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Ethel May AlabastroThis document provides information on maternal and child health indicators and genetic counseling. It discusses key global health issues such as the high rates of maternal and infant mortality in developing countries. Specific indicators are defined, such as the maternal mortality rate, infant mortality rate, and fetal death rate. Causes of mortality are outlined for mothers and infants. The purposes and process of genetic assessment and counseling are summarized to provide information to families on inherited disorders and reproductive choices.
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NCM 109 - Prelim Transes
NCM 109 - Prelim Transes
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Ethel May Alabastro0 ratings0% found this document useful (0 votes)
20 views12 pagesThis document provides information on maternal and child health indicators and genetic counseling. It discusses key global health issues such as the high rates of maternal and infant mortality in developing countries. Specific indicators are defined, such as the maternal mortality rate, infant mortality rate, and fetal death rate. Causes of mortality are outlined for mothers and infants. The purposes and process of genetic assessment and counseling are summarized to provide information to families on inherited disorders and reproductive choices.
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Framework of MCN with Abnormalities & Pre-Gestational Conditions
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NCM 109 _ Prelim Transes
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This document provides information on maternal and child health indicators and genetic counseling. It discusses key global health issues such as the high rates of maternal and infant mortality in developing countries. Specific indicators are defined, such as the maternal mortality rate, infant mortality rate, and fetal death rate. Causes of mortality are outlined for mothers and infants. The purposes and process of genetic assessment and counseling are summarized to provide information to families on inherited disorders and reproductive choices.
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0 ratings0% found this document useful (0 votes)
20 views12 pagesNCM 109 - Prelim Transes
NCM 109 - Prelim Transes
Uploaded by
Ethel May AlabastroThis document provides information on maternal and child health indicators and genetic counseling. It discusses key global health issues such as the high rates of maternal and infant mortality in developing countries. Specific indicators are defined, such as the maternal mortality rate, infant mortality rate, and fetal death rate. Causes of mortality are outlined for mothers and infants. The purposes and process of genetic assessment and counseling are summarized to provide information to families on inherited disorders and reproductive choices.
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You are on page 1of 12
Unit 1 - I tisagoodindexofthegeneralhealthcondition
FRAMEWORK FOR MATERNAL AND of a community as it reflects the ages of the
CHILD HEALTH NURSING environment and the medical condition of the
community.
● G lobal Health Situation in November 2016 - As of Feb. 2008, IMR = 13.2 / 1000 LB
by WHO
- Every day approximately 830 women IMR = Total # of deaths under 1 year registered
die from preventablecausesrelatedto in a year
pregnancy and childhood. —---------------------------------------------------- x 1000
- 99% of all maternal deaths occur in Total # of live births registered of the
developing countries. same year
- Maternalmortalityishigherinwomen
living in rural community areas and ➢ Causes of Infant Mortality Rate
also among poorer communities. ● Bacterial sepsis of the newborn
- Youngadolescentsfaceahigherriskof ● Respiratory distress of newborn
complications asaresultofpregnancy ● Pneumonia
than other women. ● Disorders related to short gestation
- Skilled care before, during, and after and low birth weight
childbirthcansavethelivesofwomen ● Congenital pneumonia
and newborn babies. ● Congenital malformation
- Between 1990 and 2015, thematernal ● Neonatal aspiration syndrome
mortality worldwide actuallydropped ● Intrauterinehypoxiaandbirthasphyxia
about 44%. Diarrhea and gastroenteritis of
- Between 2016 and 2023aspartofthe presumed infectious origin
sustainable development goals the
target was to reduce the global FETAL DEATH RATE
maternalmortalityratiotolessthan70 - Measures pregnancy wastage
per 100,000 live births, compared to - Death of the product of conception occurs prior
12 per 100,000 live births in to its complete expulsion irrespective of the
developed countries. duration of pregnancy.
- There are large disparities in - As of Feb. 2008, FDR = 5.2/1000 LB
developing countries and between
women in low-income and those
IMR = Total # of fetal deaths registered in a
women living in rural vs urban areas.
given calendar year
—---------------------------------------------------- x 1000
MATERNAL MORTALITY RATE Total # of live births registered in the
- Measures the risk of dying from causes related same year
to pregnancy, childbirth, and puerperium.
- It is an index of the obstetrical care needed and
received by women in a community.
- As of Feb. 2008, MMR = 1.1/1000 LB GENETIC AND GENETIC COUNSELING
MMR = Total # of deaths from maternal causes GENETICS
registered for a given year - Is the study of the way such disorders occur.
—---------------------------------------------------- x 1000
Total # of live births registered of the GENETIC ASSESSMENT
same year - Detailed family history (3rd Gen)
- Physical exam of both the parents & any
➢ Causes of Mortality affected children
● Hemorrhage - Seriesoflabassaysoftheblood,amnioticfluid,
● Sepsis and the maternal and fetal cells.
● Obstructed labor (labor dystocia)
which could be due to GENETIC DISORDER
malpresentation, malposition of the - Inherited or genetic disorders can be passed
fetus (ex. Shoulder presentation) or from one generation to the next because they
(lack twins or pelvic tremors) result from some change or mutation in the
● Hypertensive gene or some chromosome structure.
● Complications of unsafe abortion - A result of some changes in chromosome
structure.
