Transcript High Risk OB - Dr. NurseAna's Nursing Reviews

High Risk OB
Ana Corona, MSN, FNP-C
Nursing Instructor
November 2007
What interventions are planned by the nurse for a pregnant
patient with preexisting cardiac condition?
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Maintain normal physical and psychosocial
function
Importance of diet, medications, pacing activity
and adequate rest.
Iron intake must be adequate to prevent anemia
Sodium restrictions
Stool softeners
During labor – semi fowler’s or side lying position
with the head elevated will enhance respiratory
effort and improve circulation- 300 to 500 ml of
blood shifted from the uterus and placenta into
the central circulation.
How can HIV/AIDS in the mother affect the Fetus?
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It is capable of crossing the
placental barrier – congenital
defects such as microcephaly
(abnormal smallness of the head)
and facial deformities.
What teaching should be done about the prevention of an infection
during pregnancy?
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Start long before pregnancy –
immunization for rubella before
childbearing years
Hygiene practices – careful handwashing
proper storage of preparation of meats
should be reviewed
Safe sex practices
Medical care and treatment
Vaginal infection comfort
Vaginal Infection Comfort
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Pour warm water over urethra and vulva
Take warm sitz baths for 15 minutes 3 to 5 times
daily
Avoid strong deodorant soaps, creams and
ointments
Dry the genital area with a blowdryer
Do not wear tight fitting jeans
Do not wear panties or pantyhose with nylon
inserts
Obtain early and regular pap smears
Avoid any sexual contact during outbreaks
What is the primary difference in CPR
for the pregnant women?
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Woman on flat, firm surface with
uterus displaced laterally with a
wedge or manually or place her in a
lateral position.
Chest compressions slightly higher
on the sternum if the uterus is
enlarged enough to displace the
diaphragm into a higher position.
Identify a nursing diagnosis that may be formulated for an adolescent
patient during her first experience in labor and delivery
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Deficient knowledge, related to
choices regarding pregnancy,
childbirth experiences and
parenthood
A 46 y/o woman is pregnant. She wants the nurse to tell her what
complications of pregnancy are more common for women of her age and if the
baby is at risk. The nurse recognizes that the risks for an older woman during
pregnancy are:
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Ectopic pregnancy, placenta previa,
and medical conditions (diabetes or
hypertension) increase with age
Down syndrome or other
chromosomal anomalies – increase
with each year after age 35
(amniocentesis and chronic villus
sampling testing may be done)
Hemolytic disease occurs when:
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Basic incompatibility of blood, such as ABO
incompatibility, or from transfer of antibodies through
the placenta
Erythroblastosis fetalis is a type of hemolytic anemia
that occurs in newborns as a result of maternal fetal
blood group incompatibility, especially involving the Rh
factor and ABO blood groups
RhoGam 300mcg IM given at 28 weeks of pregnancy
and 72 hrs of delivery (Rh negative, abortion, ectopic
pregnancy and amniocentesis). A card is given
Mom needs to carry card with her at all times
Phototherapy – bilirubin levels reach 12 to 15 mg/dl
Diagnostic Tests used to determine possible hemolytic disease
are:
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Blood Typing
Indirect Coomb’s test of maternal blood –
measures the number of maternal
antibodies
Antibody titer test – level of maternal
antibodies, if exceeds 1:16 amniocentesis
may be performed
Optical density studies – measure
bilirubin level, fetal condition
After delivery – direct Coomb’s test
(infant blood to determine the presence
of antibody coated RBCs (bilirubin)
Fetal Alcohol Syndrome (FAS) may result in the newborn
experiencing withdrawal symptoms. The nurse will observe for:
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Facial and cranial anomalies,
developmental delay, mental
retardation, short attention span
Fetal alcohol effects (milder form of
FAS)
Newborn Gestational Age
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AGA: Appropriate for gestational age:
weight is between the 10th and 980th
percentile
LGA: Large for gestational age: weight is
greater than 90th percentile. Often have
hypoglycemia, respiratory distress, birth
injuries and asphyxia.
LBW: Low birth weight: weight is 2500
grams or less at birth
What is a problem seen in infants who are SGA?
