HIGH RISK PREGNANCY

1
 Adolescent Pregnancy:
Contributing Factors
uPeer pressure
u Self-esteem
uLack of role models
uGain attention
uMedia
uPoverty
uRite of passage
2
Implications of Adolescent Pregnancy

Socioeconomic:
•reliance on welfare

•cycle repeats itself Fetal Health:

Maternal health: •LBW
•CPD
•prematurity
•PIH
•resp complications
•anemia
•cp
•nut deficits
•cognitive deficits
• mortality
•death 3
Adolescent Pregnancy: Assessment

uRisks
ufundal height
u# of sexual partners
uknowledge of infant care/needs
ufamily unit/support system
ubaseline VS/weight

4
 IMPLICATIONS OF DELAYED
PREGNANCY
uPre-existing conditions
uPreterm labor SGA/LBW
uIUGR (Intra Fetal Growth Retardation)
uPIH Abruption
uC-section
uUterine fibroids PP hemorrhage
uChromosomal abnormalities

5
 DELAYED PREGNANCY:
ASSESSMENT
uPre-existing conditions
uFundal height
uAnxiety
uPsychosocial issues
 (career vs baby)

6
 Hemorrhage
uIt is the rapid loss of more than 1%
of body weight in blood.
uResults in:
♦Inadequate tissue perfusion
♦Deprivation of glucose and oxygen
to the tissues
♦Build up of waste products

7
 Antepartum hemorrhage
uBleeding that occurs anytime during
pregnancy
u
uEarly – before 20 weeks AOG
e.g. abortion
uLate – bleeding after 20 weeks AOG
e.g. abruptio placentae, placenta previa

8
 Intrapartum hemorrhage
uBleeding that occurs during labor
 e.g. uterine rupture
 uterine inversion
 abruptio placentae

9
 Postpartum hemorrhage
uBlood loss greater than 500ml in a
vaginal delivery or 1000ml in a CS
birth
u
 Early – occurs during the first 24 hours
after delivery


 Late – occurs 24 hours after vaginal

delivery
10
 Abortion
uMost common bleeding disorder of
early pregnancy
uTermination of pregnancy before age of
viability
uA fetus who is less than 24 weeks
gestation or weighing less than 600
gms is not viable

11
 Early and Late Abortion
uEarly Abortion: termination of
pregnancy before 12 weeks
u
uLate Abortion: termination of
pregnancy that occurs between
12 to 20 weeks

12
 Spontaneous Abortion
uThreatened
uInevitable
uIncomplete
uComplete
uMissed
uHabitual

13
TYPES OF SPONTANEOUS ABORTIONS

14
Spontaneous Abortion Management

 Threatened u Notify MD/MW

u Check fetus by Utz

u Bedrest, no sexual activity

 for 2 weeks after bleeding stops
u No false reassurance
 u Tocolysis

 ♣ Check by Utz for complete vs.

incomplete
 Inevitable
♣ Analgesics for D&C
♣ Save & count pads
♣ IV oxytocin
15
 Spontaneous Ab Mgmt, cont.
Incomplete
 u Hospitalization
u u Before 14 wks – D&C
u u After 14 wks – Pitocin or
Prostaglandins
u

u
uD & C
Missed
u Monitor for DIC
u Monitor for infection

16
 Spontaneous Abortion
Management
u Complete u Habitual
 - Observe  - Cervical
 - May give Cerclage
oxytocin  (Suturing of
cervix)

17
 Post Abortion Education
uBleeding, cramping X 1-2 wks
uvaginal rest X 1 wk
u temp BID

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 Incompetent Cervix
S&S Treatment
•Painless cervical dilatation •Cerclage

•Increased pelvic pressure •Bed rest

•Bloody show (pink stained) •√ FHT

•Urinary frequency •Avoid coitus

& Vaginal
•PROM & discharge of
douche
amniotic fluid
•Tocolytics
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 Ectopic Pregnancy
uIt is the implantation of the zygote
outside the uterine cavity or in an
abnormal location inside the
uterus.
uCauses: narrowing of tubes,
infection
uSite: Fallopian tube, cervix, ovary
and rare in the abdomen
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SITES OF ECTOPIC PREGNANCY

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 S & S Ectopic Pregnancy
]Amenorrhea, with positive PT
]Abdominal Pain
]Vaginal Spotting
]Rupture Severe lower abd
]↓ hCG levels pain
]No gestational sac on utz

22
Surgical Management of
Ectopic Pregnancy

23
 Hydatidiform Mole
uAlso called “molar pregnancy” or
“H-mole”
uDisorder of the placenta
characterized by degeneration of
the chorion and death of the
embryo.

