Maternal and Child Health Nursing PDF - A/Y 2024-2025

MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO MANAGEMENT AND CARE OF A ​ Inadequate Dietary Intake WOMAN WITH RISKS IN PREGNANCY ​ Food Fads ​ Excess...

MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO MANAGEMENT AND CARE OF A ​ Inadequate Dietary Intake WOMAN WITH RISKS IN PREGNANCY ​ Food Fads ​ Excessive Food Intake ​ Under or Overweight Status HIGH-RISK PREGNANCY ​ Hematocrit Value less than 33% ​ Eating Disorder ​ one in which a condition exists that jeopardizes the health of the mother, fetus, PSYCHOSOCIAL FACTORS or both ​ may result from the pregnancy or it may be ​ Smoking a condition that was present before the ​ Caffeine woman became pregnant ​ Alcohol ​ have a higher morbidity and mortality ​ Drugs compared with the mothers in the general ​ Inadequate Support System population ​ Situational Crisis ​ History of Violence FACTORS PLACING A WOMAN AT RISK ​ Emotional Distress DURING PREGNANCY ​ Unsafe Cultural Practices BIOPHYSICAL FACTORS SOCIODEMOGRAPHIC FACTORS ​ Genetic Conditions ​ Poverty Status ​ Chromosomal Disabilities ​ Lack of Prenatal Care ​ Multiple Pregnancy ​ Age younger than 15 years or older than 35 ​ Defective Genes years ​ Inherited Disorders ​ Parity - all first pregnancies and more than ​ ABO Incompatibility five pregnancies ​ Large Fetal Size ​ Marital Status - increased risk for unmarried ​ Medical and Obstetric Conditions ​ Accessibility to healthcare ​ Preterm Labor and Birth ​ Ethnicity - increased risk in nonwhite ​ Cardiovascular Diseases women ​ Chronic Hypertension ​ Incompetent Cervix ENVIRONMENTAL FACTORS ​ Placental Abnormalities ​ Infection ​ Infections ​ Diabetes ​ Radiation ​ Maternal Collagen Diseases ​ Pesticides ​ Pregnancy-induced Hypertension ​ Illicit Drugs ​ Asthma ​ Industrial Pollutants ​ Post-term Pregnancy ​ Second-hand Cigarette Smoke ​ Hemoglobinopathies ​ Personal Stress ​ Nutritional Status ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO DIAGNOSTIC TESTS CHORIONIC VILLUS SAMPLING (CVS) ULTRASOUND PURPOSE PURPOSE ​ detect chromosomal abnormalities, genetic disorders, or specific diseases ​ visualize the fetus, placenta, and amniotic ​ performed at 10-13 weeks gestation fluid ​ assess gestational age, fetal growth, TYPES anomalies, and placental location ​ guide procedures like amniocentesis 1.​ Transcervical - catheter is inserted ​ determine the gender through the cervix to collect placental tissue ​ establish the presentation and position of 2.​ Transabdominal - needle is inserted the fetus through the abdomen to access the placenta TYPES NURSING CONSIDERATIONS 1.​ Transabdominal - most common -​ uses a probe on the abdomen ​ ensure informed consent and discuss 2.​ Transvaginal - probe is inserted into the potential risks (miscarriage) vagina for better visualization, especially in ​ monitor the patient for complications like early pregnancy cramping, bleeding, or infection 3.​ 3D / 4D - provides detailed images or ​ advise the patient to rest and report any real-time video of the fetus unusual symptoms 4.​ Doppler - assesses blood flow in the placenta, umbilical cord, or fetal vessels AMNIOCENTESIS NURSING CONSIDERATIONS PURPOSE ​ Transabdominal: ensure the patient has ​ extract amniotic fluid for genetic testing, full bladder in early pregnancy for better assessing fetal lung maturity, or diagnosing imaging infections ​ Transvaginal: explain the procedure to ​ performed between 15th to 20th weeks reduce discomfort or anxiety pregnancy ​ Position the patient properly (supine with a slight left tilt to avoid vena cava TYPES compression) ​ Ensure the patient’s bladder is full before 1.​ Genetic - tests for genetic conditions and the procedure chromosomal abnormalities 2.​ Fetal Lung Maturity - measures surfactants (e.g L/S ratio) to assess lung development ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO 3.​ Infection-related - checks for infections LECITHIN / SPHINGOMYELIN (L/S) in the amniotic fluid RATIO NURSING CONSIDERATIONS PURPOSE ​ confirm informed consent and explain the ​ assess fetal lung maturity by measuring the risks and benefits ratio of lecithin to sphingomyelin in amniotic ​ monitor for post-procedure complications fluid like bleeding or contractions ​ educate the patient to avoid strenuous ELECTRONIC FETAL MONITORING (EFM) activity and report any fluid leakage or pain PURPOSE BIOPHYSICAL PROFILE ​ assess fetal heart rate and uterine activity PURPOSE to identify signs of distress ​ assess fetal health by measuring: NURSING CONSIDERATIONS ○​ fetal breathing movements ○​ gross body movements ​ ensure proper placement of monitors ○​ fetal tone ​ regularly check fetal heart rate (FHT) ○​ amniotic fluid volume patterns and respond promptly to ○​ reactive fetal heart rate (via NST) abnormalities ​ educate the patient about the purpose and TYPES reassure them during the procedure 1.​ Standard - combines ultrasound and a NONSTRESS TEST (NST) non-stress test (NST) to evaluate fetal well-being PURPOSE 2.