Sickle Cell AnemiaNursing Care:
Monitor fetal status Provide emotional support
RH SensitizationRH Sensitization is a condition in which a Rh-
negative women becomes pregnant with a Rh-positive fetus and may become sensitized to Rh antigen and develops anti-Rh antibodies which may cross the placenta in subsequent pregnancies with Rh-positive fetuses and destroy the RBC’s.
Complications:Erythroblastosis fetalisHydrops fetalis Hyperbilirubinemia /Kernicterus Fetal dead
RH Incompatibility
Rh SensitizationAll pregnant women should have a Type and
Rh and an indirect Coombs.Pregnant women who are Rh-negative should
have : Serial Indirect CoombsUnsensitized Rh-negative clients should have
RhoGam: During pregnancy at 28-32 weeks gestation After any invasive procedures. In the Postpartum period within 72 hours.
RH IncompatibilityNursing Care:
Teach Client about the importance of complying with prenatal visits, laboratory testing, and RhoGam injection
Check Laboratory results on all pregnant clients . Report findings of the client having Rh-negative blood and indirect Coombs results. Follow through if invasive procedures are done or after delivery about RhoGam.
Support client who has developed fetal complications from Rh incompatibility
Hyperthyroidism and PregnancyHYPERTHYROIDISM is an endocrine
disorder in which there is a excessive amount of the thyroid hormone produced.
Complications in pregnancy: Thyrotoxicosis(Thyroid storm)Cardiac Dysrrhythmia’sPreeclampsiaMalnutritionFetal complications: abortion, premature
deliveryNeonatal complications: Prematurity,
hyperthyroidism
Hyperthyroidism In PregnancyReview of the clinical manifestation of
HyperthyroidismTachycardia and PalpitationsNervousnessWeaknessTremorsHeat intoleranceWeight loss despite eating regular diet, Hair loss DiarrheaHyperemesis gravidarumT4 and T3 are elevated an TSH decreased
Hyperthyroidism and PregnancyNSG. DX: Alt. Nutrition, less than body
requirements Risk for injuryKnowledge deficitNsg Care-
Assess the client for clinical manifestation of complications of the hyperthyroidism or pregnancy
Monitor lab tests- thyroid function testsAdminister antithyroid medications- Propylthiouracil
(PTU)Assist the client to meet her nutritional needs during
the pregnancy with education and evaluation of diet .
Hyperthyroidism in PregnancyNsg. Care-
Daily weightsMonitor fetal statusEmotional support
Hypothyroidism in PregnancyHypothyroidism is a condition where thyroid
does not produce enough thyroid hormoneComplications
Decreased fertilityAbortionsStillbornsAnd congenital malformations
Review of the clinical manifestations of hypothyroidismCold intoleranceWeight gainDryness of skinPuffy faceConstipationMental dullness
Hypothyroidism in PregnancyLaboratory Findings
Low T4 and T3 and elevated TSH levelsNsg. Diagnosis
Risk for Maternal/Fetal InjuryKnowledge deficit
Nsg CarePreconception Care- treatment of Thyroxine prior
to getting pregnantAdminister LevothyroxineMonitor TSH levels and T4 levels Instruct the client about the importance of medical
therapyMonitor fetal status with FMC or NST’s
Systemic Lupus Erythematosus in PregnancySystemic Lupus Erythematous(SLE) is a chronic,
multisystem autoimmune disorderComplications in pregnancy
Renal FailureCardiac Problems CNS ProblemsPreeclampsiaAbortionsFetal Loss Newborn- prematurity, congenital heart block, and
neonatal lupusIUGRExacerbation of SLE
Systemic Lupus Erythematosus in PregnancyReview of the clinical manifestations of SLE
Joint painSkin rash nephritisPericarditisAnemiaLeukopeniaThrombosis of multiorgansFeverneuropsychiatric
Systemic Lupus Erythematosus in PregnancyLaboratory Findings with SLE
Leukopenia- WBC under 4,500Thrombocyctopenia- PLt- under 100,000Anemia- Hg- under 10Positive direct Coombs’ testPositive Anticardiolipin antibodiesPositive tests for rheumatic factors False Positive test for syphilisPositive antinuclear antibodies Increased serum
creatine and decreased creatine clearance and proteinuria
Cont. SLE in PregnancyNSG Diagnosis
Risk for Maternal and Fetal InjuryKnowledge DeficitAnxiety or Fear
NSG CarePreconceptation CareInstruct the client to see her health care providers
frequently and to follow the medical therapyMonitor the client and the fetus and neonate for
complicationsAdminister Medications as order
Prednisone Aspirin Cyclophosphamide( Cytoxan)- only for life-threatening
conditions Azathioprine (Imuran)
Anticardiolipin Antibody SyndromeAnticardiolipin Antibody Syndrome is an
autoimmune disorder which the client has the Anticardiolipin antibodies. It can be seen in clients with or without SLE. It can produce negative outcomes in pregnancy and fetal loss
Complications of Anticardiolipin antibody syndrome in PregnancyMaternal
Thrombosis Cerebral vascular accidents, Amaurosis fumax Transient ischemic attacks SLE Autoimmune thrombocytopenia
Anticardiolipin Antibody SyndromeCont. Complications
Fetal Complications Abortions Fetal loss IUGR
Placental insufficiencyClinical Manifestations
Several Fetal LossesSpontaneous AbortionsLaboratory findings
Positive serum Anticardiolipin antibody titer Other abnormal immunologic studies
Anticardiolipin Antibody SyndromeNsg Diagnosis
Risk for Maternal and Fetal InjuryAnxiety or Fear
Nsg CareAdminister medications
Immunosuppressant drugs- corticosteroids and others
Aspirin Anticoagulants-Heparin
Instruct on medication therapyMonitor client and fetus for complicationsEmotional support
Myasthenia gravis in PregnancyMyasthenia gravis (MG)is a complex
autoimmune disorder that affects the neuromuscular system .
