleeding Disorders of Early Pregnancy Treatment for Hydatidaform Mole Vacuum aspiration and D&C Level of hCG is tested until undetectable and levels followed for at least 1 year Women advised to delay conception until follow-up care complete Rhogam given if mother Rh negative

Treatment for Hydatidaform Mole

Vacuum aspiration and D&C

Level of hCG is tested until undetectable and levels followed for at least 1 year

Women advised to delay conception until follow-up care complete

Rhogam given if mother Rh negative

Bleeding Disorders of Early Pregnancy Nursing Care for Hydatididaform Mole Observe for bleeding and shock Emotional support Education on reasons to delay pregnancy Contraception education

Nursing Care for Hydatididaform Mole

Observe for bleeding and shock

Emotional support

Education on reasons to delay pregnancy

Contraception education

Bleeding Disorders of Late Pregnancy Placenta Previa Placenta develops in the lower part of the uterus versus the upper part There are 3 degrees of previa Marginal – reaches within 2-3 cm of cervical opening Partial – placenta partially covers the cervical opening Complete or Total – completely covers the opening

Placenta Previa

Placenta develops in the lower part of the uterus versus the upper part

There are 3 degrees of previa

Marginal – reaches within 2-3 cm of cervical opening

Partial – placenta partially covers the cervical opening

Complete or Total – completely covers the opening

Bleeding Disorders of Late Pregnancy A low-lying placenta is near the cervix Not a true placenta previa May or may not be accompanied by bleeding May be discovered during a routine exam

A low-lying placenta is near the cervix

Not a true placenta previa

May or may not be accompanied by bleeding

May be discovered during a routine exam

Bleeding Disorders of Late Pregnancy Manifestations of Placenta Previa Bright red, painless vaginal bleeding Risk of hemorrhage increases with nearing of labor Fetus often in abnormal presentation Fetus may have anemia Mother may be more at risk postpartum for infection and hemorrhage Vaginal organisms can easily reach placenta site Lower portion of uterus has fewer muscles resulting in weaker contractions

Manifestations of Placenta Previa

Bright red, painless vaginal bleeding

Risk of hemorrhage increases with nearing of labor

Fetus often in abnormal presentation

Fetus may have anemia

Mother may be more at risk postpartum for infection and hemorrhage

Vaginal organisms can easily reach placenta site

Lower portion of uterus has fewer muscles resulting in weaker contractions

Bleeding Disorders of Late Pregnancy Treatment Depends on length of gestation and amount bleeding Goal is to maintain pregnancy as long as safely possible Mother encouraged to lie on side or with pelvic tilt to avoid supine hypotension Delivery by C-section if total or partial May deliver vaginally if low-lying or marginal

Treatment

Depends on length of gestation and amount bleeding

Goal is to maintain pregnancy as long as safely possible

Mother encouraged to lie on side or with pelvic tilt to avoid supine hypotension

Delivery by C-section if total or partial

May deliver vaginally if low-lying or marginal

Bleeding Disorders of Late Pregnancy Nursing Care Observe for vaginal blood loss Observe for S/S of shock Vital signs q 15 minutes if actively bleeding and oxygen administered NO VAGINAL EXAMS Continuos fetal monitoring Prepare for Cesarean if indicated Supportive Care

Nursing Care

Observe for vaginal blood loss

Observe for S/S of shock

Vital signs q 15 minutes if actively bleeding and oxygen administered

NO VAGINAL EXAMS

Continuos fetal monitoring

Prepare for Cesarean if indicated

Supportive Care

Bleeding Disorders of Late Pregnancy Abruptio Placentae Permanent separation of placenta from implantation site Predisposing factors include Hypertension Cocaine or Alcohol Use Smoking Poor Nutrition Abdominal Trauma Prior History of Abruption Placentae Folate deficiency

