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NCM 109 – Care of At-Risk/High Risk and Sick Mothers and Child

• The course covers nursing care for at-risk/high-risk and sick mothers and children.

Nursing Care of the Pregnant Client

• Nurses support pregnant clients by ensuring their physical and emotional well-being.

Assessment of Risk Factors

• Assessment involves evaluating factors potentially affecting the mother's and baby's health.
• These factors include pre-existing health conditions, previous pregnancy complications, and maternal age.
• Lifestyle and genetic history, along with current health status are also key health indicators to monitor.
• High-risk pregnancy jeopardizes the mother, the fetus, or both.
• Risk Factors:
  • Being younger than 15 years old
  • Being primipara at 35+ years old
  • Being multiparous at 40+ years old
  • Having 5 or more pregnancies at at least 20 weeks duration
  • Gap of 8 years or more since last pregnancy.
• Medical history could be:
  • Hypertension
  • Diabetes Mellitus
  • Thyroid Disease
  • Peptic Ulcer Disease
• Maternal lifestyle habits:
  • Inadequate Nutrition leading to iron, folic acid and protein deficiency
  • Toxic substance exposure like lead, organic solvents, and radiation
  • OTC drug ingestion
• Maternal Obstetrics includes a history of:
  • 2 or more premature deliveries
  • Spontaneous abortion
  • Multiple pregnancy
  • H-mole
  • Stillbirth or fetal demise
  • Ectopic pregnancies
  • Lack of previous preparation for labor or birth
• The assessment includes inspection, palpation, percussion, and auscultation using IPPA methodology.
• Family Culture and Ethnicity:
  • Sickle cell anemia is an abnormal form of hemoglobin with rigid, sickle-shaped red blood cells
  • Thalassemia is inherited causing blood disorder from inadequate hemoglobin
  • Religious practices such as traditional beliefs are factors

Pelvic Inadequacy and Abnormal Shaping

• The pelvis structurally supports the enlarging uterus for delivery.
• Four types of pelvis:
  • Gynecoid: Most favorable for vaginal delivery, rounded and wide
  • Android: Typical male pelvis, narrow and heart-shaped, less favorable
  • Anthropoid: Oval-shaped, generally adequate for delivery, but can be long labor
  • Platypelloid: Flat pelvis, least common, often requires C-section since vaginal birth is difficult

Uterine Anomalies

• Uterine Anomalies:
  • Refers to women's differing uterus development, incompetency, position, or abnormal structure
  • Normal: pear shaped hollow organ tilted slightly forward
  • Didelphys: Rare, woman develops two uteruses, increased risk of miscarriage or preterm birth
  • Arcuate: Uterus with a minor irregularity (mild indentation at the fundus), least severe form
  • Unicornuate: Rare condition. women only has one developed half of the uterus
  • Bicornuate: Anomaly from incomplete fusion resulting two separate cavities
  • Septate: anomaly caused by incomplete growth of the central tissue

Uterine Position

• Uterine position refers to the orientation and placement of the uterus within the pelvic cavity.
• Anteverted/normal position is a uterus tilted forward (most common)
• Retroverted is a uterus tilted backward towards the spine.
• Retroflexion – bending backward
• Anteflexion – bending forward

Family History Influence

• Family history indicates genetic predisposition or shared environmental factors that may increase risk during pregnancy.
• Includes maternal and paternal medical history, and the family environment.
• Genetic examples include babies born with cleft lip and palate.

Nursing Role in Pregnancy Complications

• Nurses provide complete care to mother and unborn child during complications.

Cardiovascular Disorders and Pregnancy

• Danger of pregnancy in a woman with cardiac disease occurs due to increase in circulatory volume.
• The most dangerous time is 28-32 weeks after blood volume peaks.
• Common diseases can cause significant heart and health concerns.
• Left Sided Heart Failure signs and symptoms include:
  • fatigue
  • palpitation
  • paroxysmal nocturnal dyspnea
  • pulmonary edema
  • cough or hemoptysis
• Diagnostic Test:
  • Electrocardiogram
  • Chest X-ray
  • Coronary Angiography
  • Echocardiogram Assessment and monitoring of:
  • beta blockers
  • ACE inhibitors
  • Angiotensin receptor blockers
  • Digoxin drugs
• Treatment for left sided heart failure:
  • Medication
  • Lifestyle change
  • Surgery

Pulmonary Edema

• Pulmonary edema is a serious condition during pregnancy accumulation of fluid in the lungs, caused by impaired oxygen exchange.
• Shortness of BreathTachypneaCoughing with pink-tinged SputumCrackles is shown by signs and symptoms such as:
  • shortness of breath
  • tachypnea
  • coughing with pink-tinged sputum
  • crackles/rales lung sound
  • cyanosis with lack of oxygen
• Causes can result from:
  • Hypertensive Preeclampsia or eclampsia
  • Peripartum Cardiomyopathy
  • Valvular Heart Disease
• Assessment and monitoring requires:
  • Oxygen Therapy
  • Assistance with medication
  • Emotional Support
  • Education
• Medication treatments require:
  • Diuretics to reduce fluid retention
  • Oxygen Therapy
  • Positioning
  • Monitoring patient and treating the underlying cause

