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NURSING CARE FOR WOMEN W/ • Moderate to severe renal disease

COMPLICATIONS DURING PREGNANCY • Previous endocrine ablation 10


• Sickle cell disease 5
High-risk pregnancy • Epilepsy 5
-One in which the health of the mother/fetus • Heart disease NYHA class I (no
is in Jeopardy symptoms) 5
-increased risk of morbidity/mortality
• Hx of TB/PPD >10mm 5
before/after delivery
• Positive serology (for syphilis) 5
-leading cause of death and disability among
women (515,000 women/yr) • Pulmonary disease 5
-women: 30-endure injuries; infection and • Thyroid disease 5
disabilities
-early and consistent assessment for risk Family Hx
factors during prenatal visits • DM 1

Ways for identification clients at risks Physical risk factors


1. Assessment of risk factors • Incompetence cervix 10
a. Physiological • Uterine malformalities 10
b. Psychological • Maternal weight <100lbs or >200 lbs
C. Social 5
• Maternal age 35 and over 15 and
Risk Assessment Tool under 5
-Hobel, 1973 • Small pelvis 5
-risk factors are assigned a score
corresponding to the degree of risk Current pregnancy risk factors
-A score 19 or more indicates a high risk • Abnormal fetal position 10
that should receive more than routine • Moderate to severe preeclamsia 10
prenatal care • Multiple pregnancy 10
• Placenta abruption 10
OB Hx
• polylydromnios/oligohydromnios 10
Risk Factor
• excessive use of drugs/alcohol 5
• Previous still birth 10
• gestational diabetes (A1) 5
• Previous neonatal death 10
• kidney infection 5
• Previous premature infant 10
• mild preeclampsia 5
• Post term.42 weeks 10
• Rh sensitization only 5
• Fetal blood transfusion for hemolytic
disease 10 • Severe anemia <9g/dl hemoglobin
• Repeated miscarriages 5 5
• Severe flu syndrome/viral disease 5
• Previous infant >10lbs 5
• Vaginal spotting 5
• Six/more completed pregnancy 5
• Bladder infection 1
• Hx of eclampsia 5
• Emotional problem 1
• Previous cesarean section 1
• Mild anemia 9g/dl hemoglobin 1
• Hx of preeclampsia 1
• Moderate alcohol use 1
• Hx of preeclampsia 1
• Smoking > = 1 pack/day
• Hx of fetus w/ anomalies 1/0
Fetal diagnostic tests
Medical Hx
-birth defects
Risk factor
-diagnostic/screening test
• Abnormal PAP Test 10
• Chronic HPT 10 Diagnostic vs. screening
• Heart disease NYHA class II-IV Diagnostic – whether a fetus has a particular
(symptomatic) 10 condition w/ certainty but may provide
• Insulin dependent diabetes (>A2) limited information about the other types of
10 birth defects
Screening- not accurate, help to identify
patient at risk who light benefit from Low levels of AFP
diagnostic test -abnormal chromosomal or gestational
trophoblastic disease
Fetal well-being -Trisomy 21 (Down syndrome)
-fetus movements are directly r/t infant’s -Trisomy 18 (Edward's syndrome)
sleep-wake cycle vary from mother
-typical active fetal period lasts 40 min and Chorionic Villi Sampling (CVS)
peaks between 9PM and 10 PM in response -obtain a small part of developing placenta
to maternal hypoglycemia to analyze fetal cells
-10-12 weeks
Ultrasound -results = 24-48 hours
-non-invasive procedure;uses intermittent -can't determine spina bifida/anecephaly
ultrasonic waves transmitted by an -identify chromosome (abnormal)
alternating current to a transducer applied to -newborn: limb reduction defects
abdomen -Rh (D) immune globulin given to Rh-
-ultrasonic waves: defect off tissues w/in negative woman
abdomen, showing structures of varying -↑ rate spontaneous abortion than
densities amniocentesis
-requires full bladder (1-2 qts of water)
Amniocentesis
Transvaginal Ultrasound -insertion of thin needle through abdominal
-detect shortened cervical length/funelling and uterine walls (sample on amniotic fluid);
(predict preterm labor) invasive
-uses a probe inserted into vagina -15-17 weeks
-done early is pregnancy (fetal age, -early: 11-14 weeks of some disorder
suspected etopic pregnancy)
Usage (Amniocentesis)
Transabdominal Ultrasound -identify chromosome abnormalities,
-transducer biochemical disorders and level of AFP
-often scanned with full bladder (water every -spontaneous abortion
15 mins. 90mins before examination) -identify severity of maternal fetal blood
incompatibility and assess fetal lung maturity
Nursing Responsibility (UT2) -Rh (D) immune globulin given to Rh-
-inform patient about the procedure negative woman
-provide comfort and privacy
Nursing Responsibilities (Amniocentesis)
*empty bladder (transvaginal UT2) -dorsal -obtain informed consent
recumbent -provide comfort and privacy
*full bladder (transabdominal UTV) -supine full bladder, position, drape
*position -aseptic technique (hand wash, gloves)