​ Modified - includes NST and amniotic fluid volume assessment ONLY ​ ensure the fetus is receiving adequate oxygen and is neurologically intact NURSING CONSIDERATIONS ​ often performed in the 3rd trimester, especially for high-risk pregnancies ​ explain the test’s importance for monitoring ​ assess fetal well-being high-risk pregnancies ​ monitor FHT in response to fetal ​ provide emotional support, especially if movements without inducing stress or results are concerning contractions ​ position the patient comfortably during the ultrasound NURSING CONSIDERATIONS ​ educate the pt about the procedure and its purpose ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ encourage the pt to eat beforehand, as this ​ for a pregnant woman with pre-existing DM may stimulate fetal activity or GDM, this can lead to hyperglycemia ​ monitor for a reactive result and notify the ​ In GDM: healthcare provider if non-reactive results ○​ insulin resistance surpasses the occur pancreas’ ability to produce sufficient insulin NUTRITION IN PREGNANCY ○​ hyperglycemia occurs, affecting ​ Protein: increase by 10 to 14 grams to a maternal and fetal metabolism total of 60 grams for fetal growth and ○​ excess glucose crosses the placenta, development causing fetal hyperinsulinemia, ​ Sufficient Carbohydrates: prevent leading to macrosomia and other ketoacidosis from protein and fat used for complications energy ​ Fats: should not exceed 30% of daily EFFECTS ON PREGNANCY intake and low-fat dairy products are recommended ​ MOTHER: ​ Calcium: needs to remain at 1,200mg for ○​ increased tendency to preeclampsia the development of fetal skeleton and teeth and eclampsia, UTI, and candidiasis ​ Iron: needs from 15mg before pregnancy ○​ higher tendency dystocia because of to 30mg during pregnancy a large infant ​ Folic Acid: 400mcg to prevent neural tube ○​ increased risk of postpartum defects in the fetus hemorrhage due to overdistention of ​ Caffeine: limited to 300mg per day the ​ Avoid additives, preservatives, or artificial uterus sweeteners ○​ hydramnios ​ Avoid alcohol, as it may lead to fetal alcohol ○​ maternal mortality syndrome ○​ diabetic retinopathy ○​ diabetic nephropathy PREGESTATIONAL CONDITIONS ○​ preterm delivery DIABETES MELLITUS ​ a metabolic disorder characterized by chronic hyperglycemia due to insufficient insulin production or resistance to insulin. PATHOPHYSIOLOGY ​ during pregnancy, placental hormones such as human placental lactogen, estrogen, and cortisol increase insulin resistance to ensure adequate glucose supply to the fetus ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ INFANTS ○​ Emphasize balanced meals with ○​ macrosomia controlled carbohydrates ○​ hydramnios ○​ Recommend small, frequent meals ○​ prematurity to prevent glucose spike ○​ IUGR (Intrauterine Growth ○​ Incorporate high-fiber foods and Restriction) limit simple sugars ○​ hypoglycemia and hypocalcemia ○​ Suggest a bedtime snack to prevent ○​ predisposition to DM later in life nocturnal hypoglycemia CLASSIFICATIONS OF DM TESTS FOR PLACENTAL FUNCTION AND FETAL WELL-BEING 1.​ Type 1 Diabetes Mellitus - autoimmune destruction of beta cells, leading to absolute 1.​ Ultrasound: monitor fetal growth and insulin deficiency detect macrosomia or IUGR 2.​ Type 2 Diabetes Mellitus - insulin 2.​ Non-Stress Test - assess FHR and activity resistance with relative insulin deficiency, 3.​ Biophysical Profile - evaluate fetal often linked to obesity breathing, movements, tone, amniotic fluid 3.​ Gestational Diabetes Mellitus - glucose levels, and NST intolerance identified during pregnancy 4.​ Doppler Studies - assess umbilical artery 4.​ Prediabetes - elevated glucose levels that blood flow do not meet criteria for diabetes diagnosis ASSESSMENT PRENATAL MANAGEMENT ​ obesity, advanced maternal age ​ exercise ​ family history of diabetes ​ eat carbohydrates before exercise to ​ previous GDM prevent hypoglycemia ​ history of large-for-gestational-age (LGA) ​ avoid extreme exercise infants ​ monitor blood glucose at home ​ observe for urinary or vaginal infections NURSING DIAGNOSES AND RELATED ​ frequent monitoring of fetal well-being INTERVENTIONS DIET: 1.​ Imbalanced Nutrition: More than Body ​ Caloric Intake: enough to meet the needs Requirements: ○​ 1,800-2,400 cal/day, divided into 3 ​ administer tailored insulin doses meals and 3 snacks based on glucose monitoring results ​ Weight Gain: about 22-30lbs ​ use rapid-acting insulin before meals ​ Teach and Instruct to: reduce saturated and long-acting insulin for basal fate, reduce cholesterol, increase dietary control fibers, avoid fasting and feasting 2.​ Blood Glucose Monitoring: ○​ Goal: maintain FBS (Fasting Blood ​ encourage frequent self-monitoring Sugar) to 90mg/dl to maintain fasting levels below ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO 95mg/dL and 2-hour postprandial amount of fetal blood may enter the levels below 120mg/dL maternal circulation 3.​ Insulin Pump Therapy: ​ if mother is Rh-negative and fetus is ​ Continuous Subcutaneous Insulin Rh-positive, her immune system recognizes Infusion (CSII) provides better the fetal Rh-positive red blood cell as glucose control for some women foreign and starts producing antibodies against them POSTPARTUM ADJUSTMENT CLINICAL MANIFESTATIONS 1.​ MOTHER: ​ monitor for persistent hyperglycemia 1.​ Severe Anemia in the fetus ○​ GDM often resolves 2.​ Erythroblastosis Fetalis: hemolysis or postpartum but may indicate destruction of RBC resulting to decreased future Type 2 DM risk oxygen carrying capacity leading to IUGR ​ provide guidance on breastfeeding, with pathologic jaundice within 24 hours which can improve glucose 3.​ Hydrops fetalis: severe edema and organ metabolism failure due to anemia ​ encourage follow-up glucose testing 4.​ Heart Failure from increased cardiac 6-12 weeks postpartum workload 2.​ INFANT: ​ monitor for hypoglycemia EFFECTS DURING PREGNANCY immediately after birth ​ assess for jaundice and respiratory ​ usually no direct symptoms distress ​ risk of sensitization, which affects future ​ promote early and frequent feedings pregnancies to stabilize blood sugar levels ​ anxiety or emotional distress related to potential complications RH INCOMPATIBILITY (ISOIMMUNIZATION) ASSESSMENT AND DIAGNOSTIC TESTS 1.​ Maternal Blood Test ​ condition that occurs when Rh-negative ​ Indirect Coomb’s Test - detects mother carries and Rh-positive fetus Rh antibodies in the mother’s blood ​ mother’s immune system may produce antibodies against the Rh antigen, 2.​ Fetal Blood Test potentially harming the fetus in subsequent ​ Direct Coomb’s Test on cord pregnancies blood checks if fetal red blood cells have been attacked by maternal PATHOPHYSIOLOGY antibodies 3.