Right-Sided Heart Failure

• Characterized by the right ventricle is cannot pump blood effectively into the pulmonary circulation.
• Fatigue and weakness signs for the reason of decreased output such as:
  • peripheral edema
  • nocturia
  • swollen legs and feet
  • ascites
  • jugular vein distension
  • enlarged liver or hepatomegaly
• Assessment and monitoring of:
  • management fluid retention
  • improving cardiac function
  • prescription of diuretics
• Medications will include:
  • diuretics
  • aldosterone antagonist
• Surgical Management includes:
  • Ventricular Assist device implant or VAD

Hematologic Disorder and Pregnancy:

• Anemia:
  • Reduced red blood cell count during pregnancy, often is pseudo-anemia early in pregnancy.
  • Assessment needs to include:
    • Fatigue
    • Weakness
    • Pale skin and nails
    • Shortness of breath
  • Iron Supplement such as Vitamin B12 and dietary treatments are needed.

Iron Deficiency Anemia

• Intake of prescribed prenatal vitamins that contains is most common. Iron Deficiancy may also be caused by:
  • heavy menstral flows
  • reduced programs of getting a preganancy less than 2 yeasr before
• This must include the test for fatigue, weakness, and shortness of breath. In order to treat with the following:
  • Taking prescribed prenatal vitamins
  • Nutrition
  • Dietary Management

Folic Acid Anemia:

• Includes the Vitamin B which is neccessary for red blood cells and helps prevent neural tube defects.
• Some indications include:
  • Multiple pregnancies
  • Women will secondary hemolytic illness
  • Women who take hydantoin
• It must be determined with fatigue, weakness, pale skin diagnostic or CBC treatments.
• To treat folic acid, one must take 400ug per day with a diet reaching the following requirements.

Sickle Cell Anemia

• Blocks normal blood cell development because of genetic defects reducing the need of oxygen.
• Blacks are most the time affected. Pregnancy results in a smaller chance for effective placental circulation.
• There is no treatment except by periodic exchange.

Thalassemia

• There are similar to sickle cell anemia that also causes similar gene malfunctions and is commonly found in the Mediterranean, african and asian. Some key factors associated with it are tiredness, weakness and pale skin requiring the same treatment
• Some similar symptoms and sings include:
  • pale or yellowish color
  • slow growth
  • anlargment
  • dark urine and stool

Coagulation Disorder

• It's important to manage blood loss and prevent clotting especially because if the women has a condition.
• This could be caused by a physical state, APS or DIC
• Low molecular weight helps manage anti coagulents to prevent blood cells from passing any placenta

Respiratory Disorders and Pregnancy

• Influenza:
  • Is caused by virus that can be determined by either A,B, and C
  • Caused by fever,muscle pain, and sore throat.
• Pneumonia requires antiviral medication because the collection becomes extreme. Both mother and child should be treated safely.
• Asthma is commonly known by SOB that require short acting brochodilators

Pregnant Women with Tuberculois.

• Common causes TB to affect a fetus from infection or birth defects and should be prevented by taking the following measures.
• Pre Term baby.
• Low birth weight

Renal and Urinary Disorder and Pregnancy

• Urinary Infection
  • Caused by effects to the unrinary system that causes pain and burnig due to hormonal changes or pregnancy, as well as antibiotics needs.
• Pylonephrites:
  • A type of UTI that involves inflammation or kidneys that are caused by a certain type in the urinary tract.
• Chronic Renal Disease.
  • Its caused over time that cause swelling or fatigue as well as blood related diseases

Gastrointestinal Disorder and Pregnancy

• Peptic Ulcer disease may required antiobiotics that may be affected by lifestyle guidance or dietary.
• Hapatitis involves medication for its symptoms and treatment according to diet and test. Blood test of antivirals and eating small meals might reduce hemmorids or vomitting issues.

Neurologic Disorder and Pregnancy

• Myethemia Grevis can be treated with antibody management and medication that will affect the nervous system of the individual
• Pregnancy is very carefully monited to avoid complications that may result to serious defects.

Musculosketal Disorder and Preganacy

• Scoliosis can be a long-term for pregnant women that can lead to abnormalities. Pain is carefully managed.

Endoctrine Disorder and Pregancy

• Can be caused by many disorders and can be treated with thyroid regulation or dietary plans.
• Blood level is critically and glucose is all important

Diabetes Melitus and Pregnancy.

• Can affect all areas related to glucose and require serious medication and monitoring.

Diabetes Meletus in Pregnant Women:

• Many tests needs to be taken for safe delivery.
• A 2 or 3 hours glucose tests need to be taken.
• Signs of high sugar also needs to be determined.