NCM 109 - Care of At-Risk/High Risk Mothers and Child PDF

NCM 109 – Care of At-Risk/High Risk and Sick Mothers and Child  TOPICS: Topic 1: NURSING CARE OF THE PREGNANT CLIENT A) Health Assessment as part of the Nursing Process B) The nursing role and nursing care during pregnancy complications Topic 2: NURSING CARE OF THE C...

NCM 109 – Care of At-Risk/High Risk and Sick Mothers and Child  TOPICS: Topic 1: NURSING CARE OF THE PREGNANT CLIENT A) Health Assessment as part of the Nursing Process B) The nursing role and nursing care during pregnancy complications Topic 2: NURSING CARE OF THE CLIENT DURING LABOR AND DELIVERY A) Nursing care of the family experiencing a sudden pregnancy complication B) Nursing care of the family experiencing a complication of labor or birth C) Nursing care of the family experiencing postpartum complications Topic 3: CARE OF COUPLES WITH INFERTILITY A) Causes of infertility in males and females B) Diagnostics Test C) Nursing Interventions I. Nursing Care of Pregnant Client – - Nurses play a vital role in supporting pregnant clients by ensuring their physical and emotional well-being throughout the pregnancy journey.  Assessment of Risk Factor Involves evaluating various factors that could potentially affect the health of the mother and the baby, this includes 1. Assessing pre-existing health conditions 2. Previous pregnancy complications 3. Maternal Age 4. Lifestyle Factors 5. Genetic History 6. Current Health Status. High-risk pregnancy jeopardizes the mother, fetus, or both. A condition due to pregnancy or the result of a condition present before pregnancy.  Assessment of Risk Factor In doing our assessment we will do our clinical judgment after we have done our assessment using IPPA 1. Inspection 2. Palpation 3. Percussion 4. Auscultation  Risk Factors: MATERNAL AGE MATERNAL MEDICAL HISTORY LIFESYTLE AND MATERNAL OBSTETRICS FAMILY CULTURE AND PARITY HABITS AND GYNECOLOGY ETHNICITY Adolescents 5 or more Hypertension Inadequate OBSTETRICS: Sickle cell anemia –an younger pregnancy at Diabetes Mellitus Nutrition 2 or more premature abnormal form of than 15 least 20 weeks Thyroid Disease leading to iron, deliveries or hemoglobin, red blood cells years old duration Peptic Ulcer folic acid and spontaneous become rigid and are Disease protein abortion, multiple shaped like sickle or deficiency pregnancy, H-mole crescent moons Primi para Gap of 8 years Exposure to toxic History of stillbirth or fetal Thalassemia -is at 35 and or more since substances such demise inherited from parents older last pregnancy as lead, organic through genes, blood solvents, certain Ectopic pregnancies disorder is caused gases and when the body radiation Lack of previous doesn’t make enough prenatal or preparation or inadequate amount For labor or birth. of hemoglobin or defects of synthesis of hemoglobin Multiparas Ingestion of OTC GYNECOLOGY: Religious Practice - at 40 and (over-the- Last menstrual period LMP refers to traditional older counter) and Vaginal discharges, pain or beliefs and practices of prescription discomfort pregnant women Pelvic inadequacy or drugs abnormal shaping and  PELVIC INADEQUACY OR ABNORMAL SHAPING Pelvis – provides the structural support for enlarging uterus and creating a passageway for delivery. TYPES OF PELVIS  PELVIC INADEQUACY OR ABNORMAL SHAPING GYNECOID PLATYPELLOID ANDROID ANTHROPOID Most common for female Flat pelvis, often associated Typical male pelvis, narrow Oval-shaped, adequate for and most favorable for with delivery challenges and heart-shaped, less delivery vaginal delivery (rounded Least common type of pelvis favorable and wide pelvis) Rounded and wide pelvis Wide but shallow and it Narrow shape of android a narrow and deep pelvis, its resembles an egg or oval can make a labor difficult shape is like a upright egg lying on its side. because the baby might or oval. Vaginal birth is difficult more slowly through the birth The elongated shape of because the baby may canal, some pregnant anthropoid pelvis makes it have trouble passing women with this shape may roomier from through require C-section. front to back. Its narrow than pelvic inlet. gynecoid pelvis. Pregnant Caesarian section is women with this type of recommended pelvis able to have a vaginal birth but labor might last longer.  Uterine Anomalies Is when women’s uterus develops differently, or uterine incompetency, position or structure is not normal  Uterine Anomalies NORMAL DIDELPHYS ARCUATE UNICORNUATE BICORNUATE SEPTATE A pear shape, A rare condition A minor irregularity A rare condition A uterine A uterine anomaly hallow where a woman in the shape of that causes a anomaly caused caused by muscular organ develops two uterus. uterus, a mild women to have by incomplete incomplete A congenital indentation at the only half of the fusion resulting growth of the abnormality. fundus (top of the uterus has two separate central tissue. This Can conceive and uterus) developed. cavities partially results in the deliver successfully Is classified as the Pregnancy is or completely presence of though there is an least severe form possible but carries divided. muscular partition increased risk of of uterine a higher risk of Describe as heart (septum) dividing miscarriage or anomalies complications such shaped the uterine cavity preterm birth. miscarriage, fetal appearing to into two growth restriction have two sides, it compartments. and preterm can be treated May discover delivery with surgery even during pregnancy