Nursing Care of High-Risk Pregnant Clients

Module 3: Nursing Care of the High-Risk Pregnant Client (Medical Complications in Pregnancy)

• Description: More women enter pregnancy with pre-existing conditions (e.g., cardiac or respiratory illnesses) that can complicate pregnancy. Nursing focuses on close observation of maternal and fetal health, educating the woman and family about warning signs, and minimizing complications. The module covers illnesses and events that may complicate pregnancy, pre-existing or otherwise.

Learning Outcomes

• LO1: Integrate scientific and humanistic concepts for high-quality maternal and child nursing care.
• LO2: Apply maternal and child nursing principles to prevent pregnancy complications that put the mother and fetus at high risk.
• LO3: Assess mothers experiencing pregnancy complications using appropriate methods and tools to address existing needs.
• LO4: Develop nursing diagnoses to address maternal and family needs related to pregnancy complications.
• LO5: Implement safe and effective interventions to address maternal and fetal needs and improve outcomes.
• LO7: Evaluate expected outcomes with mothers and families for care effectiveness and improvement.
• LO8: Prevent pregnancy complications, minimizing potential risks.

Module Outline

• Cardiovascular Disorder: Assessing for signs of cardiac decompensation (e.g., cough, respiratory congestion, dyspnea, fatigue, palpitations, tachycardia, peripheral edema, chest pain) and respiratory infection/pulmonary edema. Interventions include monitoring vital signs, fetal heart rate (FHR), and fetal condition, limiting activities, and promoting rest. Adequate nutrition for anemia prevention, low sodium diet, and avoiding excessive weight gain are essential. Medications (digitalis, iron) may be part of the treatment plan. During labor, monitoring, cardiac monitors, fetal monitors, maintaining bed rest, oxygen as needed, controlled pushing, and pain management (caudal anesthesia). Postpartum care focuses on monitoring.
• Hypertensive Disorders:
  • Gestational Hypertension: Vasospasm in blood vessels, leading to elevated blood pressure during pregnancy. Pre-eclampsia is a related condition with proteinuria; effects include problems with organs like kidneys, pancreas, liver, and brain.
  • Risk Factors: Women of color, multiple pregnancies, young (<20) or older (>40) primiparas, low socio-economic background, multiple pregnancies, polyhydramnios, underlying conditions (heart disease, diabetes, renal disease).
  • Preeclampsia: Elevated blood pressure and proteinuria. The severity ranges from preeclampsia without severe features (managed at home with monitoring) to preeclampsia with severe features (hospitalization) and eclampsia (seizures requiring intensive care).
  • Intervention: Close blood pressure monitoring, monitoring of the fetus, promoting bed rest, and promoting good nutritional intake. Hydralazine or nifedipine may be administered to reduce hypertension. Delivery may be by vaginal route if stable, otherwise C-section.
• HELLP Syndrome: A serious condition involving hemolysis (red blood cell destruction), elevated liver enzymes, and low platelets. Assessment and interventions focus on maintaining maternal and fetal well-being while managing the condition.
• Urinary Tract Infection (UTI): Assessment includes signs like frequency/urgency of urination; pelvic pain; and fever. Intervention includes increasing fluid intake, hygiene measures, and antibiotic treatment.
• Rh Incompatibility: Mother is Rh-negative, fetus is Rh-positive. Maternal antibodies can attack fetal red blood cells, leading to hemolytic disease. Prevention involves Rh immunoglobulin (RhoGAM) administration in the mother.
• HIV/AIDS: Transmission prevention and management strategies are crucial for mothers and the unborn child.
• Substance Abuse: Assessment involves the use of substances and its effect on the mother and fetus. Interventions are dependent on the specific substance and involve education, counseling, and support.