Pregnancy Complications and Screening Quiz

NCM 109 - Care of Mother and Child at Risk or with Problems (Acute and Chronic) - LECTURE

• Course offered at Wesleyan University, Philippines, College of Nursing
• This is a preliminary period lecture, week 2

Chapter 20 - Care Given to a Mother Experiencing a Pregnancy Complication from a Pre-existing or Newly Acquired Illness

• Nursing Care Plan:
  • Focus on signs and symptoms of illness (subjective and objective data)
  • Examples:
    • Woman's level of exhaustion (subjective)
    • Extent of edema (objective, vital signs).
  • Nursing Diagnosis: based on gathered data
  • Examples:
    • Ineffective tissue perfusion (cardiopulmonary) related to poor heart function secondary to mitral valve prolapse during pregnancy
    • Pain related to pyelonephritis secondary to uterine pressure on ureters
    • Social isolation related to prescribed bed rest during pregnancy secondary to concurrent illness
    • Ineffective role performance related to increasing level of daily restrictions secondary to chronic illness and pregnancy.
• Outcome Identification and Planning:
  • Example: Maintaining woman's health, minimizing hospitalization, and family disruptions for chronic illness, allowing women to participate in her care and maintain self-esteem is of paramount importance, and step forward to parenthood for new mothers.

Normal Heart Diagram

• Includes: Superior Vena Cava, Inferior Vena Cava, Pulmonary Veins, Pulmonary Valve, Atrial Septum, Pulmonary Artery, Aorta, Mitral Valve, Tricuspid Valve, Aortic Valve, Ventricular Septum, Right Atrium, Left Atrium, Right Ventricle, Left Ventricle

Cardiovascular Disease and Pregnancy

• Danger of pregnancy for women with cardiac disease occurs primarily due to increasing circulatory volume.
• Most dangerous time is during weeks 28-32 after blood volume peaks.
• Conditions like mitral stenosis, mitral insufficiency, and aortic coarctation affect the left ventricle's capacity to move blood from the pulmonary circulation forward.

Implementation

• Teach measures to maintain health during pregnancy
• Specific examples given, including rest periods, exercise program, and taking medicine for thyroid condition

The Level of Failure in Pregnancy Cardiac Disorders

• Can be at the level of the mitral valve
• Normal physiologic tachycardia of pregnancy shortens diastole and decreases the time for blood flow
• Ineffective mitral valve pushing blood forward leads to pulmonary hypertension, decreased systemic blood pressure, and hypotension

Surgical Management

• Balloon valve angioplasty (to loosen mitral valve adhesions)
• If anticoagulant required, heparin is the drug of choice (does not cross the placenta)
• Right-sided heart failure occurs when the right ventricle's output is less than the blood volume received from the vena cava.
• Congenital heart defects (pulmonary stenosis, ventricular septal defects), lead to blood congestion and decreased cardiac output to the lungs

Pulmonary Edema

• Orthopneic; suddenly wakening during night with shortness of breath
• Most effectively when resting

Medication Management for Pulmonary Edema

• Antihypertensive medications
• Diuretics
• Beta blockers
• Low-sodium diet

Signs and Symptoms of Pulmonary Conditions

• Productive cough with blood-speckled sputum
• Risk factors include: spontaneous miscarriage, preterm labor, and maternal death
• Reduced oxygen saturation of blood due to alveolar dysfunction leads to increased respiratory rate (RR)
• Fatigue, weakness, dizziness, increased heart rate (HR), peripheral constriction are common symptoms.

Pregnant Patient with Peripartum Heart Disease

• Rare condition originating during pregnancy in those without previous heart disease
• Unknown cause; possibly stress of pregnancy
• Symptoms include shortness of breath, chest pain, nondependent edema, and cardiomegaly; treatment includes reducing physical activity, diuretics, arrhythmia medication, and immunosuppressive therapy.

Management of Pregnancy with Existing Conditions

• Essential to monitor fetal health (through ultrasounds, as well as other measures).
• Oxygenation
• Monitoring fetal development
• Close management to minimize risk of hypotension after epidural anesthesia

Blood Pressure and Circulation Issues with Pregnancy

• Blood pressure decreases in the aorta because less blood is reaching it
• Increased distention of liver and spleen leads to dyspnea and pain
• Fluid builds up in the peritoneal cavity in ascites
• Extreme pressure on abdominal vessels from enlarged uterus is a concern.
• Right-sided heart failure can be associated with this
• Eisenmenger syndrome may be a cause for this issue.

