Maternal Fetal Wellbeing and Complications of Pregnancy (NOT FINISHED)

Intimate Partner Violence

-Actual or threatened physical or sexual violence, or psychological/emotional abuse

-It includes threatened physical or sexual violence when the threat is used to control a person's actions

characteristics of intimate partner violence

•Use and abuse of substances

•Negative affect

•History of childhood abuse (refer to Evidence-Based Practice 9.2)

•Characteristics of perpetrator's partner

•Traditional gender role expectations

often there is _____ to _____ continuum of violence

generation to generation

pregnant women are considered a

vulnerable population

individual risk factors for committing intimate partner violence

-young age

-drinking

-personality disorder

-depression

-bad in school

-low income/unemployed

-child abuse

-desire for power

-anger and hostility

relationship risk factors

-marital conflict

-economic stress

-dysfunctional family

-marital instability

-male dominance in family

-cohabitation

-having outside sex partners

-taking agression out on others while growing up

community factors

-weak sanctions against IPV

-poverty

-low social capital

societal factors

-tarditional gender norms

-social norms supportive of violence

how will abuser act

-wont let victim speak for self

-stay by their side

phase 1 in cycle of abuse

•Tension-building

-little things are said

phase 2

•Acute battering

-actually hits her

phase 3

Honeymoon

-partner feels bad starts to act nice

-apologies

-love bomb

-gifts

the cycle increases in ____ over time

intensity

Types of Abuse

•Emotional abuse

•Physical abuse

•Financial abuse

•Sexual abuse

•Victims

•Rarely describe selves as abused; battered woman syndrome

•May feel they have a personality flaw or inadequacy

•Many abused as children

abuser profile

•Feelings of insecurity, powerlessness, and helplessness

•Refusal to share power; violence to control victim

Violence Against Pregnant Women

•Time of escalating violence in already troubled relationship

•Factors leading to battering during pregnancy

•Threats to maternal and fetal well-being

•Signs of abuse emerging during pregnancy

Violence Against Older Women

•Physical abuse

•Neglect

•Emotional abuse

•Sexual abuse

•Financial/exploitation abuse

Types of Sexual Violence

•Intimate partner violence

•Human trafficking

•Incest

•Female genital cutting

•Prostitution, bondage

•Exploitation, neglect

•Infanticide

•Sexual assault

Rape:

•penetration of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person without the consent of the victim

acquaintance rape

forcing sex on someone known by the assailant

Date rape

assault occurs within a dating or marriage situation

Statutory rape

sexual activity between an adult and person under 18 years

•Nursing management for rape

•Early intervention and immediate counseling

•Supportive care

•Evidence collection and documentation

•STI assessment

•Pregnancy prevention

•PTSD assessment

signs of abuse

-black and blue

-lack of eye contact

-guarded

-partner is advocate

-doesnt leave side

SAVE model

S:

Screen all of your clients for violence by asking: Within the last year have you been physically hurt by someone? Do you feel you are in control of your life? Within the last year, has anyone forced you to engage in sexual activities? Can you take about your abuse with me? How is your present relationship?

A:

Ask direct questions in a nonjudgmental way: Normalize the topic with women, make eye contact, stay calm, never blame the woman, do not dismiss anything she tells you, do not use formal technical language, and be direct.

V:

Validate the client by telling her believe her story, you do not blame her, it is brave of her to tell you, and there is help for her.

E:

Evaluate, Educate, and refer client by asking: what type of violence? Is she is danger right now? How is she feeling? Does she know that there are consequences to violence? Is she aware of her resources?

Intervention for abused victims goal

to enable victim to gain control of life

primary prevention

breaking the abuse cycle through community initiatives

secondary prevention

dealing with victims and abusers in early stages to prevent progression of abuse

Tertiary Prevention

: helping severely abused women and children recover and become productive members of society and rehabilitating abusers to stop the cycle of violence

High-Risk Pregnancy

•Jeopardy to mother, fetus, or both

•Condition due to pregnancy or result of condition present before pregnancy

•Higher morbidity and mortality

first antepartal visit and on going do a

risk assessment

Pregnancy Complications

•Bleeding during pregnancy

•Hyperemesis gravidarum

•Gestational hypertension

•HELLP syndrome

•Gestational diabetes

•Blood incompatibility

•Amniotic fluid imbalances

•Multiple gestation

•Premature rupture of membranes

Conditions Associated with Early Bleeding During Pregnancy

•Spontaneous abortion

•Ectopic pregnancy

•Gestational trophoblastic disease

•Cervical insufficiency

spontaneous abortion cause

•Cause unknown and highly variable

•First trimester commonly due to fetal genetic abnormalities

•Second trimester more likely related to maternal conditions

1st trimester

first 3 (fetal issue)