Abruptio Placentae

Permanent separation of placenta from implantation site

Predisposing factors include

Hypertension

Cocaine or Alcohol Use

Smoking

Poor Nutrition

Abdominal Trauma

Prior History of Abruption Placentae

Folate deficiency

Hypertension During Pregnancy Manifestations of Abruptio Placentae Bleeding with abdominal or low back pain Bleeding may be concealed at first Dark red vaginal bleeding when blood leaks past placenta Uterine tenderness and firm May have cramp-like contractions Fetus may or may not be in distress Fetus/Neonate may have anemia or hypovolemic shock

Manifestations of Abruptio Placentae

Bleeding with abdominal or low back pain

Bleeding may be concealed at first

Dark red vaginal bleeding when blood leaks past placenta

Uterine tenderness and firm

May have cramp-like contractions

Fetus may or may not be in distress

Fetus/Neonate may have anemia or hypovolemic shock

Hypertension During Pregnancy Disseminated Intravascular Coagulation (DIC) May complicate abruptio placentae Large clot behind placenta consumes clotting factors which leaves mother deficient Clot formation and destruction occurs at the same time Mother may bleed from all orifices due to depletion of clotting factors Postpartum hemorrhage may occur Infection likely due to damaged tissue being susceptible to bacteria

Disseminated Intravascular Coagulation (DIC)

May complicate abruptio placentae

Large clot behind placenta consumes clotting factors which leaves mother deficient

Clot formation and destruction occurs at the same time

Mother may bleed from all orifices due to depletion of clotting factors

Postpartum hemorrhage may occur

Infection likely due to damaged tissue being susceptible to bacteria

Hypertension During Pregnancy Treatment 1 st Choice – Immediate Cesarean Blood and clotting factor replacement if necessary After delivery problem quickly resolves Nursing Care Prepare for C-section Close, continuous monitoring of mother and baby Observe for S/S shock Prepare for compromised infant Prepare for grieving if infant dies

Treatment

1 st Choice – Immediate Cesarean

Blood and clotting factor replacement if necessary

After delivery problem quickly resolves

Nursing Care

Prepare for C-section

Close, continuous monitoring of mother and baby

Observe for S/S shock

Prepare for compromised infant

Prepare for grieving if infant dies

Hypertension During Pregnancy Hypertension During Pregnancy High blood pressure in pregnancy (PIH) Preeclampsia PIH + proteinuria Eclampsia PIH + proteinuria + convulsions/seizures Toxemia – old terminology

Hypertension During Pregnancy

High blood pressure in pregnancy (PIH)

Preeclampsia

PIH + proteinuria

Eclampsia

PIH + proteinuria + convulsions/seizures

Toxemia – old terminology

Hypertension During Pregnancy Cause unknown Birth only definitive cure Usually develops after 20 th week, but research has shown that it is determined at implantation Vasospasm is main characteristic May increase risks of further complications

Cause unknown

Birth only definitive cure

Usually develops after 20 th week, but research has shown that it is determined at implantation

Vasospasm is main characteristic

May increase risks of further complications

Hypertension During Pregnancy Risk Factors for PIH 1 st pregnancy Obesity Family history of PIH >40 years or <19 years Multifetal pregnancy Chronic hypertension Chronic renal disease Diabetes mellitus

Risk Factors for PIH

1 st pregnancy

Obesity

Family history of PIH

>40 years or <19 years

Multifetal pregnancy

Chronic hypertension

Chronic renal disease

Diabetes mellitus

Hypertension During Pregnancy If mild to moderate BP readings (systolic <160mm Hg and diastolic <110 mmHg) identified medications typically not used to treat Treated/Monitored with diet modification, daily weights, activity restriction, BP monitoring, fetal kick counts, frequent monitoring for proteinuria

If mild to moderate BP readings (systolic <160mm Hg and diastolic <110 mmHg) identified medications typically not used to treat

Treated/Monitored with diet modification, daily weights, activity restriction, BP monitoring, fetal kick counts, frequent monitoring for proteinuria