INFANT MORTALITY RATE
- Measuringtheriskofdyingduringthefirstyear GENETIC COUNSELING
of life. - It is essential that information revealed in
genetic screening be kept confidential (such
informationcouldbeusedtodamageaperson’s
reputation or harm a future career or - S eizures disorders
r elationship). - Family history of the severe inherited disorder
or genetic disorder
Purposes: - Surgery during pregnancy
● Provide concrete, accurate information about - Emotional disorders or cognitive challenge
the process of inheritance & inherited - Endocrine disorders
disorders. - Previous surgeries involving the reproductive
● Reassure their child may inherit a particular organs
disorder that the disorder will not occur. - Hemoglobinopathies
● Allow people who are affected by inherited - Sexually transmitted disease (STI)
disorders to make informed choices about - Reproductive tract anomalies (history of
future reproduction. abnormal pap smear and malignancy)
● Allow people topursuepotentialinterventions
that may exist, such as fetal surgery. CURRENT OBSTETRIC STATUS
● Allow families to beginpreparationforachild - Inadequate prenatal care
with special needs. - Intrauterine growth restricted fetus
- Large gestational age fetus
- Overweight/underweight
ASSESSMENT THAT MIGHT CATEGORIZE A
PREGNANCY AS AT RISK - Fetal or placental malformation
- RH sensitization
- Preterm labor
➢ H
IGH-RISK PREGNANCY
- Multiple gestation
- Concurrent disorder pregnancy-related
- Postdate pregnancy
complicationsorexternalfactorsjeopardizethe
- Premature rupture of membrane
health of women, fetuses, or both.
- Fibroid tumor
- Some women enter pregnancy with chronic
- Cervical cerclage (cervix cannot hold its
illnesses that when superimposed on the
dilation before term)
pregnancy makes it high risk.
- Sexually transmitted infection
- Whileotherwomenenterpregnancywithgood
- Poor immunization status
health but then develop a complication of
pregnancy that becomes high risk.
PSYCHOSOCIAL FACTOR
- In some instances a combination of particular
- Inadequate finances
circumstances like poverty, lack of support
- Lack of support system
people, poor coping mechanisms or genetic
- Exposure to environmental teratogens (like
inheritance or past history of pregnancy
pollution)
complications can cause a pregnancy to be
- Poor nutrition more than 2 children at home; no
categorized as high risk.
help
- Lack of acceptance of pregnancy
OBSTETRICAL HISTORY
- Attempt to suicide
- History of Fertility
- Inadequate or poor housing
- Premature cervical dilatation
- Father of the baby uninvolved
- Uterine /cervical anomaly
- Minority status
- Preterm labor/birth/cesarean birth
- Dangerous occupation
- Two or more spontaneous/elective abortions
- Dysfunctional grieving
- Previous macrosomic infant
- Psychiatric history
- Previous hydatidiform/choriocarcinoma
- Previous ectopic pregnancy/stillborn/neonatal
DEMOGRAPHIC FACTORS
death
- Maternal age under 16 or over 35
- Last pregnancy less than one year
- Education; under 11 years
- Previous infant with neurologic deficit
- Breast injury
LIFESTYLE
- Congenital anomaly
- Cigarette smoking more than 10 sticks per day
- Previous Multiple pregnancy
- Substance/ Drug abuse
● Multiple gestation
- Long amount of time spent commuting
● Prolonged labor
- Non-use of seatbelt
● Low birth weight
- Alcohol intake
● Mid Forcep Delivery
- Heavy lifting or long period of standing
- Unusual stress
MEDICAL HISTORY
- No in-home smoke detector
- Cardiac or pulmonary disease
- Chronic hypertension
Vulnerable Groups are Pregnant women with;
- Metabolic diseases
- Malnutrition
- Renal disease, recent UTI or bacteriuria
- Too young/too old/frequently pregnant
- Gastrointestinal disorder
- Physical deformity
- ental illness/mental retardation
M
- Poverty/unemployment/lack of education
IAGNOSTIC TEST IN HIGH-RISK PREGNANCY /
D
- Exposure to teratogens due to infection PRENATAL DETERMINATION OF FETAL STATUS
- Abuse / domestic violence/ rape/ incense
- Single parent
What is Screening?
- A process of identifying apparently healthy
PHYSICAL SIGNS & SYMPTOMS OF ADEQUATE AND people who may be at increased risk of a
POOR NUTRITION disease or condition.
What is a Diagnostic Test?
- Atesttoestablishthepresence(orabsence)of
AREA GOOD POOR NUTRITION
NUTRITION disease as a basis for treatment decisions in
symptomatic or creen-positive individuals.
1. Hair - shiny, strong w/ - dull & lifeless
good body (possible protein
deficit) DIAGNOSTIC TEST FOR HIGH-RISK PREGNANCY
2. Eyes - good eyesight, - pale & dry A. NON-INVASIVE
particularly at conjunctiva (Iron &
night, conjunctiva fluid deficit)
moist & pink - difficulty w/ night . Ultrasonography/ Fetal Ultrasound / Ultrasonic
1
vision (Vit A deficit) Testing
- A non-invasive diagnosis procedure utilizing
high-frequencysoundwavestodetectintrabody
3. Mouth - no cavities in - fissures at the structures.
teeth; corner of the mouth
- no gingivitis; (vit. A deficit)
- no cracks or - pale mucous- Purposes:
fissures in corners membranes (Iron a. In early pregnancy: to confirm pregnancy
of mouth deficit) b. To detect the fetus’s:
- Viability, growth
- Number (multiple pregnancy)
4. Neck - normal contour - thyroid enlarge - Position, presentation
of Thyroid Gland (iodine deficiency)
- Abnormalities (structural)
- smooth w/ - rough texture, poor
normal color & turgor (fluid deficit) - FHT
turgor - Age of gestation: most accurate at
- no 12-24 weeks; biparietal diameter of
ecchymotic(bluish 9.5 cm = mature fetus
) or petechial (red c. Detects placental location (placenta previa) or
dot spots) rashes placental abnormality (H-mole)
present
d. An important aid in high-risk procedures like
amniocentesis
5. Extremities - normal muscle - poor muscle tone;
mass & diminished reflexes Preparation:
circumference; (protein deficit). - Advise mother: Drink one quart of water 2
normal strength & hours before the procedure
mobility; edema
- Instruct not to void: In amniocentesis with
limited tp slight
ankle ultrasound to offer visualization = mother
involvement; should void to prevent injuring the distended
normal reflexes bladder with needle insertion.