Tilted slightly Classification : forward Bicornuate Unicollis (anteverted) in – two cavities with single cervix most women Bicornuate Bicollis- two cavities with two cervices  Uterine Position Refers to the orientation and placement of the uterus within the pelvic cavity. Uterine Position: 1. Anteverted/normal position – uterus tilted forward, most common position 2. Retroverted – tilted backward towards the spine Bending Uterus: 3. Retroflexion – bending backward 4. Anteflexion – bending forward Family History – is has a major influence in pregnancy outcomes because it can indicate a genetic predisposition or shared environment factors that may increase the risk of certain condition during pregnancy. Maternal and Paternal family medical history Family environment II. The Nursing Role and Nursing Care During Pregnancy Complications - During pregnancy complications, nurses play a vital role in providing comprehensive care to both the mother and the unborn child. I.CARDIOVASCULAR DISORDER AND PREGNANCY Gestational Problem CARDIOVASCULAR DISORDER AND PREGNANCY The danger of pregnancy in a woman with cardiac disease occurs primarily due to the increase in circulatory volume. The most dangerous time for a woman is 28 to 32 weeks after the blood volume peaks.  CARDIOVASCULAR DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Left Sided Heart Failure occurs in condition such as a Fatigue Electrocardiogram Assessment and Monitoring Medication – mitral stenosis, mitral Palpitation Chest X-ray Medication Management insufficiency and aortic Paroxysmal nocturnal Coronary Angiography Fluid Management Positioning Beta blockers (carvedilol, coarctation. dyspnea Echocardiogram Diet Counselling metoprolol, bisoprolol) Pulmonary edema Blood Test Rest and Activity Balance ACE inhibitors (lisinopril, The left ventricle cannot move Cough or hemoptysis (electrolytes) Education and Support captopril) the volume of blood forward Collaboration and Angiotensin receptor that is received by the left Coordination (Cardiologist and blockers (losartan) atrium from pulmonary OB) Digoxin (Lanoxin) circulation Aldosterone Antagonist Occurs- occurs in condition such as a mitral stenosis, Lifestyle change mitral insufficiency and aortic coarctation. Surgery – Left Ventricular Assist Device (LVAD The left ventricle cannot move the volume of blood forward that is received by the left atrium from pulmonary circulation  CARDIOVASCULAR DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 2. Pulmonary Edema Is a serious condition during Shortness of Breath Electrocardiogram Assessment and monitoring Medications – pregnancy, characterized by Tachypnea Chest X-ray Oxygen Therapy Diuretics to reduce the accumulation of fluid in the Coughing with pink-tinged Coronary Angiography Positioning fluid retention lungs, which impairs oxygen sputum Echocardiogram Assistance with medication Oxygen Therapy exchange and causes Crackles/Rales (lung Blood Tests measure oxygen Emotional Support Positioning respiratory distress. It is a sound) level, and electrolyte imbalance Education Monitoring patient medical emergency requiring Cyanosis due to lack of CT (Computed Tomography) and treating prompt recognition and oxygen scan or Magnetic Resonance underlying cause treatment to protect maternal Imaging (MRI) provides and fetal health. detailed images to assess the lungs and heart condition Causes can result from: Pregnancy specific Spontaneous Miscarriage due Hypertensive indicators: to limited oxygenation Preeclampsia or eclampsia Rapid weight gain or Preterm Labor Peripartum Cardiomyopathy Swelling Maternal Death Valvular Heart Disease or with Hypertension As oxygen saturation of the Pre-existing cardiac Decrease Fetal Movement blood decreases from conditions Reduced urine output dysfunction of the alveoli chemoreceptors stimulate respiratory center to increase respiratory  CARDIOVASCULAR DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC NURSING INTERVENTION TREATMENT TEST MANAGEMENT 3. Right-Sided Heart Failure occurs when the right ventricle Fatigue and weakness due to Electrocardiogram Assessment and monitoring Medications - diuretics and is unable to pump blood decreased output Chest X-ray Management of fluid retention aldosterone antagonist effectively into the pulmonary Peripheral edema Coronary and improving cardiac function Oxygen administration circulation. This leads to back Nocturia - frequent urination at Angiography Monitoring of Fluid intake Frequent arterial blood up of blood in the systemic night Echocardiogram Medications- prescribed - During Labor – circulation, causing fluid Swelling in the legs, ankles and Blood Test diuretics Pulmonary artery catheter to retention and congestion in feet. (electrolytes) Diet – low sodium monitor pulmonary pressure peripheral tissues. Ascites Ensuring proper rest Close Monitoring to minimize Jugular vein distention Collaboration and the risk of hypotension after Causes: Hepatomegaly and tenderness Coordination (Cardio and OB) epidural anesthesia Congenital heart defects, pulmonary valve stenosis, and atrial and ventricular septal defects can result in right- sided heart failure Surgical Management: Ventricular Assist Device implant (VAD) The device can be implanted to help a weak heart pump II. HEMATOLOGIC DISORDER AND PREGNANCY  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC NURSING INTERVENTION TREATMENT TEST MANAGEMENT 1. Anemia Blood volume expands Fatigue CBC Monitoring of hgb level