 Clinical



Severe nausea and vomiting
Severe dehydration-fluid loss
Electrolyte imbalance:






Manifestations:
Hypokalemia
Hyponatremia
Ketosis- Ketones in the urine (Ketonuria)
Metabolic acidosis
Weight loss
Bleeding gums
 Complications:






Metabolic acidosis
Starvation/malnutrition
Acid-base imbalance
Maternal death
Fetal problems (CNS malformation, IUGR)
Termination of pregnancy
 NURSING




IV therapy with replacement of electrolytes and possible
TPN.
Maintain NPO status for 24-48 hour vomiting has stopped
Facilitate the client’s environment- quiet , stress free,
and odor free
Assess and Monitor:



CARE:
VS, I&O, Daily wt. Nutritional status, Emotional support.
Laboratory studies: CBC, UA, Serum chemistries, and liver
function studies
Administer antiemetics- Relgan , Zofran,
 Nursing

After vomiting has stopped diet progresses slowly :






Care:
Clear liquids
Bland diet – cold foods first, small servings, without fluid
Regular diet
Teach client about the disease process, procedures and
treatments, diet, medications, and follow up care
Provide emotional support
Monitor Fetus if ordered.
Diabetes Mellitus
 Cardiac disease or conditions
 Hypothyroidism
 Hyperthyroidism
 Anemia’s
 Rh sensitization
 Systemic Lupus erythematosus
 Anticardiolipin Antibody Syndrome
 Myasthenia gravis
 Renal Disease
 Epilepsy
 Asthma

 DIABETES
MELLITUS is an endocrine order in which
major effect is on carbohydrate metabolism and is
the results from an inadequate product of insulin or
insulin resistance
 Classification of DM:

Pregestational:



Gestational:


Type I
Type II
Type III (GDM)
White’s Classifications of diabetes in pregnancy
 Pregestational



It is best if the client have her diabetes mellitus under
control before getting pregnant. Blood sugars in normal
ranges
Preconceptual care and guidance
Type I:



Diabetes:
Insulin therapy will vary
Complications:
 Ketoacidosis
 Fetal problems-IUGR
Type II:


Possible oral agent will be change or change to Insulin
Fetal problems

Gestational Diabetes Mellitus is the result of the
pancreas is unable to meet the increase demands for
insulin production during pregnancy and/or insulin
resistance from various hormones during pregnancy:
Increase cortisol level
 Placenta hormones-Human Placenta lactogen (hPL), insulinase

GDM starting in the last half of the pregnancy
around 28-32 weeks)
 Client may show Clinical Manifestations of DM and
problems with immune system-Freq. UTI’s and can
 It is diagnosis by :

Elevated blood glucose levels
 GTT-1 hour or 3hour

 Review





Diabetes mellitus
Hypoglycemia
Hyperglycemia
Diabetes Ketoacidosis (DKA)
Normal Adult Blood Glucose Levels
 Risk




clinical manifestations of:
factors for GDM(Class A) :
Pregnancy
Obesity
Previous large infants,
previous unexplained stillborn

Complications:







Varies with the degree of extent of disease process of DM
Preeclampsia
Polyhydraminos
Abortion
Fetal Anomalies‘- Cardiac and Neurolical defects
Stillbirth
Neonatal Problems:




Macrosomia
Hypoglycemia
Hyperbilirubinemia
Delayed lung maturity? RDS
 NURSING


Facilitate maintaining blood glucose levels within normal
levels:
Teach or review:





CARE:
ADA diet
Assessing Blood glucose
Exercise
Medications:
 NO Oral Hypoglycemic Agents ( except for those that do not
cross the placenta)
 Insulin
Monitor fetal well being- FMC and other
 Calories-
30-35 kcal/IBW(Kg) in first
trimester
and 35-36 Kcal/IBW(Kg)
per day.
 3-4 small meals and 3-4 snack per day
 Bedtime snack important with at least
25grams of carbohydrates
 At least 250 Grams of carbohydrates per day.
 Carbohydrates- 50-60% of calories
 Protein-12-20% of calories
 Fats-limited to under 30grams according to
ADA & AHA
 Nursing