- Transmission gel is spread over the maternal
. Finger and
6 - smooth, pink, - pale, breaks easily, abdomen.
Toe Nails normal little growth
- Psychological support is given to the
(protein deficit)
mother/father (couple):
7. Weight - within normal - over or ● Explain the reasons fortheprocedure,
limits of ideal underweight; benefits, and the preparation.
weight before unusually slow or ● Explain that there is no known risk
pregnancy weight rapid weight gain with infrequent and brief exposure to
gain. (inadequate or high frequency sound waves.
excessive
● Encourage verbalization of fears and
carbohydrates).
concerns. Explain further that:
. Blood
8 - within normal - decreased from ➔ Procedureisnon-invasiveand
Pressure limits for length of anemia (iron deficit) safe for mother and fetus.
pregnancy - increased from
➔ Confinement is not needed.
hypertension
➔ N o need for dye and there is Interpretation:
no X-ray irradiation. a. Normal: Reactive
➔ Procedure takes a short time - Increased FHT (acceleration) greater
(about 30 minutes) to than15bpmabovebaselinelasting15
accomplish. seconds or more ina10to20-minute
➔ period with fetal movement.
2. Cardiotocography b. Abnormal: Non-reactive
- Is atechnicalmeansofrecording(-graphy)the - No FHR acceleration with fetal
fetal heartbeat (cardio-) and the uterine movement
contractions (-toco-) during pregnancy,
typically in the 3rd trimester. Implications of Result:
- Themachineusedtoperformthemonitoringis - Abnormal results: mother needs another test,
called a cardiotocograph, more commonly maybebiophysical profile
known as an electronic fetal monitor (EFM).
. Oxytocin Challenge Test (OCT) or Contraction
4
Interpretation: Stress Test(CST)
- Interpretation of a CTG tracing requires both Purposes:
qualitative and quantitative description of: a. Observation of the response of the fetus to
● Uterine activity(contractions) induced uterine contractions.
● Baseline fetal heart rate (FHR) b. A test of feto-placental well-being.
● Baseline FHR variability
Preparation:
Test result is either ‘reactive’ or ‘non-reactive’: a. Semi-fowler's or left lateral position
- Areactivetestresultindicatesthatyourbaby’s b. BP ischeckedpriorlyandq15minutesduring
heart rate increasesbytheexpectedmovement the test
amount after each of his movements. c. Explain:
- Ifyourbaby’sheartratedoesnotincreaseafter - Procedure takes 1 to 3 hours to finish
his movements, the test will be non-reactive. - Motherreceivesoxytocinofincreasing
- A non-reactive result does not necessarily dosage "piggybacked" to the mainline
indicate a problem. and aims to cause 3 reactions in 10
- Your baby might just have been fast asleep minutes.
while the test was being done. - May be done on an outpatient basis
- Your doctor might try the test again after d. Requires external electronic FHT monitoring
making you move around or using a fetal with ultrasound transducer and
acoustic stimulator to wake your baby up. tocodynamometer to detect uterine activity.
- Ifyourresultisstill‘non-reactive’,yourdoctor
might ask you to come back for another test Interpretation:
after an hour. a. Normal: Negative
- NolatedecelerationsofFHRwitheach
3. Non-Stress Test (NST) of 3 contractions during a 10-minute
- An observation of FHT related to fetal interval
movement. b. Abnormal: Positive
- A test of fetal well-being. - With late decelerations of FHRwith3
- Usually done after week 26 of pregnancy. contractions in 10 minutes
Preparation: Implication of Results:
a. Position: semi-fowler’s or left lateral position a. Normal:
slightly turned to the left - Pregnancy continues;
b. Bp is checked first - normal result of OCT may require
c. Explain: weekly tests
- Procedure takes 30 to 60 minutes to b. Abnormal result:
finish - may indicate a need to terminate
- Mother needs to activate the “mark pregnancy
button” with each fetal movement.
- Does not need B. INVASIVE DIAGNOSTIC TEST
hospitalization-ambulatory basis
- Requires external electronic 1. Chorionic Villus Sample
monitoring of FHT with ultrasound - Chorionic villi are small structures in the
transducer and tocodynamometer to placenta that act like blood vessels.
trace the fetal activity and or uterine - These structures contain cells from the
activity. developing fetus.
- A test that removes a sample of these cells
through a needle is called chorionic villus
sampling (CVS).
- he sample can be taken through the cervix
T ● O
ther genetic abnormalities, like
(transcervical) or the abdominal wall trisomy 18
(transabdominal). Preparation:
- CVSisaformofprenataldiagnosistodetermine - Bladdershouldbeemptyduringamniocentesis
chromosomal or genetic disorders in the fetus. to minimize the chance of puncture sign a
- It entails sampling of the chorionic villus consent form before the procedure begins.
(placental tissue) and testing it for - Consideraskingsomeonetoaccompanyyouto
chromosomalabnormalities,usuallywithFISH the appointment for emotional support.
or PCR. - You would have to be anesthetized.
- CVS usually takes place at 10-12 weeks' - The needle will start from theabdominalwall
gestation earlier than amniocentesis or and move to the uterusafteralocalanesthetic
percutaneous umbilical cord blood sampling. is administered.
- It is the preferred technique before 15 weeks. - The specific amount of amniotic fluid
withdrawndependsonthenumberofweeksthe
Preparation: pregnancy has progressed.
- You might need to have a full bladder for
chorionic villus sampling, so drink plenty of After the procedure:
fluids before yourappointment.signaconsent - After the amniocentesis, your health care
form before the procedure begins. provider will continue using theultrasoundto
- Consideraskingsomeonetoaccompanyyouto monitor your baby's heart rate.
the appointment for emotional support or to - You might experience cramping or mildpelvic
drive you home afterward. discomfort after an amniocentesis.
- Youcanresumeyournormalactivitylevelafter
2. Amniocentesis the procedure. However, you might consider
- Atestthatcanbedoneduringpregnancytolook avoidingstrenuousexerciseandsexualactivity
for birth defects and genetic problems in the for a day or two.
developing baby.
