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Transcript
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? 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? 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? 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 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? 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 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: 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: 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: 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: Facial and cranial anomalies, developmental delay, mental retardation, short attention span Fetal alcohol effects (milder form of FAS) Newborn Gestational Age 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? 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? 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 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 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 Grunting on expiratory occurs first Nasal flaring Circumoral cyanosis Substernal retractions Tachypnea Treatment for respiratory distress Newborn include: Oxygen therapy Artificial surfactant Periods of rest Maintaining body temperature Identify nursing interventions for patient with mastitis 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? 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: 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: 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