Sickle Cell AnemiaNursing Care:

Monitor fetal status Provide emotional support

RH SensitizationRH Sensitization is a condition in which a Rh-

negative women becomes pregnant with a Rh-positive fetus and may become sensitized to Rh antigen and develops anti-Rh antibodies which may cross the placenta in subsequent pregnancies with Rh-positive fetuses and destroy the RBC’s.

Complications:Erythroblastosis fetalisHydrops fetalis Hyperbilirubinemia /Kernicterus Fetal dead

RH Incompatibility

Rh SensitizationAll pregnant women should have a Type and

Rh and an indirect Coombs.Pregnant women who are Rh-negative should

have : Serial Indirect CoombsUnsensitized Rh-negative clients should have

RhoGam: During pregnancy at 28-32 weeks gestation After any invasive procedures. In the Postpartum period within 72 hours.

RH IncompatibilityNursing Care:

Teach Client about the importance of complying with prenatal visits, laboratory testing, and RhoGam injection

Check Laboratory results on all pregnant clients . Report findings of the client having Rh-negative blood and indirect Coombs results. Follow through if invasive procedures are done or after delivery about RhoGam.

Support client who has developed fetal complications from Rh incompatibility

Hyperthyroidism and PregnancyHYPERTHYROIDISM is an endocrine

disorder in which there is a excessive amount of the thyroid hormone produced.

Complications in pregnancy: Thyrotoxicosis(Thyroid storm)Cardiac Dysrrhythmia’sPreeclampsiaMalnutritionFetal complications: abortion, premature

deliveryNeonatal complications: Prematurity,

hyperthyroidism

Hyperthyroidism In PregnancyReview of the clinical manifestation of

HyperthyroidismTachycardia and PalpitationsNervousnessWeaknessTremorsHeat intoleranceWeight loss despite eating regular diet, Hair loss DiarrheaHyperemesis gravidarumT4 and T3 are elevated an TSH decreased

Hyperthyroidism and PregnancyNSG. DX: Alt. Nutrition, less than body

requirements Risk for injuryKnowledge deficitNsg Care-

Assess the client for clinical manifestation of complications of the hyperthyroidism or pregnancy

Monitor lab tests- thyroid function testsAdminister antithyroid medications- Propylthiouracil

(PTU)Assist the client to meet her nutritional needs during

the pregnancy with education and evaluation of diet .

Hyperthyroidism in PregnancyNsg. Care-

Daily weightsMonitor fetal statusEmotional support

Hypothyroidism in PregnancyHypothyroidism is a condition where thyroid

does not produce enough thyroid hormoneComplications

Decreased fertilityAbortionsStillbornsAnd congenital malformations

Review of the clinical manifestations of hypothyroidismCold intoleranceWeight gainDryness of skinPuffy faceConstipationMental dullness

Hypothyroidism in PregnancyLaboratory Findings

Low T4 and T3 and elevated TSH levelsNsg. Diagnosis

Risk for Maternal/Fetal InjuryKnowledge deficit

Nsg CarePreconception Care- treatment of Thyroxine prior

to getting pregnantAdminister LevothyroxineMonitor TSH levels and T4 levels Instruct the client about the importance of medical

therapyMonitor fetal status with FMC or NST’s

Systemic Lupus Erythematosus in PregnancySystemic Lupus Erythematous(SLE) is a chronic,

multisystem autoimmune disorderComplications in pregnancy

Renal FailureCardiac Problems CNS ProblemsPreeclampsiaAbortionsFetal Loss Newborn- prematurity, congenital heart block, and

neonatal lupusIUGRExacerbation of SLE

Systemic Lupus Erythematosus in PregnancyReview of the clinical manifestations of SLE

Joint painSkin rash nephritisPericarditisAnemiaLeukopeniaThrombosis of multiorgansFeverneuropsychiatric

Systemic Lupus Erythematosus in PregnancyLaboratory Findings with SLE

Leukopenia- WBC under 4,500Thrombocyctopenia- PLt- under 100,000Anemia- Hg- under 10Positive direct Coombs’ testPositive Anticardiolipin antibodiesPositive tests for rheumatic factors False Positive test for syphilisPositive antinuclear antibodies Increased serum

creatine and decreased creatine clearance and proteinuria

Cont. SLE in PregnancyNSG Diagnosis

Risk for Maternal and Fetal InjuryKnowledge DeficitAnxiety or Fear

NSG CarePreconceptation CareInstruct the client to see her health care providers

frequently and to follow the medical therapyMonitor the client and the fetus and neonate for

complicationsAdminister Medications as order

Prednisone Aspirin Cyclophosphamide( Cytoxan)- only for life-threatening

conditions Azathioprine (Imuran)

