Transcript High_Risk_Antepartum_Nursing_Care_4

Sickle Cell Anemia
 Nursing Care:
 Monitor fetal status
 Provide emotional support
RH Sensitization
 RH Sensitization is a condition in which a Rh-negative
women becomes pregnant with a Rh-positive fetus
and may become sensitized to Rh antigen and
develops anti-Rh antibodies which may cross the
placenta in subsequent pregnancies with Rh-positive
fetuses and destroy the RBC’s.
 Complications:
 Erythroblastosis fetalis
 Hydrops fetalis
 Hyperbilirubinemia /Kernicterus
 Fetal dead
RH Incompatibility
Rh Sensitization
 All pregnant women should have a Type and Rh and
an indirect Coombs.
 Pregnant women who are Rh-negative should have :
 Serial Indirect Coombs
 Unsensitized Rh-negative clients should have RhoGam:



During pregnancy at 28-32 weeks gestation
After any invasive procedures.
In the Postpartum period within 72 hours.
RH Incompatibility
 Nursing Care:
 Teach Client about the importance of complying with
prenatal visits, laboratory testing, and RhoGam
injection
 Check Laboratory results on all pregnant clients . Report
findings of the client having Rh-negative blood and
indirect Coombs results. Follow through if invasive
procedures are done or after delivery about RhoGam.
 Support client who has developed fetal complications
from Rh incompatibility
Hyperthyroidism and Pregnancy
 HYPERTHYROIDISM is an endocrine disorder in
which there is a excessive amount of the thyroid
hormone produced.
 Complications in pregnancy:
 Thyrotoxicosis(Thyroid storm)
 Cardiac Dysrrhythmia’s
 Preeclampsia
 Malnutrition
 Fetal complications: abortion, premature delivery
 Neonatal complications: Prematurity, hyperthyroidism
Hyperthyroidism In Pregnancy
 Review of the clinical manifestation of Hyperthyroidism
 Tachycardia and Palpitations
 Nervousness
 Weakness
 Tremors
 Heat intolerance
 Weight loss despite eating regular diet,
 Hair loss
 Diarrhea
 Hyperemesis gravidarum
 T4 and T3 are elevated an TSH decreased
Hyperthyroidism and Pregnancy
 NSG. DX: Alt. Nutrition, less than body requirements
 Risk for injury
 Knowledge deficit
 Nsg Care Assess the client for clinical manifestation of
complications of the hyperthyroidism or pregnancy
 Monitor lab tests- thyroid function tests
 Administer antithyroid medications- Propylthiouracil
(PTU)
 Assist the client to meet her nutritional needs during
the pregnancy with education and evaluation of diet .
Hyperthyroidism in Pregnancy
 Nsg. Care Daily weights
 Monitor fetal status
 Emotional support
Hypothyroidism in Pregnancy
 Hypothyroidism is a condition where thyroid does not
produce enough thyroid hormone
 Complications




Decreased fertility
Abortions
Stillborns
And congenital malformations
 Review of the clinical manifestations of hypothyroidism
 Cold intolerance
 Weight gain
 Dryness of skin
 Puffy face
 Constipation
 Mental dullness
Hypothyroidism in Pregnancy
 Laboratory Findings
 Low T4 and T3 and elevated TSH levels
 Nsg. Diagnosis
 Risk for Maternal/Fetal Injury
 Knowledge deficit
 Nsg Care
 Preconception Care- treatment of Thyroxine prior to getting
pregnant
 Administer Levothyroxine
 Monitor TSH levels and T4 levels
 Instruct the client about the importance of medical therapy
 Monitor fetal status with FMC or NST’s
Systemic Lupus Erythematosus in
Pregnancy
 Systemic Lupus Erythematous(SLE) is a chronic,
multisystem autoimmune disorder
 Complications in pregnancy
Renal Failure
Cardiac Problems
CNS Problems
Preeclampsia
Abortions
Fetal Loss
Newborn- prematurity, congenital heart block, and neonatal
lupus
 IUGR
 Exacerbation of SLE