​ Ultrasound and Doppler Studies: ​ placenta normally prevents fetal and monitor fetal anemia and hydrops fetalis maternal blood from mixing. However, 4.​ Amniocentesis: measures bilirubin levels during pregnancy, labor, or medical in amniotic fluids to assess hemolysis procedures (such as amniocentesis), small severity ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ virus integrates its RNA into the host cell THERAPEUTIC MANAGEMENT DNA using an enzyme called reverse transcriptase ​ infected cells replicates the virus, leading to Prevention with Rh Immunoglobulin (RhIG) progressive immune suppression ​ Rh-negative mothers receive RhIG 3 ​ as CD4 levels drop below 200cells/𝑚𝑚 , the (RhoGAM) at 28 weeks of pregnancy and immune system becomes severely within 72 hours postpartum if the baby is compromised leading to opportunistic Rh-positive infections like pneumonia, TB, and fungal ​ RhIG is also given after miscarriage, ectopic infections pregnancy, amniocentesis, or trauma to prevent sensitization CLINICAL MANIFESTATIONS Monitoring & Treatment in Senitized Pregnancies ​ Initial Stage (Acute HIV Infection) ​ Frequent Ultrasound to detect fetal ○​ Flu-like symptoms: fever, sore anemia throat, fatigue, rash ​ Intrauterine Transfusion if severe ○​ swollen lymph nodes anemia develops ​ Asymptomatic Stage: ​ Early delivery if fetal distress is present ○​ can last for several years with no obvious symptoms NURSING RESPONSIBILITIES ○​ HIV continues to replicate and weaken the immune system ​ educate the mother on Rh incompatibility ​ Symptomatic Stage (AIDS) and its prevention ○​ Opportunistic Infections: TB, oral ​ ensure timely administration of RhoGAM thrush, pneumonia during pregnancy and postpartum ○​ Neurological Complications: ​ monitor the mother’s and fetus’ health HIV-related dementia regularly ○​ Severe weight loss, chronic diarrhea, and skin infections HIV/AIDS EFFECTS DURING PREGNANCY ​ Human Immunodeficiency Virus (HIV) ​ retrovirus that attacks the immune system, ​ Risk of Mother-to-Child Transmission specifically CD4 T lymphocytes, leading to (MTCT): without treatment, 20-50% of Acquired Immunodeficiency Syndrome infants born to HIV-positive mothers may (AIDS) contract the virus ​ weakens the body’s ability to fight infections ​ Increased risk of preterm birth and and diseases low birth weight ​ Higher chance of maternal infections PATHOPHYSIOLOGY due to a weakened immune system ​ HIV enters the body and targets the CD4 T ASSESSMENT cells, a crucial part of the immune system ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ HIV Screening Tests: ​ Breastfeeding is not ○​ Enzyme-Linked Immunosorbent recommended due to the risk of Assay (ELISA) & Western Blot HIV transmission ○​ Polymerase Chain Reaction (PCR) Test for detecting viral RNA NURSING RESPONSIBILITIES in newborns ​ CD4 Cell Count ​ Educate the mother: ○​ Normal: 50-1,500 cells/𝑚𝑚 3 ○​ explain ART adherence to reduce 3 transmission risk ○​ AIDS: below 200 cells/𝑚𝑚 ○​ promote safe sexual practices to ​ Viral Load Testing: prevent reinfection ○​ determines the amount of HIV in the ​ Monitor maternal and fetal health: blood to monitor treatment ○​ regular CD4 count and viral load effectiveness tests ○​ assess for signs of opportunistic THERAPEUTIC MANAGEMENT infections ​ Provide emotional support: 1.​ Antiretroviral Therapy (ART) ○​ address concerns about stigma and ​ Zidovudine (ZDV) is given to the mental health issues mother from the 14th week of ○​ encourage support group pregnancy and to the newborn for involvement 6 weeks postpartum to prevent ​ Ensure safe childbirth practices: transmission ○​ prepare for C-section at 38 weeks ​ other drugs include protease ○​ avoid invasive procedures to inhibitors (Ritonavir, Idinavir) and reduce blood exposure Nucleoside Reverse Transcriptase Inhibitors (NRTI) ​ Postpartum Follow-up: 2.​ Opportunistic Infection Prevention ○​ ensure infant HIV testing at 4 and ​ Prophylactic Antibiotics 6 months (Trimethoprim-Sulfamethoxazole) for ○​ monitor for neonatal infections Pneumocystis Pneumonia (PCP) and anemia due to ZDV therapy ​ vaccination against Hepa-B, Pneumococcus, and Influenza REMEMBER!! 3.​ Mode of Delivery ​ Cesarean Birth at 38 weeks is A - Abstinence recommended to reduce the risk of B - Be mutually faithful transmission C - Careful Sex 4.​ Postnatal Care D - Do not use drugs / Do not share syringes ​ newborns must receive ZDV for 6 E - Education weeks ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO SUBSTANCE ABUSE AMPHETAMINES ​ Common Substances Used: EFFECTS DURING PREGNANCY ○​ Cocaine ○​ Amphetamines ​ growth restriction, low birth weight ○​ Marijuana ​ preterm birth, Neonatal Abstinence ○​ Hashish Syndrome (NAS) ○​ Phencyclidine (PCP) ​ risk for behavioral issues in the child ○​ Narcotics ○​ Inhalants CLINICAL MANIFESTATION ○​ Alcohol ​ substance use during pregnancy can lead to ​ jitteriness, poor feeding in the newborn complications for both the mother and the ​ increased BP, anxiety, and irritability in the fetus mother COCAINE NURSING MANAGEMENT EFFECTS DURING PREGNANCY ​ encourage prenatal visits and screening ​ educate on the risks to fetal health ​ placental abruption, premature birth, fetal ​ provide support for recovery from addiction death ​ low birth weight, developmental delays, MARIJUANA irritability ​ increased risk of stillbirth EFFECTS DURING PREGNANCY CLINICAL MANIFESTATION ​ respiratory issues for the baby ​ increased risk of preterm birth and low birth ​ inadequate prenatal care weight ​ poor nutrition and hygiene ​ long-term behavioral problems in the child ​ anxiety, stress, and mood disorders CLINICAL MANIFESTATION NURSING MANAGEMENT ​ use of marijuana is often hidden due to ​ nonjudgmental care and early screening legal concerns ​ referral to substance abuse programs ​ respiratory problems in newborn ​ fetal monitoring for growth development NURSING MANAGEMENT ​ encourage cessation of