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Unformatted text preview: The High-Risk Pregnancy This plan of care provides a general framework for assessing and caring for the client and fetus in a high-risk situation during the prenatal period. Specific high-risk problems that occur in 6% or more of the prenatal population are discussed in the individual plans of care that follow. Less common problems can occur, placing both the client and the fetus in a potentially compromised situation. This plan of care focuses on these less common problems, as well as on general psychosocial considerations for all high-risk clients. (This plan of care is to be used in conjunction with the Trimesters and other plans of care for specific conditions as appropriate.) CLIENT ASSESSMENT DATA BASE Activity/Rest May be pale, listless, fatigued Circulation BP, pulse may be elevated. Ego Integrity May express concern about own self-esteem regarding problems of pregnancy. Pregnancy may not be planned/desired. Stressors may include financial concerns/lack of health insurance. Elimination May practice colonic therapy (diminishes normal colon bacteria) Food/Fluid May be malnourished/obese or underweight (weight less than 100 lb/greater than 200 lb). Dietary choices may not include all food groups (may reflect eating disorder). History of anemia (differentiate iron deficiency, sickle cell trait/disease, hemorrhage). Edema may be present in the lower extremities, include both upper/lower extremities, or be generalized. Neurosensory May have difficulty with muscle function (i.e., multiple sclerosis, myasthenia gravis, paralysis/spinal cord trauma) Respiration Breath sounds: crackles, rhonchi, expiratory wheeze Safety History of previous obstetric complications, such as PROM, placenta previa, abruptio placentae, miscarriage, two or more episodes of preterm labor/deliveries, Rh incompatibility, previous birth defects, gestational trophoblastic disease (GTD), hyperemesis gravidarum, one or more pregnancy losses due to premature dilation of the cervix, PIH, or postpartal hemorrhage, infection, or phlebitis. History of STDs, a virus of the TORCH group, or Listeria ; repeated urinary tract/vaginal infections; bowel problems; diarrhea; or recent influenza. History of exposure to teratogenic agents, high-risk occupations. May have history of intrapartal complications (e.g., hemorrhage, dystocia, PIH, meconium staining, fetal distress). Inadequate/lack of housing (affects safety as well as general well-being), history of prenatal abuse....
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- Spring '10
- PIH, preterm labor