Transcript Chapter 7 The Wonders of Birth

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Chapter 7
Conception and Development of
the Embryo and Fetus
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Basic Concepts of Inheritance
 Human Genome Project (1990)
 Chromosomes
 23 matched pairs
 DNA
 Genes
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Inheritance of Disease
 Multifactorial
 Genetic and environmental factors
 Examples: cleft lip, neural tube defects
 Unifactorial
 Single gene inheritance
 Examples: autosomal dominant, autosomal
recessive, X-linked disorders
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Autosomal Dominant Inheritance
 Single altered gene
 Mutation
 Parent who is heterozygous for the trait
 50% chance of passing trait to offspring
 Examples: Huntington’s disease,
achondroplasia, neurofibromatosis
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Autosomal Recessive
Inheritance
 Each parent has the altered gene
 25% risk of passing trait to offspring
 Specific populations
 Sickle cell anemia more frequent in black
populations
 Examples: phenylketonuria (PKU), cystic
fibrosis
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X-Linked Dominant Inheritance
 Altered gene on X chromosome
 X-linked dominant in father
 None of sons will inherit the disorder
 All of daughters will inherit the disorder
 Female with X-linked dominant trait
 50% chance of passing trait to daughters
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X-Linked Recessive Inheritance
 More common than X-linked dominant
disorders
 Occur more frequently in males
 Female carrier
 50% chance of passing to offspring
 Examples: hemophilia A, Duchenne
muscular dystrophy
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Cellular Division
 Gametes
 Ova—female gamete
 Sperm—male gamete
 Gametogenesis
 Meiosis
 Mitosis
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Process of Fertilization
 Oocyte and sperm meet in fallopian tube
 Ovulation—cervical mucus changes
 200 sperm reach fertilization site
 Capacitation
 Penetrates zona pellucida—prevents fertilization by
other sperm
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Cellular Multiplication
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Cleavage—rapid cellular division
Morula—solid ball of cells
Blastocyst—inner mass of cells
Embryoblast
Trophoblast
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Implantation
 Zygote propelled by
 Cilia
 Peristalsis
 Reaches uterine cavity in 3 to 4 days
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Nidation
 Occurs by 10th day after fertilization
 Implantation bleeding
 Blastocyst is buried beneath the
endometrial surface
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Placenta
 Develops from trophoblast cells
 Lacunae
 Chorionic villi
 Intervillous spaces
 Provides oxygenation, nutrition, waste
elimination, and hormones
 Protects fetus
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Substance Transport
Across Placenta
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Diffusion
Active transport
Pinocytosis
Bulk flow and solvent drag
Accidental capillary breaks
Independent movement
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Placental Hormones
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Human chorionic gonadotrophin (hCG)
Human placental lactogen (hPL)
Progesterone
Estrogen
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Development of the
Embryo and Fetus
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Yolk Sac
 Develops 8 to 9 days after conception
 Essential for transfer of nutrients during
second and third weeks of gestation
 Hematopoiesis
 Atrophies and is incorporated into
umbilical cord
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Umbilical Cord
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Usual location—center of placenta
55 cm long (21 in); 1 to 2 cm diameter
Vessels: one vein, two arteries
Wharton’s Jelly: protects umbilical cord
from compression
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Fetal Circulation
 Heart begins to beat and circulate blood
by end of third week
 Umbilical vein: blood from placenta to
fetus
 Low Po2 important to maintain fetal
circulation
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Fetal Circulation
 Three unique shunts
 Ductus venosus: bypasses liver and enters
inferior vena cava
 Foramen ovale: right and left atria to supply
blood to head, and upper and lower
extremities
 Ductus arteriosus: returning blood bypasses
lungs
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Fetal Membranes and
Amniotic Fluid
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Embryonic Membranes
 Early protective structures
 Two separate membranes
 Amnion—inner membrane, contains amniotic
fluid
 Chorion—outer membrane, forms fetal portion
of placenta
 Slightly adherent, form amniotic sac
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Purposes of Amniotic Fluid
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Protects and cushions fetus
Maintains normal body temperature
Symmetrical fetal growth
Freedom of movement
Essential for normal fetal lung
development
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Amniotic Fluid
 Amount: 800 mL at 24 weeks
 Fetal urine and lung secretions primary
contributors
 Slightly alkaline
 Contains antibacterial, other protective
substances
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Human Growth and
Development
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Pre-Embryonic Period
 First 2 weeks after conception
 Rapid cellular multiplication and
differentiation
 Establishment of embryonic membranes
and primary germ layers
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Embryonic Period
 Begins third week after fertilization through end
of eighth week
 Organogenetic period: formation, differentiation
of all organs
 Germ layers: ectoderm, endoderm, mesoderm
 Vulnerable to environmental insults
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Fetal Period
 Beginning ninth week until birth or
termination of pregnancy
 Rapid body growth and differentiation of
tissues, organs, and systems
 Less vulnerable stage