- Removes a small amountoffluidfromthesac Contact your healthcare provider if you have:
around the baby in the womb (uterus). - Loss of vaginal fluid or vaginal bleeding
- It is most often done in a doctor's office or - Severe uterine cramping that lastsmorethana
medical center. few hours
● You do not need to stay in the hospital. - Fever
- Done in the second trimester of pregnancy - Redness and inflammation where the needle
- Is most often offered to women who are at was inserted.
increased risk for bearing a child with birth - Unusual fetal activity or a lack of fetal
defects. movement.
- This includes women who:
● Will be 35 or older when they give 3. Embryoscopy
birth - Examination of the embryo at 9-10 weeks'
● Had a screeningtestresultthatshows gestation through the intact membranes.
there may be a birth defect or other - Done by introducing an endoscope into the
problem exocoelomic space transcervically or
● Have had babies with birth defects in transabdominally.
other pregnancies . - This is likely to remain confined to the
● Have a family history of genetic management of early pregnancy in selected
disorders families affected by recurrent genetic
- You may choose genetic counseling before the syndromes with recognizable external fetal
procedure. abnormalities.
- This will allow you to: - The procedure-related risk of fetal loss is
● Learn about other prenatal tests around 12 percent
● Make an informed decision regarding
options for prenatal diagnosis 4. Fetoscopy
- Is a diagnostic test, not a screening test - Examination of the fetus after 11 weeks'
- Is 99% accurate for diagnosing Down gestation.
syndrome - Performed transabdominally in the amniotic
- Is usually done between 14 and 20 weeks fluid.
- Amniocentesis can be used to diagnose many - The technique has evolved with the
differentgeneandchromosomeproblemsinthe miniaturization of the optical device by using
baby, including: fiber-optics technology.
● Anencephaly - This procedure is likely to find new
● Down syndrome applications with the development of
● Rare, metabolic disorders that are ultrasound examination at 10-14 weeks'
passed down through families gestationinorderto,eitherconfirmorruleout
suspected external fetal abnormalities.
5. Percutaneous Umbilical Cord Blood Sampling
MEDICAL CONDITIONS AFFECTING
- Cordocentesis, also sometimes called
PREGNANCY OUTCOMES
Percutaneous Umbilical Cord Blood Sampling
(PUBS),isadiagnostictestthatexaminesblood
from the fetus to detect fetal abnormalities. Cardiovascular disorders are diseases affecting the heart:
- An advanced imaging ultrasound determines - It involves some type of impaired cardiac
the location where the umbilical cord inserts function in all pregnancies.
into the placenta. - Complicates approximately only 1% of all
- Theultrasoundguidesathinneedlethroughthe pregnancy responsible for the 5% of maternal
abdomen and uterine walls to the umbilical deaths during pregnancy
cord.
- Theneedleisinsertedintotheumbilicalcordto ardiovascular disorders commonly cause difficulty
C
retrieve a small sample of fetal blood. duringpregnancy;VALVULARDAMAGE—characterized
- The sample is sent to the laboratory for bydamagetooradefectinoneofthefourheartvalves:
analysis, and results are usually available the mitral, aortic, tricuspid, or pulmonary.
within 72 hours.
- The procedure is similar to amniocentesis Review:
except the objective is to retrieve blood from a. Mitral and tricuspid valves controltheflowof
the fetus versus amniotic fluid. blood betweentheatriaandtheventricles(the
upper and lower chambers of the heart).
6. Cordocentesis b. Pulmonaryvalvecontrolstheflowoftheblood
- Is usually done when diagnostic information from the heart to lungs.
can not be obtained through amníocentesis, c. Aortic valve governs blood flow between the
CVS, ultrasound or the results of these tests heart and the aorta, and thereby the blood
were inconclusive. vessels to the rest of the body.
- Cordocentesisisperformedafter17weeksinto d. Mitral and aortic valves are the ones most
pregnancy. frequently affected by valvular heart disease.
- Cordocentesis detects chromosome
abnormalities(i.e.Downsyndrome)andblood RHEUMATIC HEART DISEASE
disorders (i.e. fetal hemolytic disease.).
ordocentesis may be performed to help diagnose
C - I s a complication of rheumatic fever in which
any of the following concerns: the heart valves have been permanently
1. Malformations of the fetus damaged.
2. Fetal infection (i.e. toxoplasmosis or rubella) - RHDmaynotexhibitnoticeablesymptoms,itis
3. Fetal platelet count in the mother often undiagnosed until reaching a certain
4. Fetal anemia period of time that aggravated the
5. Isoimmunisation manifestations such as pregnancy
7. Biophysical Profile (BFP) heumaticFeverisaninflammatorydiseasethatmay
R
- A scoring combining ultrasound assessment of: develop after an infection with group A Streptococcus
a. Fetal breathing bacteria (such asstrep throatorscarlet fever).
b. Fetal movement - The disease can affect the heart and the skin
c. Fetal tone
d. Reactivity of the heart rate Complications of RHS during pregnancy:
e. Amniotic fluid volume BPP could be 1. During pregnancythereisanincreaseinblood
used to predict fetal well-being in a pressure, therefore increases pressure on the
high-risk pregnancy. heart valveswhichleadstoincreasedmaternal
- Scores and fetal risks
● 8-10: Normal, low risk for chronic 2. Death of mother and the baby
asphyxia 3. Increasedriskofpretermdelivery(itmayaffect
● 4-6: Suspected chronic asphyxia baby and mother’s health)
● 0-2: Strong suspicion of chronic 4. In some cases, a serious complication is
asphyxia associated with a greater risk of heart failure
before, during, and after the delivery
TABULAR INTERPRETATION
iagnostic Tests
D
1. Electrocardiogram (ECG)
Biophysical Variable - Reveals cardiac changes in the mother
Normal (Score= 2) 2. Echocardiography
- Atestthatusedsoundwavestocreateamoving
Abnormal (Score= 0) picture of the heart
- I t provides information about the disease 7. A ssess maternal vital signs and
etiology, severity, and powerful means of cardiopulmonary status closely for changes
monitoring progression 8. Monitor fetal heart rate for changes.
