Care of Women with Complications During Pregnancy

Question 1

Nursing Responsibilities

Answer 1

Preparing the patient properly
Explaining the reason for the test
Clarifying and interpreting results in collaboration with other health care providers

Question 2

Danger Signs in Pregnancy

Answer 2

Sudden gush of fluid from the vagina 
Vaginal bleeding
Abdominal pain
Persistent vomiting
Epigastric pain
Edema of face and hands
Severe, persistent headache
Blurred vision or dizziness
Chills with fever over 38.0º C (100.4º F)
Painful urination or decreased urine output

Question 3

Pregnancy Related Complications

Answer 3

Hyperemesis gravidarum
Bleeding disorders
Hypertension
Blood incompatibility between mother and fetus
Medical disorders - DM
Infections - TORCH

Question 4

Hyperemesis Gravidarum: Treatment

Answer 4

Correct dehydration and electrolyte or acid-base imbalance (may be hypokalemic) 
Antiemetic drugs may be prescribed
In extreme cases:
- TPN may be required
- Hospitalization

Question 5

Nursing Care of Early Pregnancy Bleeding Disorders

Answer 5

Document amount and character of bleeding
Save anything that looks like clots or tissue for evaluation by pathologist
Perineal pad count with estimated amount of blood per pad (50%)
Monitor VS
If actively bleeding, woman should be kept NPO in case surgical intervention is needed

Question 6

Post-Abortion Teaching

Answer 6

Report increased bleeding
Take temperature every 8 hours for 3 days
Take an oral iron supplement if prescribed
Resume sexual activity as recommended by HCP
Return to the HCP at the recommended time for a check up and contraception information
Pregnancy can occur before the first menstrual period returns after the abortion procedure

Question 7

Emotional Care

Answer 7

Spiritual support from someone of the family’s choice and community support groups may help the family work through the grief of any pregnancy loss

Question 8

Ectopic Pregnancy: Treatment

Answer 8

Pregnancy test
Transvaginal ultrasound
Laparoscopic examination
Priority is to control bleeding
Monitor for signs of hypovolemic shock
Keep NPO is surgery is suspected 
Three actions can be taken:
- No action
- Treatment with methotrexate to inhibit cell division 
- Surgery to remove the pregnancy from the tube

Question 9

Signs and Symptoms of Hypovolemic Shock

Answer 9

Changes in fetal HR (increased, decreased, less fluctuation)
Rising, weak pulse (tachycardia)
Rising respiratory rate (tachypnea)
Shallow, irregular respirations; air hunger
Falling blood pressure (hypotension)
Decreased or absent urinary output (30 ml/hr)
Pale skin or pale mucous membranes
Cold, clammy skin
Faintness
Thirst

Question 10

Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)

Answer 10

Document blood loss
Closely monitor VS, I&O
Observe for:
- Pain
- Uterine rigidity or tenderness
Verify that orders for blood typing and cross-match have been carried out
Monitor IV infusion
Treatment .. Maintain until 34 weeks if possible

Question 11

Treatment (Excessive Bleeding)

Answer 11

Lie on side with pillow under hip to decrease supine hypotension
Try to decrease stress as much as possible
Delivery is ordered to decrease mortality
- C-section (partial or total placenta prevue and abruptio placenta if there is risk of maternal shock, clotting disorders, or fetal death)
May have to administer blood or clotting factors

Question 12

Care of the Pregnant Woman with Excessive Bleeding (Late pregnancy)

Answer 12

Prepare for surgery, if indicated (NPO)
Monitor fetal heart rate and contractions
Monitor lab results, including coagulation studies
Administer oxygen by mask
VS
NO VAG EXAM
Prepare for newborn resuscitation
Support for grieving family

Question 13

Management of GH

Answer 13

Depends on the severity of hypertension and on the maturity of the fetus
Treatment focuses on:
- Maintaining blood flow to the woman’s vital organs and placenta
- Preventing convulsions (eclampsia)
BIRTH IS CURE FOR GH