Iron Supplement during pregnancy slightly Weakness Peripheral Smear, Administering Iron Medication Dietary changes ahead of the red cell count, Pale skin and nails Serum ferritin, and Nutritional Support Vitamins most women have pseudo- Shortness of breath vitamin level test Lifestyle Guidance Supplements anemia of Dizziness or Lightheadedness (B12, folate) Education Treat underlying early pregnancy. This Rapid heartbeat Bone marrow test Collaboration – working with the cause Blood condition is normal and – to determine the healthcare team transfusion should not be confused with cause of anemia the types of anemia Hemoglobin (hgb) concentration is less than 11g/dl (hematocrit hct less than 33%) during the first and third trimester of pregnancy Normal Values: Possible Effects of taking Iron: Adult Woman Constipation – high fiber diet, increase Hgb = 12.0 – 15.5g/dl fluid intake 6-8 glasses per day Hct = 36-46% For gastric irritation - take an oral tablet Pregnant Woman with a full stomach Hgb = 11.0 – 14.0g/dl Stools black in color –Normal Hct = 33-39% *If iron deficiency is severe and the  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC NURSING INTERVENTION TREATMENT TEST MANAGEMENT 2. Iron Deficiency Anemia Most common anemia in pregnancy Extreme fatigue CBC Monitoring of hgb level Iron Supplement Causes: Weakness/poor exercise Peripheral Smear, Intake of prescribed prenatal Dietary changes Diet low in iron – low socioeconomic Tolerance Serum ferritin, vitamins containing 27mg of iron as Vitamins Supplements status Pale skin and conjunctiva Vitamin level test prophylactic therapy during Treat underlying cause Heavy menstrual flow Shortness of breath (B12, folate) pregnancy Blood transfusion unwise weight-reducing programs Dizziness or lightheadedness Bone marrow test – to Nutritional Support - diet high in getting pregnant less than 2 years Pregnant mother cannot determine the iron before the current pregnancy transport oxygen effectively cause of anemia Lifestyle Guidance it is associated with low birth Education Iron is made available in the body by weight and preterm birth Collaboration – working with the absorption from the duodenum into healthcare team the bloodstream after it has been ingested Iron is made available in the body by absorption from the duodenum into the bloodstream after it has been ingested  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 3. Folic Acid Deficiency Anemia One of the B Vitamins which is Fatigue CBC Monitoring of hgb level Iron Supplement necessary for the normal formation of Weakness Peripheral Smear, Intake of prescribed prenatal vitamins Dietary changes red blood cells in the woman Pale skin Serum ferritin, Vitamin containing 27mg of iron as Vitamins Supplements - Helps in preventing neural tube and level test prophylactic therapy during Treat underlying cause Shortness of breath abdominal wall defects in the fetus (B12, folate) pregnancy Blood transfusion Dizziness and rapid heartbeat Common Among: Bone marrow test – to Nutritional Support - diet high in iron 1. Multiple pregnancies increase fetal determine the Lifestyle Guidance Other symptoms might cause of anemia Education demand involve neurological issues All women expecting to 2. Women with secondary hemolytic Collaboration – working with the like tingling or numbness in become pregnant should healthcare team illness due to rapid destruction and the hands or feet, difficulty begin to take 400ug folic production of new red blood cells walking or mood changes acid daily plus food rich in 3. Women taking hydantoin an folate anticonvulsant agent that interferes with folate absorption 4. Women who have poor gastric absorption Megaloblastic Anemia – enlarged red blood cells- types of anemia caused by deficiencies in Vitamin B12 or folate  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING TREATMENT MANAGEMENT INTERVENTION 4. Sickle Cell Anemia: Is a genetic blood disorder that affects Pain (joint, bones) CBC 1. Assessment and Periodic exchange or blood the structure and function of Uremia ( bloody urine) Peripheral Blood monitoring transfusions throughout hemoglobin, the protein in red blood Smear 2.. Pain Management Pallor pregnancy to replace sickled cells cells responsible for carrying oxygen. Genetic Testing 3. Hydration Visual disturbance 4. Infection Prevention with non-sickled cells – serves as An abnormal form of hemoglobin that Delayed growth and Screening at the first 5. Oxygen Therapy a secondary purpose of red blood cells becomes rigid and shaped puberty pre-natal visit; 6. Blood Transfusions removing a quantity of the like sickle or crescent moons. hemoglobin analysis 7. Education and Support increased bilirubin resulting from Races usually affected: Blacks has the Women with the the breakdown of RBC as well as sickle cell trait or carries a recessive gene condition – for S hemoglobin but are asymptomatic. Monitor fetal health by an restoring the hgb level. hemoglobin :6- Effects on Pregnancy: ultrasound examination at If crisis occurs: 8mg/100ml Blockage to the placental circulation can 16-24 weeks to assess for 1. Control pain. Urinalysis- due to 2. Administering oxygen directly compromise the fetus causing vascular stasis, intrauterine fetal growth low birth weight and possibly fetal death 3. Increasing the fluid volume women are prone to of the circulatory system to bacteriuria lower viscosity 4. Blood Transfusion 5. If with infection –advise for hospitalization 6. If fetus is