lOMoARcPSD|33538472
Chapter 20 Nursing Care Of A Family Experiencing A Family
Experiencing A Pregnancy Complication From A Pre-Existing
Or Newly Acquired Illnesss
Nursing (University of Perpetual Help System Jonelta)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Chapter 20: Nursing Care Of A Family Experiencing A Family Experiencing A
Pregnancy Complication From A Pre-Existing Or Newly Acquired Illnesss
DEFINITION OF A HIGH RISK PREGNANCY
One in which a concurrent disorder, pregnancy-related complication, or external factor
jeopardizes the health of the woman, the fetus, or both.
CARDIOVASCULAR SYSTEM
A pregnant client with cardiac disease may be unable physiologically to cope with the added
plasma volume and increased cardiac output that occur during pregnancy;
blood volume is at maximum during the last weeks of the 2nd trimester
con't
CV SYSTEM CON'T
Cardiovascular disease complicates only 1% of pregnancies but accounts for 5% of maternal
deaths.
Blood volume and cardiac output increase up to 30-40% during pregnancy (peak at 28-32
weeks), which places stress on a compromised heart
Heart disease is divided into four stages
see page 516 - table 20.1
CARDIOVASCULAR ISSUES: COMMON CAUSES
Valve damage with or without valve replacement
Congenital anomalies
Coronary artery disease (CAD)
Chronic hypertensive vascular disease
Venous thromboembolic disease
Peripartum heart disease
COMMON CARDIOVASCULAR CLINICAL FINDINGS
Left sided heart failure
Associated with crackles, SOB
Occurs with mitral stenosis; mitral insufficiency; aortic coarctation
Left ventricle cannot move the large volume
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Pulmonary edema - shortness of breath, productive cough with blood speckled sputum
Orthopnea - SOB when lying flat. When chest/head is elevated it allows for gas exchange
Paroxysmal nocturnal dyspnea - waking up with SOB when sleeping
Right sided failure
Associated with body symptoms such as edema
Due to unrepaired congenital heart defect (pulmonary valve stenosis, Eisenmenger syndrome)
Right ventricle is overwhelmed
Distended liver and spleen - can cause dyspnea and pain
Ascites - fluid accumulates in the peritoneal cavity
Peripheral edema - swelling of legs/feet
Peripartum cardiomyopathy
Heart increases in size during pregnancy due to stressed CV system
Mom will feel short of breath and have chest pain.
Therapy for Peripartum Cardiomyopathy
Reduce physical activity
Take diuretic, an arrhythmia agent and digitalis
Increased risk of thromboembolism, may need heparin (increased risk of blood clot)
Data Collection
Level of exercise - what can she do without getting short of breath or cyanotic
Presence of cough or edema - rapid or difficult respirations, irregular pulse, peripheral edema.
Does she have chest pain on exertion?
Comparison of baseline vital signs - BP, HR, RR, nail bed filling should be less than 5 seconds
Data continued
Liver size - right sided heart failure involvement
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
ECG/echo
Fetal size (small for fetal age) and poor response to labor (FHR decelerations) can also go into
preterm labor
Nursing Interventions During Antepartal Period
Reduce the effects of maternal CV disease on the pregnancy and fetus by
Promote rest - limit physical activities
Promote healthy nutrition - adequate nutrition to prevent anemia; low sodium diet may be
prescribed due to fluid retention and heart failure
Avoid excessive weight gain
Educate regarding avoidance of infection - an infection increases body temp and metabolism forces heart to work more
Interventions during intrapartum and post partum periods
Intrapartum period
Maintain bed rest - position mom on left side, and head/shoulders elevated
Monitor VS frequently
Administer oxygen and pain medication as prescribed
Intrapartum period con't
Place patient on a cardiac monitor and an external fetal monitor
Epidural anesthesia is recommended to decrease energy used for pushing - a vacuum or forceps
may be used to assist birth
Postpartum period
Blood volume increases 20-40% after the delivery of the placenta
Assess for heart failure (SOB, edema)
May need decreased activity after delivery
Anticoagulant to prevent thrombus formation
postpartum period con't
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Dig therapy to promote better pumping of the heart
Antiembolic stockings or SCDs to increase venous return from the legs