24
 S & S Hydatiform Mole
uVaginal bleeding
anemia
u uterus size, cramps
uNo FHT’s
u N/V
uElevated serum or
urine HCG

Therap. Mgmt: vacuum aspiration & curettage 25

26
 Placenta Previa
uIt is a condition that may occur
during pregnancy when the
placenta implants in the lower
part of the uterus and obstructs
the cervical opening to the vagina
(birth canal).

27
 Placenta Previa
uAsian and African ethnicity is high risk
uAssociated with mothers who are
smoking and using cocaine
uComplications: Greater risk for post
partum hemorrhage, hypovolemic
shock and preterm labor
uCauses: Increased parity, maternal
age, prior cesarean births, multiple
gestation
 28
 s/sx:
vSpotting during the first and second
trimesters
vSudden, painless, and profuse vaginal
bleeding in pregnancy during the third
trimester (usually after 28 weeks)
vUterine cramping may occur with onset
of bleeding
vThe uterus is usually soft and relaxed.
u

29
 Management:
uBleeding is an emergency
uAssess the amount of blood loss
uBed rest with oxygenation as
prescribed
uSide lying or T-berg position
uNo IE or rectal exams
uKeep IV line & have blood available

30
 Abruptio Placenta
uPremature separation of a
normally implanted placenta
after 20 weeks of gestation
and before delivery of the
fetus
uCommon among hypertensive,
high parity, old age, alcoholic
mothers 31
 S&S Abruptio Placentae
•Vag bldg
(unless concealed)

•abd & low

back pain
• uterine
resting tone
•uterine
irritability
•uterine
tenderness

32
Med Mgmt of Abruptio Placentae

Mom stable,
 bleeding,
fetus immature
fetal distress

bedrest
Emergency CS
tocolytics
33
 Degree of Separation Grade
Criteria
ms of separation. Slight separation occurs after birth.
paration, enough to cause bleeding and changes in v/s. No feta
eparation. There is evidence of fetal distress and uterus is pain
paration, maternal shock or fetal death will result

34
 DIC
Placental Bleeding

Thromboplastin release

Clot formation (systemic response)

 clotting factors (fibrinogen,  plts,  PTT)

inability to form clots

profuse bleeding 35
Hemorrhagic Conditions:
Abruption & DIC
ASSESSMENT
•Bleeding

•Pain

•VS/FHR

•Uterine Activity

•OB Hx

•Fundal Ht

•Lab Data (H/H, coags)

36
 Uterine Atony
uThe failure of the uterus to contract
maximally after the delivery of the
baby and placenta, resulting in heavy
uterine bleeding.

37
 Causes:


u Multiple gestation, high parity

u Fetal macrosomia

u Polyhydramnios

u General anesthetics

u Prolonged labor, precipitous labor, augmented labor

u Infection (chorioamnionitis)

38
 S/Sx:
uExcessive bleeding at the time of
delivery
usoft uterus

39
 Uterine Inversion
uuterus literally turn inside out such that
the top of the uterus (the fundus)
comes through the cervix or even
completely outside the vagina

40
 Treatment:
u Initial treatment consists of bimanual
compression, uterine massage.

u Uterine contraction medications: Oxytocin,

Methylergonovine, and Prostaglandins

u Surgery: uterine vessel ligation or

hysterectomy (the latter is rarely used)

u Blood and fluids must be replaced as needed.

41
Retained placental Fragments
u Late post partal hemorrhage
u Fragments may become necrosed & fibrin
may be deposited. A placental polyp can
form, separate, and sudden bleeding can
occur
u Caused by abnormal placental implantation or
careless delivery of placenta
u S/Sx: vaginal bleeding, boggy fundus

42
Hypertensive Disorders of Pregnancy

u Hypertension – BP reading in 2 occasions of

at least 140/90 or a rise of 30mm/Hg
systolic and 15mm/Hg diastolic
u Gestational Hypertension – BP 140/90mmHg
develops for the first time during
pregnancy, but there is no proteinuria and
within 12 weeks postpartum the BP is
normal
u Chronic HPN – presence of HPN before
pregnancy or HPN that developed before
20 weeks AOG in the absence of H-mole
that persists after 12th wk postpartum
43
Pregnancy Induced Hypertension
u
uHPN that develops after the
20th week of gestation to a
previously normotensive
woman.

