high risk antepartum nursing care 4 (1)

8/12/2019 High Risk Antepartum Nursing Care 4 (1)

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Sickle Cell Anemia

Nursing Care: Monitor fetal status

Provide emotional support


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RH Sensitization RH Sensitization is a condition in which a Rh-negative

women becomes pregnant with a Rh-positive fetusand may become sensitized to Rh antigen and

develops anti-Rh antibodies which may cross theplacenta in subsequent pregnancies with Rh-positivefetuses and destroy the RBCs.

Complications:

Erythroblastosis fetalis Hydrops fetalis

Hyperbilirubinemia /Kernicterus

Fetal dead


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RH Incompatibility


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Rh SensitizationAll pregnant women should have a Type and Rh and

an indirect Coombs.

Pregnant women who are Rh-negative should have :

Serial Indirect Coombs Unsensitized Rh-negative clients should have RhoGam:

During pregnancy at 28-32 weeks gestation

After any invasive procedures.

In the Postpartum period within 72 hours.


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RH Incompatibility Nursing Care:

Teach Client about the importance of complying withprenatal visits, laboratory testing, and RhoGaminjection

Check Laboratory results on all pregnant clients . Reportfindings of the client having Rh-negative blood andindirect Coombs results. Follow through if invasiveprocedures are done or after delivery about RhoGam.

Support client who has developed fetal complicationsfrom Rh incompatibility


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Hyperthyroidism and Pregnancy

HYPERTHYROIDISM is an endocrine disorder inwhich there is a excessive amount of the thyroidhormone produced.

Complications in pregnancy:

Thyrotoxicosis(Thyroid storm) Cardiac Dysrrhythmias

Preeclampsia

Malnutrition

Fetal complications: abortion, premature delivery

Neonatal complications: Prematurity, hyperthyroidism


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Hyperthyroidism In Pregnancy Review of the clinical manifestation of Hyperthyroidism

Tachycardia and Palpitations

Nervousness

Weakness Tremors

Heat intolerance

Weight loss despite eating regular diet,

Hair loss Diarrhea

Hyperemesis gravidarum

T4 and T3 are elevated an TSH decreased


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Hyperthyroidism and Pregnancy NSG. DX: Alt. Nutrition, less than body requirements Risk for injury

Knowledge deficit

Nsg Care- Assess the client for clinical manifestation of

complications of the hyperthyroidism or pregnancy

Monitor lab tests- thyroid function tests

Administer antithyroid medications- Propylthiouracil(PTU)

Assist the client to meet her nutritional needs duringthe pregnancy with education and evaluation of diet .


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Hyperthyroidism in Pregnancy Nsg. Care-

Daily weights

Monitor fetal status Emotional support


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Hypothyroidism in Pregnancy Hypothyroidism is a condition where thyroid does not

produce enough thyroid hormone Complications

Decreased fertility Abortions Stillborns And congenital malformations

Review of the clinical manifestations of hypothyroidism Cold intolerance Weight gain

Dryness of skin Puffy face Constipation Mental dullness


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Systemic Lupus Erythematosus in

Pregnancy Systemic Lupus Erythematous(SLE) is a chronic,

multisystem autoimmune disorder Complications in pregnancy

Renal Failure Cardiac Problems CNS Problems Preeclampsia Abortions

Fetal Loss Newborn- prematurity, congenital heart block, and neonatal

lupus IUGR Exacerbation of SLE


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Pregnancy Review of the clinical manifestations of SLE

Joint pain

Skin rash

nephritis

Pericarditis

Anemia

Leukopenia

Thrombosis of multiorgans

Fever

neuropsychiatric


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Pregnancy Laboratory Findings with SLE

Leukopenia- WBC under 4,500

Thrombocyctopenia- PLt- under 100,000 Anemia- Hg- under 10

Positive direct Coombs test

Positive Anticardiolipin antibodies

Positive tests for rheumatic factors False Positive test for syphilis

Positive antinuclear antibodies Increased serum creatineand decreased creatine clearance and proteinuria


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Cont. SLE in Pregnancy NSG Diagnosis

Risk for Maternal and Fetal Injury Knowledge Deficit Anxiety or Fear

NSG Care Preconceptation Care Instruct the client to see her health care providers frequently

and to follow the medical therapy Monitor the client and the fetus and neonate for

complications Administer Medications as order

Prednisone Aspirin Cyclophosphamide( Cytoxan)- only for life-threatening conditions Azathioprine (Imuran)


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Anticardiolipin Antibody Syndrome Anticardiolipin Antibody Syndrome is an autoimmune

disorder which the client has the Anticardiolipinantibodies. It can be seen in clients with or without SLE. Itcan produce negative outcomes in pregnancy and fetal loss

