acute biologic crisis preg

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HIGH RISK PREGNANCY HIGH RISK PREGNANCY



ASSESSMENT ASSESSMENTNursing History Nursing History

Determining gravity and parity Determining gravity and parity

Determining presence of risk factorsDetermining presence of risk factors

Physical examinationPhysical examination

Determining Estimated Birth DateDetermining Estimated Birth DateEstimating fetal growthEstimating fetal growth



Physical examinationPhysical examinationDetermining pregnancy signsDetermining pregnancy signs

Presumptive signs:Presumptive signs:1.Amenorrhea1.Amenorrhea

2. Nausea and Vomiting2. Nausea and Vomiting3. Increased size and feeling of breast3. Increased size and feeling of breastfullnessfullness

4.Pronounced nipples4.Pronounced nipples

5.Urinary frequency 5.Urinary frequency 6.Q uickening6.Q uickening7.Fatigue7.Fatigue8.Discoloration of the vaginal mucosa8.Discoloration of the vaginal mucosa



Physical examinationDetermining pregnancy signs

Probable signs:1.

U

terine Enlargement2.Hegar s sign3.Goodell s signs4.Chadwicks signs

5.Ballottement6.Braxton Hick s contractions7.Positive pregnancy test



Physical examinationDetermining pregnancy signs

Positive signs:

1.Fetal heart rate detected by electronicdevice2. Active fetal movements palpated by

the examiner3. Outline of fetus via ultrasonography



ASSESSMENT ASSESSMENTDIAGNOSTIC EXAMINATIONDIAGNOSTIC EXAMINATION

U ltrasoundU ltrasound

Alpha Alpha--fetofeto protein screeningprotein screeningChorionicChorionic villus villus samplingsamplingFetal MovementFetal Movement

Fetal heart rateFetal heart rate1.Non1.Non--stress teststress test2.contration stress test2.contration stress test



ASSESSMENT ASSESSMENTDIAGNOSTIC EXAMINATION

Amniocentesis

Fern TestNitrazine TestPercutaneous Umbilical Blood Sampling



ANALYSIS AND PLANNING ANALYSIS AND PLANNINGNursing DiagnosisNursing Diagnosis

PrePre--existing or Newly Acquired Illnessexisting or Newly Acquired Illnessa. Risk for infectiona. Risk for infection

b. Ineffective Tissue Perfusionb. Ineffective Tissue Perfusion(cardiopulmonary)(cardiopulmonary)c. Painc. Paind. Social Isolationd. Social Isolation

e. Ineffective Role performancee. Ineffective Role performancef . Fear (pregnancy outcome)f . Fear (pregnancy outcome)g. Health Seeking Behaviors .g. Health Seeking Behaviors .h . Situational Low Self h . Situational Low Self--esteemesteem



ANALYSIS AND PLANNING ANALYSIS AND PLANNINGNursing DiagnosisNursing DiagnosisComplications of Pregnancy Complications of Pregnancy

a. Anxiety a. Anxiety b. Deficient Fluid Volumeb. Deficient Fluid Volumec. Risk for Infectionc. Risk for Infection

d. Ineffective Tissue Perfusiond. Ineffective Tissue Perfusione. Deficient Knowledgee. Deficient Knowledge



PLANNING FOR HEALTH MAINTENANCE ANDPLANNING FOR HEALTH MAINTENANCE ANDRESTORATIONRESTORATION

Preexisting or Newly Acquired IllnessPreexisting or Newly Acquired IllnessIncrease knowledge on safe sex practicesIncrease knowledge on safe sex practices

Adequate heart and lung tissue perfusion Adequate heart and lung tissue perfusion Absence of pain Absence of painFeel a sense of support and company from othersFeel a sense of support and company from others

Adequately performs roles and ADLs within limits Adequately performs roles and ADLs within limits

Adequate knowledge about the disease condition and Adequate knowledge about the disease condition andits managementits managementDemonstrate increasing knowledge on the effects of Demonstrate increasing knowledge on the effects of

illness to pregnancy illness to pregnancy

Develops positive self esteemDevelops positive self esteem



Complications of Pregnancy Complications of Pregnancy Increase knowledge about diseaseIncrease knowledge about disease

condition and its managementcondition and its management Adequate fluid volume Adequate fluid volume Absence of infection Absence of infection