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Weeks 9 to 12
 Body growth increases
 Ossification centers appear
 Intestines leave umbilical cord, enter
abdomen
 External genitalia by week 12
 Urine production begins
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Weeks 13 to 16
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Very rapid growth
Coordinated movements of limbs
Ossification of skeleton
Ovaries differentiated
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Weeks 17 to 20
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Growth slows
Quickening
Vernix caseosa
Lanugo
By 20 weeks—fetus 300 g and 19 cm
(7.3 in)
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Weeks 21 to 25
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Gains weight
Skin pink
Rapid eye movements
Surfactant by 24 weeks
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Weeks 26 to 29
 If born, fetus may survive
 Weeks 30 to 40
 Strong hand grasp reflex
 Orientation to light
 38 to 40 weeks: 3000–3800 g and 45–50 cm
(17.3–19.2 in)
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Threats to Embryonic
and Fetal Development
 Chromosomes and teratogens
 Medications and other substances
 Vitamins, alcohol, tobacco, caffeine, drugs,
radiation, and lead
 TORCH infections
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Nurse’s Role in
Prenatal Evaluation
 Initial prenatal visit
 Assessment: cultural, emotional, physical,
and physiological factors
 Education
 Genetic disorders
 Prenatal tests
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Heredity and Genetics
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Congenital anomalies
Malformation
Deformations
Dysplasia
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Maternal Age and Chromosomes
 Age 35 and above
 Increased risk of chromosomal
abnormalities
 Down syndrome
 Deletion
 Translocation
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Multifetal Pregnancy
 Monozygotic
 Develop from one zygote
 Division occurs at end of first week
 Dizygotic
 Develop from two zygotes
 Separate amnions and chorions
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Minimizing Threats to
Embryo/Fetus
 Nurse’s role
 Assessment
 Environmental and lifestyle risks
 Knowledge
 Physical and psychosocial well-being
 Preconception counseling
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Chapter 8
Physiological and Psychosocial
Changes During Pregnancy
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Hormonal Influences
 Pituitary hormones
 Influence ovarian follicular development
 Prompt ovulation
 Stimulate uterine lining
 Corpus luteum
 Estrogen: growth
 Progesterone: maintenance
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Ovarian Hormones
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Maintain endometrium
Provide nutrition
Aid in implantation
Decrease uterine contractility
Initiate breast ductal system development
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Reproductive System
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Uterus
 Patterns of uterine growth
 Estrogen, progesterone: hyperplasia,
hypertrophy allow uterus to enlarge,
stretch
 Weight increases from 70 g to 1100 g at
term
 Increased blood flow
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Braxton-Hicks Contractions
 Irregular, painless
 Prepare uterine muscles
 If irregular and last <60 seconds, reassure
woman
 Regular pattern or associated with other
symptoms, seek medical attention
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Cervix
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Chadwick’s sign
Goodell sign
Softens
Forms mucus plug
Call if discharge bloody or yellow/green,
foul odor, itching, or pain
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Vagina and Vulva
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Thickening of vaginal mucosa
Rugae
Becomes edematous
More susceptible to yeast infections
pH: decreases from 6.0 to 3.5
Discuss vulvar hygiene
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Other Reproductive Changes
 Ovaries
 Breasts
 Montgomery tubercles
 Increased pigmentation (areolae)
 Discuss bra size changes, options for infant
feeding, and strategies for successful
breastfeeding
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Integumentary System
 Hyperpigmentation
 Chloasma
 Linea nigra
 Cutaneous vascular changes
 Striae gravidarum
 Angiomas
 Palmar erythema
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Neurological System
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Decreased attention span
Poor concentration
Memory lapses
Carpal tunnel syndrome
Syncope
Anticipatory guidance regarding changes
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Cardiovascular System
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Heart
 Position: pushed upward, laterally to left
 Cardiac hypertrophy due to increased
blood volume, cardiac output
 Heart sounds: exaggerated first and third;
systolic murmurs
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Blood Volume
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Plasma and erythrocyte volume increase
Increased need for iron
Physiologic anemia
Teach regarding adequate hydration and
diet high in protein, iron
 Increased fibrinogen volume
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Cardiac Output
 Blood pressure
 Stasis of blood in lower extremities: risk for
varicose veins and venous thrombosis
 Encourage daily walks to enhance
circulation, improve intestinal peristalsis
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Supine Hypotension Syndrome
 Pressure from enlarged uterus decreases
venous return from lower extremities
 Hypotension, dizziness, diaphoresis, pallor
 Orthostatic hypotension
 Stagnation of blood in lower extremities
 Encourage to rise slowly; keep feet moving
while standing
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Respiratory System
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Increased tidal volume
Increased oxygen consumption
Diaphragm elevates
Increased chest circumference—dyspnea
Educate regarding normal changes and
symptoms
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Eyes, Ears, Nose, Throat
