Documentos de Académico
Documentos de Profesional
Documentos de Cultura
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
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
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
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
18
Incompetent Cervix
S&S Treatment
•Painless cervical dilatation •Cerclage
21
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
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)
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
profuse bleeding 35
Hemorrhagic Conditions:
Abruption & DIC
ASSESSMENT
•Bleeding
•Pain
•VS/FHR
•Uterine Activity
•OB Hx
•Fundal Ht
37
Causes:
u Fetal macrosomia
u Polyhydramnios
u General anesthetics
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.
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
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
47
S&S Eclampsia/HELLP
Syndrome
u Eclampsia u HELLP Syndrome
vfacial twitching vRUQ pain
vtonic-clonic sz vn/v
vpulmonary vedema
edema vH/H, plts
vcirc/renal failure vliver 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
56
(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, 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
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
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
71
Folic Acid Deficiency
uFolic acid is necessary normal
formation and nutrition of RBC’s.
72
S/Sx:
u Nausea
u Vomiting
u Anorexia
Treatment:
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
78
Con’t. of S/Sx:
u Excessive worry or anxiety
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
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
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
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
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 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 vaginalA. 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?
B. poverty
140
When caring for a woman with mild
preeclampsia, the nurse would be concerned
with which finding?
a.+4 proteinuria
141
The nurse is preparing to infuse
magnesium sulfate to treat preeclampsia.
In implementing this order the nurse
understands the need to:
b.Experiences no seizures
148
THE END
149