02 MEDICAL CONDITION AFFECTING PREGNANCY OUTCOME.pdf

CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING TOPIC 2: MEDICAL CONDITION AFFECTING PREGNANCY OUTCOME (PRE-GESTATIONAL CONDITION) Class III marked limitation; less than...

CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING TOPIC 2: MEDICAL CONDITION AFFECTING PREGNANCY OUTCOME (PRE-GESTATIONAL CONDITION) Class III marked limitation; less than regular/ordinary activities causes symptoms Class IV marked limitation of activities; symptomatic at rest e.g. nakaupo lang may symptoms talaga CARDIAC DISEASE 80% are classified as Class I and II pag may Variety of heart conditions both congenital heart disease and acquired that complicate pregnancy ○ nagiging successful naman Acquired and congenital mandalas h/ever may restrictions Acquired yung most prevalent form and close monitoring Risk Factors Yung Class III binibigyan ng Digitalis from Rheumatic Fever (1st tri ba?) o 90% of all rheumatic in origin Class IV icocorrect dapat during pregnancy o kaya nagging acquired yung most through surgery prevalent o Strep throat Complication of HD in pregnancy o pwede maglead to pulmonary Congestive heart failure (Left sided CHF) edema, pulmonary congestion, Maternal dysrhythmias CHF Spontaneous abortion Congenital defects Premature labor Arteriosclerosis Intra-uterine growth retardation MI o pregnancy is contraindicated in who have MI before pregnancy S/Sx o severe left ventricular damage and heart failure Palpitation Pulmonary diseases Edema o pulmonary tb tachypnea Heart surgery fatigue syncope(temporary loss of consx) dyspnea Functional Classification of Heart Disease transient, soft systolic murmurs elevated ESR near term Class I no limitation of physical activities do o erythrocyte sedimentation rate not produce symptoms 20mm/hr **diagnosing HD in pregnancy is not easy, there Class II slight limitation; asymptomatic at are common signs that mimic HD rest but regular activities produce palpitation, fatigue, dyspnea, and Diagnosis of Cardiac Disease in Pregnancy anginal pains PROPERTY OF ODLID 4 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Persistent diastolic or pre-systolic Forceps/vacuum delivery murmurs Elective CS Permanent/unequivocal cardiomegaly severe dysrhythmias severe dyspnea prior to stage of pressure Nursing Care on the diaphragm Encourage early, regular and frequent loud persistent systolic murmur prenatal care and visits Encourage compliance with medical and Treatment/Management therapeutic regimen 1. Decrease workload of the heart Frequent prenatal visits and consultation 2. Avoid activities that decrease with specialists oxygenation (smoking, rest, physical and mental. The amount of overcrowded places, infection) rest and activity depends on the functional 3. Avoid constipation ability of the heart 4. Observe proper nutrition Digitalis (Lanoxin.25 mg) check CR < 60 or 5. Early hospitalization > 100 - HOLD Diuretics (furosemide - Lasix 200 mg) During Labor observe and report bradycardia, nausea, thorough physical assessment vomiting, diarrhea, colored vision position Antibiotics - prescribe before any invasive administer O2 (prn) procedure as dental procedure and provide meticulous skin care (observe prophylaxis aseptic technique) o prior to delivery Strict monitoring of I&O to avoid volume Iron supplement to prevent or treat overload anemia Observe NPO Oxygen as necessary Provide psychological, emotional, and spiritual support ✓ Important magkaroon ng baseline para Provide continuous cardiac monitoring malaman if may abnormalities na sa signs niya Anticipate episiotomy and forceps delivery Prepare regional Anesthesia (epidural) Intra-partum Period Goals Postpartum care cardiac failure and decompensation is ✓ Mga dapat gawin during pregnancy likely to occur in the early postpartum Minimize hemodynamic changes and because of optimize perfusion 1. loss of placental circulation (30-50% Minimize changes in pulse and BP increase in blood volume Lateral position reabsorbed causing sudden fluid adequate pain relief overload) o anesthesia 2. Rapid decrease in intra-abdominal o analgesia pressure Avoidance of hemorrhage Monitor