Nursing Care of Women with Complications During Pregnancy – Flashcards
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Pregnancy related complications
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hypoeremesis gravidarum, bleeding disorders, hypertension, blood incompatibility with infant
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dilation and curettage
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D & C
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NST, AFP, Chorionic Villi Test, CBC, OCT, Amniocentesis
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Prenatal Testing
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When is a diabetes test done?
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24 - 26 weeks
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When is a Rhogam test done?
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28 weeks
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When is a Group B Strep test done?
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36 weeks
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Sudden gush of fluid from vagina, vaginal bleeding, abdominal pain, persistent vomiting, epigastric pain, edema of face & hands, severe headache, blurred vision / dizziness, Chills with fever over 100.4, painful urination / decreased urine output
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Danger signs in pregnancy
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Excessive Nausea/Vomiting; can impact fetal growth, dehydration, reduced delivery of blood, oxygen, & nutrients to fetus
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Hyperemesis Gravidarum
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Correction of dehydration / electrolytes, antiemetics, If extreme: TPN / hospitilization
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Treatment of Hyperemesis Gravidarum
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TPN
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Total parenteral nutrition, fluids given intravenously to provide nutrients the body needs when eating is not an option.
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Threatened, Inevitable, Incomplete, Complete, Missed, Recurrent
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Types of miscarriages
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Therapeutic, elective
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Types of induced miscarriages
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"Bag of waters" broke, cervix fully dilated. Nurse to assist in labor/delivery and loss afterwards.
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Inevitable Miscarriage
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Still have some products of pregnancy and must have D&C to help evacuate.
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Incomplete miscarriage
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Vaginal bleeding with closed cervix. Doctor may have to go in and fix bleeding.
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Threatened miscarriage
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Nursing care for early pregnancy bleeding
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document amount & character of blood, save any clots for doctor, perineal pad count with estimated coverage or wieght of pad, Monitor V.S, N.P.O if actively bleeding in case of surgery
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Report Increased bleeding, take temp Q8hrs for 3 days, take oral iron supplement if needed, resume sexual activity as recommended by HCP, return to HCP at the recommended time for checkup/contraception info, Pregnancy can occur without return of period
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Post miscarriage Teaching.
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Spiritual support of the family's choice and community support groups.
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Emotional care after loss
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95% of ectopic pregnancies happen in the
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Fallopian tube
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Scarring or tubal deformity may result from
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Hormonal abnormalities, STI's, inflammation, adhesion's, congenital defects, endometriosis, infections.
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Lower abdominal pain & light vaginal bleeding - (Rupture) - sudden severe pain, vaginal bleeding, hypovolemic shock, shoulder pain
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Manifestation of Ectopic Pregnancy
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Pregnancy test, transvaginal ultrasound, laparoscopic exam, control bleeding is priority.
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Treatment of ectopic pregnancy
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no action, treatment with methotrexate to stop cell division, surgery
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Actions for ectopic pregnancy
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fetal HR change, rising weak pulse, rising resp rate, shallow irregular resp, falling BP, decreased or absent urinary output, pale skin, cold & clammy, faint, thirst
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Signs of hypovolemic shock
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HCG levels are low
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during a miscarriage
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HCG levels are high
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during normal pregnancy
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Methotrexate
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inhibits cell division
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Occurs when chorionic villi abnormally increase & develop vesicles (may cause hemorrhage, clotting issues, hypertension, and eventually cancer), more likely in those of age extremes in reproductive life
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Hydatidiform Mole
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Gestational trophoblastic disease
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another term for Hydatidiform mole
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women age 35 and higher
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higher risk for Hydatidiform mole
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Bleeding, rapid uterine growth, no fetal heart activity, hyperemesis gradvidarum, very early gestational hypertention, higher than expected HCG, snowstorm pattern on ultrasound
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Symptoms of hydatidiform mole
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Uterine evacuation, D & C
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Treatment for hydatidiform mole
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Placenta Previa
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abnormal implantation of the placenta
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Bright red painless bleeding when cervix dilates.
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S/S of Placenta Previa
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Marginal, Partial, and Total
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three degrees of cervix blockage with Placenta Previa
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Risks with placenta previa
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infection, postpartum hemorrhage, fetal anemia
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Abruptio Placentae
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Normal implantation with abnormal hemorrhaging of placenta. It is very painful.
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S/S of Abruptio Placentae
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bleeding, abdominal pain, low back pain, cramps, blood only leaks when past edge of placenta
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Predisposing factors for abruptio placentae
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hypertension, cocaine / alcohol use, cigarettes, poor nutrition, injury to abdomen, history, folate deficiency
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Document blood loss, V.S., I & O, Observe for pain & uterine rigidity / tenderness, verify blood typing orders, prepare for surgery if needed, monitor fetal HR, monitor contractions, monitor lab results, O2, prep for fetal resuscitation.