use ​ support with smoking cessation programs ​ educate the mother about the effects on fetal development ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO HASHISH ​ referrals to addiction recovery programs EFFECTS DURING PREGNANCY INHALANTS ​ fetal injury, premature birth, and brain EFFECTS DURING PREGNANCY damage ​ increased risk of malformations ​ reduced oxygen supply to the fetus ​ neonatal withdrawal syndrome ​ developmental delays, congenital defects, and neurological damage CLINICAL MANIFESTATION ​ risk of miscarriage ​ hallucinations, altered mental state in the mother CLINICAL MANIFESTATION ​ poor prenatal care ​ may lead to confusion and disorientation in NURSING MANAGEMENT the mother ​ respiratory problems and developmental ​ monitor for signs of overdose or mental issues in the newborn instability ​ provide supportive care for withdrawal NURSING MANAGEMENT symptoms ​ offer counseling and rehabilitation services ​ monitor for respiratory distress in the newborn NARCOTICS (OPIOID AGONISTS) ​ educate about the dangers of inhalant use ​ encourage cessation and provide support EFFECTS DURING PREGNANCY for rehabilitation ​ NAS in newborn ALCOHOL ​ preterm birth, low birth weight, and stillbirth ​ risk of fetal death EFFECTS DURING PREGNANCY CLINICAL MANIFESTATION ​ Fetal Alcohol Syndrome (FAS): facial abnormalities, developmental delays ​ maternal dependency on substances such ​ Cognitive Impairments: learning as heroin, methadone disabilities, and growth retardation ​ withdrawal symptoms in the mother CLINICAL MANIFESTATION NURSING MANAGEMENT ​ mother’s use of alcohol often goes ​ methadone maintenance for unreported due to stigma opioid-dependent women ​ newborn with FAS show distinct facial ​ provide newborn care for withdrawal features and delayed development symptoms ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO NURSING MANAGEMENT ​ increased risk of postpartum hemorrhage ASSESSMENT ​ promote abstinence from alcohol during pregnancy ​ CBC to assess hemoglobin and hematocrit ​ provide resources for addiction treatment levels ​ support maternal and child health education ​ Serum iron, ferritin, and folic acid levels on the effects of alcohol ​ Genetic screening for hemoglobinopathies if necessary ASSESSMENT ​ early screening for substance use in IRON-DEFICIENCY ANEMIA pregnancy ​ occurs due to inadequate iron stores, ​ monitor vital signs and assess for affecting red blood cell production withdrawal symptoms ​ perform fetal assessment: growth, heart EFFECTS DURING PREGNANCY rate, and ultrasound ​ toxicology screening to detect drug use ​ educate the woman on risks to fetal ​ increased risk of preterm birth and low birth health and the importance of prenatal weight care ​ higher likelihood of requiring blood transfusions during labor ​ fetal anemia leading to developmental NURSING MANAGEMENT delays ​ nonjudgmental, supportive care ​ referral to addiction treatment programs ​ promote prenatal care and healthy CLINICAL MANIFESTATION behaviors ​ postpartum care for both mother and ​ Fatigue and Weakness newborn, including support for withdrawal ​ Pallor symptoms ​ Dizziness and Headaches ​ Brittle nails and spoon-shaped nails HEMATOLOGIC DISORDERS AND THERAPEUTIC MANAGEMENT PREGNANCY ​ Iron Supplementation: 120-200mg of ANEMIA elemental iron daily ​ Dietary Modifications: increase intake of ​ hemoglobin levels drop below 11g/dL in the iron-rich foods like red meat, legumes, and first and third trimesters to 10.5g/dL in the green leafy vegetables second trimester ​ Vitamin C Supplementation to enhance iron absorption EFFECTS ON PREGNANCY NURSING MANAGEMENT ​ increased risk for preterm labor ​ poor oxygen supply to the fetus ​ educate on proper iron intake and ​ increased susceptibility to infections supplement adherence ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ advise taking iron with Vit. C and avoiding SICKLE-CELL ANEMIA calcium-rich foods that inhibit absorption ​ autosomal recessive hemolytic disorder ​ monitor side effects like constipation and where red blood cells become black stools crescent-shaped, leading to blockages in ​ encourage hydration and fiber intake to blood vessels prevent constipation EFFECTS DURING PREGNANCY FOLIC ACID-DEFICIENCY ANEMIA ​ leads to megaloblastic anemia, ​ higher risk of sickle-cell crises (severe pain characterized by large and immature red episodes) blood cells ​ increased risk of preterm birth, fetal distress, and low birth weight EFFECTS DURING PREGNANCY ​ higher chance of preeclampsia and infections ​ increased risk of neural tube defects (e.g., spina bifida) CLINICAL MANIFESTATION ​ poor fetal growth ​ increased risk of miscarriage and placental ​ Severe pain episodes abruption ​ Anemia symptoms (fatigue, pallor) ​ Increased risk of infections CLINICAL MANIFESTATION THERAPEUTIC MANAGEMENT ​ Fatigue ​ Glossitis (inflamed tongue) ​ Hydration: at least 8 glasses of fluids daily ​ Poor fetal growth ​ Folic Acid Supplementation to support red blood cell production THERAPEUTIC MANAGEMENT ​ Pain Management: opioids if necessary ​ Oxygen Therapy to prevent sickling crises ​ Folic Acid Supplementation: 400mcg ​ Exchange Transfusions in severe cases daily pre-pregnancy, increasing to 600mcg during pregnancy NURSING MANAGEMENT ​ Dietary Sources: green leafy vegetables, citrus fruits, beans ​ monitor for infections and early signs of crisis NURSING MANAGEMENT ​ encourage hydration and rest ​ educate on fetal monitoring and emergency ​ assess compliance with prenatal vitamins signs ​ educate on folate-rich foods ​ plan for every delivery if complications arise ​ monitor for signs of anemia and fetal development ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO THALASSEMIA EFFECTS DURING PREGNANCY ​ genetic blood disorder affecting hemoglobin production, leading to chronic anemia ​ Maternal Effects: ○​ severe dehydration EFFECTS DURING