Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Chapter 11 Caring for the Woman Experiencing Complications During Pregnancy Edited by Catherine Marin, MSN/Ed(c), WHCNP, RN
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Early Pregnancy Complications Perinatal loss Ectopic pregnancy Gestational trophoblastic disease Signs/symptoms: vaginal bleeding, excessive nausea/vomiting, abdominal pain, size/date discrepancy Management: remove uterine contents
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Spontaneous Abortion Before 20 weeks of gestation Signs/symptoms: bleeding, cramping, abdominal pain, decreased symptoms of pregnancy Management: D & C
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Incompetent Cervix Painless dilation and cervical effacement Second trimester Management
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hyperemesis Gravidarum Criteria: persistent vomiting, measure of acute starvation, and weight loss Management Rest Small frequent meals (dry, bland foods) High-protein snacks
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hemorrhagic Disorders Placenta previa Signs/symptoms: painless vaginal bleeding Management: stabilization and fetal monitoring Abruptio placentae Signs/symptoms: third-trimester bleeding associated with severe abdominal pain Management: monitoring, delivery
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Preterm Labor Morbidity and mortality Subtle signs/symptoms Biochemical markers Management goals Inhibit/reduce contraction strength/frequency Optimize fetal status
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Premature Rupture of Membranes Signs/symptoms: gush/trickle of fluid from vagina Management factors Establish gestational age Ultrasound to assess fetus Assess for advanced labor, infection If advanced labor or infection, deliver fetus
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hypertensive Disorders Classifications: Chronic Preeclampsia-eclampsia Chronic hypertension with superimposed preeclampsia Gestational/transient
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Preeclampsia Multisystem, vasopressive Disease of placenta SPASMS Morbidity and mortality Management Delivery of fetus only cure
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Nursing Assessments— Preeclampsia Identify hypertension Proteinuria- 24 hr urine collection for Total Protein Edema- especially facial edema, hands and feet CNS alterations Eclampsia: seizures
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley HELLP Syndrome Complication of preeclampsia Treatment Improve platelets with FFP Delivery of fetus as soon as feasible
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Disseminated Intravascular Coagulopathy (DIC) External or internal bleeding Nursing care Meticulous maternal and fetal assessment Place indwelling catheter Oxygen—rebreathing mask Blood and blood products Emotional support
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Multiple Gestation High-risk pregnancy Morbidity and mortality Management Delivery at Level III facility
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Infections UTI Group B streptococcus TORCH STIs HIV and AIDS Tuberculosis
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Inflammatory Disease & Pregnancy Systemic lupus erythematosus (SLE) Increased risk of pregnancy complications Management Immunosuppression of SLE flare Careful fetal surveillance If flare-up during pregnancy, rapid implementation of treatment
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hemoglobinopathies Sickle cell disease Promote good dietary habits Early detection of infection and treatment Prevent dehydration Prompt treatment of sickle cell crises Fetal surveillance
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hemoglobinopathies Thalassemia Close maternal and fetal surveillance Rh 0 (D) isoimmunization Admininster RhoGAM to prevent antibody formation ABO Coombs test
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Respiratory Complications Pneumonia Aggressive management Asthma Maternal and fetal risks Careful monitoring Adjustments in therapy
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cystic Fibrosis Fetus at risk for uteroplacental insufficiency and IUGR Monitor nutritional status Early recognition and treatment of pulmonary infections Maternal and fetal surveillance
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiovascular Disease Symptoms similar to normal pregnancy physiological changes Labor, birth, immediate postpartum period Lateral recumbent position Administer IV fluids with caution Invasive hemodynamic monitoring Medications –e.g. prophylatic antibiotics
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Cardiovascular Disorders Mitral valve prolapse Pregnancy may alleviate murmur and symptoms Peripartum cardiomyopathy No history of cardiac disease Signs/symptoms: dyspnea, fatigue, peripheral/pulmonary edema
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Diabetes Mellitus Morbidity and mortality Screening and diagnosis Management Home blood glucose monitoring Adjust diet, medication, physical activity Ongoing maternal-fetal surveillance
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Thyroid Conditions Hyperthyroidism Signs/symptoms Depressed TSH and elevated free T 4 Antithyroid medications Hypothyroidism Symptoms Elevated TSH and low to normal T 3 and T 4
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Venous Thrombosis and Pulmonary Embolism Symptoms Diagnosis Doppler ultrasound Ventilation-perfusion (VQ) scan
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Psychiatric Complications Depression Bipolar disorder Anxiety disorders Eating disorders Substance addiction
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Antepartum Fetal Assessment Chorionic villus sampling PUBS Amniocentesis Amnioscopy or fetoscopy Ultrasonography Fetal kick counts
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessment of Fetal Well-Being (cont.) Doppler ultrasound Fetal biophysical profile (ultrasound and NST Non-stress test Vibroacoustic stimulation Contraction stress test Electronic fetal heart rate monitoring
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Special Conditions and Circumstances that may Complicate Pregnancy
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Antenatal Bedrest Regular community health nurse home visits Involve various community resources Support groups Provide emotional support
Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Special Conditions Adolescent Advanced age Trauma Cancer Obesity Disability