Anticardiolipin Antibody SyndromeAnticardiolipin Antibody Syndrome is an

autoimmune disorder which the client has the Anticardiolipin antibodies. It can be seen in clients with or without SLE. It can produce negative outcomes in pregnancy and fetal loss

Complications of Anticardiolipin antibody syndrome in PregnancyMaternal

Thrombosis Cerebral vascular accidents, Amaurosis fumax Transient ischemic attacks SLE Autoimmune thrombocytopenia

Anticardiolipin Antibody SyndromeCont. Complications

Fetal Complications Abortions Fetal loss IUGR

Placental insufficiencyClinical Manifestations

Several Fetal LossesSpontaneous AbortionsLaboratory findings

Positive serum Anticardiolipin antibody titer Other abnormal immunologic studies

Anticardiolipin Antibody SyndromeNsg Diagnosis

Risk for Maternal and Fetal InjuryAnxiety or Fear

Nsg CareAdminister medications

Immunosuppressant drugs- corticosteroids and others

Aspirin Anticoagulants-Heparin

Instruct on medication therapyMonitor client and fetus for complicationsEmotional support

Myasthenia gravis in PregnancyMyasthenia gravis (MG)is a complex

autoimmune disorder that affects the neuromuscular system .

Complication of MG in PregnancyExacerbation of the myasthenia gravis or a

myasthenic crisisMaternal mortality because of respiratory

arrestPregnancy lossPremature labor Transient Neonatal Myasthenia GravisPulmonary Hypoplasia of the neonate

Myasthenia Gravis in PregnancyReview of the clinical manifestations of MG

Progressive muscle weaknessDifficulty in swallowingPtosisSlurred speechFatigueProblems breathing

NSG DiagnosisRisk for Maternal and Fetal InjuryAnxiety or FearFatigueAlter nutritionRisk for aspiration

Myasthenia Gravis in PregnancyNSG Care

Monitor client and fetus for complicationsAdminister medications – Many medications will

exacerbate MG .Check any medication prior to give it. See chart Acetylcholinesterase drugs

Pyridostigmine bromide ( Mestinon) po or parental if client can not swallow Check that client can swallow first

Anticholinergics ( Atropine)for drug over dose Corticosteroids- Prednisone

Instruct client on therapy regimen and compliance with the therapy and seeing health care providers regularly.

Monitor client closely in Labor.

Myasthenia Gravis In pregnancyNote Magnesium sulfate is absolutely

contraindicated for clients who have Myasthenia Gravis

Prepare room with suction ,oxygen, and ambu bag and check emergency equipment.

Check infant at time of birth and in nursery for sucking and muscle tone. Watch when the baby feeds.

Provide frequent rest periods for mother

Deep Vein Thrombosis in PregnancyDeep Vein Thrombosis (DVT)is a condition

where blood clots form in the veins.Complications of DVT in Pregnancy

Vascular occlusionEmbolismPulmonary embolusHypoxiaAcidosis death

Deep Vein Thrombosis in PregnancyClinical Manifestations of DVT

Muscle painTenderness and swelling of calfPositive Homan’s sign

Diagnostic parametersDoppler ultrasonographyVenography may cause risk to fetusImpedance plethysmorgraphy

Deep Vein Thrombosis in PregnancyNSG Diagnosis

Alter. Tissue PerfusionRisk for Injury

NSG CareMaintain bedrest during the acute phaseApply Ted hoseMonitor fetal statusAdminister Anticoagulation therapy

Heparin-IV the Subcutaneous Follow protocols for anticoagulant therapy NO Warfarin Coumadin

Deep Vein Thrombosis In PregnancyNSG Care

No heparin therapy once labor starts.Monitor laboratory testing

PT, APTT, INR, Blood clotting times

InfectionsTypes of infections:

TORCHSTI’sOther

TORCHTORCH is a group of infections which can

cause serious problems to the fetus

T= ToxoplasmosisO= Other- Hepatitis -HIVR= RubellaC= Cytomegalovirus (CMV)H= Herpes

ToxoplasmosisToxoplasmosis is a protozoan infection which

is acquired by the infestation of raw meat and handling of raw meat in mass qualities, cat feces and handling cat litter. If the pregnant acquires toxoplasmosis during pregnancy it can be passed the fetus via the placenta.

Maternal effects are mild-flu-like symptomsFetal-abortion, and congenital effectsNeonatal effects- CNS lesions which could

lead to hydrocephy, microcephaly, seizures and chronic retinitis

ToxoplasmosisPregnant Clients should not handled cat

litter or cat feces. When handling cats wash hands afterwards

Pregnant clients should not eat raw meat and when handling large amounts of raw meat they should wear gloves. Wash hands after handling raw meat

OtherHepatitis is a viral infection. There are several

different types. HAV and HBV are the must common seen in the fetus. HAV is acquired through fecal commination. HBV is acquired through body secretions-blood and genital secretions

HBV effects on the client are fever, malaise, nausea, and abdominal discomfort and maybe liver failure.

