Chapter 9 - Medical Conditions in Pregnancy PDF

- **Cervical Insufficiency -- expulsion of the products of conception occurs** - Premature Cervical Dilatation - Risk Factors - History of cervical trauma - In utero exposure to diethylstilbestrol, ingested by client during pregnancy - Fin...

- **Cervical Insufficiency -- expulsion of the products of conception occurs** - Premature Cervical Dilatation - Risk Factors - History of cervical trauma - In utero exposure to diethylstilbestrol, ingested by client during pregnancy - Findings - Pink-stained vaginal discharge or bleeding - Possible gush of fluid - Uterine contractions with the expulsion of the fetus - Postoperative (cerclage) monitoring for uterine contractions, rupture of membranes, and manifestation of infections - Diagnostic and Therapeutic Procedures - US - Prophylactic cervical cerclage - Nursing Care - Evaluate and client support - Assess vaginal discharge - Monitor client reports of pressure and contractions - Check VS - Client Education - Discharge Instructions - Adhere to activity restrictions - Increase hydration - Avoid sex - Monitor cervical / uterine change - Cervical cerclage might be required. Placed at 12 to 14 weeks - Check VS - Bed rest - Health Promotion/Prevention - Report findings to provider - Preterm labor, rupture of membranes, infection, strong contractions less than 5 min apart, sever perineal pressure, urge to push. - Nursing Actions - Follow up for observation and supervision - Plan for removal of cerclage between 36 and 38 weeks. - **Hyperemesis Gravidarum** - Risk Factors - Maternal age younger than 30 - Multifetal gestation - Gestational trophoblastic disease - Emotional stress - Hyperthyroid disorder - Diabetes - Gastrointestinal disorder - Family hx of hyperemesis - Findings - Excessive vomiting - Dehydration - Weight loss - Increased pulse rate - Decreased blood pressure - Poor skin turgor - Laboratory Tests - UA - Chemistry profile - Thyroid test - CBC - Nursing Care - Monitor I&O - Assess skin turgor - VS - Monitor weight - Client needs to be NPO until vomiting stops - Medications - IV ringers - Pyridoxine (vitamin B6) and other vitamins as tolerated. - Use antiemetic meds (metoclopramide) cautiously. - Client Education - Advance to diet of clear liquids - Advance diet as tolerated - Sever cases may need enteral nutrition per feeding tube - **Iron-Deficiency Anemia (due to inadequacy in maternal iron storage)** - Risk Factors - Less than 2 years between pregnancies - Heavy menses - Diet low in iron - Unhealthy weight loss program - Findings - Fatigue and weakness - Craving unusual food (pica) - Laboratory Tests - Hgb - Hct - Blood ferritin - Nursing Care - Recommend iron intake (27 mg/day) - Dietary intake of food rich in iron (legumes, dried fruit, dark green leafy veggies, and meats). - Educate about constipation due to increased intake of iron. - Medications - Ferrous Sulfate Iron Supplements - Take on empty stomach - Take with OJ to increase absorption. - Diet rich in vitamin C foods to increase absorption. - Increase fiber and fluid - Parenteral Iron Therapy - Blood transfusion for clients that cannot tolerate oral iron - **Gestational Diabetes Mellitus** - Risks to Fetus - Large Baby Problems - Baby makes higher levels of insulin. - Blood sugar low - Large babys - Infections - UTI, Vaginal infections - Hydramnios - Ketoacidosis - Increased insulin resistance - Hypoglycemia - Hyperglycemia - Can cause excessive fetal growth - Risk Factors - Obesity - HTN - Glycosuria - Maternal age other than 25 - Family history - Previous birth of an infant that was large or stillborn - Findings - Hypoglycemia - Nervousness, headache, weakness, irritability, hunger, blurred vision. - Hyperglycemia - Polydipsia - Polyphagia - Polyuria - Nausea - ABD pain - Flushed dry skin - Fruity breath - Laboratory Tests - Glucose Screening - 24 to 28 weeks - If value is 130 to 140 may need 3 hr. test. - Glucose Tolerance Test - Overnight fasting - 100g glucose load is given - Urinalysis for Presence of Ketones - Procedures - Biophysical profile to ascertain fetal well being - Amniocentesis to determine fetal lung maturity - Nonstress test to assess fetal well-being - Nursing Care - Blood glucose monitoring - Monitor the fetus - Medications - Diet and exercise first, if glucose levels still high the insulin may be needed. - Client Education - Daily kick counts - Diet - Exercise - Self admin of insulin - Lab test - **Gestational Hypertension** - begins after 20 weeks of pregnancy. - 140/90 or greater on 2 different occasions at least 4 hr apart. - Preeclampsia - Headaches may occur, irritability, and edema. - Severe Preeclampsia - 160/110 or greater - Severe headache - Hyperreflexia - Blurred vision - Eclampsia - Onset of seizures or coma - Usually preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentration's - HELLP Syndrome - H- Hemolysis - EL- Elevated liver enzymes - LP -- Low platelets - Risk Factors - Maternal age younger than 19 older than 40 - First pregnancy - Extreme obesity - Multifetal gestation - Chromic renal disease - Chronic HTN - Family history if preeclampsia - Diabetes - Rheumatoid arthritis - Systemic lupus erythematosus - Findings - Severe continuous headache - Nausea - blurred vision - flash of lights or dots before the eyes - HTN, proteinuria - Periorbital, facial, hand, and ABD edema - Pitting edema in lower extremities - Vomiting - Oliguria - Hyperreflexia - Scotoma - Epigastric pain - RUQ pain - Seizures - Jaundice - Diminished breath sounds - dyspnea - Laboratory Tests - Liver enzymes - Blood creatine - BUN - Uric acid - CBC - Clotting studied - Chemistry profile - Diagnostic Procedures - Dipstick testing of urine for proteinuria - 24 hr urine collection - Non stress test, contraction stress test, biophysical profile, and UA - Doppler blood flow to assess fetal well-being - Daily kick counts. - -