MATERNAL LEC

CARE OF MOTHER AND CHILD AT RISK /WEEK 2

Week 4: Care given to a Pregnant Client  Risk for social isolation related to bed
with Special Needs rest at home
 Risk for disruption of social
A.1.Assessment:
interactions related to unclear
 Assess the strengths and weaknesses speech
of individual women (client)- to  Disruption in family dynamics related
establish to serious illness of family’s main
 accurate nursing diagnoses provider
 Establish a complete database early  Readiness for enhanced family
in pregnancy- to predict the risks a coping related to commitment to
woman may be exposed to when have a child in the face of a
pregnancy is affected by age disabling condition
extremes physical or cognitive
3.Outcome Identification and Planning
challenges
 If there is physical disability, establish  Planning for a pregnant woman with
the impact of this disability on a special needs involves identifying
woman’s lifestyle before beginning support people to help with this
to offer guidance for care added stress; can come from family,
friends, a professional organization,
2.Nursing Diagnoses
or healthcare providers
 Differ in degree but not in substance  Woman should agree with the plan
for all pregnant women  Plans should also include ways to
strengthen confidence and self
Examples: esteem
 Remember to include safe care of
 Risk for imbalanced nutrition related
the newborn
to combined needs of adolescent
and pregnancy 4. Implementation: focus on the
 Risk for fetal injury related to drug following
and alcohol use
 Impaired physical mobility related to  Promoting a healthy pregnancy and
physical disability preventing pregnancy
 Risk for injury related to unstable complications
balance  Teaching and encouraging the
 Risk of injury related to potential for client to determine how best to
unintentional injuries manage her pregnancy according
 Impaired verbal communication to her particular situation
related to spastic muscle functioning  Consider a non judgmental attitude
 Impaired home maintenance that focuses on the pregnancy and
related to a sensory challenge the baby, while avoiding

1
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

recriminations about a woman’s a.4. to choose a vocation

youth or circumstances.-to
encourage the young woman to  Helping adolescents to make their
own healthcare decisions at
prenatal care and keeping her
coming for regular visits healthcare visits helps to establish a
sense of independence
5. Outcome Evaluation  Weighing herself, viewing herself in
front of the mirror
Examples:
 Being interviewed apart from her
 Patient states that she will use walker parents
to maintain balance during  Remind parents that a pregnanct
pregnancy adolescent is considered as
 Adolescents list a weekly intake of emancipated minor or a mature
adequate calories even with minor – a person capable of making
frequent meals at fast food healthcare decisions
restaurants.  In some countries, emancipated
 Family members state they have minors can qualify and are eligible
been able to adjust to changing for special health insurance
demands of pregnancy in a who is coverage
physically challenged  Should avoid: issues with privacy,
 Patient reports to methadone parental permission, and parental
maintenance clinic daily and reports notification
no other substance use
b. Prenatal Assessment
 Patient states that she is able to
manage a daily rest period even in Adolescents are at high risk of:
light of a busy work and travel
schedule  Iron-deficiency anemia
 Premature labor
 Patient states she is able to carry out
usual lifestyle activities in spite of cast  Low birth weight infants
 Disproportion between fetal and
on injured arm.
pelvic size
B.The Pregnant Adolescent:  High rate of intimate partner
violence
a.developmental Tasks
Adolescents do not seek prenatal care
a.1. to establish a sense of self-worth or
– it’s their way of protecting the
a value system
pregnancy (if they don’t tell anyone
a.2.to emancipate from parents Other factors:
a.3.to adjust to a new body image
 Denial that she is pregnant

2
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

 Lack of knowledge of the  Starting o have colostrum

importance of prenatal care  Using a doppler technique to obtain
 Dependence on others for fetal heart tones
transportation
 Feeling awkward in a prenatal f. Pregnancy Education
setting (an adult setting)  May respond positively to health
 Fear of a first pelvic examination teachings that is directed to their
 Difficulty relating to authority figures own health more than to that of a
Management: fetus.
 Give instructions about possible
 Group pre natal care-allows them to discomforts and changes associated
interact with peers the same as they with pregnancy
do at school
1.Nutrition
c. Health History
a. Maybe a problems as teenagers
 Take a detailed health history of an enter pregnancy
adolescent at the first prenatal visit
 Best done without a parent present Reason: poor nutritional stores from
years of eating a less-than-optimal diet
 Common concerns: weight gain,
felling tires all the time  can result to preterm births and low
 Be alert of the possibility of birth weight
pregnancy; adolescent describes
symptoms as vague and hard to To prevent: girls should have an intake
define that both allows for growth the fetus
and also provides for the needs of her
d.Family Profile own growing body
Common: b.Obesity and overweight during
 Leaving home pregnancy- due to over eating and lack
of exercise
 Separate themselves emotionally