trimester 2

3-6 (maternal issue)

nursing assessment for spontaneous abortion

•Vaginal bleeding

•Cramping or contractions

•Vital signs, pain level

Client's understanding

Types of Spontaneous Abortion

•Threatened

•Inevitable

•Incomplete

•Complete

•Missed

-Habitual

Spontaneous Abortion: Nursing Management

Continued monitoring: vaginal bleeding, pad count, passage of products of conception, pain level, preparation for procedures, medications

support for spontaneous abortion

•physical and emotional; stress that woman is not the cause of the loss; verbalization of feelings, grief support, referral to community support group

ectopic pregnancy

•Ovum implantation outside the uterus (see Figure 19.1)

•Obstruction to or slowing passage of ovum through tube to uterus

therapeutic management for ectopic pregnancy

•Medical: drug therapy (methotrexate, prostaglandins, misoprostol, and actinomycin)

•Surgery if rupture

•Rh immunoglobulin if woman is Rh-negative

hallmark sign of ectopic

: abdominal pain with spotting within 6 to 8 weeks after missed menses

Nursing assessment for ectopic pregnancy

-hallmark

-contributing factors

•Laboratory and diagnostic testing: transvaginal ultrasound, serum beta hCG; additional testing to rule out other conditions

•Nursing management ectopic pregnancy

•Preparation for treatment

•Analgesics for pain

•Medications for medical treatment

•Teaching about signs and symptoms of rupture

•Surgery

•Emotional support

•Education

what meds can u give for pain

-diladid

-hydromorphone

-a little tylenol

Gestational Trophoblastic Disease 2 types

•Hydatidiform mole (semen fertilized empty egg, grows fast) (see Figure 19.2)

•Choriocarcinoma

exact cause is

unknown

therapeutic management of Gestational Trophoblastic Disease

•Immediate evacuation of uterine contents (D&C)

•Long-term follow-up and monitoring of serial hCG levels

-lack of knowledge(empty egg no baby to save)

Gestational Trophoblastic Disease •Nursing assessment

•Clinical manifestations similar to spontaneous abortion at 12 weeks

•Ultrasound visualization

•High hCG levels

Gestational Trophoblastic Disease •Nursing management (slide 31)

•Preoperative preparation

•Emotional support

•Education: treatment, serial hCG monitoring, prophylactic chemotherapy

cervical insufficiency

•Premature dilatation of cervix

•Cause unknown; possibly due to cervical damage

cervical insufficiency nursing assessment

•Risk factors

•Pink-tinged vaginal discharge or pelvic pressure

Cervical shortening via transvaginal ultrasound

cervical insufficiency therapeutic management

•Bed rest, pelvic rest, avoidance of heavy lifting

•Cervical cerclage

-lower=mcdonald

-shirodkar cercladge

-abdominal

abdominal circladge need to do

c section

-too high up baby cant come out naturally

mcdonald you can have

vaginal birth

nursing management for cervical insufficiency

•Continuing surveillance; close monitoring for preterm labor

•Emotional support

•Education

placenta previa is

•Cause unknown; placental implants over cervical os

therapeutic management of placenta previa

dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labor signs and symptoms

placenta previa nursing assessment

•Risk factors

•Vaginal bleeding (painless, bright red in second or third trimester, spontaneous cessation then recurrence)

nursing management of placenta previa

•Monitoring of maternal-fetal status

•Vaginal bleeding; pad count

•Avoidance of vaginal exams

•FHR

•Support and education: fetal movement counts, effects of prolonged bed rest (if necessary); signs and symptoms to report

•Preparation for possible cesarean birth (see Nursing Care Plan 19.1)

placental abruption

•Separation of placenta leading to compromised fetal blood supply

•Etiology unknown

therapeutic management of placental abruption

assessment, control, and restoration of blood loss; positive outcome; prevention of DIC

nursing assessment for placental abruption

•Risk factors

•Bleeding (dark red)

•Pain (knife-like), uterine tenderness, contractions

•Fetal movement and activity (decreased)

•Fetal heart rate

•Laboratory and diagnostic testing: CBC, fibrinogen levels, PT/aPTT, type and cross-match, nonstress test, biophysical profile

nursing management for placental abruption

•Tissue perfusion: left lateral position, strict bed rest, oxygen therapy, vital signs, fundal height, continuous fetal monitoring