PREGNANCY ○​ electrolyte imbalance ○​ vitamin deficiencies (B6 and B12) ​ increased risk of fetal growth restriction ○​ weight loss ​ risk of heart failure due to iron overload ○​ psychological stress (from repeated transfusions) ​ Fetal Effects: ​ increased risk of stillbirth in severe cases ○​ increased risk of IUGR ○​ preterm birth CLINICAL MANIFESTATION ○​ low birth weight due to maternal malnutrition ​ Mild Cases: fatigue pallor ​ Severe Cases: organ damage, growth ASSESSMENT restrictions, heart failure ​ Subjective Data: THERAPEUTIC MANAGEMENT ○​ ask about the severity and frequency of nausea and vomiting ​ Iron Supplementation ○​ assess the inability to tolerate food ​ Blood transfusions for severe cases and fluids ​ Iron Chelation Therapy to prevent iron ○​ ask if certain smells of food trigger overload (due to frequent transfusions) vomiting ​ Objective Findings: NURSING MANAGEMENT ○​ Weight Loss: more than 5% of pre-pregnancy weight is a concern ​ monitor for iron overload and cardiac ○​ Dehydration Indicators: complications ​ poor skin turgor ​ educate on the risks of passing the disorder ​ dry mucous membranes to offspring ​ tachycardia ​ plan for specialized neonatal care if the ○​ Laboratory Findings: fetus inherits the severe form ​ elevated hematocrit levels (due to hemoconcentration) GESTATIONAL CONDITIONS ​ decreased sodium, potassium, and chloride levels HYPEREMESIS GRAVIDARUM ​ presence of ketones in urine, indicating the body is ​ severe form of nausea and vomiting that breaking down fat for energy extends beyond the typical morning sickness experienced in early pregnancy ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO THERAPEUTIC MANAGEMENT Hyperemesis gravidarum is a severe pregnancy ​ Hospitalization: complication that requires early recognition and ○​ women with severe hyperemesis proper management. By focusing on hydration, gravidarum are hospitalized for 24 nutrition, and emotional support, nurses play a hours for monitoring vital role in improving maternal and fetal ○​ Intravenous Ringer’s Lactate with outcomes. Proper education and home care management can help women cope better with Vit. B supplementation is given to this condition and ensure a healthier pregnancy restore hydration ​ Medications: ○​ antiemetics such as metoclopramide BLEEDING DISORDERS (Reglan) or ondansetron (Zofran) are commonly used to control SPONTANEOUS MISCARRIAGE vomiting ​ loss of pregnancy before 20 weeks of ​ Nutritional Support: gestation ○​ if oral intake is not tolerated, total ​ occurs due to chromosomal abnormalities, parenteral nutrition (TPN) or maternal health conditions, infections, or enteral feeding may be necessary uterine abnormalities ○​ when vomiting subsides, the diet gradually progresses from clear COMMON CAUSES liquid to small frequent meals such as dry toast, crackers, or ​ Chromosomal Abnormalities cereal ○​ most common cause ○​ 50% - 80% of early miscarriages NURSING MANAGEMENT result from chromosomal abnormalities in the fetus ​ Monitor Hydration and Nutrition ○​ occurs due to errors in cell division ○​ assess urine output (should be at (e.g trisomy) least 30mL/h) ○​ fetus with severe structural ○​ check urine specific gravity (should abnormalities cannot develop range between 1.003 and 1.030) properly, leading to pregnancy loss ○​ monitor electrolyte levels ​ Implantation Abnormalities ​ Provide Emotional Support ○​ up to 50% of zygotes fail to implant ○​ some women may experience securely due to: anxiety or depression due to the ​ inadequate endometrial lining severity of their symptoms (poor uterine preparation) ○​ counseling may be necessary, ​ implantation in an especially if woman is considering inappropriate site (e.g., lower terminating the pregnancy due to uterus, scars) extreme discomfort ​ poor implantation prevents proper placentaol circulation, leading to fetal malnutrition and miscarriage. ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ Hormonal Imbalances ○​ Radiation, chemicals, and toxins ○​ Progesterone Deficiency (e.g- pesticides, lead exposure) may ​ corpus luteum on the ovary damage fetal DNA, leading to fails to produce enough miscarriage progesterone, leading to ​ Uterine and Cervical Abnormalities decidual breakdown and ○​ Congenital uterine anomalies pregnancy loss (e.g., bicornuate uterus, uterine ​ progesterone therapy may septum) can prevent normal help if deficiency is implantation and Petal growth. diagnosed ○​ Cervical Insufficiency: The cervix ○​ Thyroid Disorders may open too early due to past ​ poor thyroid function or trauma (surgery, repeated D&C autoimmune thyroid disease procedures), leading to affects fetal development, second-trimester miscarriage increasing the risk of ​ Autoimmune Disorders & Blood miscarriage Clotting Issues ​ Maternal Infections: ○​ Lupus or Antiphospholipid ○​ Certain infections cross the placenta, Syndrome can cause clotting affecting fetal growth and increasing issues, reducing blood flow to the the risk of miscarriage: placenta. ​ Viral Infections: rubella, ○​ Poor circulation leads to placental cytomegalovirus, insufficiency, which may result in poliomyelitis fetal demise ​ Bacterial Infections: ​ Severe Maternal Illness syphilis, UTI ○​ Uncontrolled Diabetes: ​ Parasitic Infections: ​ high blood sugar levels can toxoplasmosis (from cat impair fetal development feces or undercooked meat) ○​ High Blood Pressure or ○​ If a fetus stops growing due to Preeclampsia: infection, placental hormone levels ​ reduced blood supply to drop, triggering uterine contractions placenta may cause fetal and miscarriage death ​ Teratogenic Exposure (Drugs, Alcohol, ○​ Chronic Kidney Disease: Environmental Toxins) ​ affects maternal circulation, ○​ Medications like Isotretinoin limiting oxygen delivery to (Accutane, used for acne, can cause the fetus severe fetal abnormalities leading to ​ Trauma or Injury miscarriage) ○​ Severe abdominal trauma (e.g., ○​ Alcohol consumption during early car accidents, falls) may cause pregnancy affects fetal growth and placental detachment. increases the risk of early pregnancy ○​ Excessive physical stress (e.g., loss. heavy lifting, extreme exercise) may ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO not directly cause miscarriage, but it ​ Definition: some pregnancy tissue can aggravate underlying conditions remains in the uterus, leading to prolonged bleeding TYPES OF SPONTANEOUS MISCARRIAGE ​ Signs and Symptoms: persistent bleeding, abdominal pain, open 1.