NCM 109 - Care of Mother and Child at Risk or With Problems (Acute and Chronic)
●
SUBSTANCE ABUSE DURING PREGNANCY
● Use of illicit or recreational drugs,
medication drugs, tobacco, alcohol, etc.
during pregnancy has an adverse effect
on both mother and fetus
● A single episode of consuming two
alcoholics drinks during pregnancy can
lead to the loss of some fetal brain cells
➢ One drink is defined as 12 ounces
of beer, 5 ounces of wine, or 1.5
ounces of hard liquor
Fetal alcohol syndrome (FAS) may result to
mothers who are alcoholics, s /s includes:
● Short palpebral (eye) fissures
● A flat nasal bridge
● A thin, flat upper lip
● A poorly formed groove at the center of
the upper lip
● A small head (microcephaly)
TREATMENT & NURSING CARE;
● Identify the substance-abusing
woman early in pregnancy, educate
her about the effects of substance
abuse and encourage her to reduce or
eliminate use.
● A trusting, therapeutic nurse-patient
relationship makes it more likely tha a
woman will be thruthful about the use
of substances
➢ Use a non-judgemental approach
and treat the Issue as a health
problem
➢ Support the woman who is trying
to reduce or eliminate drug use
➢ Praise efforts
INFECTIONS DURING PREGNANCY
● The acronym TORCH has been used
to describe infections that can be
devastaling for the fetus or newborn
T- toxoplasmosis
O- other infections
R- rubella
C- cytomegalovirus
H- herpes simplex
CYTOMEGALOVIRUS (CMV) VIRAL
INFECTIONS
● Is widespread and commonly occurs
during the childbearing years
UNISIX
The infection is often asymptomatic in
the mother, however an infected
infant may have:
➢ Mental retardation
➢ Seizures
➢ Blindness
➢ Deafness
➢ Dental abnormalities
➢ Petechiae (often called a
"blueberry muffin" rash)
Treatment and Nursing Care
● No effective treatment for CMV
● Therapeutic pregnancy may be offered
if CMV infection is detected early in
pregnancy
RUBELLA
● Mild viral disease with a low fever and
rash
● Effect on the developing fetus can be
destructive
➢ Early pregnancy it can disrupt
the formation of major organs
➢ Later in pregnancy it can
damage the organs that are
already formed.
Some effects on the developing embryo or
fetus includes:
● Microcephaly
● Mental retardation
● Congenital cataracts
● Deafness
● Cardiac defects
● Intrauterine growth restrictions (IUGR)
Treatment and Nursing Care
● Immunization against rubella Infection
➢ If immunized, a woman should
not get pregnant for at least 3
months after immunization
➢ Usually offered in the postpartum
period for nonimmune women
➢ It is not given during pregnancy
because it is a live atlenuated
form of virus
● The nurse should check each
postpartum woman's chart for rubella
immunity and notify her physician if she
is not immune
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NCM 109 - Care of Mother and Child at Risk or With Problems (Acute and Chronic)
HERPESVIRUS
● There are 2 types of herpes viruses
➢ Type I-causes fever, bllsters, or
cold sores
➢ Type I- casues genital herpes
(commonly affects pregnancy)
● After the primary infection, the virus
becomes dormant in the nerves and
maybe reactivated as recurrent
(secondary) infection
● Initial infection during the first half of
pregnancy may cause spontaneous
abortion, intrauterine growth restriction,
and preterm labor
● Most pregnancies are affected by
recurrent infections rather yhan primary
infections
● The infant is infected one of the
following ways:
➢ The virus ascends into the uterus
after the membranes ruptures
➢ The infants has direct contact
with infectious lesions during
vaginal delivery
● Neonatal herpes infection can be either
localized or disseminated
➢ Disseminated neonatal infection
has a high mortality rate, and
survivors may have neurological
complications
Treatment and Nursing Care
● Cesarean delivery is required if mother
has active genital herpes to prevent the
neonate from contact with infection
● Mother and neonate do not need to be
isolated as long as direct contact with
lesions is avoided
● Breastfeeding is safe as long as no
lesions sre present in the breasts
HEPATITIS B
● The virus that causes hepatitis B
infection can be transmitted by blood,
saliva, vaginal secretions, semen, and
breast milk
● It can also cross the placenta
● The woman may be asymptomatic or
acutely ill with:
➢ Low-grade fever
➢ Anorexia
➢ Nausea and vomiting
● Some become chronic carrier of the
virus
UNISIX
●
The fetus may be infected
transplacentally or by contract at birth
with blood or vaginal secretions
➢ The infant may be chronic
carriers and continue to be a
source of the infection
Treatment and Nursing Care
● All women should be screened for
hepatitis B during pregnancy
● Immunization during pregnancy is
contraindicated
● Infants born to women with Hepatitis
B should received a single dose of
hepatitis B immune globulin (for
temporary immunity right after birth
followed by hepatitis B vaccine (for
long term immunity)
➢ If possible, injections should be
done after the infant's first bath,
so that blood and other
potentially infectious secretions
are removed to avoid introducing
them under the skin
HERPESVIRUS
● Causative agent for acquired
immunodeficiency syndrome (AIDS)
● The virus eventually cripples the
immune system, making the infected
mother susceptible to infections that
can result to death
● The mother cam acquire the virus
through:
➢ Sexual contact with an infected
person
➢ Parenteral or mucous membrane
exposure to infected body fluids
➢ Perinatal exposure (infants)
● Infants can acquire the virus through:
➢ Transplacentally
➢ Through contact with infected
maternal secretions at birth
➢ Through breast milk
● The infected woman has 20-40 percent
chance of transmitting the virus
● Infants born to HIV-positive mothers will
be HIV-positive at birth because
maternal antibodies to the virus pass
through the placenta
➢ 3-6 months are needed to
identify true HIV infection
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NCM 109 - Care of Mother and Child at Risk or With Problems (Acute and Chronic)
Nursing Care
● HIV testing is recommended for all
prenatal visits
● HIV-positive women are educated that
the transmission of HIV infection to the
newbor can be greatly reduced by
appropriate drug therapy
● Breastfeeding is contraindicated
● All infants born to HIV-positive women
are presumed to be HIV-positive
➢ Institute standard precautionary
measures
➢ Wear protective gears
➢ Anticipate and help mother cope
with anxiety
TAXOPLASMOSIS NONVIRAL INFECTIONS
● Caused by Toxoplasma gondii, a parasite
that may be required by contact with
cat feces or raw meat and transmitted
through the placenta
● The woman usually has mild symptoms
Congenital toxoplasmosis includes the
following possible signs in the newborn:
● Low birth weight
● Enlarged liver and spleen
● Jaundice
● Anemia
● Inflammation of eye structures
● Neurologic damage
Treatment & nursing care
● Therapeutic abortion may be offered to
the woman who contracts the infection
during the first half of pregnancy
● The nurse can teach the woman the
following measures to reduce the
likelihood of acquiring the infection;
➢ Cook all meat thoroughly
➢ Wash hands and all kitchen
surfaces after handling raw meat
➢ Avoid touching the mucous
membranes of the eyes or mouth
while handling raw meat
➢ Avoid uncooked eggs and
unpasteurized milk
➢ Wash fresh fruits and vegelables
well
➢ Avoid materials contaminaled
with cat feces, such as lifter
boxes, sand boxes and garden
soil.
