Chapter 5 Nursing care of women with complication during pregnancy – Flashcards
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the causes of high risk pregnancies usually include the following characteristics
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Characteristic Causes of High-Risk Pregnancies - Can relate to the pregnancy itself. -Can occur because the woman has a medical condition or injury that complicates the pregnancy. -Can result from environmental hazards that affect the mother or her fetus. -Can arise from maternal behaviors or lifestyles that have a negative effect on the mother or fetus.
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Assessment of fetal health
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Assessment of Fetal Health - Amniocentesis (An ultrasound transducer on the abdomen ensures needle placement away from the body of the fetus and the placenta. A needle is inserted into the Amniotic cavity, and a sample if amniotic fluid is collected for laboratory examination and fetal assessment) • Nursing Responsibilities - Preparing the patient properly - Explaining the reason for the test - Clarifying and interpreting results in collaboration with other health care providers
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What are the danger signs of pharmacy?
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• Danger Signs in Pregnancy - Sudden gush of fluid from the vagina - Vaginal bleeding - Abdominal pain - Persistent vomiting - Epigastric pain - Edema of face and hands - Severe, persistent headache - Blurred vision or dizziness - Chills with fever over 38.0° C (100.4° F) - Painful urination or reduced urine output
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Hyperemesis Gravidarum
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Manifestations: - Excessive nausea and vomiting that can significantly interfere with her food intake and fluid balance. • Can impact fetal growth (Resulting in a low birth-weight infant) • Dehydration (impairs perfusion of the placenta, reducing the delivery of blood oxygen and nutrients to the fetus.) • Reduced delivery of blood, oxygen, and nutrients to the fetus
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Hyperemesis Gravidarum: Treatment
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- Treatment • Correct dehydration and electrolyte or acid-base imbalance w/ oral or intravenous fluids • Antiemetic drugs may be prescribed • Dopamine antagonists such as promethazine or selective serotonin antagonists to treat nausea and vomiting. • In extreme cases • TPN may be required Hospitalization
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• Bleeding Disorders of Early Pregnancy - Types of Abortions
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• Bleeding Disorders of Early Pregnancy - Types of Abortions - Spontaneous or Intentional termination of a pregnancy before the age of viability ( 20 weeks of gestation) • Spontaneous Abortion (non intentional) Threatened • Inevitable • Incomplete • Complete • Missed • Recurrent
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Threatened Abortion
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Description: Cramping and backache with light spotting; cervix is closed; no tissue is passed.
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Treatment/ Interventions of Threatened Abortion
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Ultrasound is used to determine if fetus is living; bed rest is prescribed; avoid coitus;
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Inevitable abortion
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Increased bleeding, cramping, cervix dilates.
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treatment/ intervention of Inevitable abortion
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Patient is placed on bed rest and monitored, awaits natural evacuation of uterus, save peripads.
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Incomplete abortion
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Bleeding, cramping, dilation of cervix, Passage of tissue,
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treatment/ intervention of Incomplete abortion
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Uterus may be emptied of remaining tissue by dilation and evacuation (D and E) or vacuum extraction. Save peripads
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Complete abortion
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Passage of all products of conception; Cervix closes, Bleeding stops,
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treatment Interventions of Complete abortion
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Patient is monitored, emotional support given, Give Rhogam if indicated,
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Missed abortion
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Fetus dies in utero but is not expelled, uterine growth stops; sepsis can occur;
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Treatment/intervention of Missed abortion
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If fetus is not expelled, uterus is evacuated by( D and E) Dilation and Evacuation
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Recurrent Abortion
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Two or more consecutive spontaneous abortions (Habitual abortion), usually caused by incompetent cervix or progesterone levels inadequate to maintain pregnancy
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Treatment/ intervention of Recurrent Abortion
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incompetent cervix is treated cerclage, a reinforcement of the cervix with a surgical suture, the patient is then monitored for early signs of labor at term to prevent uterine rupture.
