Health Conditions and Vulnerable Populations Flashcards
What maternal conditions cause at-risk pregnancies?
Diabetes Cardiac and Respiratory Disorders Anemia Autoimmune Disorders Specific Infections
Who are considered “vulnerable populations” for pregnancy?
Adolescents
Women 35 and older
Women HIV+
Women who substance abuse
Diabetes Mellitus
chronic disease characterized by a relative lack of insulin or absence of the hormone that is necessary for glucose metabolism
Type 1 Diabetes
absolute insulin deficiency due to an autoimmune process
-usually ages < 30
Type 2 Diabetes
insulin resistance or deficiency related to obesity or sedentary lifestyle
-diagnosed primarily in older adults >30, but now being seen in children
Impaired Fasting Glucose and Impaired Glucose Intolerance
characterized by hyperglycemia at a level lower than what qualifies as a diagnosis of diabetes
Gestational Diabetes Mellitus
glucose intolerance with its onset during pregnancy usually around the 24th week or first detected in pregnancy
What are the 2 classifications of diabetes during pregnancy?
Pregestational and Gestational
Pregestational Diabetes
alteration in carbohydrate metabolism before conception which includes women with type 1 or 2 diabetes
Gestational Diabetes
Develops during pregnancy
-associated with either neonatal complications or maternal complications
What neonatal complications are associated with Gestational Diabetes?
macrosomia
hypoglycemia
birth trauma
What maternal complications are associated with Gestational Diabetes?
preeclampsia and cesarean birth
Patho for Gestational Diabetes
the existence of pancreatic beta-cell dysfunction before pregnancy and the unmasking of this problem by the development of insulin resistance during pregnancy
What is a normal fasting blood glucose level?
92 mg/dL
What is a normal oral glucose tolerance test result 1, 2, and 3 hours later?
1 hr- 180 mg/dL
2 hrs- 153 mg/dL
3 hrs- 140 mg/dL
What placental hormones can cause insulin resistance?
hPL and growth hormone increase in direct correlation with the growth of placental tissue, rising throughout the last 20 weeks of pregnancy causing insulin resistance
Gestational Diabetes effects on Mother
hydramnios gestational hypertension ketoacidosis preterm labor stillbirth hypoglycemia UTI's/Vaginitis Difficult labor; c/s; hemorrhage
Gestational Diabetes effects on Baby
cord prolapse congenital anomalies macrosomia birth trauma fetal asphyxia childhood obesity death respiratory distress syndrome
What should the moms HbA1C level be to so control?
< 7%
What type of diet should a pregnant woman with diabetes be on?
low carbohydrate diet with a carbohydrate content of 40% of the calories
Maternal Surveillance for Diabetes
- urine for protein, ketones, nitrates, and leukocyte esterase
- evaluation of renal function/trimester
- eye exam in first trimester
- Hba1c q 4-6 weeks
Fetal Surveillance for Diabetes
ultrasound alpha-fetoprotein levels biophysical profile nonstress testing amniocentesis
Congenital Heart Conditions
involves structural defects that are present at birth, but may not e identified at that time
What are examples of congenital heart conditions that affect pregnancy?
Tetralogy of Fallot
Arterial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus arteriosus
What are some complications for baby associated with moms congenital heart condition?
growth restriction
preterm/premature births
fetal/neonatal mortality
Which conditional heart condition should you advise the mom to avoid pregnancy?
Tetralogy of Fallot
Tetralogy of Fallot
- Hospitalization and bedrest possible after the 20th week with hemodynamic monitoring via a pulmonary artery catheter to monitor volume status
- Oxygen may be necessary during birth and labor
Arterial Septal Defect
treatment with atrioventricular nodal blocking agents and at times with electrical cardioversion
Ventricular Septal Defect
rest with limited activity if symptomatic
Patent Ductus Arteriosus
Surgical ligation of the open ductus during infancy; subsequent problems minimal after surgical correction
Acquired Heart Conditions
conditions affecting the heart and its associated blood vessels that develop during a person’s lifetime
What are examples of acquired heart conditions =?