Hypertension During Pregnancy Medication is started if BP exceeds moderate range Drugs of Choice Methyldopa (Aldomet) Labetalol Nifedipine (Procardia)

Medication is started if BP exceeds moderate range

Drugs of Choice

Methyldopa (Aldomet)

Labetalol

Nifedipine (Procardia)

Hypertension During Pregnancy Manifestations of PIH Vasospasm impede blood flow to mother and placenta resulting in: Hypertension Typically should not occur in pregnancy due to hormonal changes which decrease resistance to blood flow Edema Occurs when fluid leaves blood vessels and enters tissues Proteinuria Develops as reduced blood flow damages kidneys

Manifestations of PIH

Vasospasm impede blood flow to mother and placenta resulting in:

Hypertension

Typically should not occur in pregnancy due to hormonal changes which decrease resistance to blood flow

Edema

Occurs when fluid leaves blood vessels and enters tissues

Proteinuria

Develops as reduced blood flow damages kidneys

Hypertension During Pregnancy Other Manifestations of Preeclampsia CNS – HA Eyes – Visual disturbances Urinary Tract – Decrease UOP Respi9ratory – Pulmonary Edema GI and Liver – Epigastric pain and N/V, elevated liver enzymes Blood – HELLP – hemolysis, elevated liver enzymes, low platelets

Other Manifestations of Preeclampsia

CNS – HA

Eyes – Visual disturbances

Urinary Tract – Decrease UOP

Respi9ratory – Pulmonary Edema

GI and Liver – Epigastric pain and N/V, elevated liver enzymes

Blood – HELLP – hemolysis, elevated liver enzymes, low platelets

Hypertension During Pregnancy Eclampsia Woman has one or more generalized seizures Facial muscles twitch, then contraction of all muscles Effects on Fetus Decreased oxygen availability which may result in fetal hypoxia Meconium IUGR Fetal Death

Eclampsia

Woman has one or more generalized seizures

Facial muscles twitch, then contraction of all muscles

Effects on Fetus

Decreased oxygen availability which may result in fetal hypoxia

Meconium

IUGR

Fetal Death

Hypertension During Pregnancy Treatment of PIH Prevention Management – as discussed previously Drug Therapy Magnesium Sulfate (anticonvulsant and antihypertensive) Antihypertensive Drug Therapy if BP > 160/100 mg Hg

Treatment of PIH

Prevention

Management – as discussed previously

Drug Therapy

Magnesium Sulfate (anticonvulsant and antihypertensive)

Antihypertensive Drug Therapy if BP

> 160/100 mg Hg

Hypertension During Pregnancy Nursing Care Assist to obtain PNC Help cope with therapy Provide care/Monitor Administer meds Postpartum Care

Nursing Care

Assist to obtain PNC

Help cope with therapy

Provide care/Monitor

Administer meds

Postpartum Care

Blood Incompatibility Rh and ABO Incompatibility Rh blood factor = Rh+ No Rh blood factor in erythrocytes = Rh- Rh+ person can receive Rh- blood if all other factors compatible because factor is not present Rh incompatibility only occurs if the mother is Rh- and fetus is Rh+

Rh and ABO Incompatibility

Rh blood factor = Rh+

No Rh blood factor in erythrocytes = Rh-

Rh+ person can receive Rh- blood if all other factors compatible because factor is not present

Rh incompatibility only occurs if the mother is Rh- and fetus is Rh+

Blood Incompatibility Rh- is autosomal recessive triat – both parents must pass on this gene to the fetus Rh+ is dominate gene Rh+ person can inherit two Rh+ genes or one Rh+ and one Rh- Rh- mother does not have the factor and therefore if her fetus does her body may respond with antibody production as a defense mechanism (isoimmunization) Typically occurs at delivery and would therefore affect subsequent pregnancies

Rh- is autosomal recessive triat – both parents must pass on this gene to the fetus