Complication of MG in PregnancyExacerbation of the myasthenia gravis or a
myasthenic crisisMaternal mortality because of respiratory
arrestPregnancy lossPremature labor Transient Neonatal Myasthenia GravisPulmonary Hypoplasia of the neonate
Myasthenia Gravis in PregnancyReview of the clinical manifestations of MG
Progressive muscle weaknessDifficulty in swallowingPtosisSlurred speechFatigueProblems breathing
NSG DiagnosisRisk for Maternal and Fetal InjuryAnxiety or FearFatigueAlter nutritionRisk for aspiration
Myasthenia Gravis in PregnancyNSG Care
Monitor client and fetus for complicationsAdminister medications – Many medications will
exacerbate MG .Check any medication prior to give it. See chart Acetylcholinesterase drugs
Pyridostigmine bromide ( Mestinon) po or parental if client can not swallow Check that client can swallow first
Anticholinergics ( Atropine)for drug over dose Corticosteroids- Prednisone
Instruct client on therapy regimen and compliance with the therapy and seeing health care providers regularly.
Monitor client closely in Labor.
Myasthenia Gravis In pregnancyNote Magnesium sulfate is absolutely
contraindicated for clients who have Myasthenia Gravis
Prepare room with suction ,oxygen, and ambu bag and check emergency equipment.
Check infant at time of birth and in nursery for sucking and muscle tone. Watch when the baby feeds.
Provide frequent rest periods for mother
Deep Vein Thrombosis in PregnancyDeep Vein Thrombosis (DVT)is a condition
where blood clots form in the veins.Complications of DVT in Pregnancy
Vascular occlusionEmbolismPulmonary embolusHypoxiaAcidosis death
Deep Vein Thrombosis in PregnancyClinical Manifestations of DVT
Muscle painTenderness and swelling of calfPositive Homan’s sign
Diagnostic parametersDoppler ultrasonographyVenography may cause risk to fetusImpedance plethysmorgraphy
Deep Vein Thrombosis in PregnancyNSG Diagnosis
Alter. Tissue PerfusionRisk for Injury
NSG CareMaintain bedrest during the acute phaseApply Ted hoseMonitor fetal statusAdminister Anticoagulation therapy
Heparin-IV the Subcutaneous Follow protocols for anticoagulant therapy NO Warfarin Coumadin
Deep Vein Thrombosis In PregnancyNSG Care
No heparin therapy once labor starts.Monitor laboratory testing
PT, APTT, INR, Blood clotting times
InfectionsTypes of infections:
TORCHSTI’sOther
TORCHTORCH is a group of infections which can
cause serious problems to the fetus
T= ToxoplasmosisO= Other- Hepatitis -HIVR= RubellaC= Cytomegalovirus (CMV)H= Herpes
ToxoplasmosisToxoplasmosis is a protozoan infection which
is acquired by the infestation of raw meat and handling of raw meat in mass qualities, cat feces and handling cat litter. If the pregnant acquires toxoplasmosis during pregnancy it can be passed the fetus via the placenta.
Maternal effects are mild-flu-like symptomsFetal-abortion, and congenital effectsNeonatal effects- CNS lesions which could
lead to hydrocephy, microcephaly, seizures and chronic retinitis
ToxoplasmosisPregnant Clients should not handled cat
litter or cat feces. When handling cats wash hands afterwards
Pregnant clients should not eat raw meat and when handling large amounts of raw meat they should wear gloves. Wash hands after handling raw meat
OtherHepatitis is a viral infection. There are several
different types. HAV and HBV are the must common seen in the fetus. HAV is acquired through fecal commination. HBV is acquired through body secretions-blood and genital secretions
HBV effects on the client are fever, malaise, nausea, and abdominal discomfort and maybe liver failure.
