1. 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

2. 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

3. 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

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 Incompetent Cervix  Painless dilation and cervical effacement  Second trimester  Management

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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