Rh+ is dominate gene

Rh+ person can inherit two Rh+ genes or one Rh+ and one Rh-

Rh- mother does not have the factor and therefore if her fetus does her body may respond with antibody production as a defense mechanism (isoimmunization)

Typically occurs at delivery and would therefore affect subsequent pregnancies

Blood Incompatibility Manifestations If mother produces anti-Rh anitbodies no outward manifestation Labs reveal increased antibody titers When maternal anti-Rh antibodies cross the placenta fetal erythrocytes are destroyed (erythroblastocis fetalis)

Manifestations

If mother produces anti-Rh anitbodies no outward manifestation

Labs reveal increased antibody titers

When maternal anti-Rh antibodies cross the placenta fetal erythrocytes are destroyed (erythroblastocis fetalis)

Blood Incompatibility Nursing Care Prevent antibody production Rhogam at 28 weeks and w/in 72 hours of delivery if mother Rh- and baby Rh+ May also be given after amniocentesis as a precaution Not effective if sensitization has already occurred If antibody production occurs fetus is monitored carefully Coomb’s test Amniocentesis Percutaneous umbilical sampling test Intrauterine transfusion if severely anemic

Nursing Care

Prevent antibody production

Rhogam at 28 weeks and w/in 72 hours of delivery if mother Rh- and baby Rh+

May also be given after amniocentesis as a precaution

Not effective if sensitization has already occurred

If antibody production occurs fetus is monitored carefully

Coomb’s test

Amniocentesis

Percutaneous umbilical sampling test

Intrauterine transfusion if severely anemic

Pregnancy Complicated by Medical Conditions Diabetes Mellitus Preexisting (Type I or Type II with onset before pregnancy) Gestational (GDM occurs only during pregnancy)

Diabetes Mellitus

Preexisting (Type I or Type II with onset before pregnancy)

Gestational (GDM occurs only during pregnancy)

Pregnancy Complicated by Medical Conditions Pathophysiology of DM Pancreas produces insufficient insulin or cells resist effect of insulin Cells cannot receive glucose Body metabolizes proteina and fat for energy Ketones and acid accumulate Person loses weight Person experiences fatigue and lethargy Fluid moves to tissues to dilute excess glucose leading to increased thirst resulting in tissue dehydration and glycosuria (glucose-bearing urine)

Pathophysiology of DM

Pancreas produces insufficient insulin or cells resist effect of insulin

Cells cannot receive glucose

Body metabolizes proteina and fat for energy

Ketones and acid accumulate

Person loses weight

Person experiences fatigue and lethargy

Fluid moves to tissues to dilute excess glucose leading to increased thirst resulting in tissue dehydration and glycosuria (glucose-bearing urine)

Pregnancy Complicated by Medical Conditions Effect of Pregnancy on Glucose Metabolism Increased resistance of cells to insulin Increased speed of insulin breakdown Gestational Diabetes Mellitus Maternal Links to GDM Maternal Obesity (>198 lbs.) Previous macrosomic infant Maternal age > 25 years Previous unexplained stillbirth or infant with congenital anomalies] Family history of DM Fasting glucose > 135 mg/dl or postmeal > 200 mg/dl

Effect of Pregnancy on Glucose Metabolism

Increased resistance of cells to insulin

Increased speed of insulin breakdown

Gestational Diabetes Mellitus

Maternal Links to GDM

Maternal Obesity (>198 lbs.)

