High Risk Pregnancy (Philippines) PDF

HIGH RISK PREGN NCY NCM 109 BLEEDING DISORDER S OF PREGNANCY FIR ST TRIMESTER: Abortion and Ectopic pregnancy SECOND TRIMESTER: Hydatidiform Mole and Incompetent Cervix THIRD TRIMESTER: Placenta Prev...

HIGH RISK PREGN NCY NCM 109 BLEEDING DISORDER S OF PREGNANCY FIR ST TRIMESTER: Abortion and Ectopic pregnancy SECOND TRIMESTER: Hydatidiform Mole and Incompetent Cervix THIRD TRIMESTER: Placenta Previa and Abruptio Placenta  Which of the following is the primary reason for identifying the cause of bleeding early in pregnancy and providing timely management? A) To reduce the risk of preterm labor B) To minimize maternal and fetal morbidity and mortality C) To avoid unnecessary medical procedures D) To ensure fetal development is monitored throughout the pregnancy  ABORTION refers to the medical or surgical termination of a pregnancy before the fetus can live independently outside the mother’s womb. In the context of the Philippines, abortion is generally illegal and considered a criminal act, except under certain circumstances like saving the life of the mother.  Laws on Abortion In the Philippines n the Philippines, abortion is prohibited by law under Republic Act No. 7659 (The Death Penalty Law, as amended in 1993) and Article 256 of the Revised Penal Code of the Philippines. The law clearly states that performing, procuring, or attempting to perform an abortion is a criminal offense, and this applies regardless of whether it is performed by a medical professional or any other individual.  Penalties for Abortion in the Philippines For the Woman: The woman seeking an abortion may face penalties, which range from prison to fines depending on the circumstances of the abortion. For the Perpetrators: Those who perform or assist in an abortion can be sentenced to prison terms ranging from 6 years to life imprisonment, depending on the method used and the circumstances. A lifetime sentence may be imposed for doctors, midwives, and others who perform abortions  Penalties for Abortion in the Philippines Specific Penalties for Providers: If a medical professional (such as a doctor or nurse) is found guilty of performing an abortion, they can face imprisonment for 6 to 12 years under the Revised Penal Code. Additionally, they may be disbarred from their professional practice. Penalties for Attempted or Clandestine Abortions: If the abortion is attempted but fails, the penalty may be lighter, but it is still punishable under the law. Additionally, the presence of any non-medical personnel involved in the abortion could result in more severe punishment.  Penalties for Abortion in the Philippines Specific Penalties for Providers: If a medical professional (such as a doctor or nurse) is found guilty of performing an abortion, they can face imprisonment for 6 to 12 years under the Revised Penal Code. Additionally, they may be disbarred from their professional practice. Penalties for Attempted or Clandestine Abortions: If the abortion is attempted but fails, the penalty may be lighter, but it is still punishable under the law. Additionally, the presence of any non-medical personnel involved in the abortion could result in more severe punishment. Types of Abortion: INDUCED ABORTION THREATENED ABORTION INEVITABLE ABORTION INCOMPLETE ABORTION COMPLETE ABORTION MISSED ABORTION HABITUAL ABORTION SEPTIC ABORTION  INDUCED ABORTION: termination of a pregnancy through medical or surgical procedures. It is distinct from spontaneous abortion (miscarriage), as it is carried out intentionally, often due to various personal, health, or socioeconomic reasons.  INDUCED ABORTION: Methods: Medical abortion: Medications such as mifepristone and misoprostol to terminate the pregnancy. Surgical abortion: Procedures like suction aspiration or dilation and curettage (D&C). Management: Bed rest and monitoring; Ultrasound may show fetal heartbeat. Outcome: Pregnancy may continue or progress to another type of abortion. Management: Often requires medical intervention, such as dilation and curettage (D&C). Outcome: Pregnancy cannot be saved, and the fetus is likely lost.  Management: Observation; no further intervention needed if all tissue is expelled. Outcome: Full resolution with no further medical intervention required.  Management: D&C or medication to complete the abortion process. Outcome: Risks of infection if retained tissue is not fully expelled.  