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 Clinical Manifestations:  Severe nausea and vomiting  Severe dehydration-fluid loss  Electrolyte imbalance: Hypokalemia Hyponatremia  Ketosis- Ketones.

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Presentation on theme: " Clinical Manifestations:  Severe nausea and vomiting  Severe dehydration-fluid loss  Electrolyte imbalance: Hypokalemia Hyponatremia  Ketosis- Ketones."— Presentation transcript:

1  Clinical Manifestations:  Severe nausea and vomiting  Severe dehydration-fluid loss  Electrolyte imbalance: Hypokalemia Hyponatremia  Ketosis- Ketones in the urine (Ketonuria)  Metabolic acidosis  Weight loss  Bleeding gums

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3  Complications:  Metabolic acidosis  Starvation/malnutrition  Acid-base imbalance  Maternal death  Fetal problems (CNS malformation, IUGR)  Termination of pregnancy

4  NURSING CARE:  IV therapy with replacement of electrolytes and possible TPN.  Maintain NPO status for hour vomiting has stopped  Facilitate the client’s environment- quiet, stress free, and odor free  Assess and Monitor: VS, I&O, Daily wt. Nutritional status, Emotional support. Laboratory studies: CBC, UA, Serum chemistries, and liver function studies  Administer antiemetics- Relgan, Zofran,

5  Nursing Care:  After vomiting has stopped diet progresses slowly : Clear liquids Bland diet – cold foods first, small servings, without fluid Regular diet  Teach client about the disease process, procedures and treatments, diet, medications, and follow up care  Provide emotional support  Monitor Fetus if ordered.

6  Diabetes Mellitus  Cardiac disease or conditions  Hypothyroidism  Hyperthyroidism  Anemia’s  Rh sensitization  Systemic Lupus erythematosus  Anticardiolipin Antibody Syndrome  Myasthenia gravis  Renal Disease  Epilepsy  Asthma

7  DIABETES MELLITUS is an endocrine order in which major effect is on carbohydrate metabolism and is the results from an inadequate product of insulin or insulin resistance  Classification of DM:  Pregestational: Type I Type II  Gestational: Type III (GDM)  White’s Classifications of diabetes in pregnancy

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9  Pregestational Diabetes:  It is best if the client have her diabetes mellitus under control before getting pregnant. Blood sugars in normal ranges  Preconceptual care and guidance  Type I: Insulin therapy will vary Complications: Ketoacidosis Fetal problems-IUGR  Type II: Possible oral agent will be change or change to Insulin Fetal problems

10  Gestational Diabetes Mellitus is the result of the pancreas is unable to meet the increase demands for insulin production during pregnancy and/or insulin resistance from various hormones during pregnancy:  Increase cortisol level  Placenta hormones-Human Placenta lactogen (hPL), insulinase  GDM starting in the last half of the pregnancy around weeks)  Client may show Clinical Manifestations of DM and problems with immune system-Freq. UTI’s and can  It is diagnosis by :  Elevated blood glucose levels  GTT-1 hour or 3hour

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12  Review clinical manifestations of:  Diabetes mellitus  Hypoglycemia  Hyperglycemia  Diabetes Ketoacidosis (DKA)  Normal Adult Blood Glucose Levels  Risk factors for GDM(Class A) :  Pregnancy  Obesity  Previous large infants,  previous unexplained stillborn

13  Complications:  Varies with the degree of extent of disease process of DM  Preeclampsia  Polyhydraminos  Abortion  Fetal Anomalies‘- Cardiac and Neurolical defects  Stillbirth  Neonatal Problems: Macrosomia Hypoglycemia Hyperbilirubinemia Delayed lung maturity? RDS

14  NURSING CARE:  Facilitate maintaining blood glucose levels within normal levels:  Teach or review: ADA diet Assessing Blood glucose Exercise Medications: NO Oral Hypoglycemic Agents ( except for those that do not cross the placenta) Insulin  Monitor fetal well being- FMC and other

15  Calories kcal/IBW(Kg) in first trimester and Kcal/IBW(Kg) per day.  3-4 small meals and 3-4 snack per day  Bedtime snack important with at least 25grams of carbohydrates  At least 250 Grams of carbohydrates per day.  Carbohydrates % of calories  Protein-12-20% of calories  Fats-limited to under 30grams according to ADA & AHA

16  Nursing Care:  Monitor client for development of complications  Prepare for possible preterm delivery or cesarean section.  Intrapartum care will depend on the extent of the disease process and blood glucose levels- IV Insulin therapy maybe used.  Maintain postpartum blood glucose levels ( blood glucose levels will drop in this period because of hormonal influences of pregnancy decrease and stop-about 3- 4days after delivery.)  Careful observation of the neonate whose mother has DM.