44
The Pathological Processes of Pre-
eclampsia

45
 S&S Pre-eclampsia
uRapid wt gain
uedema of hands & face
uproteinuria
uhyperreflexic DTR’s
uvisual disturbances
uepigastric pain

46
Treatment of Pre-eclampsia

Mild: diastolic < Severe: diastolic > 110,

100, trace to 1+ 3+ proteinuria,  U/O,
proteinuria, no H/A H/A, visual disturbances
u Bedrest u Bedrest,  stimuli
u protein diet u Meds
u document fetal v Apresoline for severe
activity HPN
v MgSO4
u weekly NST
(anticonvulsant &
antihypertensive)
u Delivery

47
 S&S Eclampsia/HELLP
Syndrome
u Eclampsia u HELLP Syndrome
vfacial twitching vRUQ pain
vtonic-clonic sz vn/v
vpulmonary vedema
edema vH/H,  plts
vcirc/renal failure vliver enzymes

48
 Treatment of Eclampsia/HELLP Syndrome

uBedrest
uMeds
vMgSO4
vValium or Phenobarb (if Mg not effective,
not within 2 hr of delivery)
vHydralazine (for severe ↑ B/P)
vsteroids to  fetal lung maturity
uDelivery

49
 Assessment: Hypertensive
Disorders of Pregnancy
uPrenatal:
vwt, B/P, U/A, visual disturbances
uHospitalized Client:
vdaily wt
vhourly u/o, dipstick urine Q4H
vVS, FHR
v LOC, DTR’s

50
 Risk Control Strategies for
Hypertensive Disorders of Pregnancy
uSeizure precautions
umonitor for s/s Mg toxicity(RR<12, absent
DTR’s, sweating, flushing, confusion,  B/P)
uCa gluconate
u Mg levels
uIV MgSO4 D/C MgSO4 for RR < 12 or
absent DTR’s
u renal function (30 mL/hr)

51
Premature Labor/Rupture of Membranes

u S&S
u Treatment
v contractions
v Tocolytics
v cramps
v IV hydration
v backache
v bedrest
v diarrhea
v steroids, if needed
v Vaginal 
discharge
v ROM

52
Nursing Care for PTL/PROM
u Assessment u Teaching
vThorough history vInfection
Control
v bleeding
vComplete bed
v ROM rest without
bathroom
privileges


53
 Postterm Pregnancy
u S&S u Treatment
v Wt loss vfetal surveillance
v  uterine size
w NST, CST,
v Meconium in
Amniotic fluid BPP Q wk
u w mom
monitors
u Risks mvmt
v  fetal mortality
vInduction
v cord compression
v meconium aspiration w Pitocin (10-
20U/L) @
v LGA  shoulder
dystocia  CS 1-2 mU/min
every 20-
v episiotomy/laceration
60 min
v depression
54
 Disorders of Amniotic Fluid
u Polyhydramnios u Oligohydramnios
vS&S vRisks
w uterine w cord
distention compressio
w dyspnea n
w edema of w musculoskele
lower tal
extremities deformities
w pulmonary
vTreatment
hypoplasia
w therapeutic
amniocente vTreatment
sis w Amniotic
infusion
55
w
Risks of Multifetal Gestation
uPIH
uGDM
uPPH
uAnemia
uUTI
uPlacenta previa
uCS

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(Fetal) S&S Rh Incompatibility
uHyperbilirubinemia
vjaundice
vKernicterus (severe neuro d.o. r/t  bili)
uanemia
uhepatosplenomegaly
uHydrops fetalis
u

57
 Sequence of Assessments for Rh
Sensitization
Blood Test for Type & Rh Factor

Rh-positive
Rh-negative

No further testing
Indirect Coombs
- +
Repeat frequently Titer increasing
Give 
RhoGAM Titer not increasing
amniocentesis ( bilirubin)

Elevated
continue to monitor No change

 retest, U/S
retest prn 
58
intrauterine transfusion or
Management of Rh Incompatibility

