NCM 109 High Risk Pregnancy PDF

NCM 109 Arlene Latorre RN MAN PLACENTAL / CORD ABNORMALITIES: *1. CENTRAL INSERTION – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE FETAL SURFACE OF THE PLACENTA. *2. LATERAL INSERTION – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE PLACENTA BUT NOT AT IT...

NCM 109 Arlene Latorre RN MAN PLACENTAL / CORD ABNORMALITIES: *1. CENTRAL INSERTION – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE FETAL SURFACE OF THE PLACENTA. *2. LATERAL INSERTION – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE PLACENTA BUT NOT AT ITS EDGES. 3. Velamentous insertion of the cord The cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion May be found in multiple gestation May be associated with fetal anomalies MLNG CELESTE, RN, MD 5 * 4. Battledore insertion The cord is inserted marginally rather than centrally The cord is inserted at the edge of the placenta  Terminologies High risk pregnancy – is one in which a concurrent disorder, pregnancy related complication, or external factor jeopardizes the health of the mother, the fetus or both.  Factors in High Risk pregnancy 2 or more premature deliveries 1 or more stillbirths CPD (cephalo pelvic disproportion) Cervical incompetency Uterine structural anomalies Multiple pregnancy, placental anomalies, AF abnormalities, Hemorrhage, retained placenta PN check up inadequate Substance abuse Malnutrition lgeblancomd maternal disorders 8  Hyperemesis Gravidarum Severe unremitting nausea and vomiting persisting after 1st trimester Due to high HCG ( Human chorionic gonadotropin) levels May result to weight loss, starvation with ketosis, F&E imbalance, malnutrition, dehydration Dehydration with F & E imbalance lgeblancomd maternal disorders 9  Management IVF 3 liters in 24h NPO for 24h May give Metoclopromide Diet initiated as: – Clear liquid – full liquid diet, soft diet, full diet but given in small frequent feedings maternal disorders 10 adlatorre  Nursing Intervention Give IVF as ordered Monitor I & O Provide oral care Instruct patient to remain upright after meals to decrease reflux Dry crackers before arising Teach client to conserve energy and promote rest maternal disorders 11  Teratogenic Maternal Infections Teratogen – any factor, chemical or physical that adversely affects the fertilized ovum, embryo or fetus Can involve either sexually transmitted or systemic infections T – Toxoplasmosis O – other infections ( syphilis, HepaB, HIV) R – Rubella C – Cytomegalovirus ( CMV) H – Herpes Simplex virus  TOXOPLASMOSIS CA – Toxoplasma Gondii found in animals ( mice, sheep) - transmitted in the feces of cats who have consumed infected mice, & in meat from infected animals. SAFETY ALERT: Prenatal teaching: do not handle cat litter, wash hands after handling cats, avoid raw & undercooked meats May be asymptomatic in humans or may cause influenza like signs: fatigue, sore throat, rash, fever & eye pain May cause spontaneous abortion, intrauterine growth retardation ( IUGR) & premature delivery TREATMENT: Antibiotics if diagnosed early, however, neonatal disease may still occur  O - others Sexually Transmitted Diseases will be discussed in gynecologic disturbances  RUBELLA / GERMAN MEASLES CA: Rubella virus - The maternal infection is mild but effects on the fetus are severe. First Trimester Exposure: Deafness Eye defects ( congenital cataract & blindness) Cardiac malformation ( PDA) Microcephaly, MR, Second /Third Trimester: - premature labor, IUFD, DM, thyroid problems, neurologic defects S/s; pink maculo-papular rash; starts on face, caudal spread, slight fever, malaise, nasal catarrh, anorexia, arthralgia may develop especially in adults TREATMENT: symptomatic/supportive  Cytomegalovirus ( CMV) CA – herpes virus Droplet transmission from person to person Effects on the infant includes: Neurological challenge ( hydrocephalus, microcephalus, spasticity, ) with eye damage ( optic atrophy, deafness, liver disease As many as 75% of adult women have antibodies to CMV  Herpes Simplex Virus ( Genital Herpes Infection) Systemic involvement ( Viremia) and crosses the placenta to the fetus. 1st tri- severe congenital anomalies or spontaneous miscarriage 2nd tri & 3rd tri- premature birth, IUG retardation and continuing infection of the newborn at birth Tx; IV or oral Acyclovir (Zovirax) during pregnancy Management Antiviral agents – Acyclovir 200 mg PO q 4 hrs for 5 days Sitz bath  DANGER SIGNS OF PREGNANCY 1.VAGINAL BLEEDING = VAGINAL BLEEDING SHOULD BE REPORTED IMMEDIATELY FOR FURTHER EVALUATION 2. PERSISTENT VOMITING ( HYPEREMESIS GRAVIDARUM) = NAUSEA & VOMITING THAT CONTINUES PAST THE 12 WEEK OF PREGNANCY IS EXTENDED VOMITING. IT DEPLETES THE NUTRITIONAL SUPPLY AVAILABLE TO THE FETUS. 3. CHILLS & FEVER = MAY BE EVIDENCE OF INTRAUTERINE INFECTION WHICH IS A SERIOUS COMPLICATION FOR BOTH THE WOMAN & THE BABY. 4. SUDDEN ESCAPE OF FLUID FROM THE VAGINA = MEANS THAT THE MEMBRANES HAVE RUPTURED. BOTH THE MOTHER & THE FETUS ARE THREATENED BECAUSE UTERINE CAVITY IS NO LONGER SEALED AGAINST INFECTION. ** IF FETUS IS SMALL & HIS HEAD DOES NOT FIT INTO THE CERVIX, THE UMBILICAL CORD MAY PROLAPSE WITH THE RUPTURED MEMBRANE , THE HEAD MAY BE COMPRESSED AGAINST THE CORD. ANOTHER DANGEROUS COMPLICATION IS ASCENDING INFECTION. 5. ABDOMINAL OR CHEST PAINS = ABDOMINAL PAINS MAY MEAN TUBAL PREGNANCY THAT HAVE RUPTURED, SEPARATION OF THE PLACENTA, PRETERM LABOR WHILE CHEST PAINS MAY INDICATE PULMONARY EMBOLUS THAT FOLLOWS THROMBOPHLEBITIS. 6. ABSENCE OF FETAL HEART SOUNDS AFTER THEY HAVE INITIALLY BEEN AUSCULTATED ON THE 4TH & 5TH MONTH ( MAY INDICATE INTRAUTERINE FETAL DEATH - IUFD) 7. SWELLING OF THE FACE & FINGERS = EDEMA 8. FLASHES OF LIGHTS OR DOTS ( SCOTOMA) 9. BLURRING OF VISION 10. SEVERE HEADACHE & DIZZINESS ** MAY MEAN SIGNS OF PREGNANCY INDUCED HYPERTENSION