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Care of high risk mother, MB and family w/special needs/ W. Calley

High risk pregnancy is one in which the life or health of the mother or infant is jeopardized by a disorder coincidental with or unique to pregnancy.
Morbidity state of being diseased. may continure for months or years
Mortality quality or state of being subject to death.
Monozygotic twins that originate with one fertilized ovum; the embryonic disk divides, causing identical twins.
dizygotic Twins sthat are the result of two separate ova being fertilized at the same time. These twins have separate placentas.
Incompetent cervix is a cause of late abortion, has been traditionally defined as passive and painless dilation of the cervix during the second trimester.
Cerclage a technique that uses suture material to constrict the internal os fo the cervix. placed at 10-14 wks gestation, woman should refrain from sex, heavy lifting, and prolonged standing.
Pregnancy induced hypertension is a disease encountered during pregnancy or early in the puerperium characterized by increasing blood pressure, albuminuria and generalized edema. It includes preeclampsia and eclampaia, which places mother and fetus at risk.
Preeclampsia An abnormal condition of pregnancy characterized by the onset of acute hypertension after the 24 th week of gestation. s/s are proteinuria and edema
What are some signs of Mild Preeclampsia? increase of 30 mmHg systolic and 15 mmHg diastolic, edema in face, hands and ankles, weight gain of 3 lbs per month(2nd trimester) and 1 lb per week(3rd trimester), 1+ or 2+ proteinuria
What are some signs of severe Preeclampsia? they appear sudden, bp of 160/110 or high 2 times in 6 hrs appart with woman on bedrest, edema in hands, sacral area, abdomen, and lower extremities, significant weight gain (2 lbs in a few days or a week, 3+ or 4+ proteinuria and possible olguria
Eclampsia the most severe form of Pregnancy induced hypertension. Characterized by tonic and clonic convulsions, coma, hypertension, albuminuria, and edema.
Anasarca Massive generalized pitting edema. 4+
Kick Count a daily counting of fetal movements felt in 1 hour while the mother is resting.
What is considered dangerously low kick counts? fetal activity that is fewer than 3 counts per hour. fetal activity decreases if hypoxia developes.
TORCH group of agents that can infect the fetus or the newborn infant, causing a constellation of morbid effects. Toxolamosis, other diseases, rubella, cytomegalovirus and herpes simplex
Gestational Diabetes Mellitus is characterized by an inability to produce enough insulin to maintain normal glucose levels during pregnancy.
Glycosylated hemoglobin a combination of hemoglobin adn blood glucose making up about 4-8% of the total hemoglobin.
Brown fat source fo heat unique to neonates that is capable of greater thermogenic activity than ordinary fat
Where on the body can you find brown fat? around the adrenals, kidneys and neck; between scapulae; and behind the sternum for several weeks after birth.
Placental barrier obstruction, boundary or separation provided by the placental tissue between the fetal and maternal circulation; substances of small size excluding blood cells, may cross the barrier.
Erythroblastosis fetalis a type of hemolytic anemia that occurs in newborns as a result of maternal fetal blood group incompatibility, espicially involving the RH factor and ABO blood groups.
kernicterus an abnormal toxic accumulation of bilirubin in central nervous system tissues cause by hyperbilirubinemia. may result in neurological damage or death
Hyperbilirubinemia an excess of bilirubin in the blood of the newborn.
Indirect Coombs' test blood test that detects circulating antibodies against RBC's. the test can detect RH antibiodies in maternal blood and is used to anticipate hemolyic disease of the newborn.
Direct Coombs' test blood test to detect autoantibiodies against RBC's which can cause cellular damage. these antibiodies result in hemolytic anemia.
Phototherapy exposing the skin to fluorescent lights which converts the bilirubin to a water souluble form that can be excreted in the urine.
What should the nutritional regemin be for a pregnant woman with hyperemesis gravidarum? maintaining an acid-base and electrolyte balance. monitoring IV feeding, restrict solid intake until vomiting stops, bland solids such as toast, crackers or liquids are introduced slowly as tolerated. In severe cases TPN may be needed.
Etopic Pregnancy in this implantation occurs somewhere other than within the uterus. most common site is within the fallopian tubl. others could be the abdominal cavity, ovary, ligaments adn cervix.
What is the medical management for etopic pregnancy? rapid surgical treatment and blood replacemet therapy are almost always indicated. Salpingectomy-removal of the tube, Salpingostomy-repair of the tube. doses of methotrexate (folic acid) has been effective. provide emotional support and pt teaching.
Placenta Previa occurs when the placenta implants in the lower uterine segment. classified by the degree to which the placenta covers the internal cervical os, (complete, partial, and marginal.)
What is the most important risk factor in Placenta Previa? previous cesarean birth possibly related to endometrial scarring. other risk factors include multiple gestation, closely spaced pregnancies, previous placenta previa and advanced maternal age.