Prenatal
•per algorithm

u Prevention u Postpartum
vRhoGAM at 28 v direct
weeks Coomb’s
(unsensitized vRhoGAM to mom
women only) if baby is Rh+
(within 72 hrs
of birth)
59
 Hyperemesis Gravidarum
u S&S u Treatment
v U/O vIVF, TPN
vwt loss vantiemetics
vketonuria vSmall frequent
vdry mucous feedings
membranes vToast, unsalted
vpoor skin turgor crackers

60
 Glucose Tolerance Test

1 GTT (24 - 28 wks) 3 GTT

drink 50g glucose, •hi carb diet X 2
if 1 BS > 140 days, then NPO
after MN
•FBS, then drink
100g glucose,

• 1, 2, 3
Gestational Diabetes is diagnosed with FBS > 105
BS
or with 2 of the following BS results:
61
1 > 190, 2 > 165, 3 > 145
 Effects of Pre-Existing DM

Maternal

Fetal


u risk of: v risk of:

uPIH w Cardiac
defects
uCystitis w Macrosomia
uDKA or
w IUGR
uSpont Abortion
w Polycythemi
a
w hyperbilirubi
62
Treatment of Pre-existing DM
uTeam approach
uMonitor glycosylated Hgb A
uDiet: 50% carb, 20% prot, 30% fat
uInsulin TID
uHourly glucoses during labor
uNST’s weekly (starting at 28-30 wks)
u Amnio ( lung maturity)

63
 Effects of Gestational
Diabetes
u Maternal Effects u Fetal Effects
vUTI vmacrosomia
vhydramnios vhypoglycemia at
vPROM/preterm birth
labor vRespiratory
vshoulder dystocia Distress
Syndrome
vCS
vHPN

64
Treatment of Gestational
Diabetes

u30 to 35 cal/kg/day (3 meals, 2 snacks)

uInsulin
u FBS,NST, BPP Q week
uglycosylated Hgb A
uAmniocentesis ( lung maturity)

65
Diabetes: Patient Education
u Glucose monitoring
u insulin administration
vtype, onset, peak, duration, times, sites,
injection technique
u diet
u s/s hypoglycemia
vtremors, pallor, cold/clammy skin
vgive milk & crackers or glucagon injection
u s/s hyperglycemia
vfatigue, flushed skin, thirst, dry mouth,
vcheck glucose, call MD for insulin order
u
66
 Cord Prolapse
uthe umbilical cord drops (prolapses)
through the open cervix into the
vagina ahead of the baby.


67
 Causes:
uPremature delivery of the baby
uDelivering more than one baby per
pregnancy (twins, triplets, etc.)
uExcessive amniotic fluid
uBreech delivery (the baby comes
through the birth canal feet first)
uAn umbilical cord that is longer than
usual

68
 Iron deficiency anemia
uApproximately 20% of women, 50% of
pregnant women, and 3% of men are
iron deficient.
uIron is an essential component of
hemoglobin, the oxygen-carrying
pigment in the blood.

69
 S/SX
u Pale skin color
u Fatigue
u Irritability
u Weakness
u Shortness of breath
u Unusual food cravings (pica)
u Decreased appetite (especially in children)
u Headache - frontal
u Blue tinge to sclerae (whites of eyes)
u Microcytic, hypochromic cells

70
 Treatment:
u120 to 180mg of iron daily
uFerrous sulfate
uDiet high in iron
e.g. green leafy vegatables, meat


uIf anemia is severe, Dextran is given

IM.


71
 Folic Acid Deficiency
uFolic acid is necessary normal
formation and nutrition of RBC’s.


uDeficiency leads to formation of large

and immature RBC’s that have
shorter life span than normal RBC’s.


72
 S/Sx:
u Nausea
u Vomiting
u Anorexia
Treatment:


→Folic acid supplement 1mg/day accompanied

oral iron
→Dietary supplements
→e.g. dark green leafy vegetables, dried beans
and peas, enriched grain products

73
 Postpartum Blues
ualso known as baby blues
utransient condition that affects up to 80
percent of new mothers just after
delivery
uSymptoms peak at the fifth day and
resolves within two weeks

74
 S/Sx:
u may include abrupt mood swings from
happiness to sadness
u anxiety
u irritability
u decreased concentration
u insomnia
u Tearfulness
u crying spells that can occur for no apparent
reason

75
 Treatment:
u Treatment for postpartum blues is focused on
providing support for the mother and her
family
u reassurance that her feelings are quite
normal and experienced by many other
women postpartum
u It is important that mothers make time for
adequate sleep and rest, eat a well-
balanced diet, and allow others to care for
the baby at night if possible.