Question 14

Conservative Treatment

Answer 14

Activity restriction
Maternal assessment of fetal activity
BP monitoring
Daily weight (diet)
Checking urine for protein
Drug therapy
- Magnesium sulfate (anticonvulsant therapeutic level is 4-8 mg/dl); inhibits contractions; must have good output; drowsy, maintains DTRs and respirations
- Calcium gluconate (reverses the effects of magnesium sulfate and should be available)
- Antihypertensives (levels higher than 160/100 mm/Hg

Question 15

Nursing Care Focus

Answer 15

Assisting the woman in obtaining prenatal care
Helping her cope with therapy
Caring for acutely ill woman
- Know what signs/ symptoms to monitor for and when to intervene
Administering medications as prescribed

Question 16

Bleeding Incompatibilities

Answer 16

Rh-negative blood type is an autosomal recessive trait
Rh-positive blood type is a dominant trait
Rh incompatibility can only occur if the woman is Rh-negative and the fetus is Rh-positive

Question 17

Isoimmunization

Answer 17

The leaking of fetal Rh-positive blood into the mother’s Rh-negative circulation, causing her body to respond by making antibodies to destroy the Rh-positive erythrocytes
With subsequent pregnancy, the woman’s antibodies against Rh-positive blood cross the placenta and destroy the fetal Rh-positive erythrocytes before the infant is born

Question 18

Erythroblastosis Fetalis

Answer 18

Occurs when the maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes
Requires RhoGAM to be given at 28 weeks and within 72 hours of delivery to the mother
- Also given after amniocentesis, and if woman experiences bleeding during pregnancy
Fetal assessment tests must be done throughout pregnancy
An intrauterine transfusion may be done for the severely anemic fetus

Question 19

Factors Linked to GDM

Answer 19

Maternal obesity (>90 kg or 198 lb)
Large infant (>4000 g or 9 lb)
Maternal age older than 25 years
Previous unexplained stillbirth or infant having congenital abnormalities
Hx of GDM
Family Hx of DM
Fasting glucose level over 126 mg/dl or post meal glucose level over 200 mg/dl

Question 20

Treatment of GDM

Answer 20

Identification of GDM (routine 140 mg/dl or higher)
Diet (3 meals 2 snacks)
Monitoring blood glucose levels (PRN throughout the day, teach S&S of hypo/hyperglycemia)
Ketone monitoring (need for more carbohydrates, develop ketoacidosis (hyperglycaemia))
- Vomiting, dehydration, deep gasping breaths, confusion and may lead to death
Exercise
Insulin injections (may be used to reduce hypoglycaemia)
Fetal assessment (fetal growth, placental insufficiencies, amniotic fluid)

Question 21

Care During Labor of the Woman with GDM

Answer 21

IV infusion of dextrose may be needed
Regular insulin
Assess blood glucose levels hourly and adjust insulin administration accordingly
Close monitoring of fetus (c-section may be indicated if in distress)

Question 22

Care of the Neonate of the Woman with GDM

Answer 22

May have the following occur
- Hypoglycemia
- Respiratory distress
Injury r/t macrosomia
Blood glucose monitored closely for at least the first 24 hours after birth
Breastfeeding should be encouraged (Lowers incidence of DM later in life)

Question 23

Iron Deficiency Anemia

Answer 23

RBCs are small (microcytic) and pale (hypochromic)
Prevention:
- Iron supplements
- VC may enhance absorption
- Do not take iron with milk or antacids (calcium impairs absorption)

Question 24

Iron Deficiency Anemia: Treatment

Answer 24

Oral doses of elemental iron (ferrous fumerate 33%)

Continue therapy for about 3 months after anemia has been corrected

Question 25

Folic Acid Deficiency Anemia

Answer 25

Large, immature RBCs (megaloblastic anemia) Anticonvulsants, oral contraceptives, sulpha drugs, and alcohol can decrease absorption of folate from meals Folate is essential for normal growth and development Prevention: - Daily supplement of 400 mpg (0.4 mg)

Question 26

Folic Acid Deficiency Anemia: Treatment

Answer 26

Folate deficiency is treated with folic acid supplementation 1 mg/day (over twice the amount of the preventive supplement) - Dose may be higher in woman who have had a previous child with a neural tube defect