*drape
Non-stress Test (NST)
Alpha-Fetoprotein Testing (AFP) -response of FHR to fetal movement
-maternal alpha-fetoprotein test -monitor FHR
-determine level of fetal protein in women's
serum/sample of amniotic fluid Usage of (NST)
-16-22 weeks of pregnancy -identify fetal compromise (poor placenta
function)
High levels of AFP -reassess placenta is functioning well and
-a neural tube defect oxygenated, intact CNS
spinabifidy (open supine)
anecephaly (incomplete division of *Non-reactive at risk = not good
skull and brain) *1 fetal movement = +45FHR
-defects with esophagus
-gastroschisix (baby's failure) -30-32 weeks
*Reactive= 2 accelerations of FHR with fetal -identify reduced fetal oxygenation in
movements of 15 beats/min, lasting 15 sec conditions associated with poor placental
or more for 20 min functioning
*2-15 beats-15sec-20min -↑FHR → deprivation of oxygen
-fetal hypoxia increases, FHR changes,
Contraction Test (CT) cessation
-evaluating respiratory function of placenta -amniotic fluid is reduced when placental
-identify risk for intrauterine asphyxia by function is poor
observing response of FHR to stress of fbrem, gross body movement, loss of FT
contraction A-mniocentesis
L-/S ratio
Negative- shows 3 contractions good quality O-xytocin Test
lasting 40 or more secs in 10 min without N- on-stress Test
evidence of late decelerations E-steriol level
-fetus can handle the hypoxic stress of
uterine contractions PREGNANCY AT
RISK:PREGESTAITIONAL PROBLEMS
Positive – shows repetitive persistent late
deceleration with more than 50% of Sexually Transmitted Disease (STD)
contractions -15-24y/o
-hypoxic stress cause showing FHR -↑ STD group: Sexually active youth
-Pregnant: miscarriage, premature delivery
Equivocal – non persistent late
decelerations or with hyper stimulation (2 Risk factors:
min frequency of duration longer than 90) 1. lower socio-economic status
2. lower education level
Percutaneous Umbilical Blood Sampling 3. sexual activity with multiple partners
(PUBS) 4. unsafe sexual intercourse
-anemic fetus (maternal fetal blood
incompatibility, placenta previa, abrupt Etiologic Agent: Candida Albicaus (fungus)
placentae) Candidiasis – thick yellow vaginal disharge
-blood sample from placental vessel − extreme pruritus (yeasty
or no odor)
Lecithin to Sphingomyelin (l/S) ratio Med management:
-respiratory complications in adapting 1. application of an over-the-counter
extrauterine life anti-fungal cream (Monistat) for 7
34-38 weeks days
-lung mature → ↑ lecithin ↓ Sphingomyelin 2. oral flucanozole (anti fungal)
-2:1 (normal value)
Trichomoniasis – irritation, itching
Phosphatidyl glycerol (+) - baby will not Etiologic agent: Trichomonas vagindlis
suffer respiratory distress syndrome on Signs and symptoms – profuse greenish-
delivery yellow discharge with foul odor
Effects – preterm labor, premature rapture of
Biophysical Profile (BPP) membranes, post cesarean infection
1. FHR and reactivity (NST) [reactive -
2] Med management:
2. Fetal Breathing Movement 1. metronidazole ( anti fungal)
[breathing/60sec – 2]
3. Fetal Body Movement [3 Nursing management:
movements of arms, legs, body – 2] 1. Verbalize feelings
4. Fetal Tone [ return of flexion – 2]
5. Volume of amniotic fluid [>1cm – 2] Bacterial Vaginosis
Etiologic agent – Gardenella Vaginalis
Signs and symptoms – gray discharge, fishy
odor/musty
-pruritus 2. procaine penicillin, IM, 750mg for 10
days
Effects: 3. erythromycin 500mg, 4x//day for 14
1. pelvic inflammatory disease days (allergy to penG)
2. posthysterectomy vaginal cuff 4. azithromycin 500mg, daily for 10
cellulitis days (allergy to penG)
3. endometritis
4. amniotic fluid infection Jarisch-Herxcheimer reaction
5. preterm delivery/labor -caused due to sudden destruction of
6. PROM spirochetes;last for 24 hours
7. spontaneous abortion Signs and symptoms – fever, tachycardia,
muscle aches
Med management:
1. topical – Metronidazole (Flagyl) Gonorrhea
0.75% vaginal gel etiologic agent – neissoria gonorrhoeae
Clyndamycin 2% cream Signs and symptoms – yellow-green vaginal
2. Oral – Metronidazole 500% mg (2x) discharge
- Clyndamycin 300mg (2x) effects to fetus/pregnancy:
Chlamydia
1. severe eye infection → blindness
Etiologic agent – chlamydia vaginalis 2. endocervitis
-ectopic pregnancy, preterm PROM, 3. PROM
premature delivery
-heavy gray-white discharge Med management
-cervicitis, urethritis, vaginalis, pelvic 1. oral cefixime (Suprax) 400mg, once
inflammatory disease (clinical 2. ceftriaxone (rocephin) 125-250mg,
manifestations) IM, once
-60-70% risk → infected birth canal
Effects – conjunctivitis, pneumonia Side effects: nausea, vomiting