Mitral valve prolapse Mitral valve stenosis Aortic stenosis Peripartum cardiomyopathy Myocardial infarction
Mitral Valve Prolapse
most asymptomatic–diagnosis is made incidentally
occasional palpations, chest pain or arrhythmias
possibly need beta blockers
usually no special precautions
Mitral Valve Stenosis
general symptomatic improvement with medical management involving diuretics, beta blockers, and anticoagulant therapy
-activity restriction, reduce sodium, and potentially bedrest if condition is severe
Aortic Stenosis
Diagnosed w/ echocardiography
beta blockers, antiarrhythmic agents to reduce risk of heart failure or dysrhythmias
bedrest, limited activity, and close monitoring
Peripartum Cardiomyopathy
preload reduction w/ diuretic therapy
afterload reduction w/ vasodilators
inotropic agents
salt restriction, daily exercise
Myocardial Infarction
anticoagulant therapy, rest, and lifestyle changes
Class I
asymptomatic w/ no limitation of physical activity
Class II
symptomatic: dyspnea, chest pain w/ increased activity
Class III
symptomatic: fatigue, palpitations w/ normal activity
Class IV
symptomatic at rest or with any activity
Patho for Congenital/Acquired heart conditions
hemodynamic changes overstressing women’s cardiovascular system
Therapeutic Management for Heart Conditions
risk assessment
prenatal counseling
increased frequency of prenatal visits
Nursing Assessment for Heart Conditions
vital signs heart sounds-murmurs, irregular rhythms, heart rate weight fetal activity lifestyle
Cardiac Decompensation
the heart’s inability to maintain adequate circulation
When is the pregnant women most vulnerable to cardiac decompensation?
28-32 weeks gestation and in the first 48 hours postpartum
Signs and Symptoms of Cardiac Decompensation
shortness of breath/dyspnea cyanosis swelling of hands, feet, and face jugular vein engorgement rapid respirations abnormal heartbeats chest pain syncope fatigue cough
Nursing Management Heart Conditions
stabilization of hemodynamic status risk reduction cardiac medications energy conservation/nutrition fetal activity monitoring S/S of cardiac decompensation monitor during labor
Chronic Hypertension
hypertension before pregnancy or before 20th week gestation or persistence > 12 weeks postpartum
Therapeutic Management Hypertension
preconception counseling lifestyle changes antihypertensive agents if severe fetal movement monitoring serial ultrasounds
Nursing Management Hypertension
lifestyle changes=DASH diet
frequent antepartal visits
monitoring for abruptio placentae, preeclampsia
daily rest periods
home BP monitoring
close monitoring during labor, birth, and postpartum
DASH Diet
adequate intake of potassium, magnesium, and calcium and limits sodium to 2.4 g
Why is asthma treated aggressively in pregnant women?
because the benefits of averting an asthma attack outweigh the risks of medication
What is the ultimate goal of asthma therapy?
prevent hypoxia
What are the 3 specific drugs chosen to treat asthma during pregnancy?
budesonide
albuterol
salmeterol
Nursing assessment for asthma includes?
asthma triggers and lung auscultation
Should treatment of TB be the same for pregnant women as nonpregnant women? What is the exception?
yes
streptomycin is the exception because it is ototoxic to fetus
What are the medications used to treat TB?
isoniazid, rifampin, ethambutol
Risk factors for TB
immunocompromised
recent immigration status
homeless or overcrowded living conditions
injectable drug use
Signs and Symptoms of TB
fatigue fever night sweats nonproductive cough weakness slow weight loss anemia hemoptysis anorexia
Screening for TB includes?
TB test and if positive chest x-rays
Nursing Management for TB
compliance w/ drug therapy
education; health promotion
transmission prevention
Should moms with TB be encouraged to breastfeed?
yes as long as they are compliant with their medication
If the mother is untreated for TB at birth or is NOT compliant with medication what will happen?
they will not be allowed to breastfeed and should not be in direct contact with their newborn until at least 2 weeks after starting medications
What is the most common pathological cause of anemia during pregnancy?
Iron Deficiency
Anemia
reduction in red blood cell volume
What are some consequences of iron-deficiency anemia in pregnancy?
preterm delivery perinatal mortality low birth weight poor mental and psychomotor performance postpartum depression
Signs and Symptoms of Iron Deficiency
fatigue pica weakness malaise anorexia susceptibility to infections pale mucus membranes tachycardia pallor
What abnormal lab results are usually present with iron deficiency?
low hemoglobin, hematocrit, serum, iron, microcytic and hypochromic cells, and low serum ferritin
Why should you encourage taking iron supplements with orange juice instead of milk?
Orange juice will promote absorption while milk can inhibit absorption
Nursing Management for Iron Deficiency
- encourage compliance w/ drug therapy: prenatal vitamins and iron supplements
- dietary instruction and counseling
- education for drug therapy
What foods are recommended for iron deficiency?
foods high in iron such as: dried fruits, whole grains, green leafy vegetables, meats, peanut butter, and iron fortified cereals
Thalassemia
group of hereditary anemic disorders in which synthesis of one or both chains of hemoglobin molecules alpha and beta are defective
Alpha (Minor)
little effect on pregnancy except for mild anemia
Beta (Major)
usually no pregnancy due to lifelong, severe hemolysis, anemia, and premature death
What does the management for Thalassemia depend on?
severity of disease
Sickle Cell Anemia
an autosomal recessive inherited condition that results from a defective hemoglobin molecule
What adverse maternal outcomes are associated with Sickle Cell?