Previous macrosomic infant

Maternal age > 25 years

Previous unexplained stillbirth or infant with congenital anomalies]

Family history of DM

Fasting glucose > 135 mg/dl or postmeal > 200 mg/dl

Pregnancy Complicated by Medical Conditions Treatment of Diabetes During Pregnancy Identification Diet Modification Monitoring Ketone Monitoring PO antidiabetic agents Insulin Exercise Fetal monitoring May indicate early delivery

Treatment of Diabetes During Pregnancy

Identification

Diet Modification

Monitoring

Ketone Monitoring

PO antidiabetic agents

Insulin

Exercise

Fetal monitoring

May indicate early delivery

Pregnancy Complicated by Medical Conditions Nursing Care for Diabetes During Pregnancy Self-care/Management Emotional Support Encourage Breastfeeding

Nursing Care for Diabetes During Pregnancy

Self-care/Management

Emotional Support

Encourage Breastfeeding

Pregnancy Complicated by Medical Conditions Heart Disease Affects small percentage of pregnant women Manifestations Increased clotting causes predisposition to thrombosis If cannot meet demand leads to CHF Priority of care is limiting demands on heart throughout pregnancy, labor, delivery and postpartum period

Heart Disease

Affects small percentage of pregnant women

Manifestations

Increased clotting causes predisposition to thrombosis

If cannot meet demand leads to CHF

Priority of care is limiting demands on heart throughout pregnancy, labor, delivery and postpartum period

Pregnancy Complicated by Medical Conditions Nursing Care for Heart Disease Teach self-management to patient Teach S/S of CHF Diet modification Teach about eliminated stress

Nursing Care for Heart Disease

Teach self-management to patient

Teach S/S of CHF

Diet modification

Teach about eliminated stress

Pregnancy Complicated by Medical Conditions Anemia Hgb levels < 10.5-11.0 g/dl in pregnancy 4 types in pregnancy Iron-deficiency RBCs small and pale Prevention – iron supplements Treatment – elemental iron supplements Folic acid-deficiency Large, immature RBCs Iron-deficiency anemia may also be present Prevention – folic acid supplement Treatment – 1mg/day supplement over the amount of preventative supplement

Anemia

Hgb levels < 10.5-11.0 g/dl in pregnancy

4 types in pregnancy

Iron-deficiency

RBCs small and pale

Prevention – iron supplements

Treatment – elemental iron supplements

Folic acid-deficiency

Large, immature RBCs

Iron-deficiency anemia may also be present

Prevention – folic acid supplement

Treatment – 1mg/day supplement over the amount of preventative supplement

Pregnancy Complicated by Medical Conditions Sickle cell disease Abnormal Hgb that causes erythrocytes to become sickle-shaped during hypoxia or acidosis Autosommal recessive trait Approx 1/12 African Americans has the trait Pregnancy may cause crisis Risk to fetus – occulsion of vessels leading to preterm birth, IUGR, fetal death Thalasemia Genetic trait that causes abnormality in one of two chains of Hgb ,alpha or beta

Sickle cell disease

Abnormal Hgb that causes erythrocytes to become sickle-shaped during hypoxia or acidosis

Autosommal recessive trait

Approx 1/12 African Americans has the trait

Pregnancy may cause crisis

Risk to fetus – occulsion of vessels leading to preterm birth, IUGR, fetal death

Thalasemia

Genetic trait that causes abnormality in one of two chains of Hgb ,alpha or beta

Pregnancy Complicated by Medical Conditions Nursing Care for Anemias During Pregnancy Nutrition education Education about changes in stool pattern and characteristics Taught to avoid dehydration

Nursing Care for Anemias During Pregnancy

Nutrition education

Education about changes in stool pattern and characteristics

Taught to avoid dehydration

Pregnancy Complicated by Medical Conditions Infections TORCH - Devestating infections for fetus T – toxoplasmosis O – other infections R – rubella C – cytomegalovirus H – herpes simplex virus

Infections

TORCH - Devestating infections for fetus

T – toxoplasmosis

O – other infections

R – rubella

C – cytomegalovirus

H – herpes simplex virus

Pregnancy Complicated by Medical Conditions Viral Infections Cytomegalovirus – May be asymptomatic in mother, but serious problem in infant Mental retardation Seizures Blindness Deafness Dental abnormalities Petechiae (blueberry muffin rash) No effective treatment, therapeutic abortion may be offered if early in pregnancy