Med management HIV/AIDS


1. tetracydin and deoxycycline -4th leading cause of death among women
2. amoxicillin – pregnant 25-44 y/o
3. aztromycin (1g) -pregnant -leading cause of death and disease world
wide, main risk factor: unsafe sex
Syphilis
Etiologic agent – treponema pallidum Stages of HIV infection:
Signs and symptoms: 1. initial invasion – flulike symptoms
• primary stage – small, hard-based 2. serocoversion- converts from having
sore no HIV antibodies
• secondary stage – skin rashes, loss -happens 6weeks-1year after exposure
of patches of hair, malaise, fever 3. asymptomatic period -weight loss,
• latent stage – asymptomatic fatigue (3-11yrs)
• tertiary stage – gumma formation 4. symptomatic period – oppurtunistic
(rubbery mass of tissue) infection occur oral and vaginal
Effects: candidiasis, Kaposi sarcoma...
1. spontaneous abortion Dx procedure:
2. still born infant a. ELISA(screening test)
3. premature labor enzyme-linked immunoabsorbent assay
4. congenital syphilis (enlarged liver, antibody detection test
spleen, skin lesions, rashes, b. western blot analysis – confirmatory test
pneumonia, hepa)
Dx:risk for infection r/t dysfunction immune
Med management: system
1. benzathine penicillinG (pregnant) Nursing management:
1. aseptic technique -ascites (leak of fluid to peritoneal act)
2. administration of med as prescribed -peripheral edema
3. provide health care education on:
-breastfeeding Effect to fetus:
-protected sexual activity 1. low birth weight
2. abortion
Nursing management for STD 3. intrauterine growth retardation
1. assessment Hx taking (multiply 4. still birth
partners, unprotected sex) 5. premature labor
2. Dx = knowledge deficit Med management:
3. intervention: 1. Digoxin – to slow ventricular
-discuss causes of STD:multiply partners response and to increase
-teach about proper hygiene:perineal and myocardial contractility
hand washing 2. diuretics -for acute and chronic
-sensitivity, confidentiality heart failure
-counseling before and after testing allay 3. beta-adrenergic blockers
fears (propandol) – arrhythmia associated
-provide accurate information with ischemic heart disease
-provide referral to needed medical and 4. amonophylline – relives
psychological services bronchospasm
5. heparin- with artificial valves or
Cardiovascular Diseases artrial fibrillation
-total blood volume: at least 30%
-iron requirement: 800mg Surgical management:
-cardiac output by 25%-50%, increase heart 1. therapeutic abortion -Class II and IV
rate 2. cardiac surgery – alternative to the
therapeutic abortion
NYHA -closed cardiac surgery is preferred
Class I – no discomfort (dyspnea,
palpitation, anginal pain) on ordinary act Nursing management:
Class II – discomfort on ordinary act 1. monitor fetal well being (9PM-10AM)
Class III- discomfort on less than ordinary 2. promote rest
act 3. promote healthy nutrition – low
Class IV- dyspnea at rest. Patient is sodium diet
decompensated 4. instruct about avoiding infection

Effects to mother:

Left-sided H.F.
-edema
-Prod cough of blood-speckled sputum
-orthopnea
-increase RR
-fatigue
-dizziness
-weakness
-paroxysmal nocturnal dyspnea

Right-sided H.F. -there you go. Aralin niyo yan! :))


-jugular vein distension
-hepatomegaly ©BSN-2H notes
-extreme dyspnea
-pain