Where is the uterus located during the Second trimester? implanted in the lower uterine segment in 45% of pregnancies. as the lewre uterine segment lengthens the placenta moves upward.
What are the symptoms of Placenta previa? painless bright red vaginal bleeding occuring after 20 weeks gestation. may be intermitten or occur in gushes.
What is the Medical Management for placenta previa? cesarean birt is the treatment of choice. pt should be under close supervision, bedrest, if bleeding cannot be controled a hysterectomy is done after birth, give good pt teaching and provide emotional family support.
Abruptio Placentae is premature separation of the normally implanted placenta from the uterine wall. this generally occurs late in pregnancy, frequently during pregnancy.
What are some predisposing factors for abruptio placentae? trauma (most common), chronic hypertension, and pregnancy induced hypertension. 3 times more likely in women woth gravidity for more than 5. Cocaine users are also at risk.
What are the signs and symptoms of abruption placentae? they are sudden, severe pain accompained by uterine rigidity. the uterus may increase in size and a result of the hemorrhage.the first sigh during labor is a very strona nd constant contractions (tetany)
What do you assess for in abruptio placentae? Duration, amoutn, color and characteristic of bleeding, vital signs, pain, fetal heart rate, and emotional response.
What test are done to determine blood loss? hemoglobin and hematocrit levels.
What is the Medical Management for abruptio placentae? delivery by c/s and blood replacement is most common, side lying position with a wedge facilitates uterine placental perfusion. blood and fluid replacement therapy, fetal monitoring, continuous monitoring of both mother and fetus.
Disseminated Intravascular Coagulation is a potentially life threatening disorder that results from alterations in the normal clotting mechanism. it may be seen with abruptio placentae, incomplete abortion, hypertension or infectous process. creates excessive blood loss.
What is the medical management for disseminated intravascular coagulation? drawing PT, PTT, and platelet count, replace blood and fluids lost, restore normal clotting mechanisms. oxygen therapy(10-12L), heparin therapy, delivery of baby should occur ASAP, monitor I&O, put pt in side lying position to maxamize bloodflow.
Postpartum Hemorrhage occurs in two stages, early postpartum hemorrhage is blood loss greater than 500 mL after vaginal birth, or 100 mL after cesarean birth. this amount of blood loss is not unusual. is the leading cause of maternal mortality rate.
Late postpartum hemorrhage occurs after the first 24 hours.
What are the most common causes of postpartum hemorrhage? uterine atony(lack of normal tone and strength), hydraminos (excessive amount of amniotic fluid), or a very large infant, retained placenta or fragment of the placenta (most common), lacerations of the perineum.
What is the medical management of postpartum hemorrhage? stimulate uterine contraction, surgicaly remove fragmentsof the placenta, repair lacerations, fundal massage, keeping bladder empty and administration of oxytocics. blood transfusion may be needed.
What is the cheif complaint by the mother that indicated hemorrhage by trauma? deep severe pelvic or rectal pain, abnormal vital signs.
What is the antidote for magnesium sulfate toxicity? Calcium Gluconate by slow IV administration, ecg monitoring is done to check for dysrrythmias
What are some infecious diseases most likely to cause complications? Mastitis, Torch infections, HIV, AIDS, Tuberculosis.
Mastitis an infection of the lactating breast, occurs most often during the second and third weeks after childbirth, also may develope any time during breastfeeding and usually only affects one breast.
What is the cause of Mastitis? staphylococcus anreus. the bacteria is most oftern carreid on the hands of the mother or in the mouth or ht enewborn. the orgnaism may enter through and injured area or the nipple,
What are some symptoms of mastitis? flue like symptoms with fatigue and aching muscles. fever may present of 101 or higher, chills, maliaise adn headache. also localized redness and inflammation.
What are TORCH infections? TORCH infections include; Toxoplasmosis,other diseses (Hepatitis, german measels or 3 day measels), Rubella, Cytomegalovirus and herpes genitalis
Toxoplasmosis can be contracted by eating raw contaminated meats or contacted with the feces or and infected cat, diagnosed by blood studies, can cause spontaneous abortion, stillbirthe, neonate blindness, and retardation. woman feels fluelike symptoms.
Hepatitis A & B hep A is a virus spresd by droplets or hands. can cause spontaneous abortion and fluelike symptoms; fever, malaise and nausea. Hep B is a virus transmitted through blood and bodily fluids, signs and symptoms include rever, rash, anorexia, malaise.
Rubella, German Measles and 3-day measles is a viral infection, may present with rash and lymphedema. can cuse congenitle defects in the fetus such as congenital heart disease, mental retardation, deafness and cataracts
Cytomegalovirus is a viral disease like herpesvirus group can be spread through sex, kissing, and breastfeeding, more than half of adutlts have the antibioties for it. capable of crossing the placental barrier and can cause congenital impairment, congenital anomalies
Herpes Genitalis also called herpes type 2, caused painful lesions on external genitalia and could involve the cervix, intrauterine infection is possible if membranes rupture or vaginal delivery takes place when active lesions are present.