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Induced Labor
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Induced Labor: -therapeutic Abortion - Elective abortion
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Therapeutic Abortion
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Intentional termination of pregnancy to preserve the health of the mother
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Treatment/intervention of Therapeutic Abortion
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induced abortion is currently legal in the united states when performed by a qualified healthcare provider. Supportive counseling must be part of the plan of care.
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Elective abortion
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intentional termination of pregnancy for reasons other than the health of the mother ( Such as fetal anomaly)
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Treatment/intervention of therapeutic abortion
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Septic abortion (Hemorrhage and infection) is a risk to the mother; counseling is advised even if the mother elects to abort.
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Nursing Care of Early Pregnancy Bleeding Disorders
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Nursing Care of Early Pregnancy Bleeding Disorders - Document amount and character of bleeding. - Save anything that looks like clots or tissue for evaluation by a pathologist. - Perineal pad count with estimated amount of blood per pad (i.e., 50%). - Monitor vital signs. - If actively bleeding, woman should be kept NPO in case surgical intervention is needed.
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Post-Abortion Teaching
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• Post-Abortion Teaching - Report increased bleeding. - Take temperature every 8 hours for 3 days. - Take an oral iron supplement if prescribed. - Resume sexual activity as recommended by the health care provider. - Return to health care provider at the recommended time for a checkup and contraception information. - Pregnancy can occur before the first menstrual period returns after the abortion procedure.
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• Emotional Care
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• Emotional Care - Spiritual support of the family's choice and community support groups may help the family work through the grief of any pregnancy loss.
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• Ectopic Pregnancy******
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• Ectopic Pregnancy - 95% occur in fallopian tube - Scarring or tubal deformity may result from • Hormonal abnormalities • Inflammation • Infection • Adhesions • Congenital defects • Endometriosis
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Ectopic Pregnancy /- Manifestations
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- Manifestations • Lower abdominal pain and may have light vaginal bleeding • If tube ruptures • May have sudden severe lower abdominal pain ( bleeding might be minimal, because most blood is lost into the abdomen rather than externally through the vagina) • Vaginal bleeding • Signs of hypovolemic shock • Shoulder pain may also be felt
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Ectopic Pregnancy/ Treatment
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- Treatment • Pregnancy test (A sensitive pregnancy test for hCG ) • Transvaginal ultrasound (determines whether the embryo is growing within the uterine cavity.) • Laparoscopic examination ( View the damage tube with an endoscope) • Priority is to control bleeding • Three actions can be taken • No action (If the women's body is reabsorbing the pregnancy) • Treatment with methotrexate to inhibit cell division • Surgery to remove pregnancy from the tube
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Nursing care for Ectopic Pregnancy Observe for hypovolemic shock
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• Nursing Tip - Supporting and encouraging the grieving process in families who suffer a pregnancy loss, such as a spontaneous abortion or ectopic pregnancy, allows them to resolve their grief • Signs and Symptoms of Hypovolemic Shock - Fetal heart rate changes (increased, decreased, less fluctuation) - Rising, weak pulse (tachycardia) - Rising respiratory rate (tachypnea) - Shallow, irregular respirations; air hunger - Falling blood pressure (hypotension) - Decreased or absent urinary output (usually less than 30 mL/hr) - Pale skin or mucous membranes - Cold, clammy skin - Faintness - Thirst
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Hydatidiform Mole*******
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• Hydatidiform Mole - Also known as gestational trophoblastic disease or molar pregnancy • Occurs when chorionic villi abnormally increase and develop vesicles • May cause hemorrhage, clotting abnormalities, hypertension, and later development of cancer • More likely to occur in women at age extremes of the reproductive life
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Hydatidiform Mole/ Manfestations (Signs)
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- Manifestations • Bleeding • Rapid uterine growth • Failure to detect fetal heart activity • Signs of hyperemesis gravidarum • Unusually early development of GH • Higher-than-expected levels of hCG • A distinct "snowstorm" pattern on ultrasound with no evidence of a developing fetus
