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1230 Unit 2 Part 1

Take care of mother and baby from pregancy through after the birth (for chronic conditions). Perinatologist
Risk factors for the pregnant woman chronic medical conditions; acute infections
Women with chronic medical conditions- sometimes normal changes of pregnancy can alleviate or intensify symptoms of their illness.
Chronic disease in which glucose metabolism is impaired by lack of insulin in the body or by ineffective insulin utilization; when poorly controlled, it can adversely effect the pregancy outcomes Diabetes Mellitus
DM complicates approximately __________ of pregnancies; ___________ should be involved in the care of the pregnant woman with DM. 3% - 10%; specialists
DM where there is a higher incidence of spontaneous abortion; more likely to have C-section because of size of baby; high risk for congenital anomalies and/or stillbirth Type 1 DM
Mother with Type 1 DM is at higher risk for: hypertensive disorders; polyhydramnios (excess levels of amniotic fluid); preterm delivery; shoulder dystocia in the infant (shoulder delivered 1st)
Underlying pathophysiology is insulin resistance; mother will have increased risk for developing Type 2 DM after pregnancy; diabetogenic effect of pregnancy Gestational DM
Screening for gestational DM is done at approximately: 24-28 weeks gestation
Treatment for gestational DM: pre-pregnant care (with diabetes); monitoring and maintaining glycemic control; insulin therapy; oral hypoglycemic agents; diet therapy; excercise; fetal surveillance; determining timing of delivery
S/S of cardiovascular disease very depending on underlying cause of heart disease. Earliest warning sign of cardiac decompensation is: persistent rales (wet crackles) in the bases of the lungs
Treatment of cardiavascular disease during pregnancy: activity levels - don't over-do it; stress management; diet and medications; management during labor and pospartum period (will do cesarean if condition is bad enough); protect herself from infection; precautions to avoid clot formations
pg. 352 - Classifications of Heard Disease
Most important nursing action with pregnant client with cardiovascular disease: monitor for and teach the woman to recognize signs of cardiac decompensation (HR dropping, BP dropping, etc.)
Immediately report any fever, increased bleeding, and any signs of decompensation in the postpartum period of a woman with cardiovascular disease.
Pregnant women with cardiovascular disease should do this when traveling: move around often; get up and walk every hour or so; avoid long trips if possible
S/S of this diesease in the pregnant woman are tachycardia, tachypnea, dyspnea, pale skin, low BP, heart nurmur, HA, fatigue, weakness, and dizziness Iron-deficiency anemia
ingestion of non-food substances such as clay and laundry starch Pica
frequent chewing or sucking on ice pagophagia
Pica and pagophagia are both associated with: iron-deficiency anemia
Hemoglobin levels less than ____________ define anemia during pregnancy. 10 g/dL
Treatment of anemia during pregnancy: iron supplement (take with OJ to increase absorption). Iron will cause constipation (increase fluid intake).
Women with sickle cell anemia rarely experience symptoms of the disease during pregnancy because: their blood volume is increased and less sickled.
A woman with sickle-cell anemia is still at risk for a crisis ___________. She may experience recurrent bouts of pain in the: any time during pregnancy; joints, bones, chest and abdomen
Treatment for sickle cell crisis: oxygen, fluids, rest
What medication for cardiovascular disease cannot be taken during pregnancy? Coumadin (it crosses the placenta and increases chance for anomalies)
Clinical manifestation of asthma: shortness of breath and anxiousness
Treatment for pregnant woman with athsma: management of acute exacerbation; inhalers; labor and birth management (oxygen, breathing); will have to alter medication management (steroids can cross placenta); smoking cessation
Current recommendations for the woman with epilepsy who is pregnant are to: stay on the drug that most effectively controls her seizures
constant seizures status epilepticus
nursing care with epliepsy: teach importance of carefully following her treatment regimen and of diet high in folic acid (and taking supplement); provide emotional support during testing for fetal anomalies.
Women with disease need to do this before becoming pregnant: contact their doctor
TORCH Toxoplasmosis; Others (Hep B, Syphilus, Varicella, Herpes Zoster); Rubella (German Measles); Cytomegalovirus (CMV); Herpes Simplex Virus
Many of the TORCH infections do not have effective treatment regimens, so __________ is the focus of interventions. prevention
TORCH screen will test for latent (old) infections
Many STI's are reportable diseased tracked by the: CDC
Most common (reportable) STI in the U.S. Left untreated, increases the risk of contracting HIV/AIDS Chlamydia
Second prevalent in the US; resistant to antibiotics; can leave woman infertile or susceptible to ectopic pregnancy because of scarring in the reproductive tract Gonorrhea
Most common viral STI in the U.S.; has tendency to incrase in size during pregnancy; neonatal infection can result in life-threatening laryngeal papillomas Human papillomovirus
STI associated with adverse pregnancy outcomes; pt will have discharge/odor Trichomoniasis
Two main gols of treatment for the pregnant woman infected with HIV: prevent progression of the disease in the woman; prevent perinatal transmission of the virus to the fetus (C-section, no breastfeeding)
If a woman is HIV positive, the baby will be: positive or negative (depends on delivery). An HIV positive mother does increase the chance of the baby having it, but it doesn't mean the baby automatically has it.)