mature, the time and method of delivery are considered  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT SYMPTOMS 5. Thalassemia: Is inherited from parents through genes, Fatigue / Weakness CBC Preconception Counseling Blood Transfusion blood disorder caused when the body Pale or Yellowish skin Peripheral Blood Smear - Provide genetic counseling Management doesn’t make enough or inadequate Facial Bone deformities Hemoglobin to discuss the risk of Iron Chelation Therapy amount of hemoglobin or defects of Slow Growth Electrophoresis passing thalassemia to the Folic acid supplements synthesis of hemoglobin. Abdominal Iron Studies (Iron levels, child Thalassemia are a group of autosomal Enlargement Ferritin) Regular Hematologic recessively inherited blood disorders Dark Urine Genetic Testing Monitoring that lead to poor hemoglobin formation Prenatal Testing Fetal Monitoring and severe anemia. Regular Ultrasound to assess Is an inherited blood disorder that causes fetal growth and detect Complications: your body to have less hemoglobin than intrauterine growth restriction 1. Anemia normal, hgb enables red blood cells to (IUGR) 2. Iron Overload carry oxygen. Pain Management 3. Bone Deformities -Most common in Mediterranean, 4. Heart Problem African and Asian population 5. Endocrine Problem 6. Enlargement of Spleen and liver  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC NURSING TREATMENT MANAGEMENT TEST INTERVENTION 6. Coagulation Disorder A particular concern because Fatigue (from blood loss Prothrombin time Monitor vital signs Low molecular Weight Heparin pregnancy itself creates a or clot-related (PT) regularly, (BP, HR and RR) - Preferred anticoagulant during hypercoagulable state, a physiological complications) Activated Partial Assess for signs of bleeding pregnancy as it doesn’t cross the adaptation to prevent excessive Unusual swelling or pain Thromboplastin (e.g. gums, urine, stool or placenta bleeding during delivery. However, this (due to clotting) Time (aPTT) and vaginal bleeding. Administer clotting replacements increase clotting tendency can Shortness of breath (if fibrinogen Clotting (swelling, pain, (desmopressin) for bleeding exacerbate pre-existing coagulation pulmonary embolism levels redness in limbs) disorders such as hemophilia or disorders or lead to complication develops) D-dimer (for Observe for symptoms of Von Willebrand disease. during pregnancy. Severe headache or suspected clotting complications such as SOB, Ensure availability of blood visual disturbance (can events chest pain (Pulmonary products (e.g. fresh frozen plasma, 1. Antiphospholipid Syndrome (APS) be linked to APS or Doppler Embolism cryoprecipitate if required for an autoimmune condition causing preeclampsia) Ultrasound Severe Headache or visual conditions like Disseminated recurrent blood clots, miscarriages, Abdominal pain (due tp CT angiography changes (indicative of Intravascular Coagulation DIC) and other pregnancy complications placental abruption or a preeclampsia or clot-related like preeclampsia and intrauterine clot in abdominal veins events growth restriction Perform regular fetal 2, Disseminated Intravascular monitoring Coagulation (DIC) – a life-threatening Assess laboratory result condition associated with severe pregnancy complications such as placental abruption, amniotic fluid embolism, or preeclampsia  HEMATOLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT SYMPTOMS 6. Coagulation Disorder A.) Von Willebrand Disease Prothrombin time Low molecular Weight Heparin A coagulation disorder inherited as an - (PT) - Preferred anticoagulant during autosomal dominant trait and occurs in Activated Partial - pregnancy as it doesn’t cross the women. Thromboplastin Time placenta Have normal platelet counts but bleeding (aPTT) and fibrinogen time is prolonged levels Can not diagnose immediately if not D-dimer (for severe, until women got pregnant and suspected clotting experiences a spontaneous miscarriage events or postpartum hemorrhage Doppler Ultrasound CT angiography B) Hemophilia B (Christmas Disease) Factor IX deficiency, is a sex-linked disorder, occur only in males Females are carries and may have reduced level of factor IX (only 33% of normal) that results to hemorrhage with labor, or a spontaneous miscarriage Carriers of the disorder should be identified before pregnancy Gestational Problem HEMATOLOGIC DISORDER AND PREGNANCY Coagulation Disorder and Pregnancy C.) Idiopathic Thrombocytopenia Purpura (ITP) A decreased number of platelets is not inherited Can occur at anytime in life and can occur during pregnancy Cause is unknown Symptoms usually occur shortly after viral invasion such as upper respiratory tract infection It assumed to be autoimmune reaction (an antiplatelet antibody that destroys platelets is apparently released) Laboratory analysis reveal a marked thrombocytopenia – platelet count is as low as 20,000/mm3 from a usual count of 150, 000/mmm3 If adequate number of platelet, the woman is prone to frequent nosebleeds and minute petechiae or large ecchymosis appear in the body Gestational Problem III. RESPIRATORY DISORDER AND PREGNANCY  REPIRATORY DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT SYMPTOMS MANAGEMENT 1. Influenza Caused by the virus identified as: Fever Rapid Influenza Test Administration of antiviral Antipyretic Type A, B, or C, influenza Muscle pain PCR (Polymerase chain medication (Acetaminophen/Tylenol) to A&B are the primary types that Sore Throat