Management: Dilation and curettage (D&C) or medication to expel the fetus. Outcome: The body may eventually expel the tissue naturally or require medical intervention. Management: Thorough investigation for underlying causes (e.g., hormonal issues, structural abnormalities, or immunological factors). Outcome: Needs close monitoring for future pregnancies. Management: Immediate hospitalization, antibiotic therapy, and sometimes surgical intervention (D&C) to remove retained tissue. Outcome: Requires urgent medical care to prevent further complications, including death. MANAGEMENT  Treatment: Rest: Get lots of rest and avoid heavy exercise Pain medication: Take acetaminophen (Tylenol) for cramps Avoid sex: Don't have sex until your doctor says it's okay Eat well: Eat a balanced diet high in iron and vitamin C  Treatment: Avoid substances: Don't drink alcohol or use tobacco or illegal drugs Immune globulin: If you're Rh negative, you may be given immune globulin Hormone therapy: If you have atypical hormone levels, hormone therapy can help you carry the baby to term  Critical Question The nurse assessed a 22-year-old woman presents to the emergency department with severe abdominal pain and vaginal bleeding at 8 weeks of gestation. She reports having attempted to self-administer an abortion at home using herbal remedies. Upon examination, her vital signs are stable, but she is visibly distressed and anxious. What is the most important immediate intervention for the nurse to provide, and why?  A) Provide emotional support and ensure that she understands the legal implications of abortion in the Philippines. B) Assess the extent of bleeding and obtain a thorough history of the abortion attempt, while preparing for potential surgical intervention. C) Immediately provide contraceptive counseling to prevent future unintended pregnancies. D) Advise the patient to rest and monitor her symptoms before sending her home.  B) Assess the extent of bleeding and obtain a thorough history of the abortion attempt, while preparing for potential surgical intervention. The most important immediate intervention in this scenario is to assess the extent of bleeding, vital signs, and obtain a thorough history of the abortion attempt. The nurse should be vigilant for signs of complications, such as hemorrhage, infection, or retained products of conception, which may require surgical intervention MANAGEMENT:  Hyperemesis gravidarum (HG) usually starts between 4 and 8 weeks into a pregnancy. a severe form of nausea and vomiting during pregnancy. It is more intense and persistent than typical morning sickness. Affects about 0.3% to 2% of pregnancies. Can lead to dehydration, weight loss, and electrolyte imbalances.  Cause and Mechanism Exact cause is unknown, but it may involve hormonal, genetic, and environmental factors. Hormonal Changes: Elevated levels of hCG (human chorionic gonadotropin) and estrogen may contribute. Genetic Factors: Family history increases the risk. Other Factors: Gastrointestinal motility issues, stress, and psychiatric factors.  Potential Complications: Dehydration and electrolyte imbalances: Can affect maternal and fetal health. Weight Loss: Risk to both mother and baby, especially in severe cases. Thrombosis: Increased risk of blood clots due to dehydration and immobility. Nutritional Deficiencies: Deficiencies in vitamins and minerals can affect fetal development. Fetal Growth Retardation: If the mother is unable to eat properly.  Treatment and Management Hydration: Rehydrate the patient with intravenous (IV) fluids. Nutritional Support: Provide adequate nutrition through oral, IV, or enteral feeding. Anti-nausea Medications: Such as ondansetron, metoclopramide, or promethazine. Vitamin B6 and doxylamine (combination therapy) can help with symptoms. Corticosteroids: In severe cases to reduce inflammation and control nausea. Hospitalization: For severe cases with dehydration and electrolyte imbalances.  Medical Interventions IV Fluids: To restore hydration and correct electrolyte imbalances. Antiemetics: Medications to control nausea and vomiting: Ondansetron (Zofran) Metoclopramide (Reglan) Promethazine (Phenergan) Corticosteroids: For severe, resistant cases. Enteral Feeding: For those unable to tolerate oral intake. Parenteral Nutrition: In extreme cases.  15 minutes break… 4 groups Pathophysiology and Nursing Management: - Ectopic pregnancy - H. Mole - Septic abortion - Complete abortion Nursing Diagnosis: Risk for ineffective Tissue Perfusion related to reduced vascular flow Imbalanced Nutrition: Less than body requirements r/t inability to use glucose Risk for ineffective Coping r/t required change in lifestyle Risk for infection r/t impaired healing accompanying condition Deficient fluid volume r/t polyuria Deficient knowledge r/t complex health problems