Viral Infections

Cytomegalovirus – May be asymptomatic in mother, but serious problem in infant

Mental retardation

Seizures

Blindness

Deafness

Dental abnormalities

Petechiae (blueberry muffin rash)

No effective treatment, therapeutic abortion may be offered if early in pregnancy

Pregnancy Complicated by Medical Conditions Rubella – mild virus with low fever and rash, but effects on fetus can be devastating Microcephaly MR Congenital cataracts Deafness Cardiac defects IUGR Treatment – Immunization prior to pregnancy

Rubella – mild virus with low fever and rash, but effects on fetus can be devastating

Microcephaly

MR

Congenital cataracts

Deafness

Cardiac defects

IUGR

Treatment – Immunization prior to pregnancy

Pregnancy Complicated by Medical Conditions Herpes virus – type 1 and type 2 – type 2 affects pregnancy Infection in infant can be localized or widespread, may cause death or neurological complications Treatment and Care – Avoid contact with lesions, if active outbreak Cesarean delivery

Herpes virus – type 1 and type 2 – type 2 affects pregnancy

Infection in infant can be localized or widespread, may cause death or neurological complications

Treatment and Care – Avoid contact with lesions, if active outbreak Cesarean delivery

Pregnancy Complicated by Medical Conditions Hepatitis B – transmitted by blood and body fluids, can also cross placenta Treatment and Care – screen during pregnancy, infants born to women who are Hepatitis B+ should be given Hepatitis B immune globulin (HbIG), followed by Hep B vaccine

Hepatitis B – transmitted by blood and body fluids, can also cross placenta

Treatment and Care – screen during pregnancy, infants born to women who are Hepatitis B+ should be given Hepatitis B immune globulin (HbIG), followed by Hep B vaccine

Pregnancy Complicated by Medical Conditions HIV – causitive organism of AIDS, cripples immune system Acquired one of three ways Sexual contact with infected person Parenteral or mucous membrane exposure to infected body fluids Perinatal exposure (20% - 40% chance of infecting infant) Transplacentally Contact with infected maternal secretions at birth Breastmilk

HIV – causitive organism of AIDS, cripples immune system

Acquired one of three ways

Sexual contact with infected person

Parenteral or mucous membrane exposure to infected body fluids

Perinatal exposure (20% - 40% chance of infecting infant)

Transplacentally

Contact with infected maternal secretions at birth

Breastmilk

Pregnancy Complicated by Medical Conditions Nonviral Infections Toxoplasmosis – caused by Toxoplasma gondii, a parasite that may be in cat feces in raw meat and transmitted through the placenta Possible S/S in newborn Low birth weight Enlagred liver and spleen Jaundice Anemia Inflammation of eye structures Neurological damage

Nonviral Infections

Toxoplasmosis – caused by Toxoplasma gondii, a parasite that may be in cat feces in raw meat and transmitted through the placenta

Possible S/S in newborn

Low birth weight

Enlagred liver and spleen

Jaundice

Anemia

Inflammation of eye structures

Neurological damage

Pregnancy Complicated by Medical Conditions Treatment and Nursing Care Cook all meats thoroughly Wash hands after handling raw meat Avoid litter boxes , soil and sand boxes Wash fresh fruits and veggies well Group B streptococcus – leading cause of perinatal infections. Organism found in woman’s rectum, vagina, cervix, throat or skin. Woman usually asymptomatic, but can be transmitted to baby at delivery. Diagnosis + culture of woman’s vagina or rectum at 35-37 weeks gestation Treatment Antibiotics to mother prior to delivery Antibiotic therapy to infant after delivery

Treatment and Nursing Care

Cook all meats thoroughly

Wash hands after handling raw meat

Avoid litter boxes , soil and sand boxes

Wash fresh fruits and veggies well

Group B streptococcus – leading cause of perinatal infections. Organism found in woman’s rectum, vagina, cervix, throat or skin. Woman usually asymptomatic, but can be transmitted to baby at delivery.