Reaction) Ample Rest control fever cause seasonal flu outbreak CBC Hydration Women may be immunized Associated with preterm labor and ABG against influenza spontaneous miscarriage  REPIRATORY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTI NURSING INTERVENTION TREATMENT C TEST MANAGEMENT 2. Pneumonia Bacteria or viral infection of lung Fever Chest X-ray Administration of antiviral Antibiotics that are safe for tissue by pathogens such as Cough with or without sputum CBC medication both mother and the Streptococcus Pneumoniae Difficulty of breathing ABG Ample Rest developing fetus Pneumonia is an infection that Fatigue Blood Culture Hydration inflames your lungs’ air sacs Sputum (alveoli). The air sacs may fill up Culture with fluid or pus, causing Viral PCR symptoms such as cough, fever, Test chills, and trouble breathing. Covid 19 If the collection of fluid becomes extreme, it can limit the oxygen available not only for the woman but also for the fetus, it is associated with preterm labor due to the oxygen deficit  REPIRATORY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC NURSING INTERVENTION TREATMENT TEST MANAGEMENT 3. Asthma is chronic lung disease affecting Shortness of breath even Chest X-ray Checking and monitoring v/s. Bronchodilator –short acting people of all ages caused by the resting CBC Assess for respiratory distress bronchodilators rapidly inflammation and muscle Persistent cough ABG Check oxygen status relieve asthma symptoms tightening around the airways, Wheezing when exhaling Check the lung sounds by relaxing the airways: which makes it harder to breathe. sometimes when Fetal Monitoring Position patient upright Albuterol (Ventolin), this Triggered by an irritant such as an inhaling Ultrasound Administer medications as medication appear to be inhaled allergen (pollen, dust, and Non-stress test prescribed. safe during pregnancy cigarette smoke *These symptoms can (CTG) be mild or severe and can come and go over - time.  REPIRATORY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 4. Tuberculosis Is an infectious disease that often Chronic cough PPD Test (purified Monitoring and Assessment Isoniazid (INH) affects the lungs, caused by a Weight loss protein derivative) or Medication Management Ethambutol Hydrochloride type of bacteria called Hemoptysis Mantoux Test Patient Education (no teratogenic effect) Mycobacterium Tuberculosis Night sweats Chest X-ray Collaboration with HealthCare (An acid-fast bacillus) spreads Low grade fever Sputum Culture team through the air when an infected Chronic Fatigue Infection Control Measures person coughs, sneezes, or spit. Psychosocial Support Nutritional Support Antenatal Care – Collaborate with OB to integrate TB management into routine pre-natal care  Gestational Problem RESPIRATORY DISORDER AND PREGNANCY 4. Pregnant Women with Tuberculois: Effect of Tuberculosis to the Fetus: 1. Pre-Term Birth- TB has a higher risk due to the infection that can contribute to complications that lead to pre-term labor 2. Low Birth Weight- TB in pregnancy can affect due to maternal malnutrition, decrease nutrient transfer, inflammatory response and low oxygen supply. 3. IUGR – due to malnutrition and low oxygen supply it will affect the growth of developing fetus. 4. Transmission Risk – while its uncommon, the risk of transmitting TB from infected mother to the baby during childbirth 5. Congenital TB – although rare where the infection is transmitted from the mother to the fetus during pregnancy, this can result in serious issues for the newborn *TB can be spread by the placenta to the fetus it usually spread to the infant after birth. *Mother with TB needs to have 3 negative sputum culture before she can take care of her baby *If active TB is in the home the infant is discharge with prophylactic INH to prevent infection, with follow up skin testing (PPD test) at 3 months interval *If infant is taking INH, a mother who is taking INH should not give breastfeeding, it might toxic to the infant Gestational Problem IV. RENAL AND URINARY DISORDER AND PREGNANCY  RENAL AND URINARY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Urinary Infection Is an infection that affects any Pain in urination Clean catch urine for Assessment UTI in pregnant women part of the urinary system which Frequent urination urine analysis and Urine analysis/urine culture typically involves a course includes the kidney, bladder, Burning sensation during C&S Medication Administration of antibiotic. It’s crucial to ureters, and urethra. urination Fluid Intake use antibiotics that are safe Cloudy or Foul-smelling Follow up check up for both the mother and the Can be more common during urine (collaboration with Health developing fetus. pregnancy due to hormonal Fever Care Team) Commonly prescribed changes and pressure of the antibiotics for UTI during growing uterus on the bladder. It pregnancy: is crucial for pregnant women to 1. Amoxicillin address UTI promptly, as 2. Cephalexin untreated infections can lead to 3. Nitrofurantoin complications. 