Systemic Lupus Erythematosus in
Pregnancy
 Review of the clinical manifestations of SLE
 Joint pain
 Skin rash
 nephritis
 Pericarditis
 Anemia
 Leukopenia
 Thrombosis of multiorgans
 Fever
 neuropsychiatric
Systemic Lupus Erythematosus in
Pregnancy
 Laboratory Findings with SLE
 Leukopenia- WBC under 4,500
 Thrombocyctopenia- PLt- under 100,000
 Anemia- Hg- under 10
 Positive direct Coombs’ test
 Positive Anticardiolipin antibodies
 Positive tests for rheumatic factors
 False Positive test for syphilis
 Positive antinuclear antibodies Increased serum creatine
and decreased creatine clearance and proteinuria
Cont. SLE in Pregnancy
 NSG Diagnosis
 Risk for Maternal and Fetal Injury
 Knowledge Deficit
 Anxiety or Fear
 NSG Care
 Preconceptation Care
 Instruct the client to see her health care providers frequently
and to follow the medical therapy
 Monitor the client and the fetus and neonate for
complications
 Administer Medications as order




Prednisone
Aspirin
Cyclophosphamide( Cytoxan)- only for life-threatening conditions
Azathioprine (Imuran)
Anticardiolipin Antibody Syndrome
 Anticardiolipin Antibody Syndrome is an autoimmune
disorder which the client has the Anticardiolipin
antibodies. It can be seen in clients with or without SLE. It
can produce negative outcomes in pregnancy and fetal loss
 Complications of Anticardiolipin antibody syndrome in
Pregnancy
 Maternal






Thrombosis
Cerebral vascular accidents,
Amaurosis fumax
Transient ischemic attacks
SLE
Autoimmune thrombocytopenia
Anticardiolipin Antibody Syndrome
 Cont. Complications
 Fetal Complications



Abortions
Fetal loss
IUGR
 Placental insufficiency
 Clinical Manifestations
 Several Fetal Losses
 Spontaneous Abortions
 Laboratory findings


Positive serum Anticardiolipin antibody titer
Other abnormal immunologic studies
Anticardiolipin Antibody Syndrome
 Nsg Diagnosis
 Risk for Maternal and Fetal Injury
 Anxiety or Fear
 Nsg Care
 Administer medications



Immunosuppressant drugs- corticosteroids and others
Aspirin
Anticoagulants-Heparin
 Instruct on medication therapy
 Monitor client and fetus for complications
 Emotional support
Myasthenia gravis in Pregnancy
 Myasthenia gravis (MG)is a complex autoimmune
disorder that affects the neuromuscular system .
 Complication of MG in Pregnancy
 Exacerbation of the myasthenia gravis or a myasthenic





crisis
Maternal mortality because of respiratory arrest
Pregnancy loss
Premature labor
Transient Neonatal Myasthenia Gravis
Pulmonary Hypoplasia of the neonate
Myasthenia Gravis in Pregnancy
 Review of the clinical manifestations of MG
 Progressive muscle weakness
 Difficulty in swallowing
 Ptosis
 Slurred speech
 Fatigue
 Problems breathing
 NSG Diagnosis
 Risk for Maternal and Fetal Injury
 Anxiety or Fear
 Fatigue
 Alter nutrition
 Risk for aspiration
Myasthenia Gravis in Pregnancy
 NSG Care
 Monitor client and fetus for complications
 Administer medications – Many medications will
exacerbate MG .Check any medication prior to give it.
See chart