Ask:  Can lead to macrosomia or

overgrowth in a fetus that can lead
 About home life-could reveal to increase in the number of C/S
dysfunctional family
Management: should not restrict
 If the girl is planning to continue with
school nutrition during pregnancy to prevent
protein and vitamin deficiencies
e. Physical Examination

Examples:

3
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

c. Many girls do not eat well during cut off from peer or fellow
pregnancy because they do not know classmates
what constitutes good nutrients  This can make them more inclined to
join a class of other adolescnets in
Management: preparation for childbirth.
 talk to the person who does the
5. Birth Decisions
cooking at home
 Encourage adolescent to abandon  Pelvic measurements should be
food fad taken early and carefully in
 Get the adolescent’s approval to adolescent girlspossibility of CPD
switch to noncaffeinated soft drinks (Cephalo Pelvic Disproportion)
 Encourage “brown bag” or buy a because of the girl’s incomplete
nutritious cafeteria lunch if she is pelvic growth
attending school  Remember that labor does not differ
 Frequently remind adolescents to from labor in the older woman
take their vitamins or iron
supplement 6. Plans for the Baby

 Adolescent girls might still be scared

2. Activity and Rest
on how they will act as new mother
 Adolescents vary in their levels of and find it comfortable if they talk to
activity a good listener about their concerns.
 Assess and know the kind of sports  IF:Complications of Labor, Birth and
they are engaged in The Postpartum Period Occur
 If pregnant, may need to be
discontinued 1.CPD- is present due to lack of
engagement at the beginning of labor,
 To prevent her from being “shut out”,
suggest alternative activities a prolonged first stage of labor and
poor fetal descent
3.Physiologic Changes
 Graphing labor progress- effective
 All adolescent girls need substantial way to detect labor that is
education on the physiologic becoming abnormal or prolonged.
changes that will occur during  Presence of support person is
pregnancy important
 Provide specific instructions and
2. Postpartum Hemorrhage
information about labor and delivery
 Young adolescents are more prone
4.Childbirth Preparation
to postpartum hemorrhage than the
 When adolescent girls become average woman because if a girl’s
pregnant, they may find themselves uterus is not yet fully developed, it

4
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

becomes over distended by their own and child care is not as

pregnancy simple as it seemed.
 An overly distended uterus is more
Management:
likely not to contract as a normally
distended uterus in the postpartum  Spend time with the adolescent
period that leads to bleeding after mother and observe how she
delivery. handles her infant
 Adolescents have more frequent or  Demonstrating on how to care for a
deeper perineal lacerations child-Role modelling on feeding the
because of the size of the infant in newborn, changing the diaper,
relations to their body. bathing an infant, performing cord
 But adolescents have the tendency care and proper handling the infant
to heal early because of the are some of the ways on how to
presence of healthy and supple handle the situation.
tissue
4. Iron-Deficiency Anemia
3. Inability to Adapt Postpartally
 Many adolescent girls are deficient
 Chances may occur for the in iron because their low intake
adolescent girl to “block out” the cannot balance the amount of iron
hours of labor as if they did not lost with menstrual flows.
happen
 Giving birth is such a stress and a Signs and Symptoms:
major crisis that almost all women
 Chronic fatigue
have difficulty integrating it into their
 Pale mucous membranes
life.
 Hemoglobin level- < 11g/dL
Management:  Could be associated with BUI during
pregnancy
 Encourage her to talk about labor  Pregnancy compounds iron-
and birth to make the happening deficiency anemia – since a girl
real to her-to prevent as much as should supply enough iron from fetal
possible post partum depression growth and her increasing blood
volume
4. Lack of knowledge about infant care

 Although they may have some Management:

knowledge or experience in caring  All pregnant women should take iron
for baby once they loof after a and folic acid supplement
neighbor’s child, but still, they can  Folic acid- for RBC growth and
be overwhelmed in the postpartum prevention of neural tube defects
period when realizing the baby is

