Care of Women with Complications During Pregnancy Flashcards
Nursing Responsibilities
Preparing the patient properly
Explaining the reason for the test
Clarifying and interpreting results in collaboration with other health care providers
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 38.0º C (100.4º F) Painful urination or decreased urine output
Pregnancy Related Complications
Hyperemesis gravidarum Bleeding disorders Hypertension Blood incompatibility between mother and fetus Medical disorders - DM Infections - TORCH
Hyperemesis Gravidarum: Treatment
Correct dehydration and electrolyte or acid-base imbalance (may be hypokalemic) Antiemetic drugs may be prescribed In extreme cases: - TPN may be required - Hospitalization
Nursing Care of Early Pregnancy Bleeding Disorders
Document amount and character of bleeding
Save anything that looks like clots or tissue for evaluation by pathologist
Perineal pad count with estimated amount of blood per pad (50%)
Monitor VS
If actively bleeding, woman should be kept NPO in case surgical intervention is needed
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 HCP
Return to the HCP at the recommended time for a check up and contraception information
Pregnancy can occur before the first menstrual period returns after the abortion procedure
Emotional Care
Spiritual support from someone of the family’s choice and community support groups may help the family work through the grief of any pregnancy loss
Ectopic Pregnancy: Treatment
Pregnancy test Transvaginal ultrasound Laparoscopic examination Priority is to control bleeding Monitor for signs of hypovolemic shock Keep NPO is surgery is suspected Three actions can be taken: - No action - Treatment with methotrexate to inhibit cell division - Surgery to remove the pregnancy from the tube
Signs and Symptoms of Hypovolemic Shock
Changes in fetal HR (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 (30 ml/hr)
Pale skin or pale mucous membranes
Cold, clammy skin
Faintness
Thirst
Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)
Document blood loss Closely monitor VS, I&O Observe for: - Pain - Uterine rigidity or tenderness Verify that orders for blood typing and cross-match have been carried out Monitor IV infusion Treatment .. Maintain until 34 weeks if possible
Treatment (Excessive Bleeding)
Lie on side with pillow under hip to decrease supine hypotension
Try to decrease stress as much as possible
Delivery is ordered to decrease mortality
- C-section (partial or total placenta prevue and abruptio placenta if there is risk of maternal shock, clotting disorders, or fetal death)
May have to administer blood or clotting factors
Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)
Prepare for surgery, if indicated (NPO) Monitor fetal heart rate and contractions Monitor lab results, including coagulation studies Administer oxygen by mask VS NO VAG EXAM Prepare for newborn resuscitation Support for grieving family
Management of GH
Depends on the severity of hypertension and on the maturity of the fetus
Treatment focuses on:
- Maintaining blood flow to the woman’s vital organs and placenta
- Preventing convulsions (eclampsia)
BIRTH IS CURE FOR GH
Conservative Treatment
Activity restriction
Maternal assessment of fetal activity
BP monitoring
Daily weight (diet)
Checking urine for protein
Drug therapy
- Magnesium sulfate (anticonvulsant therapeutic level is 4-8 mg/dl); inhibits contractions; must have good output; drowsy, maintains DTRs and respirations
- Calcium gluconate (reverses the effects of magnesium sulfate and should be available)
- Antihypertensives (levels higher than 160/100 mm/Hg
Nursing Care Focus
Assisting the woman in obtaining 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
Isoimmunization
The leaking of fetal Rh-positive blood into the mother’s Rh-negative circulation, causing her body to respond by making antibodies to destroy the Rh-positive erythrocytes
With subsequent pregnancy, the woman’s antibodies against Rh-positive blood cross the placenta and destroy the fetal Rh-positive erythrocytes before the infant is born
Erythroblastosis Fetalis
Occurs when the maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes
Requires RhoGAM to be given at 28 weeks and within 72 hours of delivery to the mother
- Also given after amniocentesis, and if woman experiences bleeding during pregnancy
Fetal assessment tests must be done throughout pregnancy
An intrauterine transfusion may be done for the severely anemic fetus
Factors Linked to GDM
Maternal obesity (>90 kg or 198 lb)
Large infant (>4000 g or 9 lb)
Maternal age older than 25 years
Previous unexplained stillbirth or infant having congenital abnormalities
Hx of GDM
Family Hx of DM
Fasting glucose level over 126 mg/dl or post meal glucose level over 200 mg/dl
Treatment of GDM
Identification of GDM (routine 140 mg/dl or higher)
Diet (3 meals 2 snacks)
Monitoring blood glucose levels (PRN throughout the day, teach S&S of hypo/hyperglycemia)
Ketone monitoring (need for more carbohydrates, develop ketoacidosis (hyperglycaemia))
- Vomiting, dehydration, deep gasping breaths, confusion and may lead to death
Exercise
Insulin injections (may be used to reduce hypoglycaemia)
Fetal assessment (fetal growth, placental insufficiencies, amniotic fluid)
Care During Labor of the Woman with GDM
IV infusion of dextrose may be needed
Regular insulin
Assess blood glucose levels hourly and adjust insulin administration accordingly
