Chapter 20: Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations (OB) (Cont.)

What nursing management is done for chronic hypertension?

Nursing management: lifestyle changes (DASH diet); frequent antepartal visits; monitoring for placental abruption, preeclampsia; daily rest periods; home BP monitoring; close monitoring during labor and birth and postpartum follow-up

What is the patho of asthma?

What therapeutic management is done?

What nursing assessment is done?

What nursing management is done?

• Pathophysiology:
  o Effect of normal physiologic changes of pregnancy on respiratory system

• Therapeutic management
  o Drug therapy (budesonide, albuterol, salmeterol)

• Nursing assessment
  o Asthma triggers; lung auscultation

• Nursing management
  o Client education
  o Oxygen saturation monitoring during labor

What causes iron-deficiency anemia?

What therapeutic management is done?

What nursing assessment is done?

• Usually due to inadequate dietary intake

• Therapeutic management: eliminate symptoms, correct deficiency, replenish iron stores

• Nursing assessment:
  o Fatigue, weakness, malaise, anorexia, susceptibility to
  infection (frequent colds), pale mucous membranes,
  tachycardia, pallor
  o Abnormal lab results: low hemoglobin, low hematocrit,
  low serum iron, microcytic and hypochromic cells, and
  low serum ferritin

What education is done for iron-deficiency anemia?

• Take your prenatal vitamin daily; if you miss a dose, take it as soon as you remember.

• For best absorption, take iron supplements between meals and with vitamin C.

• Be aware of the side effects of iron supplementation.

• Avoid taking iron supplements with coffee, tea, chocolate, and high-fiber foods.

• Eat foods rich in iron, such as:

• Meats, green leafy vegetables, legumes, dried fruits, whole grains

• Peanut butter, bean dip, whole-wheat fortified breads and cereals

• For best iron absorption from foods, consume the food along with a food high in vitamin C.

• Increase your exercise, fluids, and high-fiber foods to reduce constipation.

• Plan frequent rest periods during the da

What is thalassemia?

• Inherited blood disorder with two forms: alpha (minor) + beta (major)

  • Women with alpha/minor form: little effect on pregnancy though women will have mild persistent anemia

    • this anemia doesn’t respond to iron therapy + iron supplements should not be prescribed

  • Women with beta/major form: usually no pregnancy due to lifelong, severe hemolysis, anemia, and premature death (pregnancy can be safe if it is well treated in a women w/o a heart disease)

How is thalassemia managed during pregnancy?

• Management dependent on severity of disease. Along with routine prenatal visits, thalassemic pregnant women need regular + periodic evaluation of cardiac functioning by cardiologist to prevent FVO

  • Frequent hemoglobin + ferritin levels should also be monitored to avoid iron overload

• Rest + avoid infections d/t anemia

• Supportive care + expectant management should be done throughout pregnancy

What is sickle cell anemia?

What supportive + therapeutic therapy is used during pregnancy for anemia?

• Autosomal inherited condition resulting from defective hemoglobin molecule (hemoglobin S)

• During pregnancy, only supportive therapy is used: blood transfusions for severe anemia, analgesics for pain, and antibiotics for infection

• Therapeutic tx is dependent on the health status of the woman

What are the s/s of anemia?

What are the indicators of sickle cell crisis?

• S/s: anorexia, dyspnea, malaise, pallor (of skin or mucous membranes)

• Indicators: Severe abd pain, muscle spasms, legs + joint pain, fever, stiff neck, N/V, seizures

What nursing management is done for sickle cell anemia?

What management is done during labor?

What management is done post partum?

• Clients require emotional support, education, and follow-up care to deal with this chronic condition

• Labor: encourage rest, provide pain management , supply oxygen and IV fluids, close FHR monitoring

• Postpartum: fit for antiembolism stockngs + discuss family planning options

What group of people are vulnerable to pregnancy risks?

• Adolescents

• Pregnant women over age 35

• Obese pregnant women

• Women who are positive for HIV

• Women who abuse substances

What questions should the nurse ask a pregnant teen?

• Vision of self in future

• Realistic role models; emotional support

• Level of child development education

• Financial and resource management; work and educational experience

• Anger and conflict resolution skills

• Knowledge of health and nutrition for self and child

• Challenges of parenting role

• Community resources

What nursing assessment is done for pregnant women with substance abuse + over 35?

o Preconception counseling; lifestyle changes; beginning pregnancy in optimal state of health
o Laboratory and diagnostic testing for baseline for future comparisons, amniocentesis for older women to chromosomal abnormalities, + quadruple blood test screen b/t 15 + 20 weeks for down syndrome + neural tube defects

o History + physical exam, urine toxicology (for substance abuse)

How is urine toxicology used for determining drug use in pregnant mothers?

A urine toxicology screen may also be helpful in determining drug use, although a urine screen identifies only recent or heavy use of drugs. The length of time a drug is present in urine is as follows:

• Cocaine: 24 to 48 hours in an adult, 72 to 96 hours in an infant

• Heroin: 24 hours in an adult, 24 to 48 hours in an infant

• Opioids: 1 to 4 days after use

• Marijuana: 1 week to 1 month in an adult, up to a month or longer in an infant

• Methadone: up to 10 days in an infant

What nursing management is done for pregnant with substance abuse + over 35?

Nursing management:

• promotion of healthy pregnancy

• education on early and regular prenatal care + dietary teaching (eating fortified cereals, enriched grain products, fresh fruits + vegetables, drink 6-8 glasses of water daily, take vitamin containing 400 mcg folic acid daily, 81 mg aspirin daily in at-risk preeclamptic women, avoid alcohol + smoking/secondhand smoke)

• provide continued surveillance of mother + fetus throughout pregnancy

What are the typical facial characteristics of fetal alcohol spectrum disorder?

• Low nasal bridge

• Short palpebral fissures

• Short nose

• Flat midface

• Epicanthal folds

• Minor ear abnormalities

• Receding jaw