blood loss, I&O, and Avoidance of infection fluid rate Oxygenation PROPERTY OF ODLID 5 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Assess frequently for signs Low hemoglobin (10mg/100mL) of bleeding, sepsis, and CHF Low hematocrit (37% in 1st tri, 35% in 2nd Provide non-stressful tri, 33% in 3rd tri) mother infant interaction Serum iron < 65 ug/100mL blood Routine post partum care Nursing Responsibilities promote a balanced activity and rest with Risk Factors avoidance of fatigue provide dietary instructions on iron-rich Decrease nutritional intake/malnutrition foods Heredity, cultural practice, fad diets (di ko encourage regular intake of hematinic rin alambat nakastrikethrough sa ppt) (ferrous sulphate). Take with ascorbic acid. Increased demands as in pregnancy and Administer ordered intramuscular adolescence preparation (iron dextran/Imferon) Poor absorption as in stomach and Keep warm and free from infection intestinal disease because of increased susceptibility to infection Complication DIABETES MELLITUS Associated with fetal problem - IUGR, Chronic increase perinatal mortality Deficiency in insulin production resulting increased incidence of abortion, infection, in improper metabolic interaction of carbs, premature labor, post partal hemorrhage, fats, protein, and insulin. PIH, heart failure in existing disease of the may be a concurrent disease in pregnancy heart or may have its onset on pregnancy. Assessment Findings: Objective GD ○ pale skin and mucous lining Bumabalik sa normal yung glucose after ○ pearl white sclera birth ○ brittle flattened nails Transfer of nutrients through the placenta ○ alter VS - rise in systolic pressure nagpproduce ng insulin resistance (?) with widened pulse pressure > 30 years of age, fam history, overweight, ○ tachycardia prev GDM ○ tachypnea Insulin production increases weight of the Subjective baby kapag tumaas yung blood glucose ○ fatigue or shortness of breath on kasi mataas rin yung sa mom exercise ○ headache Risk Factors ○ anorexia ○ menorrhagia Family history ○ heartburn Rapid hormonal change in pregnancy ○ flatulence Tumor / infection of the pancreas Obesity Diagnosis Stress Physical exam Laboratory findings PROPERTY OF ODLID 6 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Effects of DM on Mom and baby: 3 P’s Mom o Polyphagia (hunger) o Infertility o Polydipsia (thirst) o Spontaneous abortion o Polyuria (urine every 30 mins-1hr) o PIH Weight Loss o Infections: moniliasis, UTI increased Blood and urine sugar o Premature labor Diagnostics: o Dystocia o Screening test/ FBS (26-28 AOG) o Hypoglycemia/hyperglycemia o 140 mg/dL o Cesarean section o Glucose Tolerance Test (GTT)/ Oral o Uterine atony – postpartum Glucose Challenge Test (OGCT) hemorrhage o 2hrs postprandial Blood Sugar Baby o Glycosylated Hemoglobin o Congenital anomalies o Urine glucose monitoring. o Polyhydramnios Nx Responsibility o Macrosomia ▪ pancreas detects increase in Early detection: prenatal screening, glucose History, symptomatology o Fetal hypoxia – IUFD, still birth, Early prenatal management and increased perinatal mortality supervision o Neonatal hypoglycemia Regular prenatal visits o Prematurity Record Diet and BG levels o RDS (6hrs after birth) Serial ultrasound o Hypocalcemia Hospitalization Effects of pregnancy on DM: Provide teaching Promote control of DM Difficult to maintain blood sugar Prevention of infection, stress Insulin shock and ketoacidosis are common. HIV/AIDS Nausea and vomiting predispose to ketoacidosis caused by retrovirus Insulin requirement change in pregnancy HIV - Human immunodeficiency virus Assessment Findings: ○ affects T cells that decrease the body’s immune response Fam history, gestational DM in prev. ○ leading the individual more Preggy susceptible to opportunistic Prev infant weighing 4kg infections Prev infant with congenital defects: AIDS - Acquired Immunodeficiency polyhydramnios syndrome Spontaneous abortion/fetal death/still ○ positive in HIV with an existing births opportunistic infection Obesity Risk Factors vaginal moniliasis and UTI Marked abdominal enlargement and IV drug abuse macrosomia Prostitutes PROPERTY OF ODLID 7 