antepartum complicationsGinny Kolter, RN, MSN,APRNFall 2019
Outcomes•Delineate the bleeding problems associated with pregnancy•Contrast the etiology, medical therapy, and nursing interventions for variousbleeding problems associated with pregnancy•Discuss the medical therapy and nursing care of a woman withhyperemesis gravidarum•Describe the development and course of hypertensive disordersassociated with pregnancy•Discuss the pathology, treatment, and nursing care of pregnant womenwith diabetes•Compare placenta previa and abruptio placenta, including implications formother and fetus, and their nursing care•Analyze the maternal and fetal-newborn implications and clinical therapy indetermining nursing care of the woman with multiple gestation•Identify the physical, psychologic, and sociologic risks faced by anadolescent who is pregnant•Describe factors that have contributed to the increased incidence ofpregnancy in women over age 35
Outcomes•Discuss AIDS, including care of the pregnantwoman with HIV, neonatal implications, andramifications for the childbearing family•Identify the different STIs and review care of thepregnant woman and neonatal implications.•Define TORCH and discuss each diseaseincluding fetal/neonatal implications and care ofthe pregnant woman•Discuss substance abuse in the pregnantwoman including risks to fetus.
High Risk Pregnancy•One in which conditions exist that maythreaten the health or safety of the mother,fetus, or both•One in four women is considered high risk•Before ConceptionRisk Assessment
Emotional Support•Therapeutic Communication•Hospitalized•At home on work restriction, etc•Loss of Income•Away from Family•Is the baby going to be ok?•Is mommy going to be ok?•Role changes
Bleeding during Pregnancy•Spontaneous abortion (SAB)185–Natural termination of a pregnancy before 20weeks or less than 500g–Chromosomal abnormalities, teratogenicdrugs, faulty implantation, weak cervix,placental abnormalities, infection, maternalconditions, endocrine imbalances–Symptoms- vaginal bleeding, abdominalcramping, passage of tissue
CategoryAssessmentFindingsDiagnosisTherapeuticManagementThreatenedAbortion-Vaginal Bleeding-No cervicaldilation-Mild abdominalcramping,backache-No passage oftissue-vaginal U/SSerial HcG testing-Conservative-pelvic rest-bed restImminent Abortion(inevitable)-Heavy vaginalbleeding-ROM-Cervical dilation-Strong abdominalcramping-Possible passageOf tissue?U/S & HcG levels-D&C(before 12 wk)-CytotecIncompleteAbortion-Intense cramping-Heavy bleeding-cervical dilation-some POCsretainedU/S--D&C-Cytotec
CategoryAssessmentFindingsDiagnosisTherapeuticManagementComplete Abortion-Hx of abdominalpain & vaginalbleeding-passage of tissueU/SNone necessaryMissed Abortion-absent uterinecontractions-irregular spotting-cervix closedU/S-D&C-CytotecHabitual Abortion(Recurrent)-Hx of 3 or moreconsecutiveabortions-unable to carrythe pregnancy toviability or termClient history-ID & treatunderlying cause-hormone level-reproductive tractabnormality-Cervicalincompetency
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