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ANEMIA A. General information 1. Low red count maybe underlying conditions 2.

Most common medical disorder during the disorder. B. Assessment Findings 1. Client is pale, tired ,short of breath, dizzy 2. Hgb is less than 11g/dl: hct is less than 37% C. Intervention 1. Encourage intake of food with high Fe content and proper diet Liver, green leafy vegetables, dried foods, brown bread, Vit C, and vegetables (enhance Fe absorption) 2. Avoid excessive food loss during labor, especially in the third stage of labor by good management of labor. 3. Encourage puerperia woman on puerperia to continue taking Fe pills for about 1 month SUBSTANCE ABUSE A. General information B. Assessment findings 1. Alcohol a. Elevate the mood, depress the CNS. b. Affects the other system in the body of the mother. c. Displaces the other nutritional food intake. d. Greater risks from high blood alcohol levels e. No safe level of maternal alcohol use in the pregnancy have been established. f. Fetus may display IUGR, CNS dysfunction and craniofacial anomalies (fetal alcohol syndrome) 2. Cocaine a. Powerful stimulating very addictive. b. Causes vasoconstriction, elevated BP, tachychardia c. May preticipate seizures d. Affects ability to transport O2 in the blood e. May cause spontaneous abortion, fetal malformation, placenta abruption, neural tube defects.

Newborn may display irritability, hypertonicity, poor feeling patterns, increased risk of SIDS 3. Opiates a. Produce analgesia, euphoria, respiratory depression b. If used IV, places mother of contacting HIV, then passing in into the fetus. c. Newborn experiences withdrawal within 24-72 hours after the delivery d. High pitch cry, restlessness, poor feeding seen in the newborn. 4. Other chemicals HIV INFECTIONS HIV- is the organism that causes AIDS. Considered a STI. HIV infection can have a serious implication in a pregnant woman and her fetus. HIv infection and AIDS are considered the 3rd leading cause of death in the women between ages 25 and 45. Approximately 3 out of every 100 women giving birth are HIV positive

f.

Suspending transmission. Before advances in drug therapy the risk of neonate becoming infected via maternal virus transmission ranges from 25%-35%. But with an appropriate antiviral therapy during and after pregnancy, the rate of possible infection dropped to nearly 5%. Unfortunaetly, If infection occurs in the fetus or neonate, it progress more quickly in adult. CAUSES 1. HIV infection is caused by RETROVIRUS that targets helper T-CELLS containing the CD4+ antigen(cells that regulate normal immune response) 2. HIV is transmitted into several ways: a. Through sexual intercourse b. Contact with infected blood c. Across the placenta to the fetus during pregnancy (in case of active dse. Med noncompliance, and placental inflammation) d. Through contact during the labor and delivery e. Through breastmilk 3. For women, *heterosexual contact and* injection drug use are the two major mmodes of contracting HIV, includes: a. Having bisexual partners b. Use of inject on drugs by patient partners c. Blood transfusions (rare)

SIGNS AND SYMPTOMS 1. Lympadenopathy 2. Bacterial pneumonia 3. Fever 4. Night sweets 5. Weight loss 6. Dermatologic problems 7. Trash 8. Thrombocytopenia 9. Diarrhea 10. In addition, woman commonly experiences severe vaginal yeast that are difficult to treat. Other manifestations specific to women may include: a. b. c. d. e. Abnormal papanicolaou test Frequent human papilloma virus infections Frequent and recurrent bacterial vaginosis trychomonas and genital herpes. Severe pelvic inflammatory disease. Pneumocyaritis carani pneumonia is the most common opportunistic infection associated with female HIV infection. Cervical cancer ranks in second in prevalence. Kaposis sarcoma may also occur in women although it is rare.

WHAT TEST TELLS YOU CDCP- recommends HIV positive combination antiretroviral therapy. The treatment attempts to reduce the mothers viral load and minimize the risk of transmitting the infection to the fetus.

RISK DELIVERY CS delivery provides the lowest risk of HIV transmission from mother to fetus- lowest of performed before the labor begins or membrane are ruptured. WHEN BREAST ISNT BEST Risk for breastfeeding on mothers health, including her nutritional and immune status and viral load, as well as as length of time the child nurses at each feeding and weather the mother breast-feeds exclusively. In addition, the duration of the breast feeding foe 24 months or more transmit the infection to their neonates. MEDICATION.

Zidopodine (AST) and Didanosine (Videx)- used to slow progression of opportunistic infection such as P. carini pneumonia- the most common -it is given orally during the pregnancy -given IV during the labor -syrup for neonate Co-tromoxazole- may cause increased bilirubin levels in the neonate if administered late pregnancy. WHAT TO DO. 1. Institute standard precaution where caring for the mother throughout the pregnancy, after delivery, and when caring for the neonates. 2. Teach the pregnant woman measures to minimize the risk of virus transmission 3. Provide emotional support and guidance for the woman whos HIV positive and considering pregnancy 4. Allow the patient to verbalize the feelings and provide support 5. Assess patient for s/s of opportunistic infections such as p.carini pneumonia (fever, dry cough, chest discomfort, fatigue, shortness of brath on exertion and later at rest) and kaposis sarcoma (slightly raised, painless lesions on the skin and oral mucous membranes that are reddish or purple in fair skinned patient; painful swelling, specially on the lower legs, nausea, vomiting and bleeding if GIT is involved, DOB if lungs are involved). 6. Encourage to keep prenatal check-up to evaluate status of pregnancy 7. Assist patient taking meds 8. Institute measures during labor and delivery to minimize the fetus risk of exposure to maternal or body fluids. Avoid the use of internal fetal monitors, scalp blood sampling forceps and vacuum extraction to prevent the creation of an open lesion to fetal scalp. 9. Advise the mother that breast feeding isnt recommended bec. Of the risk of transmitting the virus. 10. Withhold blood sampling and injection of the neonate until maternal blood has been removed with the first bath 11. Educate the mother about the mode of HIV transmission and safer sex practices.

DANGER SIGNALS OF PREGNANCY A. VAGINAL BLEEDING NO MATTER HOW SLIGHT The most common cause of bleeding in early pregnancy is abortion Placenta previa is the most common cause of bleeding in late pregnancy B. FEVER AND CHILLS C. PASSAGE OF WATERY DISCHARGE PER VAGINA. This may indicate premature rupture of the membrane (PROM) D. SEVER VOMITTING- HYPEREMESIS GRAVIDARUM E. PERSISTENT HEADACHE, DIZZINESS F. DOUBLE/BLURRING/DIMNESS OF VISION G. SWELLING OF HANDS AND FACE H. ABDOMINAL PAIN Crampy, early pregnancy pains = abortion Low quadrant, radiating of the shoulder- ectopic pregnancy Hard board like, painful abdomen with or without vaginal bleeding= abruption placenta I. Sudden marked change in the character, frequency and strength of fetal movement

Fetal surveillance a. Fetal heart tones 1) Normal heart Range : 120-160 per minute b. Fetal Activity : quickening and subsequent fetal movements c. Size of the fetus: actual and rate of change; may be evaluated by fundic height assessment, fetal palpation. d. Amount of amniotic fluid - 1000ml- average normal amount e. Passage of meconium in non-breech presentation in normal, whereas in cephalic presentation, is a sign of fetal distress. f. Presentation, station in late pregnancy Preventive Health teachings a. Hygiene of pregnancy b. Prevention of discomforts c. Proper nutrition d. No drugs, alcohol, smoking

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