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Weight is less than the 10th percentile for
age
Preterm, term, or postterm (all of them)
Problems occurring during the first
trimester, infections of chromosomal
abnormalities, or a later reduction in fetal
oxygen supply and fetal nutrition as a
result of smoking, maternal hypertension
or malnutrition.
Problems: asphyxia, meconium aspiration
syndrome, hypoglycemia, and
hypothermia
What are the characteristics physical manifestations of a
preterm infant?
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Posture – froglike or flaccid
Color – ruddy and cyanosis is common
Head is very large in proportion to the body, bones of the
skull are pliable with large flat fontanel's
Skin is very thin and translucent with obvious blood vessels,
little subcutaneous fat
Lanugo coating large areas
Cartilage in the ears is pliable and can easily fold
Genitals – male small and frequently the testes are
undescended; females – labia majora are small and less
prominent then the labia minora
Cry is weak
Reflexes immature or absent
Lungs: Developmentally immature, not enough amount of
surfactant circulation not good
GI – formed but problems with absorption of nutrients are
common
Renal – immature and ineffective, fluid and acid imbalances
Neurologically immature – gag, suck, and swallow reflexes
may be weak or absent
Nursing interventions for preterm
infants include
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Maintaining and stabilizing preterm
newborns until they mature
adequately, respiratory regulation,
thermal regulation, fluid and
electrolyte regulation, sensory
stimulation and promotion of
bonding with the patents.
Nursing diagnosis preterm infant
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Risk for ineffective
thermoregulation, related to
immature temperature regulation
center, large body surface in
relation to body weight, and
minimal brown fat stores
Signs and symptoms of newborn respiratory distress
include preterm infants greatest potential problem
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Grunting on expiratory occurs first
Nasal flaring
Circumoral cyanosis
Substernal retractions
Tachypnea
Treatment for respiratory distress
Newborn include:
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Oxygen therapy
Artificial surfactant
Periods of rest
Maintaining body temperature
Identify nursing interventions for patient
with mastitis
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Prevention: Correct positioning of the infant and
avoiding nipple trauma and milk stasis, breastfeed
every 2-3 hrs, avoid continue pressure on the breasts
Once mastitis occurs: increasing comfort and helping
the mother maintain lactation, moist heat, shower or
hot packs (before feeding or pumping the breasts)
Cold packs (between feedings to reduce edema),
breasts should be completely emptied at each feeding
to prevent stasis of milk, breastfeeding or pumping
every 1 ½ to 2 hrs mother more comfortable
Massage over the affected area before and during the
feeding helps ensure complete emptying, stay in bed
during the acute phase, fluid intake should be 3000
ml/day, analgesics
Weaning during an episode of mastitis may increase
engorgement and stasis, leading to abscess formation
or recurrent infection, continue breastfeeding.
What complications should the nurse be alert
for when the mother is experiencing
gestational diabetes?
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Maternal complications – infections, difficult
labor related to increased fetal size, vascular
complications (retinopathy) azotemia,
ketoacidosis, increased incidence of
hypertensive disorders (preeclampsia and csection)
Fetal complications: stillbirth, spontaneous
abortion, hydraminos, large placenta,
Macrosomia, congenital anomalies, neonatal
hypoglycemia, neonatal hyperbilirubinemia,
increase incidence of respiratory distress
syndrome and fetal or neonatal death
The patient with Gestational diabetes should
anticipate that the following diagnostic tests be
performed:
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1 hour diabetes screening test or glucose tolerance
tests
Hemoglobin A1c
Fingerstick blood testing
Nonstress tests
Contraction stress test
Alpha-fetoprotein
Biophysical profile
Serum estriols
Baseline ultrasound
Ultrasound examinations every 4-6 weeks
Biochemical analysis of amniotic fluid to ascertain
fetal lung maturity, typically in the third trimester
Amniocentesis
Postpartum care of the adolescent
mother focuses on:
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Explicit directions for self care and
infant care are required
Support involving grandparents or
other family members through
home visits and through group
session for discussion of infant care
and parenting problems
Contraception is a high priority
Depo-Provera, Norplant