Nursing Management of Pregnancy at Risk

Chapter 20: Nursing Management of Pregnancy at Risk

• This chapter focuses on nursing management of pregnancies at risk due to selected health conditions and vulnerable populations.

Objectives

• Understand the impact of iron deficiency anemia on pregnancy.
• Describe adolescent pregnancy and the factors that place this population at risk.
• Characterize pregnancies in women over 35 and the associated risks.
• Identify risks for pregnant women with substance abuse and their fetal effects.
• Understand how maternal cardiac complications affect pregnancy and the fetus.
• Differentiate between infections such as Rubella, Cytomegalovirus (CMV), Group B Streptococcus (GBS), and sexually transmitted infections (STIs).

Iron-Deficiency Anemia

• Increased risk in pregnancy due to increased need for maternal and fetal blood volume.

• Usually caused by inadequate dietary intake.

• Possible pregnancy complications include preterm labor, low birth weight, perinatal mortality, postpartum (PP) depression, and hemorrhage.

• Nursing assessment includes subjective symptoms like fatigue, weakness, malaise, anorexia, headache, and changes in cognitive function.

• Objective findings in a patient with iron deficiency anemia include susceptibility to infections (colds), pica (unusual cravings or eating non-food items), pale mucous membranes, tachycardia, and restless legs syndrome.

• Abnormal lab results typically show low hemoglobin levels (<11), low hematocrit (<35%), and low serum iron (<30).

• Therapeutic management includes eliminating symptoms, correcting the deficiency, and replenishing iron stores.

• Routine iron supplements (30 mg/day) are started at first prenatal visit.

• Iron should be taken with vitamin C to improve absorption.

• Taking iron with meals, increasing fiber intake and fluid, eating foods like dried fruits, whole grains, leafy green vegetables, meats, peanut butter, and iron-fortified cereals to improve iron intake.

Vulnerable Populations

• This section focuses on different vulnerable populations during pregnancy.

Pregnant Adolescent

• Approximately 1 in 4 teens get pregnant by age 20, making this a substantial consideration for nurses.

• Teens are less likely to receive early and consistent prenatal care, often due to financial concerns.

• Pre-existing issues like malnutrition, infectious diseases, or deficiencies in healthcare impact pregnancy outcomes.

• Psychosocial factors such as loss of self-esteem and social discrimination negatively affect pregnancy.

• Obstetric complications, including preterm labor, low birth-weight infants, STIs, poor maternal weight gain, preeclampsia, iron-deficiency anemia, and postpartum depression are also potential complications.

• Nursing assessment should consider vision for the future, access to realistic role models, emotional support, educational level, financial resources in relation to work/school, ability to manage anger and conflict, and understanding of health and nutrition for both the mother and child.

• Challenges in parenting roles must also be considered.

• Nursing management should include support and education on options like abortion, self-parenting, adoption, or foster care.

• Future planning should involve goal setting, return to school or career options, and recognition and removal of barriers to prenatal care.

Substance Abuse in Pregnancy

• The impact of substance abuse on the fetus includes fetal vulnerability, addiction, lack of prenatal care.

• Obstetric complications include preterm labor, abortion, IUGR (intrauterine growth restriction), placental abruption, and fetal demise.

• Fetal risks include low birth weight, decreased APGAR scores, neurobehavioral and structural anomalies, and long-term childhood developmental consequences.

• Fetal effects of substances like alcohol (FASD), sedatives (CNS depression), nicotine (fetal hypoxia and IUGR), marijuana (tremors and hyperactive startle reflex), and narcotics and methamphetamines (neonatal abstinence syndrome) and cocaine (low birth weight and fetal anomalies) are presented.

• Nursing assessment must include history and physical exam, screening questions, and urine toxicology screens.

• Nursing management includes non-judgmental approach.

• It's essential to contact state protection agencies if positive newborn screens are found, and to provide support, counseling, and education.

Advanced Maternal Age in Pregnancy

• Women giving birth at 35 or older are at higher risk for infertility, pregnancy loss, chromosomal or structural birth defects.
• Obstetric complications such as gestational diabetes, hypertension (HTN), postpartum hemorrhage, preeclampsia, can occur.
• Prenatal assessment for preconception counseling should focus on optimal health before pregnancy and establish a baseline for labs and diagnostics.
• Nursing management involves promoting healthy pregnancy and education.

Cardiovascular Disorders

• Congenital or acquired heart disease can be a risk factor, along with risk factors like high cholesterol, hypertension, diabetes, smoking, obesity, and a sedentary lifestyle.
• Pregnancy stress can expose or exacerbate underlying cardiac issues.
• Prenatal risk assessment is crucial before pregnancy.
• More frequent prenatal visits are necessary, as are monitoring for premature birth, low birth weight, and respiratory distress syndrome.
• Nursing assessment should include functional class evaluation, assessment for cardiac decompensation (symptoms like shortness of breath, chest pain, rapid respirations, palpitations, and syncope) and common issues seen around 28-32 weeks.
• Nursing management involves education, counseling, and support, along with potential drug therapy, and fetal monitoring.

Infections in Pregnancy

• Different infectious risks during pregnancy, including Rubella, Cytomegalovirus (CMV), Group B Streptococcus (GBS), herpes simplex virus (HSV), and Hepatitis B Virus (HBV), are discussed.
• Each infection has specific transmission modes, characteristics, complications for the mother and the fetus, and essential management strategies.

Apply Your Knowledge

• This section provides multiple-choice questions to assess the learner's understanding of the presented information on risk factors, assessments, and management.

This quiz covers the nursing management of pregnancies at risk, focusing on health conditions such as iron deficiency anemia, substance abuse, and complications in older mothers. Test your knowledge on the factors affecting adolescent pregnancies and various maternal infections. Gain insights into how these risks impact both mother and fetus.