3. Chest Radiography (Chest X-ray) 9. Reinforce the need for more frequent prenatal
- Reveals cardiomegaly (enlarged heart and visits, and assist with arranging follow-up
hepatomegaly (enlarged liver) visits
4. Ultrasound 10. Reinforce the use of prescribed medications
- Shows fetal growth restriction 11. Alert the pt to danger signs & symptoms that
should be reported immediately
“ Late deceleration on fetal monitor are possible if the
mother’s cardiac decompression cause placental
DIABETES MELLITUS
incompetency”
reatment for Rheumatic Heart Disease
T - I sagroupofmetabolicdisorderscharacterized
It depends on the severity but may include: by elevated levels of blood glucose
- Hospital admission to treat heart failure (hyperglycemia) resulting from defects in
- Antibiotics (penicillin) for infection of the the insulin production and secretion, decreased
heart valves cellular response to insulin or both.
- Blood -thinning medicines to prevent stroke
- Heart valve surgery to replace damaged heart ypes of Diabetes Mellitus
T
valves 1. TYPE 1 (formerlyInsulin Dependent Diabetes
Mellitus)
reatment for Rheumatic Heart Disease in
T - Accounts 5 to 10 percent of diabetic patient
Pregnancy - Beta cells of the pancreas that normally
- Close medical supervision with morefrequent produce insulin are destroyed by an
prenatal visit and adjustments in pregnancy autoimmune process
drug therapy - Insulin injections are needed to control the
- Rest blood pressure glucose level
- Limitedsodiumandincreasedproteinandiron - Hasasuddenonsetusuallybeforetheageof30
intake years
- Prophylactic antibiotics as indicated
- Series of ultrasounds, non-stress test, and . TYPE 2 (formerlyNon-Insulin Dependent
2
biophysical profile to evaluate fetal status Diabetes Mellitus)
- Prophylacticantibioticduringlaborforwomen - About 90% of diabetics have type 2 diabetes
with mitral valve prolapse to protect the valve - Occurs most frequently in patients older than
30 years of age and obese
ey patient outcomes
K - Results from a decreasedsensitivitytoinsulin
The patient will: (insulin resistance) or from a decreased
1. Maintainadequatecardiacoutputandplacental amount of insulin production.
perfusion - Canbefirsttreatedwithdietandexercise,then
2. Maintain hemodynamic stability oral hypoglycemic agents as needed.
3. Perform activities of daily living within the
limitation of disease . Gestational Diabetes Mellitus
3
4. Maintain adequate fluid balance Is characterized by any degree of glucose intolerance
5. Maintain adequate ventilation with onset during pregnancy (2nd or3rdtrimester),in
6. Give birth to a viable neonate clients not previously diagnosed as diabetic.
- Occurs when the pancreas cannot respond to
Nursing Interventions the demand for more insulin
1. Assess maternal vital signs and - Pregnant women should be screened for
cardiopulmonary status closely for changes glucose levels at the 26th week of gestation
2. Monitor fetal heart rate for changes - A 3 hour glucose tolerance test will be
3. Assess maternal vital signs and performed to confirm diabetes mellitus
cardiopulmonary status closely for changes - Oralhypoglycemicagentsareneverusedduring
4. Monitor fetal heart rate for changes pregnancy
5. Reinforce the need for more frequent prenatal - Frequently can be treated by diet alone,
visits and assist with arranging follow-up visits however, insulin maybe needed for some
6. Assess maternal vital signs and clients
cardiopulmonary status closely for changes: - Most gestational diabetes convert to normal
● Monitor fetal heart rate for changes after delivery, however, these individuals have