Iron Metabolism

• The body absorbs iron from the duodenum, transferring it to the liver, spleen, and bone marrow
• Stored as ferritin; vital for effective oxygen transport and red blood cell production
• Extreme fatigue and poor exercise tolerance are associated conditions

Hematologic Disorders and Pregnancy (Anemia and Pregnancy)

• The blood volume expands, potentially leading to apparent anemia in early pregnancy
• True anemia occurs when the hemoglobin (HGB) concentration is less than 11g/dL (or hematocrit less than 33%) during the first or third trimester
• If less than 10.5g/dL (hematocrit less than 32%) in the second trimester, it's a concern
• Iron deficiency anemia is common in pregnancy; further causes include, heavy menstrual flow, low-income families and improper weight loss programs.

Classification of Heart Disease

• 1- uncompromised: ordinary physical activity causes no discomfort; no symptoms.
• 2- slightly compromised: ordinary activity causes noticeable fatigue, palpitations, dyspnea, or angina.
• 3- markedly compromised: significant fatigue, palpitations, dyspnea, or angina occur with less than ordinary activity.
• 4- severely compromised: any activity causes discomfort and symptoms occur even at rest.

Megaloblastic Anemia

• Enlarged red blood cells
• Folate intake is important: increased daily intake may be prescribed
• Sickle-Cell Anemia (inherited hemolytic condition) : abnormal amino acid in the beta chain of hemoglobin.

A Woman with Folic Acid-Deficiency Anemia

• Importance of folic acid for normal red blood cell formation in pregnant women
• Commonly seen in multiple pregnancies, hemolytic illnesses, individuals taking hydantoin(an anticonvulsive) and poor gastric absorption.

Management for Anemia and Iron-Deficiency Anemia

• Prescribed prenatal vitamins with iron (27mg)
• Dietary recommendations: green leafy vegetables, meat, and legumes
• Ferrous sulfate or ferrous gluconate (120-200 mg elemental iron/day)
• Consumption of orange juice/vitamin-C (for better absorption of iron)

Management for Therapeutic Anemia

• Blood transfusions to replace sickled cells with non-sickled cells (periodically)
• Oxygen and fluid management for crises

Coagulation Disorder (Von Willebrand Disease and Pregnancy)

• Sex-linked or male-specific coagulation disorders have little effect on pregnancies.
• In women, von Willebrand disease leads to longer bleeding times.
• Factor VIII - related antigen and factor VIII coagulation activity are reduced, leading to spontaneous and postpartum hemorrhage.
• Replacement of missing factors through blood transfusion (cryoprecipitate or frozen plasma) before childbirth, needed in cases of severe disorder.

The Woman with Thalassemia

• Inherited blood disorder leading to poor hemoglobin formation and anemia
• Common condition in people of Mediterranean, African, and Asian descent
• Treatment includes folic acid and blood transfusions containing hemoglobin-rich red blood cells.

Management Regarding Pulmonary Edema

• Oxygen administration
• Monitoring fetal development
• Monitoring pulmonary pressure during labor
• Careful monitoring to prevent hypotension after epidural anesthesia

###Diagnosis regarding Urinary Tract Infection (based on symptoms)

• Clean catch urine sample with culture and sensitivity test to determine antibiotic
• Pyelonephritis: pain in the lumbar region that radiates downward, possibly tender to palpation, nausea/vomiting, malaise, frequent urination and elevated temperature (103-104⁰F)

Hemophilia B (Christmas Disease)

• Sex-linked Factor IX deficiency disorder
• Occurs only in males; females are carriers with reduced factor IX levels (33% of normal)
• Risk of hemorrhage during labor or spontaneous miscarriage
• Management: restoration of factor IX through infusion (factor IX concentrate or fresh frozen plasma)
• Analysis of maternal serum (to detect fetal factor IX status) during pregnancy.

###A Person with Chronic Renal Disease in Pregnancy

• Pregnant women with chronic renal disease, may have increased workload on the kidney system
• Pregnant women with chronic renal disease might be candidates for hemodialysis.
• Increased filtration of waste products, and a risk for anemia is present

###The Management with Pyelonephritis

• Hospitalization for 24-48 hours
• Initiate IV antibiotics
• Maintain adequate hydration and diet
• Oral Nitrofurantoin is recommended for non-pregnant women

Precautionary Measures Regarding Urinary Tract Infection in Pregnancy

• Frequent urination (at least every two hours)
• Wiping from front to back after urination
• Preferably cotton underwear (to avoid skin infections).
• Avoiding holding urination following intercourse
• Adequate hydration