What are the nursing intervintions for a pregnant person with diabetes? nursing care is directed at maintained a normal glucose status. the pt insulin requirements will change throught pregnancy, labor and delivery. a thourough assessment is done. oral hypoglycemica are dc'd, give good pt teching
What is the importance of monitoring blood glucose during pregnancy? during pregnancy the body may not be able to produce enough insulin to meet the demands, this could result in dangerously high levels, fetal complications could include stillirth, preeclacpsia, alteration in size (larger), congenital anomalies.
What are some problems of the Cardiovascular system related to pregnancy? rheumatic heart disease, congenital heart defects, mitral valve prolapse, and cardiomyopathy.
What are the physiological concerns in adolescent pregnancies? increased risk for pregnancy induced hypertension, cephalopelvic disproportions resulting in c/s, abruptio placentae, low birth weight, IUGR, anemia, infection, preterm delivery, and perinatal death.
What are the physiological concerns in an older adult pregnancy? placenta previa, diabetes, hypertension, increased risk for down syndrome or other chromosomal anomalies.
gestational age assment was devised by lilly and victor dobowitz, estimating gestational age of and infant based on 21 strictly defined physical and neurological signs. is done between 2-8 hours of birth.
What is the preterm infants greates potential problem? the infant is developmentally immature mentally and physically.
What are the clinical manifecstations for a preterm infant? cyanosis is common, teh head appears very large and the ones of the skull are pliable with lare flat frontanelles, skin is thin and translucent, teh eares can be easily folded, genital are small with undesended testes, libia majora is small, bad reflexes.
Hemolytic Disease incompatibility of blood groups. RH incompatibility occurs only when the mother is RH- and the fetus is RH+. fot this to occur the father of the fetus must be RH+.
What are some diagnostic test used to determine high risk pregnancies? fetal monitoring, non stress test, blood tests, ultrasound, alphafetaprotein, and bpp
What are some maternal nursing interventions for hemolytic disease? Coombs test is done if it is negative the mother is given and IM injection of RhoGAM. recommended at 28 weeks of pregnancy and againd within 72 hours of delivery. provides passive antibiodies and prevents developement of naturally occuring antibioties.
What are some newborn nursing interventions for hemolytic disease? must be observed carefully, jaundice and anemia may become severe and lead to complications, monitor bilirubin, hemoglobin and hematocrit levels, provide phototherapy if jaundice, maintain hydration.
What does the use of cocaine do to the unborn fetus? cocaine raises blood pressure of the mom and puts both of them at risk for intracrainal bleeding, tachycardia, prematurity, low birth weight, stillbirth, poor feeding reflexes, decreased intellectual development, prune belly syndrome(no abd muscles)
What does alcohol abuse do to the unbourn infant? facial and cranial anomalies, developemental delay, mental retardation, short attention span, fetal alcohol effects, causes intoxication in fetus for prolonged periods. the fetus cannot metabolize drugs efficiently
Where do you assess deep tendon reflexes? Biceps, brachioradial, triceps, patellar, achilles, ankle clonus
How do you assess deep tendon reflexes? Hyperactive response(brisk with intermittent or transient clonus); 4+, more than normal (brisk) slightly hyperactive; 3+, Normal, active, expected response;2+, sluggish or dininished; 1+, no response; 0
What is the Medical management for Pregnancy induced hypertension? woman may be hospitalized, mild preeclampsia may be managed at home, bed rest, say on left lateral recumbent position to reduce pressure on inferior vena cava, well balanced diet w/ adequate protein, low sodium, iv therapy of magnesium sulfate (seizures)
What is the pathophysiology of a preterm infant? related to maternal or placental problems, baby less than 37 wks gestation, infant is developmentally immature, lungs not producing adequate o2, lack of brown fat, problems absorbing nutrients, renal system is immature, neurologically immature,
How would you instruct mother how to breastfeed with mastitis? corrrestly position infant to avoid nipple trauma and milk stasis, feed infant every 2-3 hrs, avoid formula supplements and nipple sheilds, change nipple pads when wet, avoid continuous pressure, empty breasts completly after feeding, 3000 mL daily intake
What are the hospital precautionary measures for PIH? quiet non stimulating environment, seizure precautions, emergency meds ready, emergency birth pack accessible, reduce noise, restrict visitors, provide uninterupted rest.
What are the emergency meds for PIH? hydralazine (antihypertensive vasodilator, Magnesium sulfate, Calcium gluconated immediatly after to prevent magnesium toxicity.
What is HELLP syndrome? hemolysis, elevated liver enzymes, low platelet count; represents an extension of pathology of severe preeclampsia and eclampsia. these signs appear in third trimenster or postpartum. pain in upper right quadrant, lower chest or epigastric area
Created by: wcalley