● Reinforce the need for more frequent an increased risk of developing diabetes
prenatal visits, and assist with mellitus in their lifetime
arranging follow-up visits
● Reinforce the use of prescribed Predisposing Factors
medications 1. Women 35 years of age or older
. Y
2 ounger than 25 years of age - I s use to detect the degree of
3. Obese hyperglycemia present or the amount
4. With a family with diabetes in 1st degree of glucose attached to hemoglobin
- This is advantageous because it
relatives
reflectstheaveragebloodglucoselevel
5. Hx of unexplained fetal or perinatal loss. over the past 4 to 6 weeks ( thetime
6. Hx of polycystic ovary syndrome the RBC were picking up the glucose)
7. Hx of congenital anomalies in previous not just the level on the day of resting
pregnancy - Normal level of HbA is 3.9 % - 6.9%
8. Increases the risk for hypertensivedisorderin of the total hemoglobin.
pregnancy
4. Ophthalmic Examination
- should be done once per trimester
Assessment findings or Clinical Manifestations
5. Urine Culture
● olyuria
P - Shouldbedoneeachtrimestertodetect
● Polydipsia asymptomatic UTI (Urinary Tract
● Polyphagia Infection)
● Fatigue and weakness
● Sudden vision changes Implementation
● Tingling or numbness in the hands or feet 1. Screenclientsbetweenthe24thand28thweeks
● Dry skin of pregnancy
2. Prenatal visits bimonthly for months and
● Dizziness (if hypoglycemic)
weekly thereafter
● Confusion (if hyperglycemic) 3. The goal of therapy is to maintain the blood
● Congenital anomalies glucose in a narrow low range of 65-130 mg/dl
● Macrosomia or large babies (more than 10 lbs) 4. Monitorforsignsofhypoglycemia,episodesof
● Increase risk of PIH mild or moderate hypoglycemiacanbetreated
● Poorfetalhearttoneandrate(frompoortissue with oral intake of 10 - 15 g of simple
carbohydrates
perfusion)
5. Observe for signs of hyperglycemia
● Glycosuria 6. Assess insulin needs
● Ketonuria 7. Monitor and maintain blood glucose levels
● Hydramnios according to gestational week
● Possibilityofincreasedinfection(monilialand 8. Monitor for glycosuria and ketonuria
Yeast infections) 9. Monitor weight
● Fetal death 10. Insulin administration if diet cannot control
blood glucose levels
11. Assess for signs of preeclampsia which
Diabetes Mellitus in Pregnancy
includes HPN, proteinuria and edema
- DM is more difficult to control during
12. Check for increase temperature and Signs of
pregnancy
infections
- Premature delivery is more frequent
13. Instructtheclienttoreportburningandpainon
- The newborn infant of a diabetic mother is
urination or vaginal discharges or itching
subject to hypoglycemia, hyperbilirubinemia,
14. Assess fetal status and monitor signs of
respiratory distress syndrome, and congenital
premature labor
anomalies
15. Assess for signs of polyhydramnios
16. Increase caloric intake to2200-2500dailyor
Diagnostic Tests
asprescribed,withadequateinsulintherapyso
1. FastingBloodSugar(FBS)orFastingplasma
that glucose will move into the cells
glucose/non-fasting plasma glucose (RBS)
17. Caloriesinadietshouldconsistof50%to60%
- Afastingplasmaglucoseof136mg/dl
carbohydrates, 12% to 20% protein, 20% to
or more or a non fasting plasma
30% fat
glucose of 200 mg/dl or more meets
the threshold for the diagnosis of
DIABETES. SUBSTANCE ABUSE / DRUG ABUSE CLIENT
- Normal blood glucose level is80-120
mg/dl
- ecurrently uses substances or drugs
R
2. Oral glucose Challenge Test (50-g) - Client experiences recurrently, significant
- After 60 mins or 1hr, ingestion of the harmful consequences related to the use of
50-g glucose load, a venous blood substances
- A sample is taken for glucose
determination
- Iftheresultis140mg/alormore,the Substance Dependence
woman is scheduled for a 100-g 3-hour - Pattern of repeated use of substance which
Fasting Glucose Tolerance Test. usually results in tolerance, withdrawal, and
- If 2 out of the 4 blood samples are compulsive drug-taking behavior
abnormal orthefastingbloodvalueis - Client takes substances in larger amount and
above 95 mg/dl then, a diagnosis of
over longer periods of time were intended
DIABETES is made.
- Client has the desire to cut down but
3. Glycosylated Hemoglobin Measurement unsuccessfuleffortstodecreaseordiscontinue
to use
- Daily activities revolve around the use of a 3. O
pioids (which includes codeine — cough
s ubstance syrup, heroin — china white, meperidine
hydrochloride — demerol; for treatment of
Substance Tolerance pain, methadone, morphine sulfate, opium)
- Theneedforincreaseamountofasubstanceto - Causes mental and physical
achieve the desired effect deterioration
- High risk for infections with HIV
Precipitating Factors - Hepatitis virus if taken intravenously
- Rebellion and peer group pressure in - Cause decrease response to pain,
adolescence respiratorydepression,constrictionof
- Pleasure seeking experience, as the substance pupils, euphoria, apathy, impaired
decreases physical and emotional pain judgment
- Group influence and peer pressure - In pregnancy: may induce PIH, if
- Depression injected w/ share needles, may cause
- Loss or grieving phlebitis, HIV and Hepa B infections,
subacute bacterial endocarditis
igns/Marks of substance abuse in Pregnant
S - Infants tend to be SGA (small
woman gestational age) and with increased
- May come late in prenatal check up incidence of fetal distress and
- Difficulty in following instructions for proper meconium aspiration
nutrition, iron, and vitamin supplements - Fetal liver forcedtomaturemorethan
- Cannot wait for long in a healthcare facility normal — no problem with
hyperbilirubinemia
Drug/Substance Commonly Abused - Fetal lung tissue appears to mature
1. Hallucinogens (such as lysergic acid more rapidly than normal
diethylamide, mescaline, peyote,phencyclidine, - Bornprematurely—lesslikelytohave
psilocybin — derived from mushrooms) RDS
- Causes psychosis with distorted
perception, heightened sense of 4. C
entral Nervous System Stimulants (which
awareness,grandiosity,hallucinations, includes methamphetamine — “shabu”,
mystical experience, and distortion of benzedrine inhalers, caffeine, cocaine —
time and place “crack”, diet pills)
- May harm self when under the - Stimulants lead to alertness and extra
influence energy
- No withdrawal symptoms when - Effectsincludeeuphoria,hyperactivity,
discontinued , but flashbacks may insomnia, anorexia and weight loss,
occur for several months after use tachycardia and hypertension,
stops psychotic behavior
- Bad trips may result in panic and - Psychological dependence and
unpredictable psychotic behavior. tolerance may occur
- Inpregnancy,particularlyinjuriousto - Suddendeathhasbeenassociatedwith
the fetus - from the maternal cocaine use
circulation it concentrates in the fetal - In pregnancy: Cocaine use causes
cells vasoconstriction w/c severely
compromised placental circulation
2. C annabis (which includes marijuana, “pot” leading to abruptio placenta, preterm
hashish) labor, and fetal death
- Causes altered state of awareness - Amphetamine use causes high
relaxation and mild euphoria concentration in maternal circulation,
- Decrease inhibitions showsjitterinessinNB,poorfeedingat
- Decrease motivation from prolonged birth and growth restrictions
use can cause possible psychosis
- Physiological effects include slowed 5. I nhalants(whichincludesaerosolslikeairplane
reflexes glue, cooking sprays, computer keyboard
- Causes drying of mucous membrane cleaner)
and reddening of the eyes. - Causes severe respiratory and cardiac
- In pregnancy, frequent use reduces irregularities
milk production and risk to the NB - Respiratory depression will limit the
fromexcretionofthedruginthebreast fetal oxygen supply
milk
- Some women use marijuana to 6. Alcohol
counteract nausea in early pregnancy - Is a CNS depressant affecting allbody
tissues
Complications associated with Chronic Alcohol use: - requent complaints of fatigue, SOB nausea,
F
1. Vitamin B and Thiamine deficiencies back pain, urinary frequency, and headaches
2. Confusion - More vulnerable to postpartum infections
3. Hepatitis and liver cirrhosis - May need longer courses of antibiotics for
4. Pancreatitis infection
5. Anemias
6. Immune system dysfunction Diagnosis
7. Brain damage - Clients maybe infected with the virus but has
8. Peripheral neuropathy not yet produced antibodies thereby testing is
9. Cardiac disorders negative, but being capable of infecting others
- Clients who by history may be at risk for
possible HIV but test is negative for the HIV
HIV / AIDS
antibody should retested.; it usuallytakes6to
12 weeks for a host to manufacturedetectable
➢ Human Immunodeficiency Virus HIV antibodies
- Is a causative factor in the - Enzyme-Linked Immunosorbent Assay
development of AIDS (ELISA) is a screening test for HIV antibodies
- HIV infection is a progressive, severe and is a very sensitive test but not highly
weakening of theimmunesystemthat specific
makesanindividualhighlysusceptible - A positive ELISA test indicates the need for
tootherinfectionsandcertaintypesof further testing using theWESTERN BLOT.
