NCM 109 - High Risk Pregnancy

High-Risk Pregnancy

a condition in which the life or health of the mother, the fetus, or both is jeopardized by a disorder that is coincidental with or unique to pregnancy

Screening

is the process of identifying apparently healthy individuals who may be at increased risk of developing a disease or condition

Assessment

involves gathering the detailed information needed to create a treatment plan that meets the individual needs of the patient

Age, Weight, Height, Reproductive abnormalities

Enumerate risk assessments included in physical characteristics

Adolescence, Age 35 years or older

At risk pregnancy in terms of age

Delivered baby with genetic defects, 5 or more babies, multiple pregnancy

Enumerate risk assessments included from problems in a previous pregnancy

High blood pressure, Diabetes, Kidney infections, Heart failure, Sexually transmitted infections

Enumerate risk assessments included in disorders present before pregnancy

Certain infections, medications or drugs, Radiation

Enumerate risk assessments included in exposures during pregnancy

Noninvasive, Invasive

Enumerate classifications of pregnancy diagnostic tests

Fetal ultrasound or ultrasonic testing, Nonstress test, Contraction stress test, Cardiotocography

Enumerate Noninvasive Diagnostic Tests

Chorionic villus sampling, Amniocentesis, Embryoscopy, Fetoscopy, Percutaneous umbilical cord blood sampling

Enumerate Invasive Diagnostic Tests

Cardiotocography

a technical method of recording the fetal heartbeat and uterine contractions during pregnancy

Cardio

derived from term which means Fetal heartbeat

Toco

derived from term which means Uterine contractions

Graphy

derived from term which means Recording

Anemia

most common medical disorder associated with pregnancy

Anemia

a disorder in which the body has an insufficient number of red blood cells to transport adequate oxygen to the tissues

2% to 4%

Prevalence of anemia in US

24.6%

Prevalence of anemia in the Philippines

Iron Deficiency Anemia

Most common type of anemia

4.2 to 5.4 million/mm³

normal red blood cell count

5 to 6.25 million/mm³

During pregnancy, the red blood cell count may increase to approximately

12 to 16 g/dL

normal hemoglobin level

11 g/dL

During pregnancy, the expected hemoglobin level is greater than

37% to 47%

normal hematocrit level

33%

During pregnancy, the expected hematocrit level is greater

1500 mL, or 30% to 40%

During pregnancy, total blood volume increases by approximately

40% to 50%

During pregnancy, Plasma volume increases by approximately

350 mL, or 20% to 30%

During pregnancy, Red blood cell volume increases by approximately

15% to 20%

During pregnancy, Total hemoglobin increases by approximately

Iron-Deficiency Anemia

the most common form of anemia during pregnancy and affects approximately 15% to 25% of pregnancies

below 30 micrograms/dL

Laboratory findings on serum iron level with iron-deficiency anemia

400 micrograms/dL

Laboratory findings on iron binding capacity with iron-deficiency anemia

duodenum

Iron is absorbed

liver, spleen, bone marrow

Iron is stored in

microcytic, hypochromic anemia

An inadequate dietary supply of iron decreases the amount of iron available for incorporation into red blood cells. This may lead to

Extreme fatigue, Poor exercise tolerance, Pica

S/S of Iron-Deficiency Anemia

Intake of 27 mg of iron, High Iron diet

Preventive measure againts Iron-Deficiency Anemia

120 to 200 mg

Prescribed oral iron providing how many mg of elemental iron per day to prevent iron deficiency anemia

Folic Acid Deficiency Anemia

an anemia which occurs when the patient has a lower-than-normal number of red blood cells and the cells are abnormally large.

Folate, Folacin

Folic acid may also be referred to as

megaloblastic anemia

The condition usually progresses slowly and may develop into

400 mcg

A prenatal supplement containing how many micrograms of folic acid daily to prevent Folic Acid Deficiency Anemia

Multiple pregnancies, Secondary hemolytic illness, taking hydantoin or anticoagulant agents, poor gastric absorption

Risk factors of Folic acid deficiency anemia

28 and 32 weeks

The most dangerous period or week for women with cardiovascular disease

Grade I: Uncompromised

New York Heart Association Functional Classification,There is no limitation of physical activity. The patient remains asymptomatic during normal activity.

Grade II: Slightly Compromised

New York Heart Association Functional Classification, There is mild limitation of physical activity. Symptoms occur during normal physical activity

Grade III: Markedly Compromised

New York Heart Association Functional Classification, There is marked limitation of physical activity. Symptoms occur with less-than-normal activity, although the patient remains comfortable at rest

Grade IV: Severely Compromised

New York Heart Association Functional Classification, There is severe limitation of physical activity, and symptoms may be present even at rest

Left-Sided Heart Failure

occurs when the ventricle can no longer pump enough blood throughout the body

Pulmonary edema, Shortness of breath, Hemoptysis, Orthopnea, Paroxysmal nocturnal dyspnea

Signs and Symptoms of left-sided heart failure

anticoagulants, Antihypertensives, Diuretics, Beta blockers, Fetal monitoring thru UTZ and a NST

Left-sided heart failure management

Right-Sided Heart Failure

occurs when the side of the heart cannot pump blood to the lungs as effectively as normal

Jugular venous distention, Enlargement of the liver and spleen, Dyspnea, Ascites, Peripheral edema

S/S of right sided heart failure

ACE inhibitors, Beta blockers, Diuretics, Anticoagulants

right-sided heart failure management

Venous Thromboembolic Disease

disease is a condition in which a blood clot, or thrombus, forms in a vein. The clot may become dislodged and travel through the bloodstream as an embolus

Venous stasis, Vessel damage, Hypercoagulation

Virchow's Triad

pain, redness on the calf

Venous Thromboembolic Disease manifestation

bed rest, iv then sq heparin, monitor SE of heparin

Venous Thromboembolic Disease management

Chest pain, Sudden onset of dyspnea, Cough with hemoptysis, Tachycardia, Dizziness and fainting

S/S of Pulmonary Embolism