Pitocin (for uterine contraction/involutino) should be used with caution, as it can increase blood
pressure
Cardiovascular Issues
Chronic HTN
Beta Blockers
Ace inhibitors may be used to control the elevated BP
Venous Thromboembolic Disease - DVT
Risk can be reduced by not wearing constrictive knee-high stockings, not sitting with legs
crossed and void standing in one position too long
Diagnosed by Doppler Ultrasound
DVT treatment
Bed rest
IV Heparin for 24-48 hours then changed to subcu shots in the arms/thighs. Don't want clot to
move, could become PE (S/S - chest pain, SOB)
Must stop heparin once labor starts to reduce possibility of hemorrhage
Hematologic Disorders
Iron deficiency Anemia
Develops as a result of an inadequate amount of serum iron
Most common anemia of pregnancy
Should take prenatal vitamins that contain 27 mg of iron
Iron deficiency anemia con't
Eat foods that have iron (green leafy, meat, legumes)
Give iron with OJ (vit C)
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Stools will look black tarry
Sickle Cell Anemia
Recessively inherited hematoligc anemia caused by an abnormal amino acid
Red blood cells are irregular or sickle shaped so they cannot carry as much hemoglobin. They
may clump together and then hemolyze which causes severe anemia
1 in every 10 African-Amer have the sickle cell train or carries a recessive gene
Interventions for Sickle Cell
Monitor for hemolytic sickle cell crisis- drop in hemoglobin
Treatment - blood transfusions, hydration, 02 and pain management
H - HYDRATION
O - OXYGEN
P - PAIN MGMT
UTI
Can occur in pregnancy, if untreated can develop pyelonephritis
10-15% of pregnant women are asymptomatic, obtain clean catch every prenatal visit
UTI s/s
Frequency
Pain with urination
Pyelonephritis s/s
Pain in the lumbar region that radiates down
Tender flank on palpation
Nausea/vomiting
Malaise
Frequency
Fever and Pain
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Treatment of UTI/pyelo
Urine C & S to find which ATB will work best
Tetracycline is contraindicated d/t affects on fetus - retardation of bone growth and staining of
teeth
Nursing Dx for UTI
Risk for infection related to stasis of urine with pregnancy
Interventions/Teaching
Void every 2 hours
Urinate as soon as need is felt
Wipe front to back
Cotton underwear
Void after sex
Cranberry juice helps bacteria not to stick to bladder
Tuberculosis
Highly communicable caused by Mycobacterium tuberculosis - airborne transmission
TB Assessment
Chronic cough
Wt loss
Hemoptysis
Low grade fever
night sweats
extreme fatigue
PPD skin test - is positive - chest x-ray or sputum culture will confirm dx
Treatment of TB
Isoniazid, rifampin, ethambutol hydrochloride are drugs of choice - safe during pregnancy
NB can become infected from contact with infected individuals
Urge mom to con't her medication even if breastfeeding
Hepatitis Assessment
N/V
Liver area tender to palpation
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
Urine is dark yellow
Light colored stools
Jaundice occurs late - high bilirubin
Interventions
C-section birth may be planned to reduce blood exchange
Use precautions during birth to reduce exposure to maternal body fluids
After birth mom may breast feed
Interventions con't
Infant should be washed well to remove any maternal blood and then receive the fist dose of
Hep B vaccine
Observe infant for symptoms of infection
increased temp
fussy not consoled
Woman with Diabetes Mellitus
DM is an endocrine disorder where the pancrease cannot produce adequate insulin to regulate
glucose levels
Before 1921 when insulin was synthetically produced, woman would die before childbearing
age, were sub-fertile, or had spontaneous miscarriages
Now that type 1 and 2 DM can be manged, we see 3 challenges:
How to manage type 1 and 2 diabetes during pregnancy
How to protect the infant in utero from adverse effects of increased glucose levels
How to care for an infant 24 hours after birth until the infant's insulin-glucose regulatory
mechanisms stabilizes
DM - Pathophysiology/clinical manifestations/description:
Primary concern - controlling the balance btw insulin and blood glucose to prevent hyper
and/or hypoglycemia
Infants of women with unregulated diabetes are 5x more apt to be born large for gestational
age or with anomalies
DM patho con't
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
When insulin is insufficient, glucose cannot get into body cells. The liver thinks the body needs
more glucose, so it increases the blood levels even more.