cancers
- Thevirusattacksthelymphocytesand Assessment of the Stages of AIDS
produces immune deficiency by ● Stage 1
destroying the T- helper lymphocytes; - Fever, myalgia, lymphadenopathy,
this interferes with cell-mediated headache
immunity
- Develops slowly over the years ● Stage 2
- Women infected with HIV may - A ctive but asymptomatic and may
demonstrate symptoms at the time of remain so for years
pregnancy or possibly develop - May experience an outbreakofherpes
life-threatening infections because zoster (Shingles)
normal pregnancy involves some - May experience a transient
suppression of the maternal immune thrombocytopenia
system
● Stage 3
Transmission - S ymptomatic Evidence of immune
- All body fluids from an infected host. except dysfunction
perspiration, have been shown to contain the - All body systems can present with
virus signs of immune dysfunction
- Blood, semen, and breast milk have higher - Integumentary and gynecological
concentrations of the virus, than in urine, problems are common
saliva, vomitus and stool
- HIV can cross some membranes such as the ● Stage 4
placental barrier, the blood-brain barrier, - A dvance HIV Infection
vaginal mucosa, and (in Neonate) the wallsof - Vulnerable to common bacterial
GIT infections
- Sexual contact - Development of opportunistic
- Transfusion with blood or blood products infections
- Occupational exposure, such as in health care - Serious immune compromise
workers
- Sharedneedlesduringdruguseanduseofdirty Treatment
needles 1. Zidovudine (AZT)
- Recommended for the prevention of
Perinatal Transmission maternal-fetal transmission risk if
- From infected mother to fetus or newborn via: given late in pregnancy, during labor
1. Transplacental transmission andtothenewborninfantforthefirst6
2. Contamination with maternal blood weeks of life
during birth ] - Administered orallyat14to34weeks
3. Through breast milk gestation, intravenously during labor
andintheformofsyruptotheneonate
Risk to the Mother after birth
- The mother with HIV is at high risk
Nursing Intervention during Prenatal Period a ntibodies stay in your body once they have
- Prevention of opportunistic infections formed
- Instruct the client on good handwashing - Thus, Rh incompatibility is more likely to
procedures Avoid persons who are ill. cause problems in secondorlaterpregnancies
- Avoid exposuretocatfeces,catordoglitteror (if the baby is Rh-positive)
fish tanks Avoid undercooked meats,raweggs - The Rh antibodies can cross the placenta and
and unpasteurized milk attack the baby’s red blood cells — this can
- Prevent furtherexposuretoHIVthroughsexual lead tohemolytic anemiain the body
contact or the use of needles - HemolyticAnemiaisaconditioninwhichred
- Initiate recovery for substance abuse blood cells are destroyed faster than the body
- Avoid procedures that increase the risk of can replace them
perinatal transmission such as amniocentesis - Redbloodcellscarryoxygentoallpartsofthe
and fetal scalp sampling body
- Without enough red blood cells, your baby
Nursing Intervention during Intrapartum Period won’t get enough oxygen — this can lead to
- Note that if the fetus has not been exposed to serious problems. Severe hemolytic anemia
HIV in utero, the highest risk exists during may even be fatal to the child
delivery through the birth canal
- Avoid episiotomy to decrease the amount of Outlook
maternal blood in and around the birth canal - With prompt and proper prenatal care and
- Avoid the administration of oxytocin, since screening, you can preventtheproblemsofRh
oxytocin contractions can be strong inducing incompatibility
vaginal tears, or necessitating the need for an - Screening tests allow your doctor to find out
episiotomy early in your pregnancywhetheryou’reatrisk
- Minimize the neonate's exposure to maternal for the condition
blood and body fluids - If you’re at risk, your doctor will carefully
- Placeheavyabsorbentpadsunderthemother's check on you and your baby throughout your
hips to absorb amniotic fluid and maternal pregnancy and prescribe treatment as needed
blood - Injections of a medicine called Rh immune
- Promptlyremovetheneonatefromthemother's globulin can keep your body frommakingRh
blood following delivery antibodies
- Dry the infant promptly - This medicine helps prevent the problems of
- Prepare to administer zidovudine (AZT) Rhincompatibility.Ifyou’reRh-negative,you’ll
intravenously as prescribed during labor and needthismedicineeverytimeyouhaveababy
delivery with Rh-positive blood
- OthereventsalsocanexposeyoutoRh-positive
blood, which could affect a pregnancy.
