Identifying Clients at Risk (NUR C202) PDF

NUR C202 Care of Mother and Child at Risk or with Problems (Acute and Chronic) By Gina M. Dumawal RN, MAN  OBJECTIVES Given an actual pregnant client at risk / with problems, the student will be able to: 1. Apply knowledge of normal pregnancy, anatomy an...

NUR C202 Care of Mother and Child at Risk or with Problems (Acute and Chronic) By Gina M. Dumawal RN, MAN  OBJECTIVES Given an actual pregnant client at risk / with problems, the student will be able to: 1. Apply knowledge of normal pregnancy, anatomy and physiology, and assessment techniques in caring for clients. 2. Assess the health status of a pregnant client at risk or w/ problems. 3. Utilize assessed data in order to prioritize nursing diagnosis. 4. Plan care of clients utilizing evidence –based nursing research; a) achieve the best clinical outcomes utilizing ethico-moral and legal principles, and b) plan effective care. 5. Implement individualized nursing care. 6. Evaluate effectiveness of nursing care, revising the nursing care plan as needed to promote, maintain or restore functional health status of clients with reproductive and sexual disorders. 7. Accurately reports and documents findings in clinical practice.  Identifying the Clients at Risk Women who already have a disorder before the pregnancy. The factors that categorize the woman’s pregnancy as high risk. Begins with the first prenatal visit and will continue throughout the pregnancy.  Identifying the Clients at Risk A. Assessment of Risk Factors 1. Biophysical factors Genetic considerations Nutritional Status Medical & obstetrical disorders 2. Psychosocial factors Substance Abuse Psychological status  Identifying the Clients at Risk A. Assessment of Risk Factors (cont.) 3. Sociodemographic factors Low income Lack of prenatal care Age Parity Marital status Residence 4. Environmental Factors Air pollutants  Identifying the Clients at Risk B. Review of Screening Procedures What is SCREENING? Prenatal screening tests show if a pregnancy is at ‘increased risk’ of a birth defect or has a higher chance of having a problem.  Identifying the Clients at Risk B. Review of Screening Procedures Ultrasound; doppler UTZ, transvaginal, transabdominal UTZ –use in pregnancy at high risk of fetal compromise. Chorionic villus sampling (CVS) – chromosomal or genetic abnormalities. Amniocentesis – chromosomal and genetic problems. Percutaneous umbilical blood sampling (PUBS) – detects fetal abnormality. Maternal serum-alpha fetoprotein (MSAFP) - neural tube defect and open abdominal wall defect. Magnetic resonance imaging (MRI) – evaluate fetal structure & overall growth and maternal structures. Coombs’ test; indirect – screening for Rh incompatibility.  Identifying the Clients at Risk C. Review of Diagnostic & Laboratory. Exam What is DIAGNOSTIC TEST? A test to establish the presence of (or absence) of a disease, as a basis for treatment decisions in symptomatic or screened positive individuals (confirmatory test).  Identifying the Clients at Risk C. Review of Diagnostic and Laboratory Exam (cont.) Fetal UTZ or Ultrasonic Testing – assess condition of the fetus, placental and amniotic fluid. > First Trimester Fetal UTZ is done to: 1. Determine how pregnancy is progressing. 2. Determine the number of the fetus. 3. Estimate AOG. 4. Estimate the risk of chromosomal defect. 5. Check for birth defects that affect the brain and spinal cord.  Identifying the Clients at Risk C. Review of Diagnostic and Laboratory Exam. Fetal UTZ or Ultrasonic Testing > Second Trimester Fetal UTZ is done to: 1. Estimate AOG. 2. Look for the size & position of the fetus, placenta and amniotic fluid. 3. Detect major birth defect (NTD or heart problem). > Third Trimester Fetal UTZ is done to: 1. Make sure that the fetus is alive and moving. 2. Look at the size & position of the fetus, placenta and amniotic fluid.  Identifying the Clients at Risk C. Review of Diagnostic & Laboratory Exam (cont.) Cardiotocography (CTG) - a technical means of recording (graphy) the FHB (cardio) and the uterine contractions (toco) during pregnancy typically in the third trimester. > Cardiotocograph - a machine, more commonly known as electronic fetal monitor(EFM). Nonstress Test - also known as FHR monitoring, FHR is monitored to see how it responds to the fetal movements and usually done after 26 week AOG, recommended for women at increased risk of fetal death.  Identifying the Clients at Risk C. Review of Diagnostic & Laboratory Exam. Contraction Stress Test (CST) - performed near the end of pregnancy to determine how well the fetus will cope with the contractions of childbirth. > Aims to induce contractions and monitor the fetus to check for heart rate abnormalities using a cardiotocograph. Chorionic Villi Sampling (CVS) - analysis of chorionic villi (placental tissue) from the growing placenta for chromosome or DNA analysis. > To determine chromosomal or genetic disorders in the fetus. > May be done as early as week 5 of pregnancy but is more commonly done at 8 to 10 weeks.  Identifying the Clients at Risk C. Review of Diagnostic & Laboratory Exam. Amniocentesis - look for birth defects and genetic problems in the developing fetus. > Used to diagnose different genes and chromosomal problems in the fetus. > Often offered to women who are at increased risk of having a child with birth defects. This includes women who: 1. are 35 or older when they give birth. 2. had (+) screening test result of birth defect. 3. have a history of birth defects in other pregnancies. 4. have a family history of genetic disorders.  Identifying the Clients at Risk C. Review of Diagnostic & Laboratory Exam. Embryoscopy - examination of the embryo at 9-10 week AOG to remain confined to the management of early pregnancy affected by recurrent genetic and fetal abnormalities. Fetoscopy - to visually inspect the fetus for gross abnormalities. It can be used to confirm an ultrasound finding. Percutaneous Umbilical Cord Blood Sampling - Cordocentesis also sometimes called PUBS, examines blood from the fetus to detect fetal abnormalities. Biophysical profile (BPP) – for fetal surveillance. Nonstress test (NST) – FHR monitoring. End of Slides