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treatment For Hydatidiform Mole
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Treatment • Uterine evacuation, • Dilation and evacuation(And by vacuum aspiration), • The level of hCG is tested and retested until it is undetectable (Levels are followed for at least a year), • Persistent or rising levels suggest that the vesicles remain or that malignant change has occurred. • New pregnancy should be delayed because it would confuse test for hCG
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• Bleeding Disorders of Late Pregnancy - Placenta previa
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•Bleeding Disorders of Late Pregnancy - Placenta previa - Occurs when the placenta develops in the lower part of the uterus instead of the upper •Abnormal implantation of placenta • Bright red bleeding occurs when cervix dilates, resulting in painless bleeding -Three degrees (Of Placenta previa) •Marginal ( Placenta reaches within 2-3 cm of cervical opening) Partial ( Placenta partly covers the cervical opening) Total ( Placenta completely covers the cervical opening)
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• Complications or Risks
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• Complications or Risks - Placenta previa • Infection because of vaginal organisms • Postpartum hemorrhage, because if lower segment of uterus was site of attachment, there are fewer muscle fibers, so weaker contractions may occur
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- Abruptio placentae Predisposing factors
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- Abruptio placentae •Predisposing factors •Hypertension •Cocaine or alcohol use •Cigarette smoking and poor nutrition •Blows to the abdomen •Prior history of abruptio placentae •Folate deficiency • Nursing Tip - Pain is an important symptom that distinguishes abruptio placentae from placenta previa
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Care of the Pregnant Woman with Excessive Bleeding
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• Care of the Pregnant Woman with Excessive Bleeding - Document blood loss - Closely monitor vital signs, including I&O - Observe for • Pain • Uterine rigidity or tenderness - Verify that orders for blood typing and cross-match have been carried out - Monitor intravenous infusion - Prepare for surgery, if indicated - Monitor fetal heart rate and contractions - Monitor laboratory results, including coagulation studies - Administer oxygen by mask Prepare for newborn resuscitation
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• Hypertension During Pregnancy
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•Hypertension During Pregnancy - Gestational hypertension (GH) •Preeclampsia ( GH includes proteinuria) •Eclampsia ( Preeclampsia progresses to Eclampsia when convulsions occur) •Cause of GH unknown , birth is cure •Develops after 20 weeks gestation •Vasospasm ( Spasm of arteries) is main characteristic - Chronic hypertension - Preeclampsia with superimposed chronic hypertension - Present 20 weeks before pregnancy - New occurrence of proteinuria or thrombocytopenia - An increase over baseline blood pressure of 30 mm Hg or more systolic - 15 mm Hg diastolic will place the woman in a high-risk category for GH
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Risk Factors for GH
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• Risk Factors for GH - First pregnancy - Obesity - Family history of GH - Age over 40 years or under 19 years - Multifetal pregnancy - Chronic hypertension - Chronic renal disease - Diabetes mellitus
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Manifestations of and Systems Affected by GH
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• Manifestations of and Systems Affected by GH - Hypertension - Edema - Proteinuria - Blood clotting - Central nervous system - Eyes - Urinary tract - Respiratory system - Gastrointestinal system and liver
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Management of GH
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• Management of GH - Depends on severity of the hypertension and on the maturity of the fetus - Treatment focuses on • Maintaining blood flow to the woman's vital organs and to the placenta • Preventing convulsions
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Conservative Treatment
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• Conservative Treatment - Activity restriction - Maternal assessment of fetal activity - Blood pressure monitoring - Daily weight - Checking urine for protein • Drug therapy - Magnesium sulfate • Calcium gluconate reverses effects of magnesium sulfate - Antihypertensives
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Nursing Care Focus
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• Nursing Care Focus - Assisting the woman to obtain prenatal care - Helping her cope with therapy - Caring for acutely ill woman • Know what signs/symptoms to monitor for and when to intervene - Administering medications as prescribed • Bleeding Incompatibilities - Rh-negative blood type is an autosomal recessive trait - Rh-positive blood type is a dominant trait - Rh incompatibility can only occur if the woman is Rh-negative and the fetus is Rh-positive