Rh Sensitization / Isoimmunization / Rh
Examples include a miscarriage or blood
Incompatibility
transfusion. If you’re treated with Rh immune
globulin right after these events, you may be
What is Rh Incompatibility? able to avoid rh incompatibility during your
- A condition that occurs during pregnancy if a next pregnancy
womanhasRh-negativebloodandherbabyhas
Rh-positive blood Who is at Risk for Rh Incompatibility?
- An RH-negative woman who conceives achild
● R H-negative and Rh-positive refer to whether with an Rh-positive man is at risk for Rh
your blood has Rh factor incompatibility
● Rh factor is a protein on red blood cells - Rh factor is inherited (passed from parents to
● If you have Rh factor, you’re Rh-positive children through the genes)
● If you don’t have it, you’re Rh-negative - Ifyou’reRh-negativeandthefatherofyourbaby
● Rh factor is inherited (passed from parents to is Rh-positive, the baby has a 50 percent or
children through the genes) more chance of having Rh-positive blood
● Most people are Rh-positive - Simple blood tests can show whetheryouand
● WhetheryouhaveRhfactordoesn’taffectyour the father of the baby are Rh-positive or
general health, however, itcancauseproblems Rh-negative
during pregnancy - If you’re Rh-negative, your risk of problems
from Rh incompatibilityishigherifyourwere
OVERVIEW exposed to Rh-positive blood before the
- When you’re pregnant, blood from your baby pregnancy
can cross into your bloodstream, especially - This may have happened during:
during delivery ● An earlier pregnancy (using during
- If you’re Rh-negative and your baby is delivery)
Rh-positive, your body willreacttothebaby’s ● You also may have been exposed to
blood as a foreign substance, however, the Rh-positive blood if you hadbleeding
r abdominal trauma (Example: From
o 4. A ssist with intrauterine transfusion as
a car accident) during the pregnancy indicated
● Anectopicpregnancy,amiscarriage,or 5. BeforeIUtransfusion,obtainabaselineFHRby
an induced abortion electronic monitoring, explaining the purpose
● A mismatched blood transfusion or of the procedure
blood and marrow stem cell transplant 6. After the transfusion, carefully observe the
● An injectionorpuncturewithaneedle patient for uterine contractions amniotic fluid
or other object containing Rh-positive leakingfromthevagina,andfluidleakagefrom
blood the puncture site
● Certain tests also can expose you to 7. Monitor FHR for tachycardia, bradycardia, or
Rh–positive blood. Example include variable decelerations
amniocentesis and chorionic villus 8. Preparethepatientforplanneddelivery,usually
sampling 2to4weeksbeforethetermdate,dependingon
maternal hx, serologic test and amniocentesis
Treatment for Rh Incompatibility results
- If Rh Incompatibility isdiagnosedduringyour 9. Assist with induction of labor, if indicated
pregnancy, you’ll receive Rh immune globulin 10. During labor monitor the fetus for oxygen
in your 7th month of pregnancy and again saturation
within 72 hours of delivery 11. Indication of fetal distress necessitates
- YoumayreceiveRhimmuneglobuliniftherisk immediate cesarean delivery
of blood transfer between you and thebabyis
high (If example, if you’ve had a miscarriage,
ANEMIA AND PREGNANCY
ectopic pregnancy, or bleeding during
pregnancy)
- Rh immune globulin contains Rh antibodies - conditionthatcandevelopasaresultofiron
A
thatattachtotheRhpositivebloodcellsinyour deficiencywithahemoglobinbelow10g/dLor
blood. When this happens, your body doesn’t a hematocrit below 30 g/dL
reacttothebaby’sRhpositivecellsasaforeign - Anemia predisposes the client to postpartum
substance.Asaresult,yourbodydoesn’tmake infection and hemorrhage
Rh antibodies - Most common type of anemia is IRON
- Rh immune globulin must be given at the DEFICIENCY ANEMIA
correct times to work properly
- Once you have formed Rh antibodies, the Treatment
medicine will no longer help, that’s why a ● 120 to 180 mg ofironperday(ferroussulfate
woman who has a RH-negative blood mustbe or ferrous gluconate)
treated with themedicinewitheachpregnancy - Iron is best absorbed with an acid
oranyothereventthatallowsherbloodtomix medium.
with Rh-positive - If with constipation or gastric
- Rhimmuneglobulinisinjectedintothemuscle irritation,increaseroughageinthediet
of your arm or buttock and always take the pillswithfoodto
- Side effects may include soreness at the reduce the symptoms
injection site and a slight fever ● Severeirondeficiencyanemiawithdifficultyin
- The medicine also may be injected into a vein iron therapy, IM/IV Iron (Dextran) can be
prescribed
Effect to the Fetus
● Erythroblastosis Fetalis or Hemolytic Nursing Interventions
Disease of the Newborn - Monitor hemoglobin and hematocrit levels
- Deficient of RBC that sufficient transport to every 2 weeks
body cells cannot be maintained - Administer and instruct the client about iron
● Assessment Finding: None, Mother show no and folic acid supplements
signs and symptoms - Instruct theclienttotakeironwithasourceof
Vitamin C and to avoid taking with tea
Nursing Interventions - Instructtheclienttoeatfoodshighiniron,folic
1. Assess all pregnant patients for possible acid,and protein (green leafy vegetables,
incompatibility oranges, dried beans, meat)
2. ExpecttoadministerRhoGAMaftertransfusion - Teach the client to monitor signs and
reaction, ectopic pregnancy, orspontaneousor symptoms of infection
induced abortion. Other indications include - Prepare to administer injectable iron as
placenta previa, abruptio placenta during the prescribed in severe cases
2ndor3rdtrimesterandamniocentesisresults - Prepare to administer transfusions if
that confirm isoimmunization prescribed, although they are rarely necessary
3. Administer RhoGAM as orderedtoRhnegative - Prepare for administration of oxytocin
women at 28th weeks gestation andwithin72 medications as prescribed during postpartum
hours after delivery as ordered to prevent hemorrhage
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