Diagnosis

+ culture of woman’s vagina or rectum at 35-37 weeks gestation

Treatment

Antibiotics to mother prior to delivery

Antibiotic therapy to infant after delivery

Pregnancy Complicated by Medical Conditions TB S/S fatigue weakness loss of appetite and weight Fever Night sweats Treatment and Nursing Care Isoniazid and Rifampin to mother for 9 months Infant may have preventative therapy for 3 months

TB

S/S

fatigue

weakness

loss of appetite and weight

Fever

Night sweats

Treatment and Nursing Care

Isoniazid and Rifampin to mother for 9 months

Infant may have preventative therapy for 3 months

Pregnancy Complicated by Medical Conditions Sexually Transmitted Diseases Prevention is by safe sex with protection of condom Herpes HIV Syphilis Gonorrhea Chamydia Trichomoniasis Genital Warts

Sexually Transmitted Diseases

Prevention is by safe sex with protection of condom

Herpes

HIV

Syphilis

Gonorrhea

Chamydia

Trichomoniasis

Genital Warts

Pregnancy Complicated by Medical Conditions Urinary Tract Infections More common in pregnancy due to pressure on urinary structures keeps bladder from emptying completely and because ureters dilate and lose motility under influence of relaxing effects of progesterone and relaxin Cystitis – infection of bladder S/S Burning with urination Increased frequency and urgency May have slightly elevated temp

Urinary Tract Infections

More common in pregnancy due to pressure on urinary structures keeps bladder from emptying completely and because ureters dilate and lose motility under influence of relaxing effects of progesterone and relaxin

Cystitis – infection of bladder

S/S

Burning with urination

Increased frequency and urgency

May have slightly elevated temp

Pregnancy Complicated by Medical Conditions Pyelonephritis – infection of kidney(s) S/S High fever Chills Flank pian N/V Treatment for UTIs Antibiotic therapy Nursing Care Teach to wipe front to back Intake adequate fluid Urinate before and after intercourse Teach S/S

Pyelonephritis – infection of kidney(s)

S/S

High fever

Chills

Flank pian

N/V

Treatment for UTIs

Antibiotic therapy

Nursing Care

Teach to wipe front to back

Intake adequate fluid

Urinate before and after intercourse

Teach S/S

Pregnancy Complicated by Medical Conditions Substance Abuse – the use of illicit or recreational drugs during pregnancy . Treatment and Nursing Care Identify substance abused Educate on potential effects of drug Use nonjudgmental approach

Substance Abuse – the use of illicit or recreational drugs during pregnancy .

Treatment and Nursing Care

Identify substance abused

Educate on potential effects of drug

Use nonjudgmental approach

Pregnancy Complicated by Medical Conditions Trauma During Pregnancy Manifestations of Battering May enter late to prenatal care May make up excuses Treatment and Nursing Care Provide for privacy Be nonjudgmental Offer resources Assessment of maternal and fetal well-being

Trauma During Pregnancy

Manifestations of Battering

May enter late to prenatal care

May make up excuses

Treatment and Nursing Care

Provide for privacy

Be nonjudgmental

Offer resources

Assessment of maternal and fetal well-being

Effects of a High-Risk Pregnancy on the Family Disruption of Roles Financial Difficulties Delayed Attachment Loss of Expected Birth Experience

Disruption of Roles

Financial Difficulties

Delayed Attachment

Loss of Expected Birth Experience

References Introduction to Maternity & Pediatric Nursing; Fourth Edition, 2003; Gloria Leifer, Ma, RN; Associate Professor Obstetrics, Pediatrics, and Trauma Nursing; Riverside Community College; Riverside, California; Saunders

Introduction to Maternity & Pediatric Nursing; Fourth Edition, 2003; Gloria Leifer, Ma, RN; Associate Professor Obstetrics, Pediatrics, and Trauma Nursing; Riverside Community College; Riverside, California; Saunders

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