Once blood glucose reaches 150 mg, the kidneys start to dump glucose in the urine (glycosuria).
Fat is broken down to create energy, which releases ketones into blood stream/urine
Diabetes during pregnancy
All woman appear to develop in insulin resistance as pregnancy progresses - it helps prevent
maternal glucose from falling to dangerous levels
If poorly controlled the fetus must produce more insulin to counteract the overload of glucose.
This acts as a growth stimulant, causing baby to grow greater than 10 lbs = macrosomia
DM during preg con't
Macrosomia can cause cephalopelvic disproportion or increase the risk of shoulder dystocia
More risks - caudal regression syndrome (lower extremities fail to develop), miscarriage,
stillbirth, hypoglycemia, respiratory distress syndrome, hypocalcemia, and hyperbilirubinemia.
McRoberts maneuver
Head out - shoulders get stuck.
Mom's legs get pulled wide to open up the pelvis
Prevent dystocia
Gestational Diabetes
At the midpoint of pregnancy, insulin resistance becomes most noticeable. This is when 2-3% of
pregnant women develop gestational diabetes mellitus.
The symptoms subside after pregnancy but woman have a 50-60% chance of developing type 2
DM later in life.
Gestational Diabetes Risk Factors
obesity
over 25 years old
hx of large babies - 10 lbs or more
fetal loss
polycystic ovarian syndrome
family hx of diabetes or high risk population such as Native Amer., Hispanic and Asian
Gestational Diabetes testing
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
All women should be screened during pregnancy.
Glucose screening - fasting plasma glucose of greater than or equal to 126 or nonfasting greater
than or equal to 200 meets the threshold for diagnosis.
Testing con't
If glucose is high, a second test is performed called the Glucose challenge test
Fasting sample taken, then drink 75 g glucose, then sample is taken at 1 hour, 2 hours and 3
hours later.
See table 538
Testing scale
Fasting - 95
1 hour - 180 or less
2 hours - 155 or less
3 hours 140 or less
two abnormalities - test fail
Therapeutic Mgmt for DM
Women with pre-existing diabetes and gestational DM need more frequent prenatal visits for
close monitoring of their condition
Sometimes diet alone can control gestational diabetes
Mgmt for DM con't
Insulin: short acting and intermediate
Insulin need will increase as pregnancy progresses. Insulin is adjusted to keep fasting blood
glucose below 100 and postprandial below 120.
Injection sites
Stretch skin taught and inject at 90 degree angle.
**Use arms and thigh sites and rotate injection sites for consistent absorption
Blood glucose monitor - glucose taken
if high assess urine for ketones
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
if low teach mother to eat some form of sustained carbs (milk and graham crackers)
Insulin Pump
Insulin is administered by a continuous pump through subcutaneous tissue
Remove pump when showering. Remove syringe and tubing to swim
Monitor blood glucose level 4 times a day - fasting, then 1 hour after each meal
Insulin is delivered at about 1 unit/hr then patient can give boluses based on what they eat.
Nursing Interventions During Labor
Monitor the fetal status continously for signs of distress.
Woman's glucose levels are regulated with IV insulin
Assist to carefully regulate insulin and provide IV glucose as prescribed, because labor depletes
glucogen
Nursing Interventions During the Postpartum Period
Observe for hypogylcemia in mother and newborn
Re-regulate insulin needs, as prescirbed, after the first day according to glucose testing
Determine dietary needs on the basis of blood glucose and insulin requirements
Monitor for signs of infection or postpartum hemorrhage.