HBV effects on the fetus preterm birth and fetal death.
The Neonate can be born with the infection
RubellaRubella is a viral infection that is spread by
droplets or cross the placenta. It is also called the German Measles.
Rubella titers are drawn on all pregnant womenRubella titer of 1:8 or more indicated immunityRubella less than 1:8-example a titer of 1:6 or 1:4
indicates the client is non-immune. The client will need a Rubella immunization after delivery.
Rubella effects on the client are fever, rash and mild lymphedema.
Fetal effects are abortion, congenital anomalies and death
CytomegalovirusCytomegalovirus (CMV) is a viral infection
through respiratory droplets and body fluids and cross the placenta.
CMV effects on the pregnant client are asympotomatic illness, cervical discharge, or mononucleosis-like syndrome.
CMV effects on the fetus are fetal death or severe generalized disease, hemolytic anemia, jaundice, hydrocephaly, microcephy.
CMV effects on the neonate are pneumonia, hepatosplenomegaly and deafness
Herpes Simplex Virus Herpes Simplex Virus (HSV)is a viral infection
that is spread by exposure to the vesicular lesions.
HSV effects on the pregnant client are blisters which are painful, rash, fever, malaise, nausea, and headaches.
HSV effects on the fetus are abortion, preterm labor, stillborn, IUGR- transplacental spread of infection is rare.
HSV effects on the neonate are skin lesions, mental retardation, and microcephaly
STI’s
Human Immunodeficiency Virus (HIV)ChlamydiaSyphilisHepatitis BGroup Beta Streptococci (GBS)HerpesGonorrheaHuman papillomavis (HPV)
Urinary Tract Infections in Pregnancy
Lower UTI’s – CystitisCan cause preterm labor and pyelonephritis
Upper UTI’s- PyelonephritisCan cause preterm labor , sepsis, and renal
failureMedications
Cephalosporin'sAmpicillins or AmoxicillinNo Sulfonamide within 4 weeks of delivery can
cause kernicterus in the neonateNo Trimethoprim in early pregnancyNo Tetracyclines
Epilepsy in PregnancyEpilepsy is a neurologic disorder in which there
is recurrent seizure activity.The client who is pregnant and has epilepsy
could have an increased risk for seizures , abortions, premature labor, and stillborn infants.
Many anticonvulsants can produce teratogenic effectsPhenytoin(Dilantin)Carbamazepine Dapakote
The pharmokenetics of the seizure medication is effect by the changes in physiology during pregnancy.
Trauma in PregnancyTrauma in pregnancy
Abdominal Trauma can be caused by Accidents such as falls or automobile accidents
(MVA) Assault
With weapons Abuse/violence
Complications unique to pregnancy of abdominal trauma Placenta abruption Preterm labor Uterine trauma or rupture Bladder trauma or rupture Maternal or Fetal death
Trauma in PregnancyClinical Manifestations
History of trauma or accidentVisible injuriesPainSigns of ShockUterine activityAbdominal swelling or firmnessNonreassuring fetal Heart Pattern
Nsg diagnosisRisk for Injury AnxietyAlt. Tissue Perfusion Fear
Trauma in PregnancyNSG Care
Assess and triage the serious of injuresABC’sStart Iv with Large bore catheterMonitor for clinical manifestations of shock
and /or hemorrhageMonitor uterine activityMonitor fetal heart patternI&O-hourlyBe Prepare for a delivery of the babyNotify ICN staffEmotional support
Cholcycstitis and Cholelithiasis in Pregnancy
Cholcycstitis and Cholelithiasis are common during pregnancy.
Clinical manifestationsRight upper quadrant tenderness and painMurphy” SignAttacks after mealsPain with nausea and vomiting
Medical Treatment during pregnancyLow Fat Diet
Cont. NSG Care
Monitor for signs of Gall bladder obstructionInstruct client on low fat diet
Less than 20 grams of fat Calories such come mainly from carbohydrates Plenty of fruit and vegetables Lean meats Only 10-12 % of calories such be protein
A pregnant client will not be able to have lipotripesy or drugs to dissolve gall stones.
Surgery in Pregnancy
The problem with surgery in pregnancy will vary depending on the surgery.
Complications that are unique with pregnancy preterm labor, and fetal injury from various cause such as hypoxia, medications, and trauma.
Close monitoring for labor and the fetal status are required
SUBSTANCE ABUSE in PregnancySubstance Abuse is a major problem in the
United States . It is estimated that 10% of pregnant abuse 0r use some substance during pregnancy. (Tobacco, alcohol or other drugs)
All pregnant women should be screened for substance abuse.
See text for the effects of drugs on the fetus and neonate and pregnancy
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