4. Fosfomycin  RENAL AND URINARY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 2. Pyelonephritis is a type of UTI that involves High-Grade Fever Urine analysis/urine Monitor and asses Antibiotic Therapy inflammation of the kidney, Chills culture 1. vital signs Fluid Replacement typically caused by bacteria Fatigue Imaging studies such 2. Pain Pain Management commonly Escherichia Coli (E. Nausea and vomiting as Ultrasound or CT 3. Urine Output Fetal Monitoring Coli) entering the kidneys from Dysuria scan 4. Fetal Well-being the lower urinary tract.. Flank pain Promote Infection Control Lower Abdominal pain Maintain Hydration 2 types of Pyelonephritis: Increase frequency and Relieve pain and Discomfort Urgency of urination Prevent Complication 1. Acute Pyelonephritis- sudden Hematuria Collaborative Care and severe infection of the kidney Cloudy or foul-smelling Prevention of Preterm Labor urine Education and Discharge 2. Chronic Pyelonephritis – a Planning recurring or persistent infection Complications in Pregnancy: Pre-term Sepsis Maternal Sepsis Fetal growth restriction Intrauterine infection  RENAL AND URINARY DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 3. Chronic Renal Disease is a long-term condition Fatigue Blood Test(creatinine, Assessment and monitoring Antihypertensive Medication characterized by the gradual loss Swelling(edema) in the BUN, eGFR) Medication Administration for Blood sugar management of kidney function over time. It is legs, ankles or around the 2. Imaging Studies blood pressure and blood often progressive and can lead to eyes (IVP, Ultrasound, CT sugar complications if not managed Persistent itching Scan, MRI) Lifestyle Modification effectively. Changes in urination Dietary changes CKD means the kidneys are patterns Monitoring and Regular damaged and can’t filter blood the SOB Checkups way they should. This damage High blood pressure Preventing Complications can cause wastes to build up in Nausea and vomiting Preparation for Renal the body. Replacement Therapy Problems that might arise during pregnancy: 1. Pregnancy increases the workload of the kidneys because they must excrete waste products not only for the mother but also the fetus for 40 weeks Gestational Problem V. GASTROINTESTINAL DISORDER AND PREGNANCY  GASTROINTESTINAL DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT SYMPTOMS MANAGEMENT 1. Peptic Ulcer Disease (PUD): Is a condition characterized by the Abdominal Pain Endoscopy Assessment of symptoms Antibiotic development of open sores (ulcers) on Heartburn Upper GI Series- including the nature and Proton pump inhibitors the lining of the stomach, small Nausea and Vomiting known as a barium intensity of abdominal pain Antacid intestine, or esophagus Loss of appetite swallow Medication Administration Bloating and fullness Helicobacter pylori test Dietary Guidance- diet Fatigue or H. pylori Test modifications to manage Dark or bloody stool Stool exam symptoms Coloscopy Hydration Biopsy Collaboration with Healthcare team Follow up check ups  GASTROINTESTINAL DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT SYMPTOMS MANAGEMENT 2. Hepatitis refers to inflammation of the liver, Fatigue Blood Test to detect Encourage rest Management/Treatment of which can be caused by various Jaundice viral antibodies or Adequate fluid intake hepatitis depends on its factors including viral infections, Nausea and Vomiting antigens Eating in small frequent cause; vaccination is a alcohol consumption certain Loss of appetite Liver Function Test to feeding to prevent nausea preventive measure for medications, and autoimmune Abdominal pain or assess the liver’s Administer antiviral hepatitis A and B. conditions, common types of hepatitis Discomfort health and function medication and other Antiviral medications are are hepatitis A, B, and C. Dark urine Imaging studies medications prescribed for available for some cases of Pale colored stool (ultrasound) to symptom management chronic Hepatitis B & C. evaluate liver condition Hepatitis A (HAV) – typically Liver Biopsy in some transmitted through contaminated food cases to assess liver or water or close contact with an tissue infected person B. Hepatitis B (HBV) - this virus is transmitted through blood, sexual contact, and from an infected mother to her baby during childbirth B. Hepatitis C (HCV) – mainly spread through contact with infected blood, associated with sharing needles among intravenous drug users.  GASTROINTESTINAL DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT SYMPTOMS MANAGEMENT 3. Appendicitis It is the inflammation of the appendix, a Generalized Blood Test Assessment Surgical Intervention small finger-shaped pouch attached to abdominal discomfort Ultrasound Pain Management (appendectomy) the large intestine. Appendicitis in Nausea and Vomiting CT Scan Fetal Monitoring Antibiotic Therapy pregnant woman requires careful and Typical sharp, MRI Emotional Support Pain Management prompt medical attention due to peristaltic, lower right Pre-operative preparation potential risk to both mother and the quadrant pain Post-operative care baby. Loss of appetite Patient Education The incidence of appendicitis in Fever Collaboration with the pregnant women or inflammation of the Healthcare Team appendix is high in late adolescence and occurs as frequently as one in If 36 weeks pregnant- 1,500 to 2,000 pregnancies. cesarian section and Appendicitis can cause similar removal of the appendix symptoms in pregnancy If early pregnancy laparoscopy  GASTROINTESTINAL DISORDER AND PREGNANCY DISEASES SIGNS & DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT SYMPTOMS MANAGEMENT 4. Cholecystitis and Cholelithiasis Cholecystitis – gallbladder Constant aching and Ultrasound Administer prescribed pain Conservative Management inflammation pressure in the right Blood test (LFT, CBC) relief medication Initial management often epigastrium CT Scan encourage the use of comfort