3. Anemia CONTENTS: CONTENTS: 1. INTRODUCTION. 2. CLINICAL MANIFESTIATION. 3. DEGREE OF ANEMIA. 4. CAUSES OF ANEMIA. 5. ANEMIA DURING PREGNANCY. 6. TYPES OF ANEMIA AND PREGNANCY 7. NURSING CARE PLAN. 8. Complication of anemia

4. Objectives of anemia seminar After mastering the content of this seminar you should be able to: After mastering the content of this seminar you should be able to: Define anemia and identify the causes of anemia in pregnancy Discuss the clinical manifestation of anemia and causes of it. List the types of anemia and discuss each types. Take example of N.C.P

5. Anemia INTRODUCTION Is a reduction ability of the blood to carry oxygen to the cells ¸ Also Is a deficiency in the no. of (RBC) ¸ the quantity of Hb and/or the volume of (RBC) hematocrit. In pregnancy the anemia one of the major complication health problem during pregnancy ¸ because women more prone to be have anemia.

6. Clinical manifestation Caused by the body's response to tissue. -D-Depend on the severity of hypoxia anemia and presence of coexisting disease (determine by the level of Hb). And that depend on degrees of anemia : mild anemia : (10-14) g/dl → No symptoms moderate anemia : (6-10)g/dl → Dyspnea at rest

7. CONT. CONT. degrees of anemia Sever anemia : <6g/dl→ include palpation, dyspnea, diaphoresis, integument change pallor, jaundice. Also increase HR and stroke volume, development of systolic murmurs and bruits.

8. WHAT CAUSE ANEMIA IN GENERAL Caused by: Rapid blood loss Impaired production of (RBCs). Increase destruction of (RBCs). How we can classify anemia ? Morphology: lab results of (RBCs) size ¸ color ¸ shape. Etiology: according to clinical condition causing anemia

9. So what happened during pregnancy? So what happened during pregnancy? A fetus is depend in his developmental and growing on his mother blood¸ and that lead to consume more than normal of nutrition or elements from blood of mother. So anemia in pregnancy defined as the level of hemoglobin below than 10 g/dl and level of hematocrit below 30%.

10. ANEMIA DURING PREGNANCY There are many things we want to discus in this case, and it: The definition of every types of anemia. Main causes of every type of anemia. The relationship between the type of anemia and pregnant women. Clinical manifestation to every type. The diagnostic studies to every type. The main intervention and treatment to every type. Prevention of anemia.

11. Decrease (RBC) production. Decrease hemoglobin synthesis: Iron deficiency anemia. Def. it the decrease the quantity of (RBCs) in blood. Iron is present in all RBCs as heme in Hb, so we use a Hb. To measure the decrease in RBCs. This type of anemia develops as a result of inadequate dietary intake or mal absorption, blood loss or hemolytic.

12. Cont. During pregnancy the fetus depend on his mother in his production of RBCs by the use the iron in his mother blood and the expanding of plasma volume. The s&s include pallor, glossitis, cheilitis, headache, paresthesias, pallor, and sensitivity to cold, weakness, fatigue, and tachycardia.

13. cont. Iron deficiency anemia. Diagnostic studies: include of Hb,HCT, and serum iron→ low level Serum ferritin levels and transferring saturation rates are the most reliable predictor of iron deficiency anemia. The main intervention is to treat the cause, direct iron replacing by increasing intake from good sources, and iron supplement or transfusion of (RBCs).

14. Forms of iron supplements Dietary sources of iron include meat, chicken,fish and green leafy vegetables Iron supplements (60mg/dl) of elemental iron or 300 mg ferrous sulfate by oral are commonly used. Vit.C used to enhance absorption of iron and production Hb. Empty stomach is the best for absorption of iron. The effect of iron on GI system including nausea & vomiting, epigastric discomfort, abd. Cramping, Black, tarry stool & constipation.

15. Iron deficiency anemia. Prevention of Iron deficiency anemia. In pregnancy period increase the diet that rich in iron, because 50% of pregnant women prone to have iron deficient Take iron supplements.

16. Thalsemia Def. it Genetic disorder or inherited disease of inadequate production of normal Hb. Caused by decrease production rate of globins protein, which results in hemolytic and anemia. There is no relationship between this type and pregnancy, but pregnancy makes it more badly.