17  CARDIAC DISEASE and pregnancy :  Because of the hemodynamic changes that occur in pregnancy the client who has a cardiac disorder will have problems and complications.  Outcomes will depend on the degree of cardiac compromise. See NYHA Classifications of heart disease.  Clients who have a history of Rheumatic fever may have undiagnosed cardiac effects, and may need further evaluation.  Client will never to be seen by Cardiologist and Perinatalogist  NSG. DX- Decrease cardiac output, Fluid volume excess, Activity intolerance, Risk for infection, Anxiety.

18 ClassificationFunctional Capacity Asymptomatic will normal levels of activity-No physical limitations Slightly compromised Symptomatic with greater than ordinary physical activity Marked compromised Symptomatic with ordinary activity Severely compromised Symptomatic at bed rest I II III IV

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20  Complications:  Decreased cardiac output and altered blood flow  Decreased maternal and fetal perfusion  Congestive heart failure  Preterm delivery  Death

21  NURSING CARE:  Teach client to maintain healthy life style: Adequate nutrition for pregnancy Take Prenatal vitamins and iron to prevent anemia Avoid excessive weight gain Stress management Exercise such as walking No over exertion and frequent rest periods Monitor for signs of infection Go to all appointments with her physicians Monitor fetal well being with FMC Report signs of cardiac decompensation ( heart failure)to health care providers

22  Assess and monitor for signs of cardiac decompensation.  Medication therapy:  Prenatal vitamins and iron  Stool softeners  Prophylactic Antibiotics with any invasive procedures and before delivery  Cardiac glycosides (digitalis)  Antidysrhythmia agents  Furosemide (Lasix) – only with CHF  Heparin if anticoagulant therapy is needed  No warfarin (Coumadin)

23  Nursing Care:  Head of bed elevated  Labor:  Avoid excessive stress  Epidural anesthesia is preferred  No prolonged pushing in labor- forceps or vacuum extraction may be used  Postpartum:  Continue prenatal vitamins and iron  Frequent rest periods  No staining with BM’s  Monitor closely during this period for cardiac decompensation

24  Iron Deficiency Anemia ( Microcyctic)  Folic Acid Deficiency Anemia (Macrocyctic)  Sickle Cell Anemia  ETC.  Any problem with low RBC’s will effect oxygenation to maternal and fetal tissues

25  Iron Deficiency Anemia is a result of a decrease intake of iron. It can range from mild to severe. The decrease of RBC’s can effect the transportation of oxygen to the maternal organs and to the fetus.  All pregnant women need to increase their intake of iron during pregnancy through diet or supplements  Foods high in Iron. 

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27  SICKLE CELL DISORDER is a heterozygous form of hemoglobin S (HbAS) that is common in people from the Mediterrian area and Africa. It is an Autosomal Recessive Disorder.  Sickle Cell Anemia(SCA) is the most common inherited anemia complicating pregnancy.  SCA Crisis because of the stress of the pregnancy.  Clinical manifestations of SCA Crisis:  Hemolytic anemia  Pain in joints, back, abdomen, extremities  Blood clots  Infections  Infarction to organs

28 Precipitated factors for SCA Crisis : Hypoxia Acidosis Dehydration Stress Cold Infection

29  Complications of SCA CRISIS:  Vaso-occlusion Crisis  Pain  Pulmonary emboli  Folic anemia  Fetal problems: IUGR Stillborn Hypoxia

30  NURSING CARE:  Asses and monitor client for clinical manifestations of SCA Crisis and complications  Provide the client a warm environment, and hydration,possible blood transfusions  Be prepared to start IV, give O2, analgesia.  Medications: Folic Acid Heparin- not warfarin Analgesia-NO ASA and Demerol


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