involves conservative Cholelithiasis – gallbladder Jaundice MRCP measures such as positioning measures including diet formation, gallstone are form from ERCP and breathing exercises. modification cholesterol Dietary Guidance Pain Medication Hydration Intravenous Fluids Monitoring of complications Antibiotic (worsening inflammation) Surgical Intervention Pre-operative Preparation Post Operative Care Patient Education Predisposing Factor: 1. Age 2. Obesity 3. Multiparity 4. High-fat diet Gestational Problem VI. NEUROLOGIC DISORDER AND PREGNANCY  NEUROLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Myasthenia Gravis: An autoimmune disorder Muscle weakness Antibody Testing Management of signs and Anticholinesterase drugs characterized by the Ptosis- dropping of one or both (acetylcholine receptor symptoms and ensuring (DOC) such as presence of IgG antibodies eyelids may worsen as day progresses antibodies safe pregnancy Pyridostigmine (Mestinon) or against acetylcholine Double vision (diplopia)-difficulty Imaging Studies (MRI and Monitoring of respiratory Neostigmine (Progtigmin) and coordinating eye movements leading receptors in striated to double vision U status corticosteroid such as muscle. Muscle Fatigue ltrasound) Administration of prescribed Prednisone MG is a chronic Difficulty in Swallowing medication autoimmune disorder in Slurred speech Collaboration with the Plasmapheresis – removal of which antibodies destroy Difficulty in breathing Health Care Team and replacement of plasma to the communication remove immune complexes between nerves and from the bloodstream muscle. *Atropine lifesaving antidote Causes failure of the for neostigmine if overdose straited muscle to contract, will occur *Magnesium Sulfate particularly of the to halt preterm labor or treat oropharyngeal, facial and hypertension of pregnancy extraocular groups. *An infant born to a women Occurs usually at 20-30 with the disease may show years old symptoms at birth because of the transfer of antibodies.  NEUROLOGIC DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 2. Myasthenia Gravis: Is an immune-mediated Fatigue MRI to detect lesions in Monitoring of neurological interferon Beta and Glatiramer inflammatory disease that 2. Numbness CNS status and symptoms Acetate –generally attacks myelinated axons 3. Blurred Vision 2. Cerebrospinal Fluid Medication management considered safe during in the central nervous 4. Loss of analysis to check the Symptom Management pregnancy with benefits of system. coordination/mobility problem amount of protein, white Prevention of Complications breastfeeding. Nerve fibers become 5. Pain blood cells or myelin in Emotional Support demyelinated and therefore spinal fluid Coordination with lose functions Healthcare Team Post partum planning Gestational Problem VII. MUSCULOSKELETAL DISORDER AND PREGNANCY  MUSCULOSKELETAL DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Scoliosis A medical condition Lower back pain Imaging Studies Pain management Posture mechanics to characterized by abnormal Postural Changes X-ray Promote proper positioning minimize spinal strain lateral curvature of the Stiffness or discomfort when Ultrasound Side lying positions Physical Therapy for safe spine, often in a sideways bending MRI Monitor for complications: exercises direction. Shortness of breath with Measurement of Spinal Respiratory – SOB Supportive Devices Most common among girls severe scoliosis Curvature Neurological – nerve - use maternity belts or between 12 and 14year of Fatigue compression (leg pain, lumbar supports to alleviate age Pelvic and Hip pain numbness or tingling lower back pain If not corrected the Fetal Growth Monitoring curvature progresses until Patient Education it can interfere with Assist Mobility Stainless steel rods implanted respiration and heart action Potential Pregnancy Psychological Support on both sides of the vertebrae because of chest Complications: to strengthen and straighten compression Pregnant women may have the spine, rods do not If a pregnant woman is Preterm Labor – due to pelvic more than usual back pain interfere with pregnancy extremely curved, epidural misalignment or back stress from increased tension on anesthesia may be difficult Prolonged or difficult labor – back muscle to administer for significantly affects the pelvis If pregnant woman’s pelvis pain management in labor or spine is distorted, a caesarian Increased need for C-section birth may be scheduled to rare but may occur in severe ensure a safe birth maybe spinal deformities scheduled to ensure a safe birth Gestational Problem VII. ENDOCRINE DISORDER AND PREGNANCY  ENDOCRINE DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Hypothyroidism Is when thyroid gland does Fatigue - common but Thyroid Stimulating Monitor vital signs Thioamides (methimazole) or not produce thyroid hormone more severe in pregnancy Hormone (TSH) Assess for signs and Propylthiouracil (PTUI) reduce A rare condition in late with hypothyroidism symptoms thyroid activity adolescent and especially Weight gain – unexplained Triiodothyronine (T3) Administer thyroid hormone *Cross the placenta and can rare in pregnancy because weigh gain Thyroxine (T4) replacement lead to congenital women with symptoms with Cold intolerance Monitor Laboratory Test hypothyroidism and enlarged untreated hypothyroidism Dry skin and hair Educate the patient thyroid gland (goiter) in the often anovulatory and unable Collaborate with the fetus to conceive