76
 Postpartum Depression
uoccur within the first month after
delivery, but may also occur up to
one year after delivery
umay be related to the abrupt
withdrawal of estrogen and
progesterone levels after birth that
are much higher during pregnancy

77
 S/Sx:
u Insomnia or excessive sleep

u Fatigue

u Change in appetite with weight loss or weight

gain

u Loss of interest or pleasure in life

u Decreased libido (sex drive)

u
78
 Con’t. of S/Sx:
u Excessive worry or anxiety

u Intense irritability and anger, short temper

u A sense of being overwhelmed or unable to care

for the baby

u Difficulty making decisions

u Not bonding with the baby, leading to further

shame and guilt

79
 Sickle Cell Disease
u Maternal Effects u Fetal Effects
vpain vIUGR/SGA
vjaundice vskeletal changes
vPyelonephritis
vPIH/preeclampsia
vleg ulcers
vCHF

80
 Systemic Lupus
Erythematosis
u Maternal effects u Fetal effects
vfatigue vIUGR
vmuscle/joint pain vpreterm delivery
vwt loss
vrash
vproteinuria Treatment
vPIH/preeclampsia/HELL
P •PO or IV Steroids
vPG loss

81
Cardiac Conditions During
Pregnancy

82
 Effects of Pregnancy on
Heart Disease

uIncrease blood volume

uSystemic vascular resistance drops
significantly by 25% during pregnancy
lowering systolic and diastolic blood
pressure
uThe gravid uterus can dramatically
affect venous return to the heart in
some positions

83
 S/Sx:
uDyspnea, orthopnea
uPalpitations
uChest pain
uSyncope with exertion
uNeck vein distention


84
 Management:
u Regular prenatal visits
u ECG
u Echocardiogram
u Frequent rest periods
u Diet
 e.g.  iron, protein and minerals
  Na


85
Problems with POWER,
PASSAGE AND
PASSENGER

86
 Shoulder Dystocia
 painful, w a.monitor uterine
contraction
difficult, frequency,
prolonged intensity,
duration
labor and w b.observe
birth effacement,
dilitation and
resulting in descent
failure to w c.observe uterine
resting tone
efface, for hypertonus
and/or w d.monitor fetal
heart rate for
descend non-reassuring
within an pattern
w e.observe fetal
expected presenting part
time frame for molding,
87
asyncliticism
 Management:
w a.evaluate fetal status for size, position and
reassuring heart rate
w b.evaluate pelvic parameters for adequacy,
empty bladder
w c.evaluate uterine activity for frequency,
intensity and duration
w d.provide sedation and rest if appropriate in
latent phase, ambulation in active phase,
maternal repositioning to turn fetal head
position, and hydration
u
88
 w e.prepare for pitocin augmentation if
in active phase
w f.provide adequate physical and
emotional support for pain
w g.provide pain relief if appropriate
w h.prepare for cesarean birth if
appropriate
w i.prepare for shoulder dystocia if
macrosomic
w j.prepare for neonatal resuscitation if
necessary
u 89
Sexually Transmitted Disease

90
 Candidiasis
uCaused by the fungus “Candida”
u estrogen which causes vaginal pH to
be less acidic
uThick, cream cheese-like vaginal
discharge
uExtreme pruritus
uTreatment: Monistat (Miconazole)

91
92
 Trichomoniasis
uProtozoan infection: Trichomonas
vaginalis
uYellow-gray frothy vaginal discharge
uTreatment: Metronidazole (can be
teratogenic)
uTopical clotrimazole
u

93
94
 Chlamydia Trachomatis
uChlamydia (gram-negative)
uHeavy-gray white vaginal discharge
uTreatment: erythromycin and amoxicillin
u

95
96
 Syphilis
uCaused by spirochete “Treponema
Pallidum”
uPainless ulcer (chancre)
uTreatment: benzanthine penicillin G
u

97
98
 Herpes Simplex Virus Type 2
uPainful, small, pinpoint vesicles
surrounded by erythema on the
vulva or in the vagina 3 to 7 days
after exposure


uTreatment: Acyclovir (zovirax)

u

99
100
 Gonorrhea
uCaused by: Neisseria gonorrhoeae
uClap disease
uYellow-green vaginal discharge
uTreatment: oral cefixime or Ceftriaxone
Sodium IM