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Bisexual partners monitoring for early signs of complications o Important especially to teenagers such as weight loss Transmission of HIV infection 2nd and 3rd trimester Sexual exposure to genital secretion of an infected person presence of fever Perinatal exposure of an infant to infected inspection of mouth infections such as oral maternal secretion through birth (vertical thrush or leucoplakia transmission) frequent assessment of the lungs for Parenteral exposure to infected blood or presence of pneumonia tissue assessment of serology regularly to Intimate contact with blood products monitor if HIV/AIDS is progressing infected close monitoring of fetal status BPS, non-stress test, UTZ Maternal Risk Nursing Care AIDS defining disease that are most Universal precaution/reverse isolation common in women than men precaution Includes Help patient understand that it is a fatal o wasting syndrome disease and help her accept that other o esophageal candidiasis people will raise her child o Herpes simplex virus disease provide emotional support Non-AIDS defining gynecologic disorders: o Support the client very important o candidiasis Discuss ways on how to prevent acquiring o cervical pathology opportunistic infections encourage strict adherence to therapeutic Therapeutic Management regimen and management Administration of Antiretroviral Drug using S-A-D Habits of Pregnancy 3 part ZDV (Zidovudine) Prophylaxis Smoking Oral ZDV o 8-12 hrs birth continuing up to 6 pregnant should not smoke weeks of life for babies use of > 5 cigs a day in pregnancy doubles IV ZDV a woman’s risk of delivering a low birth Oral ZDV for the infant starting 8-12 hrs infant after birth continuing up to 6 weeks of life prenatal tobacco exposure causes learning and attention problems in children 1st prenatal visit should include assessment of Effects of Tobacco Use Platelet count, CBC with differential count Increased risk of SGA and repeated each trimester to monitor Prematurity anemia, thrombocytopenia, leukopenia Infant mortality that are associated with HIV infection and spontaneous abortion antiviral therapy placenta previa/abruptio placenta PROPERTY OF ODLID 8 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Premature rupture of membranes reduce intake of coffee, tea, colas, and cocoa to 300 mg of caffeine per day or no Causes of Adverse Effects of Smoking more than 2-3 servings per day (US FDA) Nicotine, a vasoconstrictor, causes reduced placental perfusion Drugs The increase of carbon monoxide causes functional inactivation of maternal and only be taken by pregnant women when fetal inactivation of maternal and fetal prescribed by their physicians hemoglobin prescribed in pregnancy should have Smokers have decreased plasma volume benefits or advantages outweighing risks Smokers have reduced appetite, resulting best recommendation: no medication is to decreased caloric intake taken during pregnancy unless absolutely necessary and prescribed Alcohol intake of illicit drugs in the first trimester can cause the most adverse fetal ingestion by pregnant women is likely to malformation because cause fetal abnormalities o placental barrier is not yet fully leading known teratogens in the Western developed World ▪ placenta is mature by 10-12 weeks of gestation Effects of chronic Alcoholism: Fetal Alcohol o rapid organogenesis takes place Syndrome during this period and could Retardation/delays: cognitive, motor, therefore be altered attention, and learning deficits the so-called hard drugs may cause Mental retardation: associated growth retardation and drug withdrawal microcephaly, down syndrome and seizure which is associated with increased disorders neonatal mortality Craniofacial defects: flat midface, wide The most harmful effect of heroin on the nasal bridge, thin upper lip neonates is withdrawal or neonatal Cardiovascular defects: flat midface, wide abstinence syndrome w/c has group of nasal bridge, thin upper lip signs Cardiovascular effects o sneezing Limb defects o irritability Impaired fine and gross motor function o vomiting and diarrheal o seizures Caffeine PROPERTY OF ODLID 9