 Blurred vision—decreased intraocular
pressure and corneal thickening
 Temporary condition
 Nasal stuffiness, congestion—increased
mucus production
 Epistaxis
 Encourage increased fluid intake
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Gastrointestinal System
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Upper GI Tract
 Mouth
 Gingivitis, ptyalism, hypertrophy of gums,
epulis
 Esophagus—pyrosis, reflux
 Stomach and small intestine
 Morning sickness, absorption of nutrients
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Lower GI Tract
 Large Intestine—constipation
 Liver and gallbladder
 Cholestasia, cholecystitis, cholelithiasis
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Urinary System
 Bladder
 Urinary frequency and urgency
 Kidneys and ureters
 Structural changes
 Functional changes
 Glomerular filtration rate increases
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Endocrine System
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Endocrine Glands
 Thyroid gland
 Increased T4
 Progressive increase in basal metabolic rate
 Pituitary gland
 Prolactin
 Oxytocin
 Vasopressin
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Endocrine Glands
 Adrenal glands
 Increased cortisol
 Increased aldosterone
 Pancreas
 Increased number, size of beta cells
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Musculoskeletal System
 Postural changes
 Lumbar lordosis
 “Waddle” gait
 Calcium storage
 Decreased maternal serum calcium
 Lower extremity cramps
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Assessment and
Health Education
 Comprehensive history and physical exam
 Ongoing education focusing on current
trimester and physical changes
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Psychosocial Changes
 Decreased ability to deal with stress and
cope with changes of pregnancy
 Major developmental phases—
ambivalence and conflicting emotions
 Nursing care tailored through each
pregnancy milestone
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Developmental and
Family Changes
 Duvall: stages of family development
 Prepare for role as childcare providers
 Reorganize home, family member duties,
patterns of money management
 Reorient family relationships
 Each pregnancy—adjust to transitions in
relationships with each other, children
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Maternal Role Transition
 Rubin—“tasks of pregnancy”
 Incorporate pregnancy into identity
 Acceptance of the child
 Reorder relationships
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Maternal Tasks of Pregnancy
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Seeking safe passage
Securing acceptance
Learning to give of self
Committing self to the unknown child
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Pregnant Adolescent
 Normal adolescent developmental tasks
conflict with tasks of pregnancy
 May not seek prenatal care
 Not future oriented—may not accept
reality of unborn child
 Acceptance of pregnancy hindered
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Paternal Adaptation
 Styles of involvement: observer,
expressive, and instrumental
 Couvade
 “Announcement” phase
 “Moratorium” phase
 “Focusing” phase
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Developmental Processes
 Grappling with the reality of pregnancy
and the child
 Struggling for recognition as a parent
 Creating the role of involved father
 Seeking parenting information
 Couvade
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Adaptation of Siblings
 Reactions influenced by age and level of
involvement with pregnancy
 Toddlers
 Regression
 Older children
 May not grasp reality of a baby in the family
 Adolescents
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Adaptation of Grandparents
 Age affects reactions
 Number and spacing of other
grandchildren
 Perceptions of the role of grandparents
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Other Considerations
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Single mother
Cultural influences
High-tech management
Societal influences
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Nursing Assessment
of Psychosocial Changes
 Thorough history: family background, past
obstetrical events, status of current
pregnancy
 Each visit—ask about pregnancy
experience, address concerns, offer
anticipatory guidance
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Chapter 9
The Prenatal Assessment
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Prenatal Period
 Maternal reactions
 Ambivalence
 Maternal self-preservation
 World Health Report “Make Every Woman and
Every Child Count”
 Prenatal care
 Societal support of pregnant women
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CAREing for the Patient
 Nurse’s role
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Communicate
Advocate
Empower women
Help woman become informed recipient of care
Facilitate shared decision-making
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Stress and Pregnancy
 Nurse’s role
 Focus on communication, personalized care,
education
 Provide support
 Offer stress management techniques
 Gain woman’s confidence
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Healthy People 2010
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Access to care
Barriers to service
Health insurance
Health provider barriers
System barriers
Social disparities
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Maternal-Child Nursing Care
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The First Prenatal Visit
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Nurse’s Role—First
Prenatal Visit
 Build positive, nonthreatening relationship
 Therapeutic communication
 Avoid medical/technical jargon
 Provide user-friendly service
 Goal: to explain purpose of prenatal care;
to establish specific goals
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Comprehensive Health History
 Biographical data
 Social history—intimate partner violence
and drug use
 Psychological assessment
 Obstetric history
 Current pregnancy
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Signs and Symptoms
of Pregnancy
 Presumptive
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Amenorrhea