Complications of Anticardiolipin antibody syndrome inPregnancy

Maternal

Thrombosis

Cerebral vascular accidents,

Amaurosis fumax Transient ischemic attacks

SLE

Autoimmune thrombocytopenia


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Anticardiolipin Antibody Syndrome Nsg Diagnosis

Risk for Maternal and Fetal Injury

Anxiety or Fear

Nsg Care

Administer medications

Immunosuppressant drugs- corticosteroids and others

Aspirin

Anticoagulants-Heparin

Instruct on medication therapy

Monitor client and fetus for complications

Emotional support


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Myasthenia gravis in Pregnancy

Myasthenia gravis (MG)is a complex autoimmunedisorder that affects the neuromuscular system .

Complication of MG in Pregnancy

Exacerbation of the myasthenia gravis or a myasthenic

crisis Maternal mortality because of respiratory arrest

Pregnancy loss

Premature labor

Transient Neonatal Myasthenia Gravis

Pulmonary Hypoplasia of the neonate


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Myasthenia Gravis in Pregnancy Review of the clinical manifestations of MG

Progressive muscle weakness Difficulty in swallowing Ptosis

Slurred speech Fatigue Problems breathing

NSG Diagnosis Risk for Maternal and Fetal Injury

Anxiety or Fear Fatigue Alter nutrition Risk for aspiration


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Myasthenia Gravis in Pregnancy NSG Care

Monitor client and fetus for complications

Administer medications Many medications willexacerbate MG .Check any medication prior to give it.

See chart Acetylcholinesterase drugs

Pyridostigmine bromide ( Mestinon) po or parental if clientcan not swallow Check that client can swallow first

Anticholinergics ( Atropine)for drug over dose

Corticosteroids- Prednisone Instruct client on therapy regimen and compliance with

the therapy and seeing health care providers regularly.

Monitor client closely in Labor.


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Myasthenia Gravis In pregnancy

NoteMagnesium sulfate is absolutely contraindicatedfor clients who have Myasthenia Gravis

Prepare room with suction ,oxygen, and ambu bag andcheck emergency equipment.

Check infant at time of birth and in nursery forsucking and muscle tone. Watch when the baby feeds.

Provide frequent rest periods for mother


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Deep Vein Thrombosis in

Pregnancy Deep Vein Thrombosis (DVT)is a condition where

blood clots form in the veins.

Complications of DVT in Pregnancy

Vascular occlusion

Embolism

Pulmonary embolus

Hypoxia Acidosis

death


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Pregnancy Clinical Manifestations of DVT

Muscle pain

Tenderness and swelling of calf

Positive Homans sign

Diagnostic parameters

Doppler ultrasonography

Venography may cause risk to fetus Impedance plethysmorgraphy


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Pregnancy NSG Diagnosis

Alter. Tissue Perfusion

Risk for Injury

NSG Care Maintain bedrest during the acute phase

Apply Ted hose

Monitor fetal status

Administer Anticoagulation therapy Heparin-IV the Subcutaneous

Follow protocols for anticoagulant therapy

NO Warfarin Coumadin


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Deep Vein Thrombosis In

Pregnancy NSG Care

No heparin therapy once labor starts.

Monitor laboratory testing

PT, APTT, INR, Blood clotting times


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Infections Types of infections:

TORCH

STIs

Other


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TORCH TORCH is a group of infections which can cause

serious problems to the fetus

T= Toxoplasmosis

O= Other- Hepatitis -HIV R= Rubella

C= Cytomegalovirus (CMV)

H= Herpes


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Toxoplasmosis Toxoplasmosis is a protozoan infection which is

acquired by the infestation of raw meat and handlingof raw meat in mass qualities, cat feces and handlingcat litter. If the pregnant acquires toxoplasmosis

during pregnancy it can be passed the fetus via theplacenta.

Maternal effects are mild-flu-like symptoms

Fetal-abortion, and congenital effects

Neonatal effects- CNS lesions which could lead tohydrocephy, microcephaly, seizures and chronicretinitis


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Toxoplasmosis Pregnant Clients should not handled cat litter or cat

feces. When handling cats wash hands afterwards

Pregnant clients should not eat raw meat and whenhandling large amounts of raw meat they should wear

gloves. Wash hands after handling raw meat


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Other Hepatitis is a viral infection. There are several different

types. HAV and HBV are the must common seen inthe fetus. HAV is acquired through fecal commination.

HBV is acquired through body secretions-blood andgenital secretions

HBV effects on the client are fever, malaise, nausea,and abdominal discomfort and maybe liver failure.