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Care of the pregnant women with excessive bleeding
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Preeclampsia, Eclampsia
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Gestational Hypertension
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Increase in systolic BP- 30 mm-Hg Increase in diastolic BP- 15 mm-Hg
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High-Risk signs Gestational Hypertension
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First pregnancy, obesity, family history, over 40 or under 19, multifetal pregnancy, chronic hypertension, chronic renal disease, DM
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Risk factors for gestational hypertension
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Hypertension, edema in face/hands/lower extremeties, proteinuria, blood clotting, CNS- headaches, blurred or double vision, urinary tract, Resp system, gastro / liver
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manifestations and systems affected by GH
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Maintaining blood flow to women's vital organs & placenta, preventing convulsions, watch for HELLP syndrome
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management of GH
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HELLP syndrome
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Hemolysis, Elevated Liver enzymes, Low Platelets
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Conservative treatment of GH
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activity restriction, maternal assessment of fetal activity, monitor BP, daily weight, check for urine protein, magnesium sulfate, (calcium gluconate reserves!), antihypertensives
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Assisting the woman to obtain prenatal care, helping her cope with therapy, caring for acutely ill woman- Knowing what S/S to look for and when to intervene, administering, meds as prescribed.
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Nursing care focus
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Rh - negative
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autosomal recessive trait
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Rh - positive
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dominant trait
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Rh incompatibility can only occur in women that are
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Rh - negative with an rh - positive fetus
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leaking of fetal Rh-positive blood into mothers rh-negative blood
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Isoimmunization
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Erythroblastosis Fetalis
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maternal anti-Rh antibodies cross into placenta and destroy fetal erythrocytes
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When is RhoGAM given?
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28 weeks & 72 hours after delivery; also after an amniocentesis
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Fetal assessment test done throughout pregnancy, intrauterine blood transfusion done for severely anemic fetus
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If anti-RH antibodies are present.
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Coombs test
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Anti-RH antibody test for babies blood
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Indirect Coombs test
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Anti-RH antibody test for mother
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Factors linked to gestational DM
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maternal obesity, large infant (over 9lbs), maternal age over 25, previous unexplained stillbirth, HX of infant having congenital defects, HX of GDM, family history of DM, fasting glucose over 126, post-meal glucose over 200
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Hormones- estrogen and progesterone, insuinase- an enzyme,. and increased prolactin levels have two effects on glucose metabolism
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increased resistance of cells to insulin, increased speed of insulin breakdown.
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Hypoglycemia if unable to increase insulin production, fetal hypoglycemia between meal, risk for organ damage during 2nd and 3rd trimester R/T hyperglycemia because fetal tissue has resistance to maternal insulin action.
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Gestational DM Risks
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Macrosomic Infant
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Baby born weighing more than 8lbs 13oz
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Treatment of GDM
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diet, blood glucose monitoring, ketone monitoring, exercise, fetal assessment
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Intravenous infusion of dextrose if needed, regular insulin, assess blood glucose
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Labor of woman with GDM
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Blood glucose monitoring for 24hrs after birth, breastfeeding is encouraged
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Care for baby whose mother had GDM
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Manifestations of heart disease
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increased levels of clotting factor, increased thrombosis
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Heart cannot handle increased workload, CHF results; Fetus suffers reduced placental blood flow
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Thrombosis risk in pregnant women
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CHF
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persistent cough, moist lung sounds, fatigue, difficulty breathing on exertion, orthopnea, pitting edema, palpitations, changes in fetal HR
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treatment for CHF
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under care of OB & cardiologist, limit physical activity, drugs (beta-adrenergic blockers, anticoagulants, diuretics), vaginal birth preferred
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reduced ability of the blood to carry oxygen to the cells
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Anemia
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Two types of nutritional anemia
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iron deficiency & folic acid deficiency
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two types of genetic disorders ( anemia)
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Sickle Cell, Thalassemia
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Nutritional Anemia
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easily fatigued, pale skin, shortness of breath, pounding heart, rapid pulse
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RBCs are small, microcytic, and pale, hypochromic
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Iron-deficiency Anemia
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Iron supplements, vitamin C may enhance absorption
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Prevention of Iron deficiency Anemia
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Milk, antacids, calcium
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Things that impair iron absorbtion
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Oral doses of elemental iron, continue therapy for about 3 months after anemia has been corrected
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Treatment of Iron deficiency Anemia
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Large, immature RBCs (Megaloblastic anemia)
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folic acid deficiency Anemia
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Preventative supplement daily for folic acid
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400 mcg or 0.4 mg
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anticonvulsants, oral contraceptives, sulfa drugs, and alcohol
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Things that decrease folic acid absorption during meals.
