Failure to correct nutritional imbalances in

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Failure to correct nutritional imbalances in pregnancy can result in intrauterine growth retardation, central nervous system malformations and fetal death Failure to correct nutritional imbalances in pregnancy can result in severe dehydration, metabolic alkalosis, ketosis, cardiac dysrhythmias and death for the woman
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Maternal understanding of the disease process and recommended therapies may provide impetus for self-care Normal pregnancy cardiovascular changes increase the heart's workload Cardiac disease in pregnancy can deteriorate rapidly Client must verbalize understanding of cardiac findings indicating complications Pregnant cardiac clients must be monitored closely for decompensation Cardiac output maximizes at approximatley 28 weeks; is increased during labor and is at its highest during first hour postpartum Class II-IV cardiac clients should labor side-lying, semi-Fowler's to facilitate cardiac emptying; pulse oximetry should be used to monitor tissue prefusion; and cardiac monitoring should be maintained Class II-IV cardiac clients should have induction, regional anesthesia, should not push during birth, legs should never be higher than the heart and should be monitored intensively following delivery Failure to detect blood incompatability with the fetus can result in RBC hemolysis and severe morbidity or mortality RhoGAM should be administered to all sensitized client's within 72 hours following delivery, miscarriage, or abortion Antigen-antibody reaction Aortic valve stenosis & regurgitation Cardiac decompensation Congestive heart failure Erythroblastosis fetalis Hemolysis Human Chorionic Gonadotropin Human Placental Lactogen (HPL) Hyperinsulinism Metabolic acidosis Mitral stenosis & regurgitation Prophylactic Antibiotic Therapy RhoGAM Shoulder Dystocia II. Complications during labor and delivery A. Dystocia 1. Definition a. painful, difficult, prolonged labor and birth resulting in failure to efface, and/or descend within an expected time frame b. fetal dystocia c. pelvic dystocia d. uterine dystocia e. hypotonic dysfunction f. hypertonic dysfunction g. CPD - cephalopelvic disproportion 2. Data collection a. monitor uterine contraction frequency, intensity, duration b. observe effacement , dilitation and descent c. observe uterine resting tone for hypertonus d. monitor fetal heart rate for non-reassuring pattern e. observe fetal presenting part for molding , asyncliticism f. monitor maternal coping skills g. monitor amniotic fluid 3. Management a. establish cause for dystocia I. powers II. passage III. passenger IV. maternal position V. psychologic responses b. treat cause of dystocia for vaginal delivery c. prepare for cesarean birth if approrpriate 4. Nursing interventions
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a. evaluate fetal status for size, position and reassuring heart rate b. evaluate pelvic parameters for adequacy, empty bladder c. evaluate uterine activity for frequency, intensity and duration d. provide sedation and rest if appropriate in latent phase, ambulation in active
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