HBV effects on the fetus preterm birth and fetal death.

The Neonate can be born with the infection


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Rubella

Rubella is a viral infection that is spread by droplets orcross the placenta. It is also called the GermanMeasles.

Rubella titers are drawn on all pregnant women Rubella titer of 1:8 or more indicated immunity

Rubella less than 1:8-example a titer of 1:6 or 1:4indicates the client is non-immune. The client will needa Rubella immunization after delivery.

Rubella effects on the client are fever, rash and mildlymphedema.

Fetal effects are abortion, congenital anomalies anddeath


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Cytomegalovirus

Cytomegalovirus (CMV) is a viral infection throughrespiratory droplets and body fluids and cross theplacenta.

CMV effects on the pregnant client are asympotomaticillness, cervical discharge, or mononucleosis-likesyndrome.

CMV effects on the fetus are fetal death or severe

generalized disease, hemolytic anemia, jaundice,hydrocephaly, microcephy.

CMV effects on the neonate are pneumonia,hepatosplenomegaly and deafness


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Herpes Simplex Virus

Herpes Simplex Virus (HSV)is a viral infection that isspread by exposure to the vesicular lesions.

HSV effects on the pregnant client are blisters whichare painful, rash, fever, malaise, nausea, andheadaches.

HSV effects on the fetus are abortion, preterm labor,

stillborn, IUGR- transplacental spread of infection israre.

HSV effects on the neonate are skin lesions, mentalretardation, and microcephaly


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STIs

Human Immunodeficiency Virus (HIV)

Chlamydia

Syphilis Hepatitis B

Group Beta Streptococci (GBS)

Herpes

Gonorrhea

Human papillomavis (HPV)


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Urinary Tract Infections in

Pregnancy Lower UTIs Cystitis Can cause preterm labor and pyelonephritis

Upper UTIs- Pyelonephritis

Can cause preterm labor , sepsis, and renal failure Medications

Cephalosporin's

Ampicillins or Amoxicillin

No Sulfonamide within 4 weeks of delivery can causekernicterus in the neonate

No Trimethoprim in early pregnancy

No Tetracyclines


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Epilepsy in Pregnancy Epilepsy is a neurologic disorder in which there is

recurrent seizure activity.

The client who is pregnant and has epilepsy couldhave an increased risk for seizures , abortions,premature labor, and stillborn infants.

Many anticonvulsants can produce teratogenic effects

Phenytoin(Dilantin)

Carbamazepine

Dapakote The pharmokenetics of the seizure medication is effect

by the changes in physiology during pregnancy.


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Trauma in Pregnancy

Trauma in pregnancy Abdominal Trauma can be caused by

Accidents such as falls or automobile accidents (MVA)

Assault

With weapons

Abuse/violence

Complications unique to pregnancy of abdominaltrauma Placenta abruption

Preterm labor Uterine trauma or rupture

Bladder trauma or rupture

Maternal or Fetal death


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Trauma in Pregnancy

Clinical Manifestations History of trauma or accident

Visible injuries

Pain

Signs of Shock

Uterine activity

Abdominal swelling or firmness

Nonreassuring fetal Heart Pattern

Nsg diagnosis

Risk for Injury Anxiety

Alt. Tissue Perfusion Fear


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Trauma in Pregnancy

NSG Care Assess and triage the serious of injures

ABCs

Start Iv with Large bore catheter

Monitor for clinical manifestations of shock and /orhemorrhage

Monitor uterine activity

Monitor fetal heart pattern

I&O-hourly Be Prepare for a delivery of the baby

Notify ICN staff

Emotional support


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Cholcycstitis and Cholelithiasis in

Pregnancy Cholcycstitis and Cholelithiasis are common during

pregnancy.

Clinical manifestations Right upper quadrant tenderness and pain

Murphy Sign

Attacks after meals

Pain with nausea and vomiting

Medical Treatment during pregnancy

Low Fat Diet


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Cont. NSG Care

Monitor for signs of Gall bladder obstruction

Instruct client on low fat diet

Less than 20grams of fat Calories such come mainly from carbohydrates

Plenty of fruit and vegetables

Lean meats

Only 10-12% of calories such be proteinA pregnant client will not be able to have lipotripesy

or drugs to dissolve gall stones.


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SUBSTANCE ABUSE in Pregnancy Substance Abuse is a major problem in the United

States . It is estimated that 10% of pregnant abuse 0ruse some substance during pregnancy. (Tobacco,

alcohol or other drugs)All pregnant women should be screened for substance

abuse.

See text for the effects of drugs on the fetus andneonate and pregnancy


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high risk antepartum nursing care 4 (1)

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