UNISIX
GROUP STREPTOCOCCUS (GBS) INFECTION
● Leading cause of perinatal infections
that have a high neonatal mortality rate
● The organism can be found in the
woman's rectum, vagina, cervix, throat,
or skin
● Although she in colonized with the
organism, the woman is usually
asymptomatic, but the infant may be
infected through contact at birth with
vaginal secretions
➢ The risk is greater if the woman
has a long labor or premature
rupture of membranes
Symptoms include:
● An elevated temperature
● Rapid heart rate
● abdominal distention
Diagnosis
● GBS infection is confirmed by vaginal or
rectal culture
Treatment
● All positive cultures require immediate
penicillin treatment
TUBERCULOSIS
● Pregnant women are screened by
tuberculin skin test
● If the screening test is positive, they
should have a chest radiograph (x-ray)
with the abdomen shielded with a lead
apron
● Sputum cultures that are positive for
the bacterium confirms diagnosis
● The newborn may acquire the disease
by contact with an untreated mother
after birth
The adult with tuberculosis experiences:
● Fatigue
● Weakness
● Loss of appetite
● Weight loss
● Fever
● Night sweats
Treatment and Nursing Care
● Notify the physician immediately for
positive culfures
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NCM 109 - Care of Mother and Child at Risk or With Problems (Acute and Chronic)
●
●
Usual drug treatment for tuberculosis
are given to the pregnant client
Teach the family how organism is
transmitted and the importance of
continuing the drug therapy
SEXUALLY TRANSMITTED INFECTIONS
● Includes gonorrhea, syphilis,
Chlamydia, trichomoniasis, and
condylomata acuminate (genital warts)
● • Changes in the vaginal secretions that
occur during pregnancy can increase
the risk of developing vaginal infection
➢ High estrogen levels present
during pregnancy thicken the
vaginal mucosa and increase
secretions that have a high
glycogen content
➢ This makes the woman
susceptible to yeast infections
and other microorganisms
● All sexual contacts of persons infected
with a disease that can be sexually
transmitted should be informed and
treated to stop the cycle of infection
and reinfection
● Use of condom reduces the sexual
spread of STIs
URINARY TRACT INFECTION
● Common in female because of
➢ The short urethra
➢ The ease of contamination of the
urethra from the rectum, and of
contamination from the vagina
during sexual activity
● The urinary tract is normally
self-cleaning because acidic urine
inhibits the growlh of microorganisms
and flushes them out of the body with
each voiding
● Pregnancy alters this self-cleaning
action because
➢ Pressure on urinary structures
keeps the bladder from emptying
completely
➢ The ureters dilate and lose
motility under the relaxing
effects of progesterone
● Urine that is retained in the bladder
becomes more alkaline, providing a
favourable environment for the growth
of microorganisms
● Some women have excessive
microorganisms in their urine but with
UNISIX
no symptoms (asymptomatic
bacteruria) which leads to cystitis
(bladder infection) or pylenophritis
(kindey infection)
Cystitis
● Burning wilh urination
● Increased frequency and urgency of
urination
● A normal or slightly elevated
temperature
Pyelonephritis
● High fever
● Chills
● Flank pain or tenderness
● Nausea and vomiting
➢ The high maternal fever is
dangerous for the fetus because
it increases the fetal metabolic
rate increases felal oxygen needs
t levels that the mother cannot
readily supply
Treatment:
● Antibiotic, often ampicillin
Nursing care:
● Teach woman to reduce the
introduction of rectal microorganism
into the bladder
➢ Front-to-back direction should be
used when wiping after urination
or a bowel movement, when
doing perineal cleansing, or
when applying and removing
perineal pads
● Adequate fluid intake promotes
frequent voiding
➢ At least 8 glasses per day
➢ Cranberry juice may make the
urine more acidic and therefore
less conducive to growth of
microorganism
● Sexual intercourse mildly irritates the
bladder and urethra, which can
promote a UTI
➢ Urinating before intercourse
reduces irritation
➢ Urinating afterward flushes urine
from the bladder
➢ Using water-soluble lubricant
during intercourse can also
reduce periurethral irritation
related to intercourse
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