​ Threatened Miscarriage cervix ​ Definition: miscarriage that may ​ Assessment: ultrasound shows happen but has not yet occurred retained fetal or placental tissue ​ Signs and Symptoms: vaginal ​ Management: D&C or misoprostol spotting, mild cramping, no cervical to evacuate the uterus dilation 5.​ Missed Miscarriage ​ Assessment: ultrasound to check ​ Definition: fetus has died in the fetal viability; hCG monitoring uterus, but the body has not ​ Management: rest, avoid heavy expelled it activities, and monitor for ​ Signs and Symptoms: no fetal progression movement, no heart tones, brownish 2.​ Imminent (Inevitable Miscarriage) discharge, closed cervix ​ Definition: miscarriage that cannot ​ Assessment: absent fetal heartbeat be prevented as cervical dilation has on ultrasound, declining hCG levels started ​ Management: D&E or ​ Signs and Symptoms: heavy prostaglandin induction if beyond 14 bleeding, strong cramping, open weeks to prevent DIC (Disseminated cervix Intravascular Coagulation) ​ Assessment: ultrasound confirms fetal demie or non-viability ASSESSMENT ​ Management: if fetal tissue remains, dilation and evacuation ​ History: (D&E) may be required ○​ Onset 3.​ Complete Miscarriage ○​ Amount and duration of vaginal ​ Definition: all fetal and placental bleeding tissue has been expelled from the ​ Physical Exam uterus ○​ Vital Signs: hypotension and ​ Signs and Symptoms: sudden tachycardia indicate hemorrhage reduction in bleeding, uterus ○​ Abdominal Exam: uterine returning to normal size tenderness suggests infection ​ Assessment: no retained products ​ Laboratory & Imaging seen on ultrasound ○​ Ultrasound: determining fetal ​ Management: no further medical viability and retained tissue intervention is needed ○​ hCG Levels: low or declining levels -​ monitor for bleeding and indicate poor placental function infection 4.​ Incomplete Miscarriage ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO THERAPEUTIC MANAGEMENT ○​ educate on signs of infection: fever, foul-smelling, discharge, persistent 1.​ Threatened Miscarriage pain ​ observation, hydration, avoiding strenuous activity COMPLICATIONS OF MISCARRIAGE 2.​ Incomplete/Imminent Miscarriage ​ D&C or misoprostol to expel retained ​ Hemorrhage products ○​ Cause: Retained placenta, uterine ​ oxytocin may be used to contract atony. the uterus ○​ Management: Uterine massage, 3.​ Missed Miscarriage oxytocin, blood ​ If before 14 weeks: D&C or ○​ transfusion if needed. expectant management ​ Infection ​ If after 14 weeks: Prostaglandins ○​ Symptoms: Fever, abdominal pain, or oxytocin induction to prevent foul vaginal discharge. complications ○​ Management: IV antibiotics, D&C if infected tissue remains NURSING MANAGEMENT ​ Septic Abortion ○​ Cause: Retained infected tissue, ​ Monitor Bleeding & Vital Signs unsafe abortion. ○​ Assess blood loss: heavy bleeding ○​ Management: Immediate (soaking >1 pad per hour) suggests antibiotics, IV fluids, surgical hemorrhage evacuation ○​ Check for hypovolemic shock: ​ Isoimmunization (Rh Incompatibility) Low BP, tachycardia, pale skin ○​ Risk: Rh-negative mother carrying ​ Emotional Support Rh-positive fetus. ○​ allow the patient to express feelings ○​ Management: Administer Rh of loss and grief immune globulin (RhIG) within 72 ○​ explain the medical situation in clear, hours of miscarriage. compassionate terms ​ Psychological Impact (Powerlessness ​ Medication Administration & Anxiety) ○​ Pain Relief: NSAIDs or ○​ Feelings of guilt, grief, and acetaminophen as prescribed depression are common. ○​ IV Fluids: to correct dehydration ○​ Nursing Interventions: from bleeding ​ Allow the woman to verbalize ○​ Antibiotics: if infection is suspected her feelings. ​ Post-Miscarriage Care ​ Encourage support groups ○​ avoid tampons and sexual activity and counseling if needed until the bleeding stops ○​ iron-rich foods and supplements for blood loss recovery ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ○​ shoulder pain (caused by blood ECTOPIC PREGNANCY irritating the diaphragm) ○​ fainting, dizziness, or rapid heartbeat ​ occurs when a fertilized egg implants (due to hemorrhage) outside the uterine cavity, most commonly in the fallopian tube DIAGNOSTIC TESTS ​ other locations include: ovary, cervix, or abdominal cavity ​ Transvaginal Ultrasound: confirms the ​ life-threatening emergency because the absence of an embryo in the uterus and implanted embryo cannot develop properly detects an abnormal mass in the fallopian and may rupture, leading to severe bleeding tube and shock ​ Blood Tests (hCG & Progesterone Levels) EFFECTS ON PREGNANCY ○​ Lower than expected hCG levels suggest abnormal pregnancy ​ Non-viability: embryo cannot survive ○​ Low progesterone levels indicate outside the uterus poor pregnancy progression ​ Severe Internal Bleeding: ruptured ​ Culdocentesis (Rarely Used) ectopic pregnancy can cause hemorrhagic ○​ a needle is inserted through the shock vaginal wall to check for blood in the ​ Future Fertility Risks: if fallopian tube is peritoneal cavity, indicating internal damaged or removed, future pregnancies bleeding may be affected ​ Laparoscopy ​ Emotional Impact: women may ○​ minimally invasive surgical procedure experience grief, anxiety, or depression due to directly visualize and confirm an to pregnancy loss ectopic pregnancy ASSESSMENT THERAPEUTIC MANAGEMENT ​ Early Signs (6-12 weeks of Pregnancy) 1.