5
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

 Neural tube defects are birth defects C. The Pregnant Woman Over Age 40
of the brain, spine, or spinal cord. Years
They happen in the first month of
 Advanced maternal age is the label
pregnancy, often before a woman
even knows that she is pregnant. for pregnant women 35 years and
older at delivery.
 The two most common neural tube
defects are spina bifida and  In the past, if the age is over 40 years
old, the woman is considered at high
anencephaly. In spina bifida, the
fetal spinal column doesn't close risk for many complications
 Today, there is little evidence of
completely
serious complications in women
 Help the adolescent girl to prepare a
schedule in taking her iron and folic older than 40 years
1. Developmental Tasks and Pregnancy
acid and other vitamins
 Prepare a diet rich in iron content  To develop Generativity- a sense of
moving away from themselves and
 Iron supplement is not strong unless
there is a strong dietary intake of iron becoming involved with the world or
community
rich foods.
 Effects of the supplement: the  Some people are thinking the way
they are, the way they will be.
client’s body recognizes It has
additional iron, she will begin rapidly Signs of developing this task: joining
forming immature red blood cells. groups, civic organizations, community
out reach activities and the like
Assessment if the girl is taking the
supplement or not:  A feeling of ambivalent during
pregnancy may occur-feeling of she
1. Scheduling of reticulocyte analysis
after 2 weeks-if not elevated, want to continue with community
activity yet want to continue to
secondary problem exists or the girl is
not taking the supplement concentrate with her pregnancy
2. Black tarry stool-the girl is taking the Management: encouraging her to
supplement discuss how this conflict fells can help
her balance her life and manage two
Other Health Teachings:
life phases this way
 Advice the girl to take the
Other important worries:
supplement after meal or with a full
stomach to prevent gastric irritation  Sandwich generations: being
 Advice the girl to eat high fiber diet pressured by responsibilities by both
and increase fluid intake to prevent older and younger family members
constipation  Having enough energy
 Arranging for child care

6
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

 Financial and space strains d. Physical Examination-to establish a

general health and to identify any
2. Prenatal Assessment problems

a. Health History: focus on:  Check for the breasts- for any
abnormalities
 Signs and symptoms of pregnancy
 Check for fundal height
 How the woman feel about the  >check for circulatory disturbances:
pregnancy, how it fits into her
presence of varicosities
lifestyle  urinalysis- specific gravity, glucose
 Ask if medication is taken to relieve
and protein
symptoms
e. Chromosomal Assessment:
b. Family Profile
 Down Syndrome is higher in older
 Ask about the decision is made to
women
get married or pregnant  Genetic screening is offered to
 Source of income
detect if an open spinal cord or
 How many persons are dependent chromosomal defect could be
on her-many people can
present in the fetus
complicate the pregnancy
Procedure:
c. Day History
a. ultrasound-to examine for nuchal
 woman’s type of work or home translucency (seen in chromosomal
responsibilities
abnormalities)
 Distance of home from workplace
 Nuchal translucency is the normal
 Diet fluid-filled subcutaneous space
 Exercise
identified at the back of the fetal
 If belongs to a health club-saunas neck during the late first trimester
and hot tubs must not be longer
and early second trimester (11 weeks
than 10 minutes at a time if 3 days to 13 weeks 6 days)
pregnant-contraindicated during
pregnancy because of possible b. Analysis maternal serum levels of
hyperthemia and teratogenic Alpha Feto Protein (AFP) and free beta
effects of extreme heat human chorionic gonadotropin (hCG)-
 Personal habits-cigarette smoking to evaluate for chromosomal disorders
and alcohol consumption- could be in the fetus
detrimental to
 a fetus  done at 11 to 13 weeks
 between 15 and 20 weeks gestation,
the MSAFP test is repeated to identify

7
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

if the fetus is at risk for open neural b. Prenatal Class-urge her to join a
tube defects childbirth preparation or prenatal
exercises Complications of Labor, Birth
c. Circulating free DNA (cfDNA)-to
and the Postpartum Period
screen fro chromosomal abnormalities
1. Failure to Progress in Labor
 done as early as 10 weeks
 Accurate noninvasive blood test  May be prolonged due to cervical
dilatation does not seem to occur as
d. Chorionic villi sampling (CVS) and
spontaneously as it does in younger
amniocentesis – to diagnose women.
chromosomal genetic disorders
 Graphing labor progress is a good
 considered and diagnostic tests method- to determine when labor is
rather than screening tests becoming prolonged.
 They asses the actual karyotype of  Many women at this age need
the fetus to give a definite answers cesarean birth if labor becomes so
about the presence and absence of overly prolonged
chromosomal disorders 2. Postpartum Hemorrhage
Nursing Consideration:
 uterus may not contract as readily in
 Make sure is prepared for these the postpartum period
studies  may be prone to perineal- anal tears
 Offer support during this time because her perineum is less supple
 Alert her that false-positive results
D. The Pregnant Woman Who is
can occur
Physically or Cognitively Challenged
3. Pregnancy Education:
a. Nutrition  In the past, women with conditions
 assess for the number of meals and such as vision, hearing, cognitive,
she eats outside her home each neurologic or orthopedic challenges
week, including those she packs for where sheltered by their families that
lunch or eats in restaurants. prohibit them from having sexual or
 If she enjoys these, give her tips on marriage partners
how to pack her meals  Today, with varying degrees of
 Substitute a caffeine free soft drinks disability attend public schools, work
in place of an alcoholic beverages in offices, join community
 Milk or juice decaffeinated coffee organizations, establish sexual
for regular coffee relationships and plan pregnancies
 For calcium- puddings or yougurt or just like anyone else.
ask her doctor for calcium
supplement

