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Caring for the Woman Experiencing Complications During Pregnancy

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Chapter 11 Caring for the Woman Experiencing Complications During Pregnancy Edited by Catherine Marin, MSN/Ed(c), WHCNP, RN * Refer to Box 11-10 for nursing diagnoses ... – PowerPoint PPT presentation

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Title: Caring for the Woman Experiencing Complications During Pregnancy


1
Chapter 11
  • Caring for the Woman Experiencing Complications
    During Pregnancy
  • Edited by Catherine Marin, MSN/Ed(c), WHCNP, RN

2
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

3
Spontaneous Abortion
  • Before 20 weeks of gestation
  • Signs/symptoms bleeding, cramping, abdominal
    pain, decreased symptoms of pregnancy
  • Management D C

4
Incompetent Cervix
  • Painless dilation and cervical effacement
  • Second trimester
  • Management

5
Hyperemesis Gravidarum
  • Criteria persistent vomiting, measure of acute
    starvation, and weight loss
  • Management
  • Rest
  • Small frequent meals (dry, bland foods)
  • High-protein snacks

6
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

7
Preterm Labor
  • Morbidity and mortality
  • Subtle signs/symptoms
  • Biochemical markers
  • Management goals
  • Inhibit/reduce contraction strength/frequency
  • Optimize fetal status

8
Premature Rupture of Membranes
  • Signs/symptoms gush/trickle of fluid from vagina
  • Management factors
  • Establish gestational age
  • Ultrasound to assess fetus
  • Assess for advanced labor, infection
  • If advanced labor or infection, deliver fetus

9
Hypertensive Disorders
  • Classifications
  • Chronic
  • Preeclampsia-eclampsia
  • Chronic hypertension with superimposed
    preeclampsia
  • Gestational/transient

10
Preeclampsia
  • Multisystem, vasopressive
  • Disease of placenta
  • SPASMS
  • Morbidity and mortality
  • Management
  • Delivery of fetus only cure

11
Nursing AssessmentsPreeclampsia
  • Identify hypertension
  • Proteinuria- 24 hr urine collection for Total
    Protein
  • Edema- especially facial edema, hands and feet
  • CNS alterations
  • Eclampsia seizures

12
HELLP Syndrome
  • Complication of preeclampsia
  • Treatment
  • Improve platelets with FFP
  • Delivery of fetus as soon as feasible

13
Disseminated Intravascular Coagulopathy (DIC)
  • External or internal bleeding
  • Nursing care
  • Meticulous maternal and fetal assessment
  • Place indwelling catheter
  • Oxygenrebreathing mask
  • Blood and blood products
  • Emotional support

14
Multiple Gestation
  • High-risk pregnancy
  • Morbidity and mortality
  • Management
  • Delivery at Level III facility

15
Infections
  • UTI
  • Group B streptococcus
  • TORCH
  • STIs
  • HIV and AIDS
  • Tuberculosis

16
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

17
Hemoglobinopathies
  • Sickle cell disease
  • Promote good dietary habits
  • Early detection of infection and treatment
  • Prevent dehydration
  • Prompt treatment of sickle cell crises
  • Fetal surveillance

18
Hemoglobinopathies
  • Thalassemia
  • Close maternal and fetal surveillance
  • Rh0(D) isoimmunization
  • Admininster RhoGAM to prevent antibody formation
  • ABO
  • Coombs test

19
Respiratory Complications
  • Pneumonia
  • Aggressive management
  • Asthma
  • Maternal and fetal risks
  • Careful monitoring
  • Adjustments in therapy

20
Cystic Fibrosis
  • Fetus at risk for uteroplacental insufficiency
    and IUGR
  • Monitor nutritional status
  • Early recognition and treatment of pulmonary
    infections
  • Maternal and fetal surveillance

21
Cardiovascular Disease
  • Symptoms similar to normal pregnancy
    physiological changes
  • Labor, birth, immediate postpartum period
  • Lateral recumbent position
  • Administer IV fluids with caution
  • Invasive hemodynamic monitoring
  • Medications e.g. prophylatic antibiotics

22
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

23
Diabetes Mellitus
  • Morbidity and mortality
  • Screening and diagnosis
  • Management
  • Home blood glucose monitoring
  • Adjust diet, medication, physical activity
  • Ongoing maternal-fetal surveillance

24
Thyroid Conditions
  • Hyperthyroidism
  • Signs/symptoms
  • Depressed TSH and elevated free T4
  • Antithyroid medications
  • Hypothyroidism
  • Symptoms
  • Elevated TSH and low to normal T3 and T4

25
Venous Thrombosis and Pulmonary Embolism
  • Symptoms
  • Diagnosis
  • Doppler ultrasound
  • Ventilation-perfusion (VQ) scan

26
Psychiatric Complications
  • Depression
  • Bipolar disorder
  • Anxiety disorders
  • Eating disorders
  • Substance addiction

27
Antepartum Fetal Assessment
  • Chorionic villus sampling
  • PUBS
  • Amniocentesis
  • Amnioscopy or fetoscopy
  • Ultrasonography
  • Fetal kick counts

28
Assessment of Fetal Well-Being (cont.)
  • Doppler ultrasound
  • Fetal biophysical profile (ultrasound and NST
  • Non-stress test
  • Vibroacoustic stimulation
  • Contraction stress test
  • Electronic fetal heart rate monitoring

29
Special Conditions and Circumstances that may
Complicate Pregnancy
30
Antenatal Bedrest
  • Regular community health nurse home visits
  • Involve various community resources
  • Support groups
  • Provide emotional support

31
Other Special Conditions
  • Adolescent
  • Advanced age
  • Trauma
  • Cancer
  • Obesity
  • Disability
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