Maternal Health Flashcards
Prenatal guiding principles
- Mother and fetus are one
- A pre-existing disease is usually exacerbated by pregnancy
- Illness increases a mother’s anxiety levels
- The nurse must know the illness itself and then apply knowledge of the normal symptoms of pregnancy
Prenatal assessments principles
- Obtain baseline before pregnancy or early in pregnancy
- Establish a trusting relationship
- Systematic, consistent, thorough and ongoing assessments to identify changes
Cardiovascular disorders and Pregnancy
- Supine hypotension > women should lie on left side with a pillow to support and avoid extra pressure on inferior vena cava.
- During pregnancy blood volume increases o 30-50% and peaks at 28-32 weeks.
- Smoking has huge impacts on the placenta
- The placenta is not a primary organ > if perfusion is compromised, the placenta will be neglected > decreased placental perfusion > Fetal IUGR > Intrauterine Growth Restriction
Focused Assessments:
SOB? , edema past ankles?, Baseline and Trends
Hematological disorders and Pregnancy
- Look in the Antenatal record for Hb to see if the mother is going into labour with an anaemic status
- Anaemia - 12-15% > body responds similarly as to a CVA;
Causes: heavy periods, multiparity
True anemia? versus Pseudoanemia?
Anemia: Nursing assessments/ considerations in Pregnancy
- Assessment of nutritional intake and status
- Assess for fatigue, dizziness, pallor, sore tongue, anorexia
- N and V
- Warmth of extremities
- signs of infection, and severe pain (due to veno- occlusive crisis
- Monitor Labs
- Encourage to eat foods high in iron and folic acids like green leafy vegetables, fish, meat, poultry, eggs, and legumes.
- Tachycardia?
- Teach how to prepare food in order to minimize the loss of iron and folic acid
- Vit C for iron absorption
- Diet high in fibre and fluids to avoid constipation (side effect of iron intake)
- Good hygiene to avoid UTI
- Teach client to watch out for signs of preterm labour
- Observe and monitor fetal well being
- Rest as much as possible
- Provide emotional support
Pregnancy complicated by a sudden illness: guiding principles
- Prioritization > Circulation Airway Breathing for mother and fetus
> Hypervolemia
> Internal bleeding
> Infection r/t chronic illness - Consider the “seen” and the “unseen” - fetus and blood loss
Common Orders for OB Emergencies
O2 by mask 10LPM IV 16-18G with volume expander RL or NS EFM Stat bloodwork (Hb, Hct, plats, D-dimer, coags, CBC, X-Match and type, 2 RBC units) Monitor urinary output > catheterize to get bladder out of the way and ready for possible c-section Left lateral position VS q5-15 min Support > preserve personhood
Common causes of bleeding during pregnancy
Spontaneous abortion (miscarriage) - SA
Ectopic pregnancy
Placenta previa
Abruptio placentae
Spontaneous abortion
15-30% of pregnancies end in SA
ALL bleeding in pregnancy needs investigation - midwife or OB GYN
Early < 16 weeks
Late 16-20 weeks is rarely a problem
Bleeding after 12 weeks > bleeding can be PROFUSE and LIFE-THREATENING
Be prepared for hemorrhage and shock protocol
Never minimize the loss
Placenta Previa
5/1000 births
Hemorrhage > can be life-threatening for the mother and babe
NO PV exams ever!!
Vigilant monitoring
Bed rest
Hospitalization
Betamethasone given to mature lungs faster
Less placental blood flow > IUGR
Uterus has less muscle fibres at the bottom > higher potential of hemorrhage during labour
S+s: Painless, bright red blood loss at anytime in pregnancy
Preterm labour induced C-section to Tx and prevent loss
Abruptio placentae
Most common cause of perinatal death
et idiopathic > multiparity?, HTN?, ?older mothers, PIH, trauma, vasoconstriction > cocaine or smoking.
S+S: usually occurs late in pregnancy or during labour, sharp and stabbing pain at fundus, tender uterus on palpation, abnormally increased pain associated with contractions, abnormally increased rate and pace in labour, blood “older” -port wine - d/t hypoxia and concealed bleeding
Preterm Labour
Responsible for 2/3 neonatal deaths
< 37 weeks gestation
High correlation with dehydration (Summer), UTI’s, periodontal disease (oral bacteria), partner violence/abuse > stress
<23 weeks survival rate is extremely low
** 4 or more contractions in 20 min **
any changes to vaginal secretions
Interventions: Bed rest hydration tx UTIs betamethasone (to mature lungs Turbutalane to stop [ ] Abx to treat infections Magnesium sulphate > smooth muscle relaxant
Preterm Rupture of Membranes
Caused by infection, multiple gestation, unknown.
Risk of cord prolapse
Tx:
Significant risk of infection to neonate and mom
Labour is not stopped if labour is started d/t infection
IV access
Abx IV
Bedrest
Betamethasone
Confirmed with nitrazine paper. Vaginal pH (4.5-6.0) and amniotic fluid is alkaline (7.1-7.3) > result of secretion will have a higher pH and turn blue
Gestational HTN (Preeclampsia/eclampsia)
Cause> vasospasm, idiopathic et
Risk for seizures, coma and death r/t cerebral edema
3 cardinal signs:
> Increased BP (30mmHg above baseline)
> Edema
> Proteinuria
S+s:
headache, blurred vision or visual disturbance, epigastric pain and discomfort
Assess: urine dips for protein, 24h creatinine clearance, liver Fx, clonus, daily weight
Tx: bed rest, labetalol, magnesium sulfate > anti convulsant
Labour and Birth: Guiding Principles
- Know what is normal, communicate and act when deviates from normal (GP and OB)
- Methodical and thourough assessment with documentation
- PREVENTATIVE NURSING
- Evidence-based practice
- Preserve personhood: sensibility to fear andvulnerability; incorporate mom’s wishes of they are safe for her and baby; promote privacy; honour unique birth.