preeclampsia eclampsia preterm labor placental abruption intrauterine growth restriction low birth weight mortality
Therapeutic Management for Sickle Cell
dependent on status
- supportive therapy
- blood transfusions if severe
- analgesics for pain
- antibiotics for infections
Sickle Cell Crisis
severe abdominal pain muscle spasms leg pain joint pain fever stiff neck nausea/vomiting seizures
Nursing management for sickle cell during labor
rest
pain management
oxygen and IV fluids
close FHR monitoring
Nursing management for sickle cell postpartum
antiembolism stockings and family planning options
Localized Autoimmune Disease
targets specific organ
-thyroid gland in Hashimoto’s thyroiditis and Grave’s disease
Systemic Autoimmune Disease
target multiple organs
-Systemic Lupus Erythematosus targets lungs, heart, joints, kidneys, brain, and red blood cells
What is the focus of therapy for Systemic Autoimmune Diseases (Lupus)?
control disease flare-ups, suppress symptoms, and prevent organ damage
Cytomegalovirus
Most common congenital and perinatal viral infection in the world
- transmitted via body fluids
- typically asymptomatic
Rubella
German measles
-spread by droplets or direct contact w/ contaminated object
Herpes Simplex Virus
Genital Herpes
-greatest risk of infection is developing primary infection right before birth
Hep B Virus
Everyone should be tested
-If mom is Hep B positive expect to administer HBIG and Hep B vaccine within 12 hours of birth
Varicella Zoster Virus
Transmitted to fetus through placenta resulting in congenital varicella syndrome
Parvovirus B19
common, self-limiting, benign childhood virus that causes erythema infectiosum, also known as Fifth’s Disease
- severe anemia in fetus
- infected child will have flaming red cheeks and rash
- contagious before rash
Group B Streptococcus
Most common cause of sepsis, meningitis, and pneumonia in newborns
-mother will be given PENG and IV antibiotics 4 hours before birth
Toxoplasmosis
Parasitic infection
-transmitted from cat feces, undercooked meat, and contaminated water
HIV
Mothers can NOT breastfeed
at risk for preterm delivery, fetal growth restriction, PROM, hemorrhage, infection, poor wound healing, UTI
Therapeutic Management for HIV
Oral antiviral drugs twice daily from 14 weeks until birth; IV administration during labor; oral syrup for newborn in first 6 weeks of life; decision for birthing method
Nursing Assessment for HIV
history and physical exam
HIV antibody testing
STI screens
Nursing Management HIV
pretest and posttest counseling
education
support
What should you offer support for with HIV?
Preparation for labor, birth, and afterward
Elective c/s
Compliance with antiretroviral therapy
Family Planning methods
Nursing Assessment for Pregnant Adolescent
- vision of future
- realistic role models; emotional support
- level of education
- financial and resource management
- anger and conflict resolution skills
- knowledge of health/nutrition for self and baby
- challenges of parenthood
- community resources
Nursing Management for Pregnant Adolescent
- Support
- Future planning: return to school; career/job counseling; options for pregnancy
- Frequent evaluation of physical and emotional well being
- Stress management/self care
- Education
Nursing Assessment for pregnant women 35 and Older
- preconception counseling
- lifestyle changes-beginning in optimal health
- labs/diagnostic testing for baseline
- amniocentesis
- quadruple blood test screen
Nursing Management for Women 35 and Older
promote healthy pregnancy education early and regular prenatal care dietary teaching continued surveillance
Substance Abuse Impact on Pregnancy
fetal vulnerability
teratogenic effect
addiction consequences
Alcohol and Pregnancy
fetal alcohol syndrome/spectrum disorder
abortion
inadequate weight gain
Caffeine and Pregnancy
vasoconstriction and mild diuresis in mom
fetal stimulation
should not consume more than 300 mg a day
Nicotine and Pregnancy
vasoconstriction reduced uteroplacental blood flow decreased birth weight abortion/premature abruptio placentae
Cocaine and Pregnancy
vasoconstriction gestational hypertension abruptio placentae snow baby syndrome CNS defects
Marijuana and Pregnancy
anemia inadequate weight gain amotivational syndrome hyperactive startle reflex tremors premature
Opiates and Narcotics (Heroine)
withdrawal abruptio placentae preterm labor PROM perinatal asphyxia sepsis and death intellectual impairment malnutrition
Sedatives
CNS depression newborn withdrawal maternal seizures in labor newborn abstinence syndrome delayed lung maturity
Nursing management for Substance Abuse
- nonjudgmental approach
- state protection agency investigation for positive newborn drug screen
- counseling
- education
Nursing Assessment for Substance Abuse
history and physical exam
urine toxicology
The most common harmful effect of heroin and other narcotics is what?
withdrawal and neonatal abstinence syndrome
