Maternal & Child health

What are the leading causes of death in children?

- Respiratory infections

- Diarrhoeal diseases

- Measles

- Malaria

- Malnutrition

- Newborn conditions

What immunisations are given at pregnancy?

- Tetanus + diptheria + whooping cough (pertussis)

- Influenza

What immunisations are given at 6 weeks?

- Rotavirus (1st dose must be given before 15 weeks)

- Diptheria + tetanus + pertussis + polio + hepatitis B + Haemophilus influenzae type b (Hib)

- Pneumococcal disease

What immunisations are given at 3 months?

- Rotavirus (2nd dose given before 25 weeks)

- Diptheria + tetanus + pertussis + polio + hepatitis B + Haemophilus influenzae type b (Hib)

What immunisations are given at 5 months?

- Diptheria + tetanus + pertussis + polio + hepatitis B + Haemophilus influenzae type b (Hib)

- Pneumococcal disease

What immunisations are given at 12 months?

- Measles + mumps + rubella

- Pneumococcal disease

What immunisations are given at 15 months?

- Haemophilus influenzae type b (Hib)

- Measles + mumps + rubella

- Chickenpox (varicella)

What immunisations are given at 4 years?

- Diphtheria, tetanus, pertussis, polio, hepatitis

What immunisations are given at 11+12 years?

- Diphtheria, tetanus, pertussis

- Human papillomavirus (HPV)

What immunisations are given at 45 years?

- Diphtheria, tetanus, pertussis

What immunisations are given at 65 years?

- Diphtheria, tetanus, pertussis

- Influenza

- Shingles

What is hyperemesis gravidarum?

Excessive vomiting during pregnancy - can progress from vomiting all food to retching between meals

What are the risks of hyperemesis gravidarum

- Dehydration, electrolye imbalance

- If left untreated, muscle wasting, severe protein and vitamin deficiency

What is the nursing management of hyperemesis gravidarum?

- Antiemetics, IV therapy in outpatient

- Hospitalisation if not resolving - may include total parenteral nutrition

- In patient: Relaxed quiet environment, away from food odours or strong smells, encourage oral hygiene, monitor weight, emotional support

What are nonemergent causes of bleeding during early pregnancy?

- Implantation bleeding

- Sex

- Infection

- Hormones

What are serious causes of bleeding in early pregnancy?

- Ectopic pregnancy (fertilised egg implants outside the uterus)

- Miscarriage (can be threatened, imminent, complete, incomplete, missed)

- Anembryonic gestation (gestational sac but no embryo or yolk sac)

- Molar pregnancy (hydatidiform mole - abnormal tissue grows around the fertilised egg)

What are nursing considerations for Rh isoimmunisation?

- Routine maternal blood type and pH factor with a routine Rh antibody screen (Indirect Coombs)

- Antibody screening repeated at 28 weeks, and if still negative, they are given an IM injection of Rh immune globulin

- After bith, the babys blood type is tested and if found to be Rh+ the injection is repeated

What are causes of bleeding in late pregnancy?

1. Placenta previa: When the placenta implants over or within 2cm of the interval cervical os (painless)

2. Placental abruption: Separation of the placenta from the uterine wall before delivery (painful with bleeding, contractions)

What is the difference between revealed placenta abruption and concealed placenta abruption?

Revealed: Placenta pulls away from uterine wall and blood leaks from the uterus

Concealed: Placenta partially detaches from wall, blood collects between the placenta and the uterus wall

What is Postpartum haemorrhage? (PPH)

Blood loss of >=500mL; considered Major PPH if >=1000mL

Primary - within 24 hours of delivery

Secondary - 24 hours to 12 weeks after delivery

What are risk factors for postpartum haemorrhage before birth?

Placenta previa, carrying twins/triplets, previous PPH, BMI>35, Anaemia, Fibroid, Clotting problems, Preeclampsia

What are risk factors for postpartum haemorrhage during and immediately after birth?

Delivery by c-section, induction, retained placenta, perineal tear or episiotomy, forceps or ventouse delivery, long labour, large baby (>4kg), fever, having GA, precipitous delivery, infections, coagulation abnormalities, uterine atony

What are risk factors for gestational diabetes (GDM)

• Maternal older age

• Family hx of diabetes

• Previous delivery of macrosomic newborn (>4kg)

• Hx of unexplained stillbirth or miscarriage

  • PCOS

What are adverse outcomes of gestational diabetes for the mother?

• Pregnancy associated HTN

• 3rd and 4th degree perineal tears

• PPH

• C-section

• Operative vaginal birth

• Preterm labour

• Polyhdramnios

• Lifetime risk of CVD and stroke

What are adverse outcomes of GDM for the infant?

• Shoulder dystocia with possible fx

• Macrosomia

• Hypoglycaemia

• Respiratory distress syndrome

• Jaundice

• Large or small gestational age

• Stillbirth

• Childhood obesity

• Metabolic syndrome later in life

• T2DM later in life

What is considered hypertension in pregnancy?

Diastolic >=90 OR Systolic >=140

What is gestational hypertension?

• New onset of hypertension after 20 weeks gestation

• No signs of pre-eclampsia

What is pre-eclampsia?

