Nursing Care of High Risk Patients PDF

 risk nursing care of high ① Assx. Of clients at risk...

 risk nursing care of high ① Assx. Of clients at risk begins w/ 1st prenatal visit I continues through puerperium 1st Prenatal visit of of early 6- to wks > - as soon as pregnancy ② Risk factors including physiological socio demographic psychological & -. & environmental factors > physiological = mother itself I ↓ 18 yrs I 1^40 yrs = at ) risk = malnutrition > socio - demographic = living condition > psychological = physically I mentally prepared ③ Vulnerable group are pregnant women w/ : * physiologic problems 1 malnutrition ) * mothers too young too old ( scoliosis Csdeliv) * physical deformity = * mental illness / retardation medical conditions * DM * Rheumatic Disease * HIV * substance use  diabetes mellitus in body tends to hyperglycemia from detect insulin ketoacidosis get - -. > secretion , insulin action or both energy from fatty acids Insulin glucose levels regulates pathophysiology = - = , insulin stimulates protein synthesis & storage ① Ineffective 2 insufficient of fatty acids causes glucose accumulation of hyper osmolarity beta cells in Islet Langerhans ⑥ Hyperglycemia - = Of blood 3 triad signs : ③ cellular DHN I polyuria causes * polydipsia * Polyuria polydipsia of * polyphagia ④ weight loss occurs because of fat & muscle tissue breakdown = ketones Gluconeogenesis - production of ⑤ tissue breakdown = starvation new glucose l polyphagia ) NORMAL Hyper osmolarity will sip 90 120mg/ at - = - water out the cells → cells become DHN lesser blood V01 leading to thirsty COMPLICATIONS = → →. = ① Atherosclerosis - accumulation of classification : glucose in blood 1 ( ) damage in retina ② Retinopathy IDDM * Type - * type 2 ( NIDDM ) kidney damage ③ Nephropathy - - * GDM damage ⑨ Neuropathy nerve 1 2 type type onset cataract in DM excess sugar juvenile onset adult - - - ( young ) lifestyle will go to lens become alcohol - sugar - autoimmune - 90-95 % = sorbitol t) ketoacidosis - 5- 10% - - f) ketoacidosis * ketones * B- hydrolytic acid * aceto acetic acid metabolic changes w/ Pregnancy : Assessment : * 1st Trines - ↑ estrogen & " * Physical Exam * BP monitoring * * Fundicht progesterone ECG. stimulates beta cells * Check for vision w/ - - ↓ blood glucose * wt - gain * 2nd 23rd Trines Lab Test : ↑ tolerance to * Fasting Blood sugar ( FBS ) glucose - - ↑ insulin resistance - NV : to -110mg / dl - ↑ estrogen , progesterone , prolactin - 6- 8 hrs NPO cortisol , insulin ase - pm = ↑ 126 for 2 readings > Placenta - has f) effect in insulin * Random Blood sugar ( RBS ) estro , proges cortisol HCS I -2 hrs F meal - - , , < 150mg / dl - = DELIVERY = ( for pregnant) after * Oral Glucose Tolerance Test 106TH maternal glucose drops - deliv - FBS first → drink orange juice hormones return to normal F 1hr extract blood until 2hr5 - -. = LACTATION = * Glycosylated hgb ( HBAIC ) 13 months ) normalizes glucose levels most accurate - - - insulin requirements ↓ - reflects serum glucose levels - Nv : 4.4 % - 6.4% - no fasting maternal complications Nursing DX : ① Risk for ineffective tissue perfusion ① Macros omiq Rtt reduced vascular flow ② shoulder Dystociq ③ PIH ② Imbalanced nutrition less than body ④ Preterm Labor ⑦ PROM requirements Ht inability to use ⑤ Hydramnios glucose ⑥ Hypotension ③ Risk for infection RH impaired rheumatic heating accompanying condition heart disease ④ Deficient fluid v01. RH polyuria - caused by group A beta hemolytic accompanying condition streptococcus 1 Pyogenes) - creates autoimmune reaction in tissue = Management = - starts w/ rheumatic fever [tonsillitis! ( 60 -120mg /dl ) ( achieving euglycemia can lead to death - chronic acquired disease - ① Diet - balanced - 1800 -2400 kcal ( 30cal / kg ) - 40-50% Cto = CLASSIFICATION = 20% CHON 12 ① promised nncom - Class I - - - 20-3090 Fats 10% sat - fats limitation physical act no - , ② 15-30 mins Exercise walk ② Class I slightly compromised - - ergometry recumbent bicycle limitation arm slight - - , - best time is after meals - extra attention to pregnant w/ ③ Class - markedly compromised vascnlopathy - moderate limitation ③ Insulin therapy ④ Class I - severely compromised oral no hypoglycemic agents - ' for pregnant = teratogens > treatment is lifetime in ) " ( " - subq u > DOC = Penicillin G N - it allergic can give macrolides ④ Glucose monitoring CBG = erythromycin = Complications = * murmur * cardiomegaly * valvular insufficiency human others : immunodeficiency * practice nutritional sale sex , no oral sex * support virus * Observe standard I blood precautions - infection through heterosexual contact IV pfannensteil bikini out in Cs & drug use > - transmission : * maternal circulation substance abuse * Labor & delivery by inoculation includes drugs alcohol ingestion & smoking - I , * Breastfeeding = Complications = * bleeding * prematurity 013 Complications pretrial : * miscarriage * placenta * preterm * MGR * stillbirth * SGA , SIDS * * PROM IUFD > marijuana ( TAC ) - ↓ fetal oxygenation Management = ↑ maternal BP , HR = - ① Preconception counselling ↓ Placental blood flow - pregnancy not encouraged - - prenatal care it pregnant > smoking Cs recommended ↑ risk premature - - - fetal disorder / respiratory > MGR - intrauterine growth restriction = management = > MFD - intrauterine fetal demise * meconium sample ( newborn ) * Hair sample ( mother ) Treatment = = = Treatment = * IV zidovudine during intra partum * Detoxification period * Education on OB effects * Rehab  AN f mi G oral Iron 60 120mg / day - - - - most common disorder - check for nausea I vomit - reduction of oxygen carrying - taken F meals w/ rite capacity of blood ↑ workload of > Im ( intern ) failure it associated track technique - congestive a - M Pitt Rh sensitization classification : _ maternal blood loss is RH ↳ while ① Iron - deficiency - MC fetal blood is RH ( t) ② Folic Acid deficiency memos - mother forms antibodies IgM & IgG ③ sickle cell Hemoglobin opathy instead " 'd destroys through hemolysis hermit ) ④ thalassemia ' destroyed ) happens in 1st but not pregnancy - bone marrow produce enough antibodies makes on 2nd pregnancy maternal complications : * Blood loss / Hypovolemic shock = Assessment = ① Anemia ② Jaundice - yellow discoloration caused bilirubin = Assessment - = ③ enlargement of newborn 's liner & spleen ① capillary Refill test ② Hematocrit continons destruction - 37 -47 Do 1 pregnant) NV : ⑨ Edema of newborn - = consider physiologic anemia ⑤ Dyspnea I DOB ) = Lab Test = * Coombs test 12*4) or e) Management - = = * iron - foods rich * iron dosage * Neibauer Betke test * folic acid rich food = Management = of 300 Mcg RH ( rhogam) I ✓ injection birth ( win 72hrs7 birth )  Complications = = * Erythroblastosis Fetalis * fetal is Hydrops