Question 27

Nursing Care for Woman with Anemias During Pregnancy

Answer 27

Teach woman which foods are high in iron and folic acid Teach woman how to take supplements - Do not take iron supplements at the same time as drinking milk - Do not take antacids with iron - When taking iron, stools will be dark green to black

Question 28

Nursing Care for Woman with Anemias During Pregnancy

Answer 28

The woman with sickle cell disease requires close medical and nursing care - Teach her to prevent dehydration and activities that cause hypoxia - Teach her to avoid situations where exposure to infection are more likely - Teach her to promptly report any signs of infection

Question 29

Infections

Answer 29

Acronym TORCH use to describe infections that can be devastating to the fetus or mother - Toxoplasmosis - Other infections - Rubella - Cytomegalovirus - Herpes

Question 30

Viral Infections

Answer 30

No effective therapy Immunizations can prevent some infections Rubella: 3 months before or in postpartum period CMV: there is no effective treatment, therapeutic pregnancy termination may be offered if discovered early in pregnancy - mental retardation - seizures - blindness - deafness - dental abnormalities - petechiae

Question 31

Herpes Virus: Treatment and Nursing Care

Answer 31

Avoid contact with lesions - If woman has active genital herpes when membranes rupture or labor begins Cesarean delivery may be required if lesions are present at time of delivery Mother and infant do not need to be isolated as long as direct contact with lesions is avoided Widespread neonatal infection has a high mortality rate and survivors may have neurological deficits

Question 32

Hepatitis B

Answer 32

Transmitted by blood, saliva, vaginal secretions, semen, and breast milk; can also cross the placenta Fetus may be infected transplacentally or by contact with blood or vaginal secretions during delivery Upon delivery, the neonate should receive a single dose of hepatitis B immune globulin, followed by the hepatitis B vaccine

Question 33

Nursing Care HIV

Answer 33

Educate the woman who is HIV positive on methods to reduce the risk of transmission to her developing fetus/ infant (antiretrovirals - suppress HIV) Pregnant woman with AIDS are more susceptible to infections Breastfeeding is contraindicated for mothers who are HIV positive Neonates presumed to be HIV positive

Question 34

Toxoplasmosis

Answer 34

Treatment - Therapeutic abortion Preventive measures - Cook all meat thoroughly - Wash hands and all kitchen surfaces after handling raw meat - Avoid uncooked eggs and unpasteurized milk - Wash fresh fruits and vegetables well - Avoid materials contaminated with cat feces

Question 35

Other Infections

Answer 35

STIs - Protected sexual contact - Treated when possible UTIs - Antibiotics: oral or IV - Teaching re: how to reduce - Adequate fluid intake to increase urination - Urinating pre and post sexual intercourse - Teach S&S of cystitis or pyelonephritis

Question 36

Environmental Hazards During Pregnancy

Answer 36

Substance Abuse - Questions should focus on how the information will help nurses and physicians provide the safest and most appropriate care to the pregnant woman and her child Alcohol - A single episode of consuming two alcoholic drinks can lead to the loss of some fetal brain cells

Question 37

Trauma During Pregnancy

Answer 37

``` 3 leading causes of traumatic death: - Automobile accidents - Homicide - Suicide Battering Bruises in various stages of healing ```

Question 38

Nursing Tip

Answer 38

If a woman confides that she is being abused during her pregnancy, this information must be kept absolutely confidential Her life may be in danger if her abuser learns that she told someone She should be referred to local shelters, but the decision to leave her abuser is hers alone

Question 39

Effects of a High-Risk Pregnancy on the Family

Answer 39

Disruption of usual roles Financial difficulties Delay attachment to the infant Loss of expected birth experience

Question 40

Interventions for the Grieving Process

Answer 40

Allow parents to remain together in privacy Accept behaviours r/t grieving Develop a plan of care to provide support to the family Offer a memento such as a footprint Offer parents an opportunity to hold the infant, if they choose Prepare parents for the appearance of the infant Provide parents with educational materials and referrals to support groups Discuss wishes concerning religious and cultural rituals