• Hypertension PLUS

• Other S/S: proteinuria, low platelets, elevated LFTs

• S/S may include: headache, visual disturbances, epigastric pain, SOB, nausea/vomiting, sudden swelling in hands/face/feet, hyperreflexia

What are risk factors for developing pre-eclampsia?

• Previous hx of pre-eclampsia

• Renal disease

• Chronic HTN

• Previous hx of HELLP (Haemolysis, Elevated LFTs and low platelet count)

• Diabetes

• FH of pre-eclampsia in mother or sister

• Genetic ancestry - African, India, Maori, Pacific Peoples

• Nulliparity (never given birth to child at viable age)

• Multiple pregnancy (twins/triplets)

• Change in partner

• BMI >35

• Maternal age >40

• Pregnancy interval >10 years

• Diastolic BP >=80 at booking

What are the maternal risks of pre-eclampsia?

• Damage to kidneys/liver

• Increased risk of stroke

• Increase risk of clotting problems

• Risk of placental abruption

• Eclampsia (seizure)

What are the infants risks of pre-eclampsia?

• Poor growth (Intrauterine growth restriction IUGR)

• Increase risk of premature birth

• Increased risk of still birth

How do you assess for pre-eclampsia?

• Symptoms: Swelling in hands, face and feet, headaches, visual changes, hyperreflexia, weight gain, epigastric pain

  • Lab tests: urinary protein, KFTs (BUN, Creatinine, uric acid levels), clotting studies, liver enzymes, magnesium levels

What would occur for management of pre-eclampsia?

• Low dose aspirin starting in second trimester - to decrease chance of developing pre-eclampsia

• Antihypertensives

• Magnesium sulfate given IV during labour (monitor for signs of toxicity: decreased RR, slurred speech, awkward movements)

• Delivery

What is eclampsia?

A grand mal convulsion (tonic-clonic seizure) - can occur before or during labour or in the early PP period

How to manage eclampsia?

• Keep patient on their side to aid circulation to the placenta

• Head tilted down to allow saliva to drain

  • Precaution to prevent injury - oral airway, nasopharynx suctioning and oxygen may be indicated

What is considered pre-term labour?

Labour starting before 37 weeks gestation

What are risk factors for preterm labour?

• Hx of premature birth

• Multiple pregnancy

• Assisted reproductive technology (ART)

• STIs, UTIs, other vaginal infections

• Short cervix

• Smoking, drinking, illicit drugs

• Underweight or obese

• Poor dental hygiene

• Diabetes

• Domestic violence

S/S of premature labour?

• Gush of fluid - possible water breaking

• Bleeding (Mucus plug dislodged)

• Contractions

• Sometimes labour symptoms are les specific: abdominal cramps, pelvic pressure, low back ache, diarrhoea, nausea

What are other emergent complications of pregnancy?

• DVT - leg pain, swelling, lower abdominal pain

• PE - leading cause of death in pregnancy in developed world: dyspnoea, chest pain, low grade fever, blood in sputum, collapse

Risk factors for children born to stressed mothers?

• Poorer mental health

• Impaired executive functioning

• Lower psychological resilience

What is antenatal depression?

Depression that occurs during the pregnancy

S/S: depression, hopelessness and uselessness, panic and anxiety attacks, poor sleep, lose of joy

What is postnatal depression?

Is a mood disorder that can affect women after childbirth
3 types: Postnatal or maternity blues, Postnatal depression, Postnatal psychosis

How to manage antenatal and postnatal depression?

• Screening for symptoms

• Offering support

• Referring to mental health professionals when needed

What screening tools may be used to detect antental and postnatal depression?

Edinburgh Postnatal Depression Scale (EPDS) and PHQ-3

What is croup?

Respiratory infection that causes swelling around the larynx and trachea - leads to harsh “seal-bark” cough, hoarse voice and high pitched whistling sound when breathing

What causes croup?

Parainfluenza viruses and other viral infections that spread through airborne droplets or touching contaminated surfaces

What is athma?

Long-term condition that causes bronchoconstriction and increased mucus production

What triggers asthma?

• Allergens

• Sickness

• Air irritants

• Weather and activity

What is bronchiolitis?

Common lung infection that causes swelling and irritation and buildup of mucus in the small airways - Caused by viruses

What is pneumonia?

Infection of the alveoli in one or both lungs. Alveoli may fill with fluid or pus causing cough with phlegm or pus, fever, chills and difficulty breathing.

What is cystic fibrosis?

Inherited genetic condition that causes the body to produce thick, sticky mucus. Fluid clogs the lungs, GI tract and other organs leading to breathing and digestion problems

What are some signs and symptoms of increased work of breathing in children?

• Nasal flare

• Tracheal tug

• Intercoastal recession

• Suprasternal recession

What is respiratory failute

Life threatening deterioration in pulmonary gas exchange, resulting in inadequate oxygenation & CO2 retention

What are the types of acute respiratory failure?

• Type 1 = Hypoxemic - affects all organs & tissues

• Type 2 = Hypercapnic - decreases blood pH

• Combined type 1 & 2

What are some nursing interventions to consider in treating respiratory failure?

• Maintenance of oxygen to prevent hypoxia

• Maintenance of respiration with vent support

• Maintenance of normal body temp

• Maintenance of fluid, electrolyte, and acid-base balance

• Maintenance of nutrition

• Antibiotics as ordered to treat infection

• Constant observation

• Always reassurance

• Always communicate