###A Woman with Pneumonia

• Bacterial or viral infection of lung tissue by pathogens (e.g, Streptococcus pneumoniae, Hemophilus influenzae, Mycoplasma pneumoniae).
• Symptoms: acute inflammatory response; lungs' alveoli flood with fluid, reducing breathing space.
• Treatment: antibiotics and oxygen administration

###A Woman with Influenza

• Virus causing respiratory illness like A, B, or C
• Symptoms: fever, sore throat, etc
• Treatment: antipyretics and antiviral medication (Oseltamivir)
• Vaccination available for prevention

A Woman with Gestational Diabetes Mellitus

• Glucose management during pregnancy
• Monitoring blood levels (70 to 110 mg/dL fasting, 90-180 mg/dL non-fasting)
• Treatment may include medication and or modification of lifestyle.

Management and Treatment of Hyperthyroidism

• Levothyroxine(Synthroid) to manage thyroid hormone
• Important that dosage of medication increases during pregnancy to meet the demand
• Important that the woman is advised to take medications at least 4 hours away from iron, calcium or any soy product to ensure proper absorption of the medication

A Woman with Hypothyroidism

• Underproduction of thyroid hormones
• Woman may experience difficulties in conception, and spontaneous miscarriage.
• Symptoms can include fatigue and weight gain, dry skin, and intolerance to cold

A Woman with Diabetes Mellitus

• Pancreas does not produce enough insulin to regulate blood glucose levels
• Management involves managing blood glucose levels through diet, exercise, and potentially insulin therapy

Maternal Effects Due to Gestational Diabetes

• Hypoglycemia (in early pregnancy)
• Increased risk of frequent infections (moniliasis), and polyhydramnios
• Potential for dystocia

Fetal Effects Due to Gestational Diabetes

• Possible premature birth, hypoglycemia, and macrosomia (excess fetal weight) during pregnancy

Fetal Monitoring After Diagnosis of Gestational Diabetes (GD)

• Non-stress tests (NST) or periodic ultrasound checks around 32 weeks to monitor fetal well-being
• Monitoring fetal heart rate at rest and during movements.

Signs and Symptoms of Hypocalcemia in Newborns

• High-pitched cry
• Tremors
• Potential for seizures

New Born Effects of Maternal Diabetes

• Hypoglycemia due to elevated levels of insulin in the newborn
• Requires close monitoring and possible treatment to regulate blood glucose levels

Effects of Gestational Diabetes to the Fetus

• Fetal macrosomia arises with maternal hyperglycemia
• Fetal increase in insulin production to regulate blood sugar levels
• Increased amount of fat stores can elevate fetal weight

Cancer and Pregnancy

• Several forms of cancer may affect women of childbearing age
• Decisions regarding treatment must carefully consider potential teratogenic effects on the fetus and balance the risk for the mother against the risk for the fetus.

Management and Treatment for Mental Illness in Pregnancy

• Specific treatment may vary depending on diagnosis and needs
• It may involve therapy or medication to help manage conditions. Care of the newborn deserves extra attention

Classification of Diabetes Mellitus

• Type 1: Beta cells in the pancreas are destroyed.
• Type 2: Insulin resistance with relative deficiency.
• Gestational: Glucose intolerance during pregnancy

Glucose Screening Test

• Useful in detecting diabetes during a pregnancy
• Blood tests are taken to detect abnormally high levels of blood sugar

Assessment of Glucose Levels Through Laboratory Studies

• Random plasma glucose level greater than 200 mg/dL is abnormal.
• A 50-g oral glucose tolerance test is performed (24 to 48 weeks).
• Diagnosis is confirmed if 2 of 4 results show abnormality.

Symptoms of Gestational Diabetes

• Unusual fatigue and frequent urination

###General Management of Type 2 Diabetes

• Careful management of blood sugar through a balanced diet, regular exercise, and, potentially, insulin therapy.

Signs of Pregnancy-Related Effects

• High serum cholesterol and keto-acidosis
• Increased urination and thirst
• Dehydration

Effect of Hyperglycemia on Urine

• Presence of glucose in the urine
• Increased urine output (polyuria)
• Increased thirst (polydipsia).

###Effects of Gestational Diabetes on the Fetus

• Macrosomia (large weight) -due to increased glucose production and insulin
• Hypoglycemia after birth due to overly high levels of insulin present.

Test your knowledge on pregnancy complications, screening tests, and common conditions affecting expectant mothers. This quiz covers various medical aspects, including thioamides, glucose tolerance tests, and genetic disorders. Aim for a safe and healthy pregnancy with this informative assessment.