Close monitoring of fetus (c-section may be indicated if in distress)
Care of the Neonate of the Woman with GDM
May have the following occur
- Hypoglycemia
- Respiratory distress
Injury r/t macrosomia
Blood glucose monitored closely for at least the first 24 hours after birth
Breastfeeding should be encouraged (Lowers incidence of DM later in life)
Iron Deficiency Anemia
RBCs are small (microcytic) and pale (hypochromic)
Prevention:
- Iron supplements
- VC may enhance absorption
- Do not take iron with milk or antacids (calcium impairs absorption)
Iron Deficiency Anemia: Treatment
Oral doses of elemental iron (ferrous fumerate 33%)
Continue therapy for about 3 months after anemia has been corrected
Folic Acid Deficiency Anemia
Large, immature RBCs (megaloblastic anemia)
Anticonvulsants, oral contraceptives, sulpha drugs, and alcohol can decrease absorption of folate from meals
Folate is essential for normal growth and development
Prevention:
- Daily supplement of 400 mpg (0.4 mg)
Folic Acid Deficiency Anemia: Treatment
Folate deficiency is treated with folic acid supplementation
1 mg/day (over twice the amount of the preventive supplement)
- Dose may be higher in woman who have had a previous child with a neural tube defect
Nursing Care for Woman with Anemias During Pregnancy
Teach woman which foods are high in iron and folic acid
Teach woman how to take supplements
- Do not take iron supplements at the same time as drinking milk
- Do not take antacids with iron
- When taking iron, stools will be dark green to black
Nursing Care for Woman with Anemias During Pregnancy
The woman with sickle cell disease requires close medical and nursing care
- Teach her to prevent dehydration and activities that cause hypoxia
- Teach her to avoid situations where exposure to infection are more likely
- Teach her to promptly report any signs of infection
Infections
Acronym TORCH use to describe infections that can be devastating to the fetus or mother
- Toxoplasmosis
- Other infections
- Rubella
- Cytomegalovirus
- Herpes
Viral Infections
No effective therapy
Immunizations can prevent some infections
Rubella: 3 months before or in postpartum period
CMV: there is no effective treatment, therapeutic pregnancy termination may be offered if discovered early in pregnancy
- mental retardation
- seizures
- blindness
- deafness
- dental abnormalities
- petechiae
Herpes Virus: Treatment and Nursing Care
Avoid contact with lesions
- If woman has active genital herpes when membranes rupture or labor begins
Cesarean delivery may be required if lesions are present at time of delivery
Mother and infant do not need to be isolated as long as direct contact with lesions is avoided
Widespread neonatal infection has a high mortality rate and survivors may have neurological deficits
Hepatitis B
Transmitted by blood, saliva, vaginal secretions, semen, and breast milk; can also cross the placenta
Fetus may be infected transplacentally or by contact with blood or vaginal secretions during delivery
Upon delivery, the neonate should receive a single dose of hepatitis B immune globulin, followed by the hepatitis B vaccine
Nursing Care HIV
Educate the woman who is HIV positive on methods to reduce the risk of transmission to her developing fetus/ infant (antiretrovirals - suppress HIV)
Pregnant woman with AIDS are more susceptible to infections
Breastfeeding is contraindicated for mothers who are HIV positive
Neonates presumed to be HIV positive
Toxoplasmosis
Treatment
- Therapeutic abortion
Preventive measures
- Cook all meat thoroughly
- Wash hands and all kitchen surfaces after handling raw meat
- Avoid uncooked eggs and unpasteurized milk
- Wash fresh fruits and vegetables well
- Avoid materials contaminated with cat feces
Other Infections
STIs
- Protected sexual contact
- Treated when possible
UTIs
- Antibiotics: oral or IV
- Teaching re: how to reduce
- Adequate fluid intake to increase urination
- Urinating pre and post sexual intercourse
- Teach S&S of cystitis or pyelonephritis
Environmental Hazards During Pregnancy
Substance Abuse
- Questions should focus on how the information will help nurses and physicians provide the safest and most appropriate care to the pregnant woman and her child
Alcohol
- A single episode of consuming two alcoholic drinks can lead to the loss of some fetal brain cells
Trauma During Pregnancy
3 leading causes of traumatic death: - Automobile accidents - Homicide - Suicide Battering Bruises in various stages of healing
Nursing Tip
If a woman confides that she is being abused during her pregnancy, this information must be kept absolutely confidential
Her life may be in danger if her abuser learns that she told someone
She should be referred to local shelters, but the decision to leave her abuser is hers alone
Effects of a High-Risk Pregnancy on the Family
Disruption of usual roles
Financial difficulties
Delay attachment to the infant
Loss of expected birth experience
Interventions for the Grieving Process
Allow parents to remain together in privacy
Accept behaviours r/t grieving
Develop a plan of care to provide support to the family
Offer a memento such as a footprint
Offer parents an opportunity to hold the infant, if they choose
Prepare parents for the appearance of the infant
Provide parents with educational materials and referrals to support groups
Discuss wishes concerning religious and cultural rituals