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Folic acid supplement of 1mg/day- twice the amount for preventative. Dose higher for women who had a previous child with neural tube defect.
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Treatment of folic acid deficiency
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Autosomal recessive, abnormal hemoglobin, distorted erythrocytes- crescent shaped, clogged blood vessels,
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Sickle Cell Anemia
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preterm birth, fetal growth restriction, death
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Sickle Cell Anemia effects on pregnancy
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O2 & fluids given continuously
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Treatment of Sickle Cell Anemia during labor
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Genetic abnormality in 1 of 2 chains of hemoglobin, fetus not affected, iron supplements can cause overload- stores higher than usual iron
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Thalassemia
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beta chain
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Most common Thalassemia seen in USA
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Thalassemia from 1 parent, woman have few problems other than mild anemia
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Minor
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Thalassemia from 2 parent
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Major
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Infections devastating to fetus: TORCH
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Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes
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mental retardation, seizures, blindness, deafness, dental problems, petechia - no treatment / therapeutic abortion
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Cytomegalovirus
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microcephaly, mental retardation, congenital cataracts, deafness, cardiac arrest, IGR - no pregnancy 1 month after shot
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Rubella
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two types: one that causes cold sores, one causes genital sores. After initial infection it lies dormant in nerves, can activate at anytime
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Herpes
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Spontaneous miscarriage, IUGR, preterm laber, infant can be infected within 1-2 days
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Infection of Herpes during first half of pregnancy
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Localized, disseminated-aka widespread, atributed to high mortality rate
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Neonatal Herpes
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Avoid contact with lesions, no need for isolation as long as lesions avioded, Breastfeeding OK if no lesions on breast
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Treatment and nursing care of herpes
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Parasite acquired by contact with cat feces or raw meat, transmitted through placenta
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Toxoplasmosis
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Low birth weight, enlarged liver / spleen, jaundice, anemia, inflammation of eye structures, neurological damage,
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S/S of Toxoplasmosis
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Treatment for toxoplasmosis
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therapeutic abortion
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Prevention of toxoplasmosis
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cook all meat, wash hands, avoid undercooked eggs & unpasteurized milk, wash all fruits & veggies, avoid cat feces contamination
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spreads through infected mosquito's, infected people can spread to mosquito's and sexual contact, causes birth defects.
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Zika virus
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leading cause of perinatal infection with high mortality rate. Organism found in womans rectum, vagina, cervix, & throat / skin, deadly to infants- higher risk to infants if labor is long or premature membrane rupture.
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Group B Strep
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Symptoms of Group B Strep
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elevated temp within 12 hours of delivery, rapid HR, abdominal distention - possible death
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Treatment for Group B Strep
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Penicillin
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Increasing cases in U.S., multidrug-resistant strains increasing, mother tested through PPD skin test
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Tuberculosis (TB)
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Chest xray to confirm, infanct kept away from mother until cleared by PHD, reported to local PHD
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Positive TB test.
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Altered self-cleaning action d/t pressure on urinary structures, prevents bladder from emptying completely
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Causes of UTIs during pregnancy
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retained urine may become alkaline, can produced Cystitis
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Risks of UTI during pregnancy
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Cystitis s/s
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burning, increased frequency & urgency, normal or slightly elevated temp
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Pyelonephritis
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high fever, chills, flank pain / tenderness, nausea, vomiting
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A- can be easily transmitted from person to person b- can be spread via food and water c- can be spread via manufactured weapons designed to spread disease
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Three categories of bioterrorism
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Can lead to loss of fetal brain cells
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consuming alcohol during pregnancy
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Three leading cuases of traumatic death
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automobile accidents, homicide, suicide
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Signs of battering
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bruises in various stages of healing
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If a woman confides that she is being abused
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keep is quiet- her abuser could lash out if he learns she has told, refer her to a local shelter- leave the decision up to her to leave abuser.
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Disruption of usual roles, financial difficulties, delayed attachment to infant, loss of expected birth experience.
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Effects of high-risk pregnancy on families
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allow parents to remain together in privacy, accept behaviors related to grieving, develop a plan of care to provide support to the family, offer a memento such as a footprint, offer opportunity to hold infant, prepare parents for appearance of infant, provide parents with educational materials and referrals to support groups, discuss wishes concerning religious and cultural rituals.
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interventions to help the grieving process