Adequate tissue perfusion Adequate tissue perfusion



Preexisting or Newly Acquired IllnessPreexisting or Newly Acquired IllnessSexually Transmitted Disease (STD)Sexually Transmitted Disease (STD)

CandidiasisCandidiasisTrichomonasTrichomonasBacterialBacterial Vaginosis Vaginosis

ChlamydiaChlamydia



SyphilisSyphilis Stages of SyphilisStages of SyphilisPrimary Primary

StageStage

Most infectious stage Appearance of ulcerative, painless lesions producedby spirochetes at the point of entry into the body

Secondary Secondary StageStage

Highly infectious stage Appearance of lesions about 3 weeks after theprimary stage anywhere on the skin and mucousmembranesGeneralized lymphadenopathy

Tertiary Tertiary StageStage

Entrance of spirochetes into the internal organs,causing permanent damage; symptoms occurring 10 to 30 years following the untreated primary lesionsInvasion of the CNS causing meningitis, ataxia,

general paresis, and progressive mental deteriorationDeleterious effects on the aortic valve and aorta



Herpes Simplex Virus Type 2 infectionHerpes Simplex Virus Type 2 infectionGonorrhreaGonorrhreaHumanHuman PapillomavirusPapillomavirus

Group B Streptococcal infectionGroup B Streptococcal infectionHIV infectionHIV infection



STAGE SSTAGE S OF ACQUIRED IMMUN ODE FICIENCY OF ACQUIRED IMMUN ODE FICIENCY S YNDR OMES YNDR OME

STAGE 1STAGE 1 Fever, myalgia, lymphadenopathy, headache

STAGESTAGE 22Infection is active but asymptomatic and may remain for

yearsPerson may experience an outbreak of herpes zosterPerson may experience a transient thrombocytopenia

STAGE 3STAGE 3Person is asymptomaticImmunedysfunction is evident

A ll body systems can show signs of immune dysfunctionIntegumentary and gynecological problems are common

STAGE 4STAGE 4 A dvanced H IV infectionPerson is vulnerable to common bacterial infectionsDevelopment of opportunistic infections occurs

Serious immune compromise occurs



Hematologic DisordersHematologic Disorders Anemia in Pregnancy Anemia in Pregnancy a. Iron Deficiency Anemiaa. Iron Deficiency Anemia

b. Folic Acid Deficiency Anemiab. Folic Acid Deficiency Anemiac. Sickle Cell Anemiac. Sickle Cell AnemiaCoagulation disorders in pregnancy Coagulation disorders in pregnancy

a. Vona. Von Willebrand s Willebrand s DiseaseDiseaseb. Hemophilia Bb. Hemophilia Bc. Idiopathic Thrombocytopeniac. Idiopathic Thrombocytopenia PurpuraPurpura



Renal and Urinary disorderUrinary Tract infectionChronic renal disease

StageStage 1:1:D iminishedD iminishedR enalR enalR eserveR eserve

R enal function is reducedR enal function is reducedNo accumulation of metabolic waste occursNo accumulation of metabolic waste occursThe healthier kidney compensatesThe healthier kidney compensatesNocturiaNocturia andand polyuriapolyuria occur as a result of occur as a result of

decreaseddecreased ability to concentrate urineability to concentrate urine

Stage 2: R enalStage 2: R enalInsufficiency Insufficiency

Metabolic waste begin to accumulateMetabolic waste begin to accumulateOliguriaOliguriaand edema occur as a resultand edema occur as a result of decreasedof decreased

ability to concentrate urineability to concentrate urine

Stage 3: EndStage 3: EndStageStage

Excessive accumulation of metabolic waste occursExcessive accumulation of metabolic waste occursKidneys are unable to maintain homeostasisKidneys are unable to maintain homeostasisD ialysisD ialysis or other renal replacement therapy isor other renal replacement therapy is

requiredrequired



Respiratory DisordersRespiratory Disorders Acute Acute NasopharyngitisNasopharyngitisInfluenzaInfluenzaPneumoniaPneumonia Asthma AsthmaTuberculosisTuberculosisCystic fibrosisCystic fibrosis



Rheumatic DisorderRheumatic Disorder Juvenile Rheumatoid Arthritis Juvenile Rheumatoid ArthritisSystemic LupusSystemic Lupus ErythematosusErythematosusGastrointestinal DisorderGastrointestinal Disorder

