1. Hyperemesis Gravadium
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

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

4. Hyperemesis Gravidarum
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. Hyperemesis Gravidarum
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. Pregestational Conditions
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 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 resistance
Classification of DM:
Pregestational:
Type I
Type II
Gestational:
Type III (GDM)
White’s Classifications of diabetes in pregnancy

8. White’s Classification of Diabetes Mellitus in Pregnancy

9. Diabetes Mellitus 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. Diabetes Mellitus
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

12. Diabetes Mellitus in Pregnancy
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. Diabetes Mellitus in pregnancy
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. Diabetes Mellitus in Pregnancy
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. Diet 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 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. Diabetes Mellitus in pregnancy
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 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. NYHA Classifications of Cardiac DiseaseII
III IV
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
Classification
Functional Capacity

20. Cardiac Disease and Pregnancy
Complications:
Decreased cardiac output and altered blood flow
Decreased maternal and fetal perfusion
Congestive heart failure
Preterm delivery
Death

21. Cardiac Disease and Pregnancy
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. Cardiac Disease and Pregnancy
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. Cardiac Disease and Pregnancy
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. Anemia’s 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 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 supplements
Foods high in Iron.

26. Folic Acid Deficiency Anemia

27. Sickle 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 anemia
Pain in joints , back, abdomen, extremities
Blood clots
Infections
Infarction to organs

28. Sickle Cell Anemia Precipitated factors for SCA Crisis : Hypoxia
Acidosis
Dehydration
Stress
Cold
Infection

29. Sickle Cell Anemia Complications of SCA CRISIS: Vaso-occlusion Crisis
Pain
Pulmonary emboli
Folic anemia
Fetal problems:
IUGR
Stillborn
Hypoxia

30. Sickle Cell Anemia and Pregnancy
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