Nausea/vomiting
Urinary frequency
Breast tenderness
 Probable
 Piskacek sign
 Hegar sign
 Chadwick sign
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Pregnancy Tests
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Positive Signs of Pregnancy
 Fetal heartbeat
 Fetal movements
 Visualization of fetus
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Estimated date of birth (EDB)
 Naegele’s rule
 History
 Intercourse/signs and symptoms
 Date of last normal menstrual period
 Date of positive home pregnancy test
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Shelton Hisley
Pregnancy Classification System
 Gravid/gravida/gravidity
 Nulligravida
 Primigravida
 Multigravida
 Parity
 GTPAL classification system
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Medical History
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Medical conditions
Dental health
Eye health
Immunizations
Hepatitis B infection
Environmental hazards
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Gynecological History
 DES exposure
 Breast surgery/cancer/lumps/biopsies
 History of rape, abuse
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Gynecological History
 Infertility
 Surgeries
 Therapeutic/elective pregnancy
terminations
 History of STIs
 Cervical pathology
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Screening and Diagnostic Tests
 Screening
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Rh factor, antibody screen
Sexually transmitted infections
HIV
Cervical cancer
 Diagnostic
 To confirm presence of disease
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Prenatal Physical Examination
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Prepare patient and environment
Obtain consent to be examined
Ongoing interaction
General assessment
Nutritional assessment
Abdominal palpation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Focused Obstetrical Examination
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Head, neck, lungs
Skin
Breasts
Abdomen
Uterine size, fetal position, fundal height
Vagina and pelvis
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Leopold Maneuvers
 First: determine fetal body part that
occupies uterine fundus
 Second: determine location of fetal spine
 Third: compare fundus with lower uterine
segment
 Fourth: determine ballottement;
engagement
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Fetal Heart Auscultation
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120 to 160 beats per minute
Fetoscope
Doppler ultrasound stethoscope
Electronic fetal monitoring for high-risk
pregnancies
 Non-stress test
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Subsequent Prenatal
Examinations
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Maternal weight gain/edema
Blood pressure
Urine
Uterine growth
Fetal heart tones
Fetal movements and presentation
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Assessing Special Populations
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Teenage Pregnancy
 Nurse’s role
 Heighten public awareness
 Empower women/families to reduce unwanted
pregnancies
 Advocate for responsible sexual behavior
 Impact on society
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Teenage Pregnancy
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Cultural influences
Identifying adolescents at risk
Impact on developmental tasks
Delayed entry into care
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Nursing Care of
Pregnant Adolescent
 Assessment
 Closely monitor for iron deficiency anemia,
STIs, preeclampsia
 High-risk behaviors
 Knowledge regarding personal care and
care of infant
 Promote optimal nutrition
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Older Gravida:
Considerations in Pregnancy
 Identify chronic medical conditions
 Identify detrimental lifestyle habits
 Physical examination: focus on breasts
and circulatory problems
 Offer screening for fetal chromosomal
abnormalities
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 10
Promoting a Healthy Pregnancy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Planning for Pregnancy
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Preconception
Periconception
Interconception
Preconception counseling
 Identify conditions that could adversely affect
pregnancy
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The Healthy Body
 Menstrual and medical history
 Exposure to childhood illnesses
 Exposure to STIs
 Exposures related to lifestyle choices
 Physical examination
 Laboratory evaluation
 Genetic testing
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Healthy Mind
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Readiness for motherhood
Psychological changes during pregnancy
The healthy relationship
Readiness for fatherhood
Support for life changes
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nutrition and Weight Gain
 Nutritional elements
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Calories
Protein
Water
Minerals and vitamins
 Iron
 Folic acid
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Weight Gain
 Affected by:
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Physiological factors
Social influences
Inadequate diet
Inadequate physical activity
 Management
 Daily food and fluid intake
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Factors That Affect Nutrition
 Eating disorders
 PICA
 Anorexia nervosa, bulimia nervosa
 Cultural factors
 Vegetarian diets
 Food cravings and food aversions
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Exercise, Work, and Rest
 Exercise
 Muscle strengthening
 No rigorous aerobic activity
 Work
 Impact on pregnancy
 Maternity leave
 Rest
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Medications
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Safe versus teratogenic
Over-the-counter
Herbal and homeopathic preparations
Prescription
FDA pregnancy categories
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Common Discomforts
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Nausea and vomiting
Ptyalism
Fatigue
Nasal congestion
Backache
Leukorrhea
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Common Discomforts (cont.)