Appendicitis AppendicitisGastroesophagealGastroesophageal Reflux Disease orReflux Disease or HiatalHiatal

HerniaHernia

CholecystitisCholecystitisCholelithiasisCholelithiasisHepatitisHepatitisInflammatory bowel diseaseInflammatory bowel disease



Neurologic DisorderNeurologic DisorderSeizure DisorderSeizure DisorderMyasthenia gravisMyasthenia gravisMultiple SclerosisMultiple Sclerosis

Musculoskeletal DisorderMusculoskeletal DisorderScoliosisScoliosis



Cardiovascular DisorderCardiovascular DisorderClassification of Heart DiseaseClassification of Heart Disease

ClassClass Description

11 Uncompromised . Women have no limitations of physical activity . Uncompromised . Women have no limitations of physical activity .

Ordinary physical activity causes discomfort . They Ordinary physical activity causes discomfort . They have no symptomshave no symptomsof cardiac insufficiency and noof cardiac insufficiency and no anginalanginal pain .pain .

22 Slightly compromised . Women have slightSlightly compromised . Women have slight limitation of physicallimitation of physicalactivity . Ordinary physical activity causes excessive fatigue,activity . Ordinary physical activity causes excessive fatigue,palpitation, andpalpitation, and dyspneadyspnea oror anginalanginal pain .pain .

3 3 MarkedMarked compromised . Women have a moderate to marked limitationcompromised . Women have a moderate to marked limitationof physical activity . During less than ordinary activity, they experienceof physical activity . During less than ordinary activity, they experienceexcessive fatigue, palpitations,excessive fatigue, palpitations, dyspneadyspnea, or, or anginalanginal pain .pain .

44 Severely compromised . Women are unable to carry outSeverely compromised . Women are unable to carry out any physicalany physicalactivity without experiencing discomfort . Even at rest, they activity without experiencing discomfort . Even at rest, they

experience symptoms of cardiac insufficiency orexperience symptoms of cardiac insufficiency or anginalanginal painpain



Cardiovascular DisorderCardiovascular DisorderCardiac DiseaseCardiac Disease

a.Lefta

.Left--Sided Heart failureSided Heart failureb. Rightb. Right--Sided Heart failureSided Heart failure

c. Peripheral Heart Diseasec. Peripheral Heart Disease



Assessment of Woman with Cardiac Disease Assessment of Woman with Cardiac DiseaseHealth History Health History

Physical ExaminationPhysical ExaminationDiagnostic ExaminationsDiagnostic ExaminationsComplicationsComplications

ManagementManagement



Cardiac DisorderCardiac Disorder Artificial Valve Prosthesis Artificial Valve Prosthesis

Chronic Hypertensive Vascular DiseaseChronic Hypertensive Vascular Disease Venous Venous ThromboembolicThromboembolic DiseaseDisease



Endocrine DisorderEndocrine DisorderThyroid DysfunctionThyroid Dysfunction

a. Hypothyroidisma. Hypothyroidismb. Hyperthyroidismb. Hyperthyroidism

Diabetes MellitusDiabetes Mellitus



CancerCancerCancers during childbearing yearsCancers during childbearing years

a. Cervicala. Cervicalb. Breastb. Breastc. Ovarianc. Ovariand. Thyroidd. Thyroide. Leukemiae. Leukemiaf . Melanomaf . Melanomag. Lymphomasg. Lymphomas



Mental IllnessMental IllnessSchizophrenia and DepressionSchizophrenia and DepressionTraumaTrauma

Physiologic Changes in Pregnancy that AffectPhysiologic Changes in Pregnancy that AffectTrauma CareTrauma Care

a. Compensating during traumatic injury a. Compensating during traumatic injury

b. Hemorrhageb. Hemorrhagec. Laceration of the legs/perineum bleedingc. Laceration of the legs/perineum bleedingd. Bleeding in the abdominal cavity d. Bleeding in the abdominal cavity



Management for Different Emergency relatedManagement for Different Emergency relatedto Pregnancy to Pregnancy Emergency (lifeEmergency (life--threatening)threatening)Open WoundsOpen WoundsBlunt Abdominal traumaBlunt Abdominal traumaGunshot WoundGunshot WoundPoisoningPoisoningChokingChokingOrthopedic InjuriesOrthopedic InjuriesBurnsBurns

acute biologic crisis preg

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