8
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

1. Rights of the Physically or Cognitively periodically for tightening or the

Challenged Person presence of contractions so she is
aware for beginning of labor
 People should be made feel
 Women with muscle spacsticity or
psychologically welcome as well as spinal cord injury may not be able to
physically able to access the inside
push effectively for the second stage
of the building of labor and so she may need a
 Hospital cannot deny care to a
cesarean birth
person with a disability even though  Birth from a a Sim or dorsal
a disabling condition complicates
recumbent position is usually best as
treatment
this avoid a lithotomy (true for all
 A woman with disability has the full women)
right to her child, so the baby cannot
 Braille watches used by persons who
be taken from her at birth without are visually challenged may not
her full consent
have second hands. This means they
a. Safety measures to explore: may need to time the length of
contractions by counting their length
 Assess if the woman has an rather than timing them by a watch.
emergency contact persons,  During labor, the woman who is
suppliers of transportation and hearing challenged cannot hear
individual considerations such as information on how she is progressing
mobility, elimination an dpossible if you are not directly facing her. If
autonomic responses she needs to communicate with her
 Be certain the woman reviews any support person in sign language, act
medicine she is taking for her primary as an advocate to keep her hands
condition with her pregnancy care free by equipment such as
provider to be certain this will intravenous line. Hand the infant to
continue to be safe during her as soon as possible after birth so
pregnancy. she can see and feel the baby is
crying and breathing well.
b. Pregnancy Education
 Be certain to identify the usual
 If couple are both visually sounds of birthing rooms for the
challenged for example, refer them visually challenged woman as
local branch of the national hearing sounds and not being able
nonprofit organization to identify them can be frightening.

c. Modifications for Labor and Birth d. Modifications for Post Partum Care

 A woman with spinal cord injury Assess if woman needs:

need to palpate her abdomen

9
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

 Additional support to be successful intense high when inhaled-can lead

at breastfeeding to immediate death due to cardiac
 A return appointment for both herself failure
and her infant for follow up care
 Or desires contraceptive information Effects on Pregnancy:
and what would be best for her  Harmful because the extreme
individual circumstances vasoconstriction can severely
compromise placental circulation –
E. A Woman Who is Substance
Dependent premature separation of the
placenta-preterm labor or fetal
 Substance abuse is defined as the death
inability to meet major role  Can be detected through urinalysis
obligations, an increase in legal up to 1 week after use.
problems or risk-taking behavior, or
exposure to hazardous situations Management:
because of an addicting substance  counsel women to discontinue using
 A substance dependent- when he or it during pregnancy but usually
she has withdrawal symptoms disappointing because the effects
following discontinuation of the are so intense
substance, combined with
abandonment of important 2.Amphetamines
activities, spending increased time in
 Methamphetamine (i.e. speed) is a
activities related to the substance
neurostimulant and neurotoxin that
use, using substances for a longer
has a pharmacologic effect similar
time than planned or continued use
to cocaine
despite worsening problems
 It is easily and cheaply
because of substance abuse.
manufactured in home labs
1.Cocaine  Ice, a rock type methamphetamine
that is smoked can produce high
 Derived from Erythroxylum coca, a concentrations of the substance in
plant grown almost exclusively in the maternal circulation
South America  Women develop blackened and
 When sniffed into the nose or smoke infected teeth
in pipe, it is absorbed across the  Newborns show jitteriness and poor
mucous membranes and affects the feedingat birth and maybe with
CNS-vasoconstriction-increased V/S growth restriction
rapidly
 Alkaloidal cocaine- a concentrated
mixture produces a more rapid and

10
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2

3.Marijuana and Hashish  Include model airplane glue,

cooking sprays and computer
 They are obtained from the hemp keyboard cleaner
plant, cannabis
 May seem innocent but they contain
 When smoked, they produce freon as a propellant – severe
tachycardia and a sense of well
respiratory and cardiac irregularities
being
 Effect on the fetus is not fully Effects on Pregnancy:
documented because they are
frequently part of polysubstance  Not well documented but they have
similar effects to alcohol
abuse or at the very least cigarette
dependency
use
 Respiratory depression can cause
4. Phencyclidine decreased fetal oxygen supply to a
serious level.
 Developed in the 1950’s as an
intravenous anesthetics
 It is no longer used that way
because although it creates a
feeling euphoria, it also causes
irritation and possibly long term
hallucinations
 It could injure the fetus because the
substance tends to leave the
maternal circulation and
concentrate in fetal cells

4.Narcoric Agonists

 Opiates – used for the relief of pain

such as morphine, oxycodone,
merperidine (Demerol) and codeine
are widely abused substances
because they can be obtained by
prescription and they have dramatic
euphoric effect

5. Inhalants

 Inhalants abuse refers to as “sniffing”

or “huffing” of aerosol substances
 Usually abused by adolescents

11