Acetylcholinesterase drugs
 Pyridostigmine bromide ( Mestinon) po or parental if client
can not swallow Check that client can swallow first
Anticholinergics ( Atropine)for drug over dose
Corticosteroids- Prednisone
 Instruct client on therapy regimen and compliance with
the therapy and seeing health care providers regularly.
 Monitor client closely in Labor.
Myasthenia Gravis In pregnancy
 Note Magnesium sulfate is absolutely contraindicated
for clients who have Myasthenia Gravis
 Prepare room with suction ,oxygen, and ambu bag and
check emergency equipment.
 Check infant at time of birth and in nursery for
sucking and muscle tone. Watch when the baby feeds.
 Provide frequent rest periods for mother
Deep Vein Thrombosis in
Pregnancy
 Deep Vein Thrombosis (DVT)is a condition where
blood clots form in the veins.
 Complications of DVT in Pregnancy
 Vascular occlusion
 Embolism
 Pulmonary embolus
 Hypoxia
 Acidosis
 death
Deep Vein Thrombosis in
Pregnancy
 Clinical Manifestations of DVT
 Muscle pain
 Tenderness and swelling of calf
 Positive Homan’s sign
 Diagnostic parameters
 Doppler ultrasonography
 Venography may cause risk to fetus
 Impedance plethysmorgraphy
Deep Vein Thrombosis in
Pregnancy
 NSG Diagnosis
 Alter. Tissue Perfusion
 Risk for Injury
 NSG Care
 Maintain bedrest during the acute phase
 Apply Ted hose
 Monitor fetal status
 Administer Anticoagulation therapy



Heparin-IV the Subcutaneous
Follow protocols for anticoagulant therapy
NO Warfarin Coumadin
Deep Vein Thrombosis In
Pregnancy
 NSG Care
 No heparin therapy once labor starts.
 Monitor laboratory testing

PT, APTT, INR, Blood clotting times
Infections
 Types of infections:
 TORCH
 STI’s
 Other
TORCH
 TORCH is a group of infections which can cause
serious problems to the fetus
 T= Toxoplasmosis
 O= Other- Hepatitis -HIV
 R= Rubella
 C= Cytomegalovirus (CMV)
 H= Herpes
Toxoplasmosis
 Toxoplasmosis is a protozoan infection which is
acquired by the infestation of raw meat and handling
of raw meat in mass qualities, cat feces and handling
cat litter. If the pregnant acquires toxoplasmosis
during pregnancy it can be passed the fetus via the
placenta.
 Maternal effects are mild-flu-like symptoms
 Fetal-abortion, and congenital effects
 Neonatal effects- CNS lesions which could lead to
hydrocephy, microcephaly, seizures and chronic
retinitis
Toxoplasmosis
 Pregnant Clients should not handled cat litter or cat
feces. When handling cats wash hands afterwards
 Pregnant clients should not eat raw meat and when
handling large amounts of raw meat they should wear
gloves. Wash hands after handling raw meat
Other
 Hepatitis is a viral infection. There are several different
types. HAV and HBV are the must common seen in
the fetus. HAV is acquired through fecal commination.
HBV is acquired through body secretions-blood and
genital secretions
 HBV effects on the client are fever, malaise, nausea,
and abdominal discomfort and maybe liver failure.
 HBV effects on the fetus preterm birth and fetal death.
 The Neonate can be born with the infection
Rubella
 Rubella is a viral infection that is spread by droplets or
cross the placenta. It is also called the German
Measles.
 Rubella titers are drawn on all pregnant women
 Rubella titer of 1:8 or more indicated immunity
 Rubella less than 1:8-example a titer of 1:6 or 1:4
indicates the client is non-immune. The client will need
a Rubella immunization after delivery.
 Rubella effects on the client are fever, rash and mild
lymphedema.
 Fetal effects are abortion, congenital anomalies and
death
Cytomegalovirus
 Cytomegalovirus (CMV) is a viral infection through
respiratory droplets and body fluids and cross the
placenta.
 CMV effects on the pregnant client are asympotomatic
illness, cervical discharge, or mononucleosis-like
syndrome.
 CMV effects on the fetus are fetal death or severe
generalized disease, hemolytic anemia, jaundice,
hydrocephaly, microcephy.
 CMV effects on the neonate are pneumonia,
hepatosplenomegaly and deafness
Herpes Simplex Virus
 Herpes Simplex Virus (HSV)is a viral infection that is
spread by exposure to the vesicular lesions.
 HSV effects on the pregnant client are blisters which
are painful, rash, fever, malaise, nausea, and
headaches.
 HSV effects on the fetus are abortion, preterm labor,
stillborn, IUGR- transplacental spread of infection is
rare.
 HSV effects on the neonate are skin lesions, mental
retardation, and microcephaly
STI’s
 Human Immunodeficiency Virus (HIV)
 Chlamydia
 Syphilis
 Hepatitis B
 Group Beta Streptococci (GBS)
 Herpes
 Gonorrhea
 Human papillomavis (HPV)
Urinary Tract Infections in
Pregnancy
 Lower UTI’s – Cystitis
 Can cause preterm labor and pyelonephritis
 Upper UTI’s- Pyelonephritis
 Can cause preterm labor , sepsis, and renal failure
 Medications
 Cephalosporin's
 Ampicillins or Amoxicillin
 No Sulfonamide within 4 weeks of delivery can cause
kernicterus in the neonate
 No Trimethoprim in early pregnancy
 No Tetracyclines
Epilepsy in Pregnancy
 Epilepsy is a neurologic disorder in which there is
recurrent seizure activity.
 The client who is pregnant and has epilepsy could
have an increased risk for seizures , abortions,
premature labor, and stillborn infants.
 Many anticonvulsants can produce teratogenic effects
 Phenytoin(Dilantin)
 Carbamazepine
 Dapakote
 The pharmokenetics of the seizure medication is effect
by the changes in physiology during pregnancy.
Trauma in Pregnancy
 Trauma in pregnancy
 Abdominal Trauma can be caused by


