PREGNANCY AT RISK PREGESTATION PROBLEMS by sammyc2007

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									PREGNANCY AT
    RISK:
PREGESTATION
  PROBLEMS
 MNCN Chapter 14
           Heart Disease
• 1. Congenital Heart Defects
  – Arterial septal defect
  – Ventricular septal defect
  – Patent ductus arteriosus
  – Coarctation of aorta
  – Tetralogy of Fallot
       More Heart Disease
• 2. Rheumatic fever: causes scarring and
  may result in stenosis and/or regurgitation
• 3. Peripartum cardiomyopathy: occurs in
  the last months of pregnancy due to a
  dysfunction of the left ventricle, causing
  an enlarged heart, tachycardia, rales
• 4. Mitral Valve prolapse: usually tolerated
  well in pregnancy, some have symptoms
  Medical Therapy for heart
           disease
• Medical Therapy
• Classification of functional capacity
  – Class   I: no limit of physical activity
  – Class   II: slight limitation
  – Class   III: marked limitation
  – Class   IV: no physical activity
 More on Medical Therapy:
          Heart
• Drug Therapy: antibiotics, heparin,
  diuretics antiarrhythmic drugs
• Treatment of Class III and IV
• Nursing Assessment
  – Antepartal
  – Labor and Delivery
  – Post-partem
        Diabetes Mellitus
• A. Known Diabetes prior to
  pregnancy
  – Type I: insulin Dependant
  – Type II: insulin resistant
  – Pregnancy demands on insulin
    • First trimester: decreased need
    • Second and third trimester: increased need
      for insulin
    • Glucose use increases
Maternal Effects of Diabetes
      on Pregnancy
• Hydramnios
• Preeclampsia
• Hyperglycemia
• Urinary tract infectios
• Monilial vaginitis
 Fetal effects resulting from
  Maternal Plasma glucose
• Fetal death
• Macrosomia
• Respiratory distress syndrome
• hyperbiliurbinemia
– Gestational Diabetes Mellitus (GDM)

– Diabetogenic effect of pregnancy
• B. Influence of pregnancy on
  diabetes
• C. Influence of diabetes on
  pregnancy outcome
  – Maternal risks
  – Fetal- neonatal risks
           Medical Therapy for
                Diabetes
•   Team approach for care
•   Diet
•   Insulin
•   Glucose monitoring
•   Fetal well-being
    –   Alphafetoprotein
    –   Biophysical profile
    –   Fetal movement (kick counts)
    –   Nonstress testing
     More on Gestational
          Diabetes
• Screening: urine and blood tests
• Making the diagnosis
• Treatment
  – Intrapartal medical management: any
    diabetic
  – Labor
  – Postpartem
  Other Medical Conditions
• Anemia
 – Iron deficiency
 – Sickle Cell Anemia
 – Folic Acid Deficiency
• HIV/AIDS
 – Testing
 – Options when positive r/t pregnancy
 – Transmission
     SUBSTANCE ABUSE
• Alcohol
• Cocaine
• Marijuana
• Heroin
• Methadone

• Nursing Care
   OTHER LESS COMMON
      CONDITIONS
• Rheumatoid Arthritis
  – Remission of symptoms during
    pregnancy
  – May stop medication if in remission
  – Anemia may be present due to ASA use
  – Promote rest
• Epilepsy
  – Continue with medications to control
    seizures
  – Vitamin supplementation is
    recommended (esp. folic acid and
    vitamin D)
           Hepatitis B
• All pregnant women should be
  screened for the surface antigen
  (HBsAg)
• Perinatal transmission most often
  occurs at or near the time of
  childbirth
• Infants born to HbsAg + mothers
  should receive HBIG and start Hep B
  immunizations soon after birth
• Hyperthyroidism: complications of
  preeclampsia and postpartum
  hemorrhage a risk

• Hypothyroidism: Thyroid med.
  Should continue during pregnancy.
  if untreated, fetal loss 50%
  Maternal Phenylketonuria
• Diet low in phenylalanine is
  recommended (special formula)
• Children may inherit PKU or be a
  carrier
        Systemic Lupus
     Erythematosus (SLE)
• Before conception: remission
  recommended for 5-7 months
• Pregnancy complications
  – Diabetes, Preeclampsia, premature
    rupture of membranes
  – Urinary tract infections
  – Medication therapy is contraindicated
    during pregnancy.
    Maternal Tuberculosis
• May be associated with HIV infection
• May need multiple medications if
  active infection such as isoniazid and
  either ethamutol or rifampin or both

								
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