HBV effects on the fetus preterm birth and fetal death.

The Neonate can be born with the infection

RubellaRubella is a viral infection that is spread by

droplets or cross the placenta. It is also called the German Measles.

Rubella titers are drawn on all pregnant womenRubella titer of 1:8 or more indicated immunityRubella less than 1:8-example a titer of 1:6 or 1:4

indicates the client is non-immune. The client will need a Rubella immunization after delivery.

Rubella effects on the client are fever, rash and mild lymphedema.

Fetal effects are abortion, congenital anomalies and death

CytomegalovirusCytomegalovirus (CMV) is a viral infection

through respiratory droplets and body fluids and cross the placenta.

CMV effects on the pregnant client are asympotomatic illness, cervical discharge, or mononucleosis-like syndrome.

CMV effects on the fetus are fetal death or severe generalized disease, hemolytic anemia, jaundice, hydrocephaly, microcephy.

CMV effects on the neonate are pneumonia, hepatosplenomegaly and deafness

Herpes Simplex Virus Herpes Simplex Virus (HSV)is a viral infection

that is spread by exposure to the vesicular lesions.

HSV effects on the pregnant client are blisters which are painful, rash, fever, malaise, nausea, and headaches.

HSV effects on the fetus are abortion, preterm labor, stillborn, IUGR- transplacental spread of infection is rare.

HSV effects on the neonate are skin lesions, mental retardation, and microcephaly

STI’s

Human Immunodeficiency Virus (HIV)ChlamydiaSyphilisHepatitis BGroup Beta Streptococci (GBS)HerpesGonorrheaHuman papillomavis (HPV)

Urinary Tract Infections in Pregnancy

Lower UTI’s – CystitisCan cause preterm labor and pyelonephritis

Upper UTI’s- PyelonephritisCan cause preterm labor , sepsis, and renal

failureMedications

Cephalosporin'sAmpicillins or AmoxicillinNo Sulfonamide within 4 weeks of delivery can

cause kernicterus in the neonateNo Trimethoprim in early pregnancyNo Tetracyclines

Epilepsy in PregnancyEpilepsy is a neurologic disorder in which there

is recurrent seizure activity.The client who is pregnant and has epilepsy

could have an increased risk for seizures , abortions, premature labor, and stillborn infants.

Many anticonvulsants can produce teratogenic effectsPhenytoin(Dilantin)Carbamazepine Dapakote

The pharmokenetics of the seizure medication is effect by the changes in physiology during pregnancy.

Trauma in PregnancyTrauma in pregnancy

Abdominal Trauma can be caused by Accidents such as falls or automobile accidents

(MVA) Assault

With weapons Abuse/violence

Complications unique to pregnancy of abdominal trauma Placenta abruption Preterm labor Uterine trauma or rupture Bladder trauma or rupture Maternal or Fetal death

Trauma in PregnancyClinical Manifestations

History of trauma or accidentVisible injuriesPainSigns of ShockUterine activityAbdominal swelling or firmnessNonreassuring fetal Heart Pattern

Nsg diagnosisRisk for Injury AnxietyAlt. Tissue Perfusion Fear

Trauma in PregnancyNSG Care

Assess and triage the serious of injuresABC’sStart Iv with Large bore catheterMonitor for clinical manifestations of shock

and /or hemorrhageMonitor uterine activityMonitor fetal heart patternI&O-hourlyBe Prepare for a delivery of the babyNotify ICN staffEmotional support

Cholcycstitis and Cholelithiasis in Pregnancy

Cholcycstitis and Cholelithiasis are common during pregnancy.

Clinical manifestationsRight upper quadrant tenderness and painMurphy” SignAttacks after mealsPain with nausea and vomiting

Medical Treatment during pregnancyLow Fat Diet

Cont. NSG Care

Monitor for signs of Gall bladder obstructionInstruct client on low fat diet

Less than 20 grams of fat Calories such come mainly from carbohydrates Plenty of fruit and vegetables Lean meats Only 10-12 % of calories such be protein

A pregnant client will not be able to have lipotripesy or drugs to dissolve gall stones.

Surgery in Pregnancy

The problem with surgery in pregnancy will vary depending on the surgery.

Complications that are unique with pregnancy preterm labor, and fetal injury from various cause such as hypoxia, medications, and trauma.

Close monitoring for labor and the fetal status are required

SUBSTANCE ABUSE in PregnancySubstance Abuse is a major problem in the

United States . It is estimated that 10% of pregnant abuse 0r use some substance during pregnancy. (Tobacco, alcohol or other drugs)

All pregnant women should be screened for substance abuse.

See text for the effects of drugs on the fetus and neonate and pregnancy

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