17. Cont. Thalsemia S&S splenomegaly, hepatomegaly, jaundice, pallor, mental physical retardation & chronic anemia. Diagnosis by level of Hb & HCT in blood. The main intervention is blood transfusion. No way to prevent this type of anemia, we can just decrease s&s.

18. Defective DNA synthesis Group of disorders caused by impaired DNA synthesis and characterizes by the presence of large RBCs, but defective and easily destroyed.

19. Vitamin B12 (coblamin) deficiency Def. lack of Vit. B12 in body, and Vit. B12 is important production of blood cells and function of daily nervous system. Caused by decrease presence or absence of intrinsic factor which is a protein secreted by gastric mucosa, also the diet that low in Vit. B12 or intestinal malabsorption. During pregnancy malnutrition or elements deficiency. S&S tissue hypoxia, abdominal pain, dyspnea, fatigue, weakness, numbness, palness. Diagnostic studies. Lab tests of Vit. B12 levels and HCT level

20. Cont. Cont. Vit. B12 Deficiency The main intervention : pt should be instructed on adequate dietary and parenteral administration. Is Vit. B12 supplements Vit. B12 pills with a more balanced diet (lack of Vit. B12). In malabsorption is Vit. B12 injection. In pernicious anemia requires lifelong therapy. Increase intake of meats, eggs and diary products. Prevention o f lack Vit. B12 be by the balance diet also to prevent it after surgery the Pt. take injection of Vit. B12.

21. Folic acid deficiency. Def. F.A deficiency which is imp. for growth of RBCs and formation. CCaused by poor nutrition, malabsorption syndrome, alcohol abuse, hemodialysis pt., cytotoxic drugs and pregnancy. TThe need for F.A increase during pregnancy because the poor nutrition and is combined usually with Vit. B 12 deficiency. Folic acid deficiency is associated with neural tube defects. All women of childbearing age take (0.4mg) of folic acid daily.

22. Cont. Folic acid deficiency. S&S headache, weakness, sore mouth and tongue, pallor. Diagnostic studies. CBC (size, shape, quantity). The main intervention: F.A supplements and well balances nutrition. Prevention of it by increase the intake of food high in folic acid includes leafy dark green vegetables, fruits and liver.

23. B. increase RBC destruction 1. Sickle cell anemia. Def. Group of inherited disorders characterized by presence of abnormal form Hb in the blood. This abnormal Hb (HbS) causes the sickling of RBCs. Caused by malnutrition, excessive physical activity, emotional stress, dehydration, genetic disorder and bone marrow disorder.

24. Cont. Sickle cell anemia. During pregnancy malnutrition or emotional stress the main factors to cause S.C. S&S pallor of mucus membrane, fatigue, breathlessness, rapid HR, fever, failure of the spleen to fagocytize F.B, susceptibility to infections, decrease exercise tolerance, Jaundice, pain due to ischemia of tissue. Diagnostic studies: CBC SICKLE CELL TEST DNA TESTING

25. The main intervention and treatment: for s.c.a Transfusion to maintain the HCT of at least 30% avoid tissue deoxygenation. promote proper hydration. Bone marrow transplants. Genetic counseling. Prevention: consist of well balanced nutrition, and appropriate physical activity.

26. C. Rapid blood loss ACUTE BLOOD LOSS. CHRONIC BLOOD LOSS Complication of anemia: 1.Premature labor 2.Intrauterine growth retardation. 3.Increase the risk for infection after birth.

27. Nursing care plan Risk for altered tissue perfusion related to maternal anemia during pregnancy. Objective data:-exhaustion, headache, lethargic. Subjective data:- pale, decrease BP, hypothetic, decrease PVC.

28. CONT. N.C.P Outcome identification:-client will take adequate measures to guard against anemia during pregnancy and experience adequate tissue perfusion during pregnancy. Outcome identification:-client will take adequate measures to guard against anemia during pregnancy and experience adequate tissue perfusion during pregnancy.

29. CONT. N.C.P CONT. N.C.P Intervention Intervention 1. Instruct how to have adequate time for rest and sleep 2. Instruct how to increase her nutritional intake. 3. Instruct how to avoid over load activities. 4. Teach her the proper way of preparing her weal's. 5. Give her the prescribed iron or folic pills 6. Increase her fluid intake. 7. Review plans for lab testing and scheduling of antepartum care visit.