•Support and education: empathy, understanding, explanations, possible loss of fetus, reduction of recurrence

hyperemesis gravidum

Severe form of nausea and vomiting

•Weight loss >5% of prepregnancy body weight

•Dehydration, metabolic acidosis, alkalosis, and hypokalemia

hyperemesis gravidarum sx usually

resolve around week 20

therapeutic management for hyperemesis gravidarum

•Conservative (diet and lifestyle changes)

•Hospitalization with parenteral therapy (see Drug Guide 19.2)

Nursing Assessment for Hyperemesis Gravidarum

•Onset, duration, course of N/V; diet history; risk factors, weight, associated symptoms, perception of situation

•Liver enzymes, CBC, BUN, electrolytes, urine specific gravity, ultrasound

nursing management for hyperemesis gravidarum

•Comfort and nutrition (NPO, IV fluids, hygiene, oral care, I&O)

•Support and education: reassurance; home care follow-up (see Teaching Guidelines 19.1)

Hypertensive Disorders of Pregnancy

•Gestational hypertension

•Preeclampsia

•Eclampsia

•Chronic hypertension

•Chronic hypertension with superimposed preeclampsia

•Mild preeclampsia management

•Bed rest, daily BP monitoring, and fetal movement counts

Hospitalization; IV magnesium sulfate during labor

•Severe preeclampsia management

•Hospitalization; oxytocin and magnesium sulfate; preparation for birth

•Eclampsia management

•Seizure management, magnesium sulfate, antihypertensive agents; birth once seizures controlled -MAGSULFATE IS GIVEN FOR SEIZURES ONLY DURING ECLAMPSIA (4-7)

gestational HTN nursing assessment

•: risk factors, BP, nutritional intake, weight, edema; urine for protein; other laboratory tests if indicated

gestational HTN •Nursing management

•Home management for mild preeclampsia

•Hospitalization for severe preeclampsia; quiet environment, sedatives, seizure precautions, antihypertensives DTR testing, assessing for magnesium toxicity and labor

•uterine contraction monitoring; preparation for birth

•Follow-up care

HELLP syndrome

Hemolysis, Elevated liver enzymes, Low platelets, RECIPE FOR DIC

nursing assessment/ management HELP

-similar to that for severe preeclampsia; laboratory test results

-•same as for severe preeclampsia

Blood Incompatibility

•ABO incompatibility: type O mothers and fetuses with type A or B blood (less severe than Rh incompatibility)

•Rh incompatibility: exposure of Rh-negative mother to Rh-positive fetal blood; sensitization; antibody production; risk increases with each subsequent pregnancy and fetus with Rh-positive blood OR IF first baby was RH negative, their antibodies would attack the other baby

nursing assessment for blood incompatibility

•maternal blood type and Rh status

blood incompatibility nursing management

•: RhoGAM at 28 weeks

Hydramnios

•Amniotic fluid >2,000 mL

hydramnios therapeutic management

•Therapeutic management: close monitoring; removal of fluid, indomethacin (decreases fluid by decreasing fetal urinary output)

hydraminios nursing assessment

•risk factors, fundal height, abdominal discomfort, difficulty palpating fetal parts, or obtaining FHR

hydramnios nursing management

•ongoing assessment and monitoring; assisting with therapeutic amniocentesis (sterile)

Oligohydramnios

•Amniotic fluid <500 mL

oligohydramnios therapeutic management

serial monitoring; amnioinfusion and birth for fetal compromise

Oligohydramnios nursing assessment

risk factors, fluid leaking from vagina, dehydration, fetal kidney issues

oligohydramnios nursing management

•continuous fetal surveillance; assistance with amnioinfusion, comfort measures, position changes

multiple gestation therapeutic management

•: serial ultrasounds, close monitoring during labor, operative delivery (common)

multiple gestation nursing assessment

uterus larger than expected for EDB; ultrasound confirmation

multiple gesttaions nursing management

•education and support antepartally; labor management with perinatal team on standby; postpartum assessment for possible hemorrhage

PROM

women beyond 37 weeks' gestation premature rupture of membranes

PPROM

women less than 37 weeks' gestation premature rupture of membranes

premature rupture of membranes tx

•dependent on gestational age; no unsterile digital cervical exams until woman is in active labor; expectant management if fetal lungs immature

nursing assessment for PROM

•: risk factors, signs and symptoms of labor, electronic FHR monitoring, amniotic fluid characteristics (see Box 19.3); nitrazine test, fern test, ultrasound

PROM nursing management

•Infection prevention

•Identification of uterine contractions

•Education and support

•Discharge home (PPROM) if no labor within 48 hours (see Teaching Guidelines 19.3)