Jittery with tachypnea and Healthcare Team to ensure *Women should be regulated *The thyroid gland produces tachycardia fetal well being on the lowest possible dose hormones that regulate the Prevent complication and advice to keep a record of body’s metabolic rate doses controlling heart, Methimazole- drug of choice muscle and digestive for pregnant women function, brain development and bone maintenance *If hyperthyroidism is not regulated during pregnancy, an infant may be born with symptoms of hyperthyroidism because of the excess stimulation  ENDOCRINE DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 1. Hyperthyroidism Is when the thyroid gland Rapid heart rate Thyroid Stimulating Vital signs monitoring Antithyroid Medications overproduce thyroid hormone Exophthalmia - protruding Hormone (TSH) Particularly heart rate and Beta-blockers (propranolol) eyeballs Triiodothyronine (T3) blood pressure Radioactive Iodine Therapy Heat Intolerance Thyroxine (T4 Administration of medication Heart Palpitation Thyroid Ultrasound Monitor Laboratory Test Weight Loss ECG Promote comfort and Surgery: Thyroidectomy Tremors symptoms relief removal of thyroid Fatigue Prevent complications Educate the patient and family  ENDOCRINE DISORDER AND PREGNANCY DISEASES SIGNS & SYMPTOMS DIAGNOSTIC TEST NURSING INTERVENTION TREATMENT MANAGEMENT 3. Diabetes Mellitus Is an endocrine disorder in Polyphagia –feeling hungry FBS) Fasting Plasma Monitor Blood Sugar Diet management which the pancreas cannot frequently Glucose after 8 hours of Glucose levels Exercise produce insulin to regulate Polydipsia –feeling thirsty fasting Monitor for Blood glucose monitoring body glucose Polyuria –frequent (RBS) Nonwasting hypo/hyperglycemia Insulin therapy as prescribed level urination plasma glucose Nutritional Support and oral It is a group metabolic Weight loss Education Hypoglycemic agents disorder characterized by Increase in appetite Insulin Administration or oral (metformin and glyburide) hypo/hyperglycemia resulting Glycosuria sugar in the hypoglycemic medication from absolute insulin urine for 2 consecutive Educate on labor and deficiency, not enough visits Delivery consideration production of insulin for the 2. Recurrent vaginal Collaborate with Healthcare body cells or insulin moniliasis – fungal infection team resistance. 3. Macrosomia of the fetus by ultrasound 4. Polyhydramnios – excessive amniotic fluid Risk in Diabetes Complicated Pregnancy: 1. Spontaneous abortion 2. Preeclampsia 3. Preterm Labor  Gestational Problem ENDOCRINE DISORDER AND PREGNANCY 3. Pregnant Women with Diabetes Is an endocrine disorder in which the pancreas cannot produce insulin to regulate body glucose level Is a group metabolic disorder characterized by hypo/hyperglycemia resulting from absolute insulin deficiency, not enough production of insulin for the body cells or insulin resistance. Classification : Type 1 – Insulin dependent/juvenile - develop in childhood or adolescence - produces little or no insulin Type 2 – non-insulin dependent - adult onset) - body does not utilize insulin or insulin resistance Gestational DM – is a type of diabetes that develops during pregnancy. It occurs when the body is unable to produce enough insulin to meet the increase demand during pregnancy. GDM can pose risk to both mother and the baby.  Gestational Problem ENDOCRINE DISORDER AND PREGNANCY 3. Pregnant Women with Diabetes Mellitus Levels of Impaired Glucose metabolism: Impaired Glucose Tolerance - 2 H post prandial blood sugar, higher than 140 but lower than 200 mg/dl Impaired fasting glucose- FBS 100 or higher but lower than 126mg/dl *IGT and IFG is a test used to describe a state where blood glucose level are higher than normal but not high enough to be classified as diabetes Diagnostic Test: 1. (FBS) Fasting Plasma Glucose after 8 hour fasting 2. (RBS) Non fasting plasma glucose Signs and Symptoms: 1. Polyphagia –feeling hungry frequently 2. Polydipsia –feeling thirsty 3. Polyuria –frequent urination 4. Weight loss 5. Increase in appetite  Gestational Problem ENDOCRINE DISORDER AND PREGNANCY 3. Pregnant Women with Diabetes Mellitus Glucose Test to Diagnose GDM 1. Oral Glucose Challenge Test (OCG) At the end of 1 st trimester Patient will be given 50 gm oral glucose solution After 1hour blood sample will be taken (do not take anything after taking the glucose) Glucose level should not exceed130-140 mg/dl 2. Oral Glucose Tolerance Test (OGTT) Fasting Blood Sugar 8 to 14 hours prior to test Baseline blood sugar will be taken (FBS) Patient will be given 100 gm oral glucose solution Blood sugar level will be tested every hour with in 3 hours Normal Result for 3 hours test: Fasting result – 95 mg/dl 1H – less than 180 mg/d 2H – less than 155- mg/dl 3H – less than 140mg/dl  Gestational Problem ENDOCRINE DISORDER AND PREGNANCY 3. Pregnant Women with Diabetes Mellitus Gestational Diabetes Signs and Symptoms: 1. Glycosuria sugar in the urine for 2 consecutive visits 2. Recurrent vaginal moniliasis – fungal infection 3. Macrosomia of the fetus by ultrasound Management of Diabetes Mellitus 4. Polyhydramnios – excessive amniotic fluid 1. Diet management Risk in Diabetes Complicated Pregnancy: 2. Exercise 3. Blood glucose monitoring 1. Spontaneous abortion 4. Insulin therapy as prescribed 2. Preeclampsia oral hypoglycemic 3. Preterm Labor agents (metformin 4. Polyhydramnios and glyburide) 5. Infection 6. Diabetic Keto acidosis 7. Diabetic retinopathy 8. Fetal death THANK YOU!!!