30. CONT. N.C.P Outcome evaluation: Outcome evaluation: client takes prenatal supplement daily; Hb is above 11 mg/dl; fetal heart rate is 120 to 1160 client takes prenatal supplement daily; Hb is above 11 mg/dl; fetal heart rate is 120 to 1160

31. COMPLICATION Of THE PREGNANT WOMEN i. Premature labor ii. Hypertension iii. Low birth wt. iv. Septicemia v. Maternal anemia.

32. URINARY TRACT INFECTION Contents. Contents. 1. Definitions of UTI and type of it 2. Risk of UTI on women. 3. Signs and symptoms of UTI. 4. Diagnostic studies for UTI. 5. Risk of UTI during pregnancy. 6. Assessment of UTI. 7. Nursing care plan 8. prevention of UTI.

33. URINARY TRACT INFECTION OBJECTIVES Each one of you will be able to: Identify UTI Identify UTI Explain the diagnostic studies Explain the diagnostic studies Assess the patient who have UTI Assess the patient who have UTI the complication of UTI on pregnancy the complication of UTI on pregnancy

34. Urinary tract infection UTI : IS THE PRESENCE OF ANY PATHOGENIC MO IN THE UT WITH OR WITHOUT S&S. Common pathogen found in UTI : Escherichia coli and Entrobacteia. Major types of UTI : cysitits (infection of the bladder), urithritis, prostatitis, and pyelonephritis. In women more prone to UTI because of the short female urethras (4cm), and proximity to Vagina, periuretheral gland, and rectum.

35. Cont. Cont. UTI Elderly women often have incomplete emptying of the bladder and urinary stasis; post menopausal women are susceptible to colonization of bacteria due to absence of estrogen. * FEMALE 14 TIMES TO HAVE UTI MORE THAN MALE.* UTI affects 5%_ 20% of pregnant women, and it the most common infection of bacteria during pregnancy.

36. Clinical manifestations Lower U TI : frequent pain and burning on urination, spasm of the bladder, hematuria, and back pain may be present. Upper U TI : fever, chills, flank pain, painful urination, tenderness as the costovertebral angle, nausea, vomiting, pruritus, wt. loss, edema, fatigue, and shortness of breath.

37. DIAGNOSTIC STUDIES. Includes: Urinalysis, CBC, electrolytes, createnin and BUN,. Also Urine culture (C&S), KUB, IVP or IVU and testing for STD.

38. What happened during pregnancy? The anatomic changes during pregnancy in UT predispose women to infection, the growing of uterus compress both uterus which decrease the flow to the bladder, and that increase the mother and also the fetus to infection by the causing of urinary stasis.

39. Cont. The incidence of glycosuria increased, which favor bacterial growth and development of UTI. During pregnancy the plasma volume increase and GFR and urine output increase.

40. ASSESSMENT Hx. Of S&S of U TI. Knowledge about if pt. know to prevent UTI and complication Identify the color, volume, odor concentration, and frequently of urine.

41. Nursing care plan Nursing diagnosis: risk for infection to stasis of urine with pregnancy. Nursing diagnosis: risk for infection to stasis of urine with pregnancy. subjective data: subjective data: 1. pain on urination 2. Frequency of urination 3. Hematuria Objective data: Objective data: bacterial count of more than 100,000 colonies per milliliter in a clean-catch specimen bacterial count of more than 100,000 colonies per milliliter in a clean-catch specimen

42. Cont. N.C.P Outcome identification: client will demonstrate no signs of infection during pregnancy. Outcome identification: client will demonstrate no signs of infection during pregnancy. Intervention: Intervention: voiding frequency (at least per 2 hrs) Wiping front to back after bowel movements.

43. Prevention i.General hygiene ii.Drink 8-12 glasses of liquid/day iii.Urinate before and after intercourse.

44. REFERENCES Lewis, medical surgical nursing, 6 th edition, 2004, Lewis, medical surgical nursing, 6 th edition, 2004, Burroughs, Maternity nursing, 3 rd edition, 1997 Burroughs, Maternity nursing, 3 rd edition, 1997 Matenal & child nursing care, 3 rd edition Matenal & child nursing care, 3 rd edition www.ask.com www.ask.com www.ask.com www.who/complication during pregnancy.com www.who/complication during pregnancy.com www.who/complication during pregnancy.com www.who/complication during pregnancy.com