101
 Human Papilloma Virus
uCondyloma Acuminatum
uCauliflower-like lesions
uTreatment: Tricloroacetic acid or
bichloroacetic acid

102
 AIDS
u Maternal Effects u Fetal Effects
vvaginal vAsymptomatic at
candidiasis birth
vPID vCandidal diaper
vgenital herpes rash
vthrush
vPCP
vdiarrhea
vrecurrent
bacterial
Treatment: infections
vdevelopmental
ZDV (zidovudine) during PG, L&D
delay
ZDV to neonate for 6 wks 103
High Risk Pedia

104
 Preterm Newborn
uNeonate born before 37 weeks of
gestation
uAssessment includes:
♦Body temperature below normal
♦Poor suck and swallowing reflex
♦Minimal creases in the soles and
palms

105
 Con’t. Assessment:
♦Extends extremities and cannot
maintain flexion
♦Testes are undescended in boys
♦Labia are narrow in girls
♦Lanugo is present in skin and in the
hair

106
 Postterm Infant
uA neonate born after 42 weeks of
pregnancy

107
 Assessment:
uHypoglycemia
uDry and cracked skin without
lanugo
uFingernails long and extended
over ends of the fingers
uProfuse scalp hair
uMeconium staining possibly
present on nails and umbilical
cord
108
 Small for gestational age
uA neonate who
is plotted at or
below the 10th
percentile on
the
intrauterine
growth curve

109
 Assessment
uFetal distress
uLowered or elevated body
temperature
uHypoglycemia
uSigns of polycythemia

110
 Large for gestational age
uA neonate who is plotted at or above
the 90th percentile on the intrauterine
growth curve

111
 Assessment
uGestational age
uBirth trauma or injury
uRespiratory distress
uHypoglycemia


112
 Respiratory Distress
Syndrome
uA serious lung disorder caused
by immaturity and inability to
produce surfactant, resulting
in hypoxia and acidosis

113
 Assessment
uTachypnea
uNasal flaring
uExpiratory grunting
uRetractions
uDecreased breath sounds
uPallor and cyanosis
uApnea
u
114
 Meconium Aspiration
Syndrome
 Caused by hypoxia in utero
 
 Vagal reflex relaxation of the rectal
sphincter
 
 Release of meconium into the amniotic
 fluid

115
 S/Sx:
uTachypnea
u
uRetractions


uCyanosis


uBarrel chest

116
 Mgt.
uSuctioning
uAssisted ventilation
uThermal neutral environment

117
 Sudden Infant Death
Syndrome
uContributory factors:
→Viral respiratory infection
→Distorted familial breathing patterns
→Possible lack of surfactant in alveoli
→Sleeping prone rather than on the
side or back

118
 The Newborn At Risk
Because of Maternal Infection or
Illness

119
 Fetal Alcohol Syndrome
ucaused by maternal alcohol
use during pregnancy
uSyndrome causes mental and
physical retardation

120
121
 Congenital Rubella
uCaused by Rubella virus


uCauses congenital fetal

malformations if the mother is
infected in the first trimester

122
 S/Sx:
uThrombocytopenia
uCataracts
uHeart disease
uDeafness
uMicrocephaly
uMotor and Cognitive impairment

123
124
125
 Opthalmia Neonatorum
uEye infection at birth or during the
first month of life


uCaused by:
 Neisseria gonorrhoeae
Chlamydia Trachomatis


126
127
128
 S/Sx:
uConjunctiva becomes fiery red
uThick pus present
uEdematous eyelids


  If left untreated, it causes opacity

of the cornea and severe vision
impairment

129
 Treatment:
uIf gonococcal infection is present,
IV cetriaxone and penicillin is
given.
u
uIf chlamydia is identified,
erythromycin ophthalmic solution
is used.
130
 The Infant of a Diabetic
Mother
u Macrosomic babies


u Caudal regression syndrome (hypoplasia of lower

extremities)


u Cushingoid (fat and puffy)



u Lethargic
u

131
 Management:
uEarly feeding with formula
u
uInfusion of glucose

132
133
 The Infant of A Drug-Dependent
Mother
uSGA
uIrritability
uDisturbed sleep patterns
uShrill, high pitched cry
uTachypnea
uTremors
u