Care:
Monitor client for development of complications
Prepare for possible preterm delivery or cesarean
section.
Intrapartum care will depend on the extent of the
disease process and blood glucose levels- IV Insulin
therapy maybe used.
Maintain postpartum blood glucose levels ( blood glucose
levels will drop in this period because of hormonal
influences of pregnancy decrease and stop-about 34days after delivery.)
Careful observation of the neonate whose mother has
DM.
 CARDIAC





DISEASE and pregnancy :
Because of the hemodynamic changes that occur in
pregnancy the client who has a cardiac disorder will
have problems and complications.
Outcomes will depend on the degree of cardiac
compromise. See NYHA Classifications of heart disease.
Clients who have a history of Rheumatic fever may have
undiagnosed cardiac effects, and may need further
evaluation.
Client will never to be seen by Cardiologist and
Perinatalogist
NSG. DX- Decrease cardiac output, Fluid volume excess,
Activity intolerance, Risk for infection, Anxiety.
I
II
III
IV
Classification
Asymptomatic will normal
levels of activity-No
physical limitations
Slightly compromised
Symptomatic with greater
than ordinary physical
activity
Marked compromised
Symptomatic with ordinary
activity Capacity
Functional
Severely compromised
 Complications:





Decreased cardiac output and altered blood flow
Decreased maternal and fetal perfusion
Congestive heart failure
Preterm delivery
Death
 NURSING

CARE:
Teach client to maintain healthy life style:










Adequate nutrition for pregnancy
Take Prenatal vitamins and iron to prevent anemia
Avoid excessive weight gain
Stress management
Exercise such as walking
No over exertion and frequent rest periods
Monitor for signs of infection
Go to all appointments with her physicians
Monitor fetal well being with FMC
Report signs of cardiac decompensation ( heart failure)to
health care providers
 Assess
and monitor for signs of cardiac
decompensation.
 Medication therapy:








Prenatal vitamins and iron
Stool softeners
Prophylactic Antibiotics with any invasive procedures
and before delivery
Cardiac glycosides (digitalis)
Antidysrhythmia agents
Furosemide (Lasix) – only with CHF
Heparin if anticoagulant therapy is needed
No warfarin (Coumadin)
Nursing Care:
 Head of bed elevated
 Labor:

Avoid excessive stress
 Epidural anesthesia is preferred
 No prolonged pushing in labor- forceps or vacuum extraction
may be used


Postpartum:
Continue prenatal vitamins and iron
 Frequent rest periods
 No staining with BM’s
 Monitor closely during this period for cardiac decompensation

 Iron
Deficiency Anemia ( Microcyctic)
 Folic Acid Deficiency Anemia (Macrocyctic)
 Sickle Cell Anemia
 ETC.
 Any problem with low RBC’s will effect oxygenation
to maternal and fetal tissues
 Iron
Deficiency Anemia is a result of a decrease
intake of iron. It can range from mild to severe.
The decrease of RBC’s can effect the transportation
of oxygen to the maternal organs and to the fetus.
 All pregnant women need to increase their intake of
iron during pregnancy through diet or supplements
 Foods high in Iron.

SICKLE CELL DISORDER is a heterozygous form of
hemoglobin S (HbAS) that is common in people from the
Mediterrian area and Africa. It is an Autosomal
Recessive Disorder.
 Sickle Cell Anemia(SCA) is the most common inherited
anemia complicating pregnancy.
 SCA Crisis because of the stress of the pregnancy.
 Clinical manifestations of SCA Crisis:

Hemolytic anemia
Pain in joints , back, abdomen, extremities
Blood clots
 Infections
 Infarction to organs



Precipitated factors for SCA Crisis :
Hypoxia
Acidosis
Dehydration
Stress
Cold
Infection
 Complications





of SCA CRISIS:
Vaso-occlusion Crisis
Pain
Pulmonary emboli
Folic anemia
Fetal problems:



IUGR
Stillborn
Hypoxia
 NURSING




CARE:
Asses and monitor client for clinical
manifestations of SCA Crisis and complications
Provide the client a warm environment, and
hydration ,possible blood transfusions
Be prepared to start IV, give O2, analgesia.
Medications:



Folic Acid
Heparin- not warfarin
Analgesia-NO ASA and Demerol