03 GESTATIONAL CONDITION AFFECTING PREGNANCY OUTCOMES.pdf

CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING TOPIC 3: GESTATIONAL CONDITION AFFECTING PREGNANCY OUTCOMES metropramide (plasil, reglan)...

CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING TOPIC 3: GESTATIONAL CONDITION AFFECTING PREGNANCY OUTCOMES metropramide (plasil, reglan) Antihistamine diphenhydramine (benadryl) meclizine (antivertigo) dimenhydramine (dramamine) Intravenous formula of nutrients and ECTOPsupplementation enteral feeding ECTOPIC PREGNANCY HYPEREMESIS GRAVIDARUM condition in which pregnancy develop outside of the uterine cavity condition characterized by severe nausea and vomiting and weight loss and dehydration Predisposing factors seen in patient with Hydatidiform mole (H-mole), advance diabetes, anorexia, Fallopian tube narrowing or constricted nervosa or bulimia, or gastrointestinal PID: pelvic inflammatory disease disease such as peptic ulcer (salpingitis: inflammation of FT, endometritis: inflammation of uterine lining) Other reasons include puerperal and postpartal sepsis surgery of the fallopian tubes high level of HCG congenital abnormalities of the fallopian high level of estrogen tubes increased glucose drain on maternal adhesions, spasms, tumors metabolism IUD usag: intrauterine device family history (genetics) psychogenic factors Types Therapy Tubal o most common type; found in Prevention: multivitamin at time of 90-95% of cases conception o tubal rupture occurs before 12 increased dietary sources of potassium weeks and magnesium Cervical ginger 1 gram Abdominal acupressure at pressure points Ovarian Pharmacologic Management Antiemetics prochlorperazine (comprazine) trimethobenzamide (tigan) ondanstron (zofran) PROPERTY OF ODLID 10 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Nx Implementation Carry out an ongoing assessment for shock implement shock treatment position on modified trendelenburg Infuse D5LRS for plasma administration, blood transfusion or drug administration Monitor VS, bleeding, I&O Provide physical and psychological support - preoperative and postoperative Anticipate grief Anticipate guilt responses Anticipate fear related to potential disturbance in child-bearing capacity in the future Assessment Findings GESTATIONAL TROPHOBLASTIC DISEASE Amenorrhea or abnormal menstrual Approximately 20% of patients with period - spotting - most common sign primary hydatidiform mole develop early sign of pregnancy persistent GTD (invasive mole, nausea and vomiting choriocarcinoma, placental site, Bluish navel (Cullen’s signs) because of trophoblastic tumor) the blood in the peritoneal cavity A benign neoplasm of chorion. The chorion Rectal pressure because of blood in the fails to develop into a full-term placenta, cul-de-sac and instead degenerates and become Positive pregnancy test fluid-filled vesicles Sharp localized pain when cervix is touched Assessment Findings Sign of shock/circulatory collapse Kehr’s sign: sudden, acute low abdominal Brownish or reddish intermittent or pain radiating to the shoulder or neck pain profuse vaginal bleeding by 12 weeks Culdocentesis: checks for abnormal fluid Expulsion, spontaneous, of molar cyst in the abdominal cavity behind the uterus usually occurs between the 16th and 18th Rapid uterine enlargement inconsistent Treatment with the age of gestation Symptoms of PIH before 20 weeks Surgical removal of ruptured tube: Excessive nausea and vomiting because of Laparoscopy excessive HCG (1-2 million IU/L/24 hours) Salpingectomy/salpingostomy Positive pregnancy test (non-rupture) No fetal signs - heart tones, parts, and Management of profound shock if rupture: movements blood replacement Abdominal pain Antibiotics - (treat PID) Methotrexate PROPERTY OF ODLID 11 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING HCG titer monitoring for one year - no pregnancy for one year (use contraceptive) Medical replacement; blood fluid plasma Chemotherapy for malignancy: methotrexate Chest X-ray to detect early lung metastasis Complication Choriocarcinoma: most dreaded Hemorrhage: most serious during early treatment phase Uterine perforation Infection Nx Implementation Advise bed rest Monitor VS, blood loss, molar/tissue passage I&O Maintain fluid and electrolyte balance, plasma, and blood volume through replacement Prepare for D&C hysterectomy Provide psychological support; anticipate Fear related to potential development of cancer Disturbance in self-esteem for carrying an abnormal pregnancy The chromosomal complement is XXY in prepare for discharge 70% of cases ○ emphasize the need to follow-up The abnormal conceptus in these cases HCG Titer determination for one arises from the fertilization of an egg with year a haploid set of chromosomes either by ○ Reinforce instructions on no two sperm, each with a set of haploid pregnancy for one year; give chromosomes or by a single sperm with a instructions related to diploid 46XY complement contraception Treatment INCOMPETENT CERVIX evacuation by D&C or hysterectomy if no condition characterized by a mechanical spontaneous evacuation defect in the cervix causing a cervical Hysterectomy if above 45 years old and no effacement and dilation and expulsion of future pregnancy is desired or with the products of conception in increased chorionic gonadotropin level mid-trimester of pregnancy after D&C PROPERTY OF ODLID 13 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Risk Factors congenital defect of the cervix (short) trauma to the cervix as in forceful dilation and curettage and difficult delivery cervical lacerations o paulit-ulit na niraraspa Assessment Findings painless contractions resulting in delivery of dead or non-viable fetus history of abortion finding of a relax cervical os on pelvic examination Nx Implementation Treatment Provide psychological support to client Provide post cerclage procedure care Cerclage procedure during 14-16 weeks Advise limitation of physical activities AOG or prior to next pregnancy: suture or within 2 weeks after treatment ribbon is place beneath cervical mucosa to Maternal and fetal growth monitoring: close cervix routine prenatal care Shirodkar procedure - permanent Instruct client to report signs of labor suturing of the cervix Assess for signs of labor, infection, or McDonalds procedure - temporary, purse premature rupture of membranes string suturing of the cervix; suture Prepare client for stitch removal removed at term in preparation for a vaginal delivery ABORTION termination of pregnancy before the age of viability usually before 20-24 weeks Types 1. Spontaneous with medical or mechanical intervention Causes Defective ovum/Congenital defects Unknown causes Maternal factors: ○ viral infection ○ Malnutrition ○ Trauma (physical and mental) congenital defects of the reproductive tract Incompetent cevix PROPERTY OF ODLID 14 CARE OF MOTHER, CHILD AT RISK: ACUTE/CHRONIC IDIANALE BATCH 2024 ST. LUKE’S COLLEGE OF NURSING Hormonal - decreased Blood, plasma, fluid replacement progesterone Habitual Abortion: Systemic diseases in the mother o determine etiology (DM, thyroid dysfunction, severe o treatment of underlying causes; anemia) o cerclage operation/cervical closure Environmental Hazards for incompetent cervix Rh incompatibility Blood Tests: 2. Induced with medical or mechanical o BT intervention o Rh Factor o Combs’ Test Signs of Abortion o Serum o Fibrinogen Vaginal bleeding or spotting, mild to o Clotting time severe o Platelet Uterine/abdominal cramps Passage of tissues or product of conception Signs related to blood loss/shock: pallor, tachycardia, tachypnea, cold clammy skin, restlessness, oliguria, air hunger, and hypotension Therapeutic Management Surgery: D&C or dilatation/suction curettage Antibiotics: specially for septic abortion PROPERTY OF ODLID 15