4Hyperemesis Gravidarum NURSING CARE:IV therapy with replacement of electrolytes and possible TPN.Maintain NPO status for hour vomiting has stoppedFacilitate the client’s environment- quiet , stress free, and odor freeAssess and Monitor:VS, I&O, Daily wt. Nutritional status, Emotional support.Laboratory studies: CBC, UA, Serum chemistries, and liver function studiesAdminister antiemetics- Relgan , Zofran,
5Hyperemesis Gravidarum Nursing Care:After vomiting has stopped diet progresses slowly :Clear liquidsBland diet – cold foods first, small servings, without fluidRegular dietTeach client about the disease process, procedures and treatments, diet, medications, and follow up careProvide emotional supportMonitor Fetus if ordered.
7Diabetes Mellitus In Pregnancy 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 resistanceClassification of DM:Pregestational:Type IType IIGestational:Type III (GDM)White’s Classifications of diabetes in pregnancy
8White’s Classification of Diabetes Mellitus in Pregnancy
9Diabetes Mellitus Pregestational Diabetes: It is best if the client have her diabetes mellitus under control before getting pregnant. Blood sugars in normal rangesPreconceptual care and guidanceType I:Insulin therapy will varyComplications:KetoacidosisFetal problems-IUGRType II:Possible oral agent will be change or change to InsulinFetal problems
10Diabetes MellitusGestational 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 levelPlacenta hormones-Human Placenta lactogen (hPL), insulinaseGDM 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 canIt is diagnosis by :Elevated blood glucose levelsGTT-1 hour or 3hour
12Diabetes Mellitus in Pregnancy Review clinical manifestations of:Diabetes mellitusHypoglycemiaHyperglycemiaDiabetes Ketoacidosis (DKA)Normal Adult Blood Glucose LevelsRisk factors for GDM(Class A) :PregnancyObesityPrevious large infants,previous unexplained stillborn
13Diabetes Mellitus in pregnancy Complications:Varies with the degree of extent of disease process of DMPreeclampsiaPolyhydraminosAbortionFetal Anomalies‘- Cardiac and Neurolical defectsStillbirthNeonatal Problems:MacrosomiaHypoglycemiaHyperbilirubinemiaDelayed lung maturity? RDS
14Diabetes Mellitus in Pregnancy NURSING CARE:Facilitate maintaining blood glucose levels within normal levels:Teach or review:ADA dietAssessing Blood glucoseExerciseMedications:NO Oral Hypoglycemic Agents ( except for those that do not cross the placenta)InsulinMonitor fetal well being- FMC and other
15Diet for the client who is pregnant and has diabetes mellitus Calories kcal/IBW(Kg) in first trimester and Kcal/IBW(Kg) per day.3-4 small meals and 3-4 snack per dayBedtime snack important with at least 25grams of carbohydratesAt least 250 Grams of carbohydrates per day.Carbohydrates % of caloriesProtein-12-20% of caloriesFats-limited to under 30grams according to ADA & AHA
16Diabetes Mellitus in pregnancy Nursing Care:Monitor client for development of complicationsPrepare 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.
17Cardiac Disease 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 PerinatalogistNSG. DX- Decrease cardiac output, Fluid volume excess, Activity intolerance, Risk for infection, Anxiety.
18NYHA Classifications of Cardiac Disease IIIIIIVAsymptomatic 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 restClassificationFunctional Capacity
20Cardiac Disease and Pregnancy Complications:Decreased cardiac output and altered blood flowDecreased maternal and fetal perfusionCongestive heart failurePreterm deliveryDeath
21Cardiac Disease and Pregnancy NURSING CARE:Teach client to maintain healthy life style:Adequate nutrition for pregnancyTake Prenatal vitamins and iron to prevent anemiaAvoid excessive weight gainStress managementExercise such as walkingNo over exertion and frequent rest periodsMonitor for signs of infectionGo to all appointments with her physiciansMonitor fetal well being with FMCReport signs of cardiac decompensation ( heart failure)to health care providers
22Cardiac Disease and Pregnancy Assess and monitor for signs of cardiac decompensation.Medication therapy:Prenatal vitamins and ironStool softenersProphylactic Antibiotics with any invasive procedures and before deliveryCardiac glycosides (digitalis)Antidysrhythmia agentsFurosemide (Lasix) – only with CHFHeparin if anticoagulant therapy is neededNo warfarin (Coumadin)
23Cardiac Disease and Pregnancy Nursing Care:Head of bed elevatedLabor:Avoid excessive stressEpidural anesthesia is preferredNo prolonged pushing in labor- forceps or vacuum extraction may be usedPostpartum:Continue prenatal vitamins and ironFrequent rest periodsNo staining with BM’sMonitor closely during this period for cardiac decompensation
24Anemia’s Iron Deficiency Anemia ( Microcyctic) Folic Acid Deficiency Anemia (Macrocyctic)Sickle Cell AnemiaETC.Any problem with low RBC’s will effect oxygenation to maternal and fetal tissues
25Iron Deficiency Anemia in pregnancy 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 supplementsFoods high in Iron.
27Sickle Cell Anemia and Pregnancy 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 anemiaPain in joints , back, abdomen, extremitiesBlood clotsInfectionsInfarction to organs
30Sickle Cell Anemia and Pregnancy NURSING CARE:Asses and monitor client for clinical manifestations of SCA Crisis and complicationsProvide the client a warm environment, and hydration ,possible blood transfusionsBe prepared to start IV, give O2, analgesia.Medications:Folic AcidHeparin- not warfarinAnalgesia-NO ASA and Demerol