​ Medical Treatment (Early, Unruptured ○​ missed menstrual period Ectopic Pregnancy) ○​ positive pregnancy test ​ Methotrexate ○​ mild cramping or lower abdominal ○​ chemotherapy drug that pain stops cell growth and ○​ light vaginal spotting or brown dissolves the pregnancy discharge ○​ used if fallopian tube has not ​ Signs of Rupture (Emergency ruptured and hCG level is Situation) below 5,000 IU/L ○​ sudden sharp, stabbing pain in one ○​ requires serial hCG lower abdominal quadrant monitoring until levels return ○​ heavy vaginal bleeding or internal to normal bleeding (can lead to shock) ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO 2.​ Surgical Treatment (For Ruptured or ○​ advise against pregnancy for at least Advanced Ectopic Pregnancy) 3-6 months to allow healing ​ Laparoscopic Salphingostomy: ​ Prevention of Future Ectopic ○​ small incision is made in the Pregnancies: fallopian tube to remove the ○​ treat pelvic infections warly to pregnancy without removing prevent tubal scarring the tube. ○​ encourage smoking cessation, as ○​ preserves fertility in future smoking increases risk pregnancies. ○​ monitor for recurrent ectopic ​ Laparoscopic Salpingectomy: pregnancy, which occurs in 10-20% ○​ removes the affected of cases fallopian tube if it is severely damaged or bleeding INCOMPETENT CERVIX excessively. ○​ may reduce fertility by 50%, ​ also known as premature cervical dilatation but pregnancy is still possible ​ occurs when the cervix opens too early in from the other ovary. pregnancy, leading to pregnancy loss or ​ Emergency Open Surgery preterm birth (Laparotomy): ​ typically painless ○​ performed if the ectopic ​ first sign might be vaginal spotting, pelvic pregnancy has ruptured, pressure, or rupture of membranes causing life-threatening ​ often results in miscarriage around the 20th bleeding. week of pregnancy when the fetus is too ○​ requires blood transfusion in immature to survive severe hemorrhage cases. EFFECTS ON PREGNANCY NURSING MANAGEMENT ​ Increased risk of second-trimester ​ Monitor for Shock Symptoms miscarriage due to the inability of the ○​ assess VS (low BP, high PR) cervix to stay closed. ○​ check for heavy bleeding (visible or ​ Preterm labor or birth if the cervix opens internal) too early but the fetus is viable. ​ Emotional Support & Counseling ​ Rupture of membranes leading to ○​ explain the treatment plan and infection or premature birth. future fertility options ​ Emotional distress for the mother due to ○​ provide grief counseling and refer to unexpected pregnancy loss support groups if needed ​ Postoperative Care ASSESSMENT ○​ monitor for infection (fever, increased pain) ​ Painless cervical dilation without ○​ encourage rest and gradual activity contractions. resumption ​ Pelvic pressure or vaginal fullness felt by the patient. ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ Increased vaginal discharge that may ​ Progesterone Therapy be pink-tinged. ○​ Vaginal progesterone suppositories ​ Short cervix on ultrasound (measuring help strengthen the cervix and delay less than 25 mm before 24 weeks). labor. ​ History of multiple second-trimester ​ Bed Rest & Activity Restriction pregnancy losses. ○​ Advising limited physical activity to reduce pressure on the cervix. DIAGNOSTIC TESTS ○​ Pelvic rest (no sexual intercourse) is often recommended. ​ Transvaginal Ultrasound ​ Close Monitoring ○​ measures cervical length ○​ Regular ultrasounds to check cervical ​ shortened cervix is a key length. indicator ○​ Hospitalization if the cervix ○​ detects funneling (opening of the continues to shorten despite internal cervical os) treatment. ​ Pelvic Exam ○​ checks for cervical softening and NURSING MANAGEMENT dilation without contractions ​ Hysterosalpingography (HSG) ​ Preoperative Care for Cervical ○​ for non-pregnant women Cerclage ○​ evaluates for structural abnormalities ○​ Educate the patient on the of the uterus and cervix procedure and its benefits. ○​ Monitor for contractions, bleeding, or THERAPEUTIC MANAGEMENT infection before surgery. ​ Postoperative Care ​ Cervical Cerclage (Surgical Stitching of ○​ Monitor for signs of labor the Cervix ) (contractions, cramping, bleeding). ○​ McDonald Procedure: nylon ○​ Encourage rest and pelvic rest for at sutures placed around the cervix to least a few days. tighten the opening ​ Patient Education ○​ Shirodkar Procedure: more ○​ Teach the importance of follow-up permanent suture technique placed ultrasounds deeper into the cervix ○​ Instruct the woman to report any ○​ Timing: vaginal bleeding, fluid leakage, or ​ Preventive Cerclage: contractions 12-14 weeks gestation for ○​ Emotional support, as pregnancy high-risk women. loss can be traumatic ​ Emergency Cerclage: Placed before 24 weeks if the cervix starts opening. ​ Sutures are removed at 37-38 weeks to allow vaginal delivery. ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ Risk of Hemorrhage - if bleeding is PLACENTA PERVA severe, the mother may need a blood transfusion ​ placenta partially or completely covers the ​ Fetal Complications - prematurity, low cervix instead of attaching to the upper birth weight, or fetal distress due to oxygen uterine wall deprivation ​ can cause painless vaginal bleeding in the second or third trimester and can lead ASSESSMENT to complications for both the mother and the baby ​ History of Painless Vaginal Bleeding ○​ bleeding usually occurs after 20 TYPES OF PLACENTA PERVA weeks of gestation ○​ no uterine contractions or pain are ​ Complete Placenta Previa - The placenta present in most cases fully covers the cervix. preventing vaginal ​ Physical Findings delivery. ○​ soft, non-tender uterus (no ​ Partial Placenta Previa - The placenta contractions) partially covers the cervix. ○​ normal fetal heart rate (unless fetal ​ Marginal Placenta Previa - The edge of distress develops) the placenta touches the cervix but does not cover it. A VAGINAL EXAM SHOULD NEVER BE ​ Low-lying Placenta - The placenta is PERFORMED IN SUSPECTED PLACENTA implanted low in the uterus but does not PREVIA, AS IT MAY CAUSE SEVERE reach the cervix. BLEEDING ​ Transvaginal Ultrasound ○​ Confirms placental position over or near the cervix. ○​ Best performed after 20 weeks to determine if the placenta is still covering the cervix. ​ Fetal Monitoring EFFECTS ON PREGNANCY ○​ Evaluates fetal heart rate and well-being. ​ Painless vaginal bleeding (often bright ​ Hemoglobin & Hematocrit Tests red) occurs as the cervix starts to thin and ○​ Checks for maternal blood loss and dilate anemia. ​ Preterm Birth - babies may need to be ​ Coagulation Studies delivered early due to excessive bleeding ○​ If excessive bleeding occurs, clotting ​ Placental Separation (Abruption Risk) tests help assess the risk of - if the placenta detaches suddenly, it can hemorrhage. cause fetal distress THERAPEUTIC MANAGEMENT ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ○​ Monitor vital signs (low BP, high HR ​ Immediate Care Measures (Acute = signs of blood loss). Bleeding Episodes) ○​ Assess fetal well-being (fetal heart ○​ Hospitalization for close monitoring if monitoring). bleeding is significant. ​ Prevent Further Bleeding ○​ IV Fluids and Blood Transfusion if ○​ No vaginal exams or internal fetal hemoglobin drops too low. monitoring. ○​ Oxygen therapy for maternal ○​ Ensure the patient follows bed rest stabilization. recommendations. ○​ Steroid Injections (Betamethasone) ​ Educational and Psychological Support to speed up fetal lung maturity if ○​ Educate the patient on the condition early delivery is needed. and the importance of close ​ Continuing Care Measures (If Bleeding monitoring. Stops) ○​ Address anxiety and fears about ○​ Bed Rest - Limited activity to pregnancy complications and early prevent triggering further bleeding. delivery. ○​ Pelvic Rest - Avoid sexual ○​ Provide reassurance and refer to intercourse, vaginal exams, and support groups if needed. strenuous activities. ​ Postpartum Care ○​ Frequent Ultrasounds to check ○​ Monitor for postpartum hemorrhage placental position and fetal growth. (placenta previa increases risk). ○​ Iron Supplements if anemia is ○​ Assess for anemia and provide iron present. supplements if needed. ​ Birth Plan (Delivery Method) ○​ Educate about future pregnancy ○​ Planned Cesarean Section risks, as placenta previa can recur. (C-Section) ​ If placenta previa persists ABRUPTIO PLACENTAE until 36-37 weeks, a (PREMATURE SEPARATION OF C-section is required. PLACENTA) ​ If the placenta moves away from the cervix, vaginal birth ​ premature separation of the placenta, may be possible. occurs when the placenta detaches from the ○​ Emergency C-Section uterine wall before the fetus is delivered. ​ If severe hemorrhage or fetal ​ medical emergency as it can lead to severe distress occurs, immediate maternal and fetal complications. delivery is needed. EFFECTS ON PREGNANCY NURSING MANAGEMENT ​ For the Mother: can cause severe ​ Monitor for Bleeding hemorrhage, leading to hypovolemic shock, ○​ Assess the amount, color, and disseminated intravascular coagulation pattern of vaginal bleeding. (DIC), and even maternal death if left untreated. ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ For the Fetus : Since the placenta THERAPEUTIC MANAGEMENT provides oxygen and nutrients, early detachment can result in fetal hypoxia, ​ Immediate Care Measures: growth restriction, preterm birth, or stillbirth ○​ Monitor maternal vital signs and fetal heart rate continuously. ASSESSMENT ○​ Position the mother in left lateral recumbent position to optimize ​ Sudden, sharp abdominal pain that is of placental blood flow. ten located in the fundal region. ○​ Administer oxygen to improve fetal ​ Continuous dull pain following the sharp oxygenation. pain. ○​ Establish IV access and administer ​ Vaginal bleeding, which may be mild to fluids or blood transfusion if severe, or even concealed inside the uterus. necessary. ​ Uterine tenderness and rigidity due to ○​ Prepare for emergency delivery if blood accumulation behind the placenta. fetal distress is noted or maternal ​ Signs of maternal shock such as pallor, condition worsens. dizziness, weak pulse, and hypotension. ​ Continuing Care Measures: ​ Fetal distress due to oxygen deprivation, ○​ Monitor for further bleeding and noted by abnormal fetal heart rate patterns. complications like DIC. ○​ Assess coagulation status to prevent DIAGNOSTIC TESTS excessive bleeding. ○​ Administer corticosteroids (e.g., ​ Ultrasound: While not always definitive, it betamethasone) if preterm birth is may detect retroplacental clots. expected, to enhance fetal lung ​ Fetal Heart Monitoring: Abnormalities maturity. such as late decelerations may indicate fetal ​ Birth: distress. ○​ Vaginal delivery may be ​ Blood Tests attempted if bleeding is minimal and ○​ Complete blood count (CBC) to fetal distress is not present. check for anemia. ○​ Cesarean section is required in ○​ Coagulation studies to assess for cases of severe hemorrhage, fetal DIC. distress, or significant placental ○​ Kleihaver-Betke test to detect separation. fetal blood in maternal circulation. ​ Clinical Examination: based on NURSING MANAGEMENT symptoms and risk factors such as hypertension, trauma, or substance use ​ Assess and monitor maternal vital signs, uterine contractions, and fetal heart rate. ​ Monitor blood loss and observe for signs of shock. ​ Prepare for emergency delivery if the situation deteriorates. ROSETTE ANGELA A ZAPE | RR25 MATERNAL AND CHILD HEALTH NURSING A/Y 2024-2025 (2ND SEMESTER)​ MR. JALM LAVANDERO ​ Educate the patient and family on the condition and possible outcomes. ​ Provide emotional support to alleviate anxiety and fear. ROSETTE ANGELA A ZAPE | RR25