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Urinary frequency
Dyspepsia
Flatulence
Constipation/hemorrhoids
Dental problems
Leg cramps
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Common Discomforts (cont.)
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Dependent edema
Varicosities
Dyspareunia
Nocturia
Insomnia
Round ligament pain
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Common Discomforts (cont.)
 Hyperventilation, shortness of breath
 Numbness/tingling in fingers
 Supine Hypotensive Syndrome
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Signs and Symptoms
of Danger
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
First Trimester
 Severe, persistent vomiting
 Abdominal pain and vaginal bleeding
 Indicators of infection
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Second Trimester
 Maternal complications
 Preeclampsia
 Premature rupture of the membranes
 Preterm labor
 Fetal complications
 Decreased fundal height
 Absence of fetal movement after quickening
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Third Trimester
 Maternal complications
 Gestational diabetes
 Placenta previa
 Abruptio placentae
 Fetal complications
 Hypoxia
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Pregnancy Map
 Prenatal care map
 Timetable
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Childbirth Education
 Primary goal
 To promote a positive childbearing experience
 Topics
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Anatomy and physiology
Comfort measures
Labor and birth process
Relaxation and pain management
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Childbirth Education—Methods
 Lamaze
 Empowerment
 Dispelling myths
 Controlled breathing, position, massage, relaxation
 Bradley
 Inward relaxation
 Normal breathing
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Methods
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Dick-Read
HypnoBirthing
LeBoyer method
Odent method
Birthing from within
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Finding Information on
Childbirth Education
 Primary source—health care provider
 Online and at-home programs
 Parents need to ask questions about the
class to determine if it fits their needs
 Factors related to personal values and
beliefs
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Birth Plan
 Written information that identifies labor
and birth preferences
 The choices
 Choosing a provider
 Choosing a location
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 11
Caring for the Woman
Experiencing Complications
During Pregnancy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Early Pregnancy Complications
 Perinatal loss
 Ectopic pregnancy
 Gestational trophoblastic disease
 Signs/symptoms: vaginal bleeding, excessive
nausea/vomiting, abdominal pain, size/date
discrepancy
 Management: remove uterine contents
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Spontaneous Abortion
 Before 20 weeks of gestation
 Signs/symptoms: bleeding, cramping,
abdominal pain, decreased symptoms of
pregnancy
 Management: D & C
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Incompetent Cervix
 Painless dilation and cervical effacement
 Second trimester
 Management
 Cerclage
 Bedrest
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hyperemesis Gravidarum
 Criteria: persistent vomiting, measure of
acute starvation, and weight loss
 Management
 Rest
 Small frequent meals (dry, bland foods)
 High-protein snacks
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hemorrhagic Disorders
 Placenta previa
 Signs/symptoms: painless vaginal bleeding
 Management: stabilization and fetal
monitoring
 Abruptio placentae
 Signs/symptoms: third-trimester bleeding
associated with severe abdominal pain
 Management: monitoring, delivery
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Preterm Labor
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Morbidity and mortality
Subtle signs/symptoms
Biochemical markers
Management goals
 Inhibit/reduce contraction strength/frequency
 Optimize fetal status
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Premature Rupture of
Membranes
 Signs/symptoms: gush/trickle of fluid from
vagina
 Management factors
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Establish gestational age
Ultrasound to assess fetus
Assess for advanced labor, infection
If advanced labor or infection, deliver fetus
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hypertensive Disorders
 Classifications:
 Chronic
 Preeclampsia-eclampsia
 Chronic hypertension with superimposed
preeclampsia
 Gestational/transient
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Preeclampsia
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Multisystem, vasopressive
Disease of placenta
SPASMS
Morbidity and mortality
Management
