Chapter 17: Pregnancy at Risk: Pregnancy-Related Complications - PowerPoint Presentation

Slide1

Chapter

17:

Pregnancy at Risk: Pregnancy-Related Complications

Hyperemesis Gravidarum

Nursing care of hyperemesis gravidarum focuses on

Decreasing trigger factors

Assisting the woman with regaining fluid balance

Obtaining nutrition needed for healthy fetal development.

Question

Although there is not a clear understanding of what causes hyperemesis gravidarum, several conditions have been linked with it. What is one condition that has been linked with hyperemesis gravidarum?

a. Single pregnancies

b. Older mother

c. Molar pregnancy

d. Obesity

Answer

c. Molar pregnancy

Rationale: The risk of hyperemesis is increased with a multiple gestation (pregnancy with more than one fetus), molar pregnancy, or when there is a history of hyperemesis gravidarum.

Ectopic Pregnancy

Signs and symptoms of ectopic pregnancy include missed menstrual period, nausea and vomiting, abdominal pain, shoulder pain, and vaginal spotting or bleeding.

If the fallopian tube ruptures, the woman experiences hemorrhage into the abdominal cavity and may develop hypovolemic shock.

Early Pregnancy Loss

Spontaneous abortion is loss of a pregnancy before the fetus is able to survive outside the uterus on his or her own (before viability, usually 20

weeks’

gestation).

Abortions are classified according to whether or not the uterus is emptied, or for how long the products of conception are retained.

The six types of spontaneous abortion are threatened, inevitable, incomplete, complete, missed, and habitual (recurrent).

Question

Early pregnancy loss, commonly known as “miscarriage” can occur for a variety of reasons. What is one of these reasons?

a. First pregnancy

b. Active maternal infection

c. Young age of mother

d. Multiple pregnancy

Answer

b. Active maternal infection

Rationale: Factors that increase the risk for spontaneous abortion include advancing maternal age, history of previous spontaneous abortion, smoking, alcohol and substance abuse, increasing gravidity, uterine defects and tumors, active maternal infection, and chronic maternal health factors, such as diabetes mellitus, renal disease, etc.

Cervical Insufficiency

Cerclage is the surgical procedure used to treat cervical insufficiency.

A suture closes the cervix with the goal that the woman will be able to carry the pregnancy to near-term.

Molar Pregnancy

For the woman with a molar pregnancy, provide client information regarding follow-up care, including the importance of frequent obstetrical visits, monitoring of serum hCG levels, avoiding pregnancy for at least

1

year, and reporting any symptoms of metastasis (e.g., severe persistent headache, cough or bloody sputum, or unexpected vaginal bleeding).

Question

A young woman has delivered a molar pregnancy. You are giving her discharge instructions when she asks you why she has to have blood drawn every

1

to

2

weeks by her primary caregiver. What is your best response?

a. To detect malignancy, which is treatable if caught early

b. To make sure you don’t develop ovarian cancer

c. Most women with a molar pregnancy get cancer during the following year

d. To detect any precursors to a malignancy

Answer

a. To detect malignancy, which is treatable if caught early

Rationale: Continued follow-up for

1

year is extremely important. The woman returns to the doctor’s office every

1

to

2 weeks

to have hCG levels drawn. This monitoring is necessary to detect malignancy, which is highly treatable if caught early.

Placenta Previa

Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to, or covers the cervix.

Abruptio placentae is associated with dark red, painful bleeding caused by the premature separation of the placenta from the wall of the uterus at any time before the end of labor.

Nursing Care Bleeding Disorder

The nursing process is used to develop the plan of care for a woman with a bleeding disorder.

The focus of the care plan is maintaining placental perfusion and fluid volume, avoiding maternal and fetal injury (dealing with decreased perfusion and hypoxia), preventing maternal injury (dealing with isoimmunization), and reducing anxiety and pain.

Hypertensive Disorders in Pregnancy

Hypertensive disorders are classified according to when in relation to the pregnancy the high blood pressure is first diagnosed, the presence or absence of proteinuria, and whether or not the condition resolves spontaneously after delivery.

The four categories of hypertension are gestational hypertension, preeclampsia/eclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension.

Hypertensive Disorders in Pregnancy (cont.)

Priority nursing interventions for the woman with preeclampsia–eclampsia include maintaining bed rest in a side-lying position; monitoring neurologic status, blood pressure, urinary output, and daily weights; maintaining a minimally stimulating environment; instituting seizure precautions; observing for signs of an impending seizure (headache, blurred vision, epigastric pain, hyperactive reflexes, and presence of clonus); assisting the RN with administering magnesium sulfate; and monitoring the fetus (fetal kick counts, fetal heart rate, and NSTs).

Question

Tell

whether

the following statement is true or false.

One of the first signs of magnesium sulfate toxicity is an absence of reflexes.

Answer

True

Rationale: Magnesium toxicity begins when serum magnesium levels approach 9 mg/dL. First reflexes disappear, then (as the levels increase), respiratory depression and cardiac arrest can follow.

Multiple Gestation

A multiple gestation (multifetal pregnancy) is at risk.

The woman is more likely to experience hyperemesis gravidarum, pyelonephritis, preterm labor, placenta previa, preeclampsia–eclampsia, and postpartum hemorrhage.

Close observation of the pregnancy with special attention to diet and fetal well-being is recommended.

The mode of delivery is dependent on several factors, the most important of which is the presentation of each twin.

Blood Incompatibilities

Rh and ABO incompatibilities can cause hemolytic disease of the fetus/newborn.

The goal of therapy for Rh incompatibility is to prevent isoimmunization of the woman.

This is done by administering RhoGAM to the Rh-negative woman within 72 hours of spontaneous abortion, birth, or invasive procedures, such as amniocentesis.

If the woman is isoimmunized, the focus of nursing care becomes the fetus, who may require exchange transfusions.