Accidents such as falls or automobile accidents (MVA)
Assault
 With weapons
 Abuse/violence
 Complications unique to pregnancy of abdominal
trauma





Placenta abruption
Preterm labor
Uterine trauma or rupture
Bladder trauma or rupture
Maternal or Fetal death
Trauma in Pregnancy
 Clinical Manifestations
 History of trauma or accident
 Visible injuries
 Pain
 Signs of Shock
 Uterine activity
 Abdominal swelling or firmness
 Nonreassuring fetal Heart Pattern
 Nsg diagnosis
 Risk for Injury
Anxiety
 Alt. Tissue Perfusion
Fear
Trauma in Pregnancy
 NSG Care
 Assess and triage the serious of injures
 ABC’s
 Start Iv with Large bore catheter
 Monitor for clinical manifestations of shock and /or
hemorrhage
 Monitor uterine activity
 Monitor fetal heart pattern
 I&O-hourly
 Be Prepare for a delivery of the baby
 Notify ICN staff
 Emotional support
Cholcycstitis and Cholelithiasis in
Pregnancy
 Cholcycstitis and Cholelithiasis are common during
pregnancy.
 Clinical manifestations
 Right upper quadrant tenderness and pain
 Murphy” Sign
 Attacks after meals
 Pain with nausea and vomiting
 Medical Treatment during pregnancy
 Low Fat Diet
Cont.
 NSG Care
 Monitor for signs of Gall bladder obstruction
 Instruct client on low fat diet

Less than 20 grams of fat
Calories such come mainly from carbohydrates
Plenty of fruit and vegetables
Lean meats

Only 10-12 % of calories such be protein



 A pregnant client will not be able to have lipotripesy
or drugs to dissolve gall stones.
Surgery in
Pregnancy
 The problem with surgery in pregnancy will vary
depending on the surgery.
 Complications that are unique with pregnancy
preterm labor, and fetal injury from various cause such
as hypoxia, medications, and trauma.
 Close monitoring for labor and the fetal status are
required
SUBSTANCE ABUSE in Pregnancy
 Substance Abuse is a major problem in the United
States . It is estimated that 10% of pregnant abuse 0r
use some substance during pregnancy. (Tobacco,
alcohol or other drugs)
 All pregnant women should be screened for substance
abuse.
 See text for the effects of drugs on the fetus and
neonate and pregnancy
For now