Nursing care for pregnant woman with HIV: assure confidentiality; ensure she understands risks to her sexual partners; explore her understanding of the treatment regimen
Nursing diagnosis for pregnant woman with HIV will involve: teaching
Encourage mothers to be __________ about STI's. honest
Cycle of violence: when a woman goes back to her partner over and over even though they are abusive.
Getting hit in the stomach (abused) can cause: pre-term labor
Interventions for the victim of IPV (Intimate Partner Violence) are directed toward: safety assessment and planning
The decision of whether a woman should leave an abusive relationship must be made exclusively by: the woman
Nursing care for IPV: assist RN to assess for abuse; document the woman's responses to questions about IPV; carefully respond with supportive statments; document your assessment objectively; be knowledgeable about local resources
Many pregnant teens seek: late prenatal care; may be fearful of disclosing her pregnancy; parents of girl may be mad or upset; girl has right to decide what happens with her child
Best treatment for teenage pregnancy: prevention
Nursing care for teenage pregnancy: caring for developmental needs; caring for physical needs; adequate nutrution is essential; caring for emotional and psychological needs; be knowledgeable about community resources for the pregnant teen.
Nursing care for an older pregnant woman: approach her with an open mind; may feel they have "too much" medical information and feel overwhelmed
disorder of early pregnancy; characterized by severe nausea and vomiting; results in weight loss, nutritional deficiencies, and/or electrolyte and acid/base imbalance; most often appears between 8-12 weeks gestation; resolves by week 20 hyperemisis gravidarum
exact cause of hyperemisis gravidarum is: unknown
Risk of hyperemisis gravidarum is increased with: a multiple gestation; molar pregnancy; history of hyperemesis gravidarum; stress and psychological factors can contribute
Clinical features of hyperemisis gravidarum: syptoms of dehydration; postural hypotension; elevated hematocrit
Pts with hyperemisis gravidarum will have: persistent nausea and vomiting, often with complete inability to retain food and fluids during the 1st 20 weeks; may need IV fluids; significant weight loss; dehydration; acid/base electrolyte imbalances; decreased potassium (causing cardiac dysrhythmia)
may be added for pt with hyperemisis gravidarum; many of which are in pregnancy Category C; usually more effective when given on a regular, around-the-clock schedule vs. PRN; given by parenteral injection or rectal suppository antiemetics
Emergency treatment for hyperemisis gravidarum correcting fluid, electrolyte, and acid/base imbalances; NPO for 24 hours until vomiting stops; Pyridoxine (Vit B6) with or without doxylamine is the recommended first-line therapy; antiemetics may be added; once clear liquid diet; thiamine supplements
Nursing care after vomiting has stopped promote intake; mouth care before and after meals; observe family dynamics
Can occur at any time during pregnancy bleeding disorders
Early pregnancy can be caused by: ectopic pregnancy and spontaneous abortions; molar pregnancy
Mid-pregnancy bleeding can be caused by: cervical insufficiency
Late-pregancy bleeding can be caused by: placenta previa and abruptio placenta
Pregnancy that occurs outside of the uterus; leading cause of pregnancy-related death in the first trimester; can be caused by any condition or surgical procedure that can injur a fallopian tube ectopic pregnancy
Clinical manifestations of ectopic pregnancy: symptoms usually appear 4-8 weeks after LMP; most common sympton - pelvic pain and/or vaginal spotting; late signs include shoulder pin and hypovolemic shock (associated with tubal rupture); diagnosis not always immediately apparent
Tests done to confirm ectopic pregnancy: serum or urine pregnancy test; transvaginal ultrasound; culdocentesis; laparoscopy
treatment of ectopic pregnancy: depends on condition of the woman; shock requires emergency treatment; may need blood expanders or transfusion; labaraoscopic surgery is the most common; salpingectomy; IM injection of methotrexate; Rh-non-sensitized women require RhoGam
Nursing care for ectopic pregnancy: VS; monitor vaginal bleeding; rport heavy bleeding or signs of shock; assist to prepare for surgery; once stable, emotional issues become the focus; instruct woman regarding danger signs after discharge
most common complication of pregnancy; occurs les than 20 weeks of gestation or fetal size of less than 350-500 grams; common name is miscarriage; usually happens during the first trimester spontaneous abortion
Factors that increase risk of spontaneous abortion: advanced maternal age; history of previous spontaneous abortion; smoking, alcohol and substance abuse; increasing gravidity; uterine defects and tumors; active maternal infection; chronic maternal health factors (DM, renal disease, etc.)
Three overall categories of causation of spontaneous abortion: fetal (usually genetic), maternal (multiple factors), environmental (poor nutrition, exposure to chemicals, etc.)
occurs before 12 weeks; usually fetal cause early abortion
occurs between 12 and 20 weeks; usually maternal cause late abortion
Typical symptoms of spontaneous abortion: cramping and spotting or frank bleeding; hCG levels will be drawn; transvaginal ultrasound
Conservative treatment if there is a: threatened abortion
inevitable, incomplete, complete, and missed abortion treatment: prostaglandin misoprostol (Cytotec) given by mouth; vacuum aspiration or dilation and curettage (D&C) are the most common surgical methods used to clear the uterus; after uterine evacuation-IV oxytocin (Pitocin), oral methylergonovine maleate (Methergine)
nursing care after spontaneous abortion: assess vital signs, amount and appearance of vaginal bleeding, and pain level; report falling BP or rising pulse; save all expelled tissue; provide analgesics as ordered; grief reactions to be expected; accept and support woman's emotions
Created by: akgalyean