 Delivery of fetus only cure
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Nursing Assessments—
Preeclampsia
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Identify hypertension
Proteinuria
Edema
CNS alterations
 Eclampsia: seizures
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
HELLP Syndrome
 Complication of preeclampsia
 Treatment
 Improve platelets with FFP
 Delivery of fetus as soon as feasible
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Disseminated
Intravascular Coagulopathy (DIC)
 External or internal bleeding
 Nursing care
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Meticulous maternal and fetal assessment
Place indwelling catheter
Oxygen—rebreathing mask
Blood and blood products
Emotional support
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Multiple Gestation
 High-risk pregnancy
 Morbidity and mortality
 Management
 Delivery at Level III facility
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Infections
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UTI
Group B streptococcus
TORCH
STIs
HIV and AIDS
Tuberculosis
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Inflammatory Disease
& Pregnancy
 Systemic lupus erythematosus (SLE)
 Increased risk of pregnancy complications
 Management
 Immunosuppression of SLE flare
 Careful fetal surveillance
 If flare-up during pregnancy, rapid implementation
of treatment
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hemoglobinopathies
 Sickle cell disease
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Promote good dietary habits
Early detection of infection and treatment
Prevent dehydration
Prompt treatment of sickle cell crises
Fetal surveillance
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hemoglobinopathies
 Thalassemia
 Close maternal and fetal surveillance
 Rh0(D) isoimmunization
 Admininster RhoGAM to prevent
 ABO
 Coombs test
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Respiratory Complications
 Pneumonia
 Aggressive management
 Asthma
 Maternal and fetal risks
 Careful monitoring
 Adjustments in therapy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Cystic Fibrosis
 Fetus at risk for uteroplacental
insufficiency and IUGR
 Monitor nutritional status
 Early recognition and treatment of
pulmonary infections
 Maternal and fetal surveillance
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiovascular Disease
 Symptoms similar to normal pregnancy
physiological changes
 Labor, birth, immediate postpartum period
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Lateral recumbent position
Administer IV fluids with caution
Invasive hemodynamic monitoring
Medications
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Other Cardiovascular Disorders
 Mitral valve prolapse
 Pregnancy may alleviate murmur and
symptoms
 Peripartum cardiomyopathy
 No history of cardiac disease
 Signs/symptoms: dyspnea, fatigue,
peripheral/pulmonary edema
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Diabetes Mellitus
 Morbidity and mortality
 Screening and diagnosis
 Management
 Home blood glucose monitoring
 Adjust diet, medication, physical activity
 Ongoing maternal-fetal surveillance
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Thyroid Conditions
 Hyperthyroidism
 Signs/symptoms
 Depressed TSH and elevated free T4
 Antithyroid medications
 Hypothyroidism
 Symptoms
 Elevated TSH and low to normal T3 and T4
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Venous Thrombosis
and Pulmonary Embolism
 Symptoms
 Diagnosis
 Doppler ultrasound
 Ventilation-perfusion (VQ) scan
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Psychiatric Complications
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Depression
Bipolar disorder
Anxiety disorders
Eating disorders
Substance addiction
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Antepartum Fetal Assessment
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Chorionic villus sampling
PUBS
Amniocentesis
Amnioscopy or fetoscopy
Ultrasonography
Fetal kick counts
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Assessment of Fetal
Well-Being (cont.)
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Doppler ultrasound
Fetal biophysical profile
Non-stress test
Vibroacoustic stimulation
Contraction stress test
Electronic fetal heart rate monitoring
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Special Conditions and
Circumstances that may
Complicate Pregnancy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Antenatal Bedrest
 Regular community health nurse home
visits
 Involve various community resources
 Support groups
 Provide emotional support
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Special Conditions
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Adolescent
Advanced age
Trauma
Cancer
Obesity
Disability
Susan Ward
Shelton Hisley