134
 Cocaine
uCNS stimulant and peripheral
sympathomimetic
uMaternal effects:
uIncreased BP
uDecreased uterine blood flow
uIncrease vascular resistance

135
 Fetal Effects of Cocaine
uNeurobehavioral depression
uThis includes the ff:
uLethargy
uPoor suck
uWeak cry
uDifficulty arousing

136
 Heroine
uCNS depressant
uMaternal effects:
uDecreased BP
uIncreased uterine bleeding


137
138
Spontaneous Abortion Matching –
Choose all that apply.
1. 1. Initial symptom is vaginalA. Threatened
bleeding
2. 2. Membranes rupture and
abortion
cervix dilates B. Inevitable abortion
3. 3. Some, not all, products of
conception are expelled.C. Incomplete abortion
4. 4. Treatment includes D&C
5. 5. All products of conception
D. Complete abortion
passed E. Missed abortion
6. 6. All unsensitized Rh neg
women should receive
RhoGAM
7. 7. May be treated with
bedrest
8. 8. Retained dead fetus
9. 9. May be complicated by
DIC
10. 10. Pregnancy may continue 139
Which of the following socioeconomic factors
contributes to the high incidence of
adolescent pregnancy?

A. lack of adequate birth control

B. poverty

C. lack of information on safe sex

D. availability of public assistance for

unmarried mothers

140
 When caring for a woman with mild
preeclampsia, the nurse would be concerned
with which finding?

a.+4 proteinuria

b.+2 dependent edema in ankles

c.Blood pressure 156/100

d.+2 DTR’s, absent clonus

141
 The nurse is preparing to infuse
magnesium sulfate to treat preeclampsia.
In implementing this order the nurse
understands the need to:

a.Prepare a solution of 20 g MgSO4 in 100cc

D5W

b.Monitor maternal VS, FHR and uterine

contractions every hour

c.Expect the maintenance dose to be

approximately 4g/hr

d.Discontinue the infusion and report a

respiratory rate of < 12 breaths/minute
142
The primary expected outcome for care
associated with the administration of
MgSO4 would be met if the woman:

a.Exhibits a decrease in both systolic and

diastolic blood pressure

b.Experiences no seizures

c.States that she feels more relaxed and

calm

d.Urinates more frequently, resulting in a

decrease in pathologic edema
e. 143
 A primigravida at 10 weeks gestation reports
slight vaginal spotting without passage of tissue
and mild uterine cramping. When examined, no
cervical dilation is noted. The nurse caring for
this woman should:

a.Anticipate that the woman will be sent

home and placed on bedrest with
instructions to avoid stress or orgasm

b.Prepare the woman for a dilatation and

curettage

c.Notify a grief counselor to assist the

woman with the imminent loss of her
fetus

d.Tell the woman that the doctor most likely

144
 CASE STUDY I

A G3P2 woman, at 38 wks gestation, arrives at

the obstetric unit with c/o painless vaginal
bleeding.

1. What is the nursing priority at this time?

2. What assessments are necessary?

3. What is the most likely etiology of the

bleeding?

4. What is the expected treatment for

Anne? 145
 CASE STUDY
II
A G1P0woman, at 35 wks gestation, is
visiting the midwife for a routine prenatal
visit. On assessment, the nurse finds that
she has gained 8 lbs in the past month.

1. What is the significance (if any) of this

weight gain?

2. What other assessments should the

nurse make at this time?

3. What is the required treatment for 146

A 22 y.o. G1P0
CASE STUDY III
who has a history of IDDM X 6 yrs and whose LMP
was 12 wks ago arrives at the prenatal clinic.
1. How will this client’s diabetes be affected by her
pregnancy?

2. What changes will she most likely have to make to adjust

to her pregnancy?

3. What routine assessments will be made at each prenatal

visit?

4. What tests will be required as the pregnancy

progresses?

5. What fetal effects occur with pre-existing diabetes?

6. How will L&D be altered by pre-existing diabetes?

7. What possible newborn complications could occur with

pre-existing diabetes? 147
 MATH PROBLEM
For induction, Pitocin is ordered – 10
Units in 500 mL to start at 2 mU/min
and increase by 1 mU/min every 20
minutes until effective contractions are
achieved.
At what rate will the nurse start the IV?

By how much will the rate be increased

every 20 minutes?

148
THE END

149