chronic conditions that will affect pregnancy
cardiovascular disease kidney disease unintentional injury
who is at risk in high risk pregnancies
both the woman and the fetus
risks of high risk pregnancy
the pregnancy complicates the disease
the disease complicates the pregnancy affecting the fetus or leaving a woman less equipped to
function in the future
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
pregnancy is a time that women show
extra care and concern for keeping healthy because there's two of them
this extra motivation encourages the mother to keep her and her fetus safe
high risk pregnancy
a pregnancy which is concurrent with disorder related to complication or an external factor
jeopardizes the health the woman feed us or both
why is it important to identify women with high-risk pregnancies
the illness can complicate the pregnancy and the woman's entire lifestyle
typically does just one factor contribute to a high-risk pregnancy
no typically more than one factor
how do you establish a baseline when caring for a woman with a high-risk pregnancy
through your vital signs prenatal assessment past medical history physical exam and further
education
Iris pregnancy cardiovascular system
cardiovascular disease complicates only 1% of pregnancies but accounts for 5% of maternal
deaths
how does blood volume and cardiac output coincide with cardiovascular system pregnancy
risks
blood volume increases 50% during pregnancy and cardio output does as well placing stress on
a compromised heart
what criteria is commonly used to categorize a severity of heart disease
New York heart association criteria
what cardiovascular disorders are the most common high-risk pregnancies
ruemetic fever or Kawasaki disease
congenital abnormality such as septal defects or uncorrected cohortation of the aorta
Marfan Syndrome
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
genetic connective tissue disorder that can cause a ruptured aorta
it causes aortic dilitation and is a high risk for pregnancy
what is a correlation between cardiovascular disease and pregnancy
as the number of women delaying their first pregnancy increases or the corresponding incidents
to coronary artery disease and varicosities during pregnancy
what disease doesn't correlate with age and causes cardiovascular disease and women
paripartum heart disease rare heart disease occurs unrelated to age
what type of approach does a woman with cardiovascular disease in pregnancy need
multi-professional team approach
how much does blood increase in cardiac output increase in pregnancy
50% and 30%
when does blood volume increases peak in pregnancy
week 28 to week 32
if a woman has heart disease this is the time where science and symptoms will be noted if not
at the very beginning of the pregnancy
severe heart failure and increased blood volume
toward the end of pregnancy her heart may become so overwhelmed by the blood volume that
her cardiac output falls to the point that all vital organs can no longer be perfused to adequately
when this happens oxygen and nutritional requirements of her cells and those are the fetus are
not met
to protect the pregnancy outcome heart diseases divided into how many categories
four categories
woman with a class one or two heart disease
experience a normal pregnancy and birth
woman with class three heart disease
complete pregnancy best by maintaining special interventions such as bed rest
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
woman with class four heart disease
ask to avoid pregnancy because they're in cardiac failure at rest
left-sided heart failure causes
mitral stenosis mitral insufficiency aortic coarctation
blood backs up into the pulmonary system and cannot be spread effectively to the body
signs and symptoms of left-sided heart failure
pulmonary hypertension
lower cardiac output
lower systemic blood pressure
distended heart
pulmonary edema
orthopnea
perioxomal nocturnal dyspnea
orthopnea
woman cannot sleep in any position except with chest and head elevated causing fluid to pull
away from lungs
paroxysmal nocturnal dyspnea
the sun waking at night with shortness of breath
right-sided heart failure causes
the right ventricle is overwhelmed with the amount of blood received
unrepaired congenital heart defects such as pulmonary valve stenosis
A Eisenmenger syndrome
Eisenmenger syndrome
a right to left atrial or ventricular septal defect with accompanying pulmonary valve stenosis
signs and symptoms of right-sided heart failure
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
liver and spleen distended and enlargement
distension of abdomen and lower extremity vessels
ascites
peripheral edema
is right-sided heart failure or left-sided heart fail more ill-advised for pregnancy
right-sided heart failure
if they do become pregnant need oxygen administration and frequent blood gas assessments
cardiovascular issues and high risk pregnancy
valve damage or no valve replacement
congenital abnormalities
coronary heart disease
chronic hypertensive vascular disease
Venus thromboembolic disease
peripartum hard disease
peripartal cardiomyopathy
Myocardial failure apparently due to the effect of the pregnancy on the circulatory system.
exceptionally rare
assessment of a woman with cardiovascular system high-risk pregnancy
her level of exercise presence of copper edema comparison of baseline vital signs her liver size
ekg's echocardiograms the fetal size and response to labor
if a woman has a low exercise performance before pregnancy
evaluate to what degree identify shortness of breath or cyanosis
if a woman has a cough or edema
important to note because pulmonary edema from heart failure may be manifested by a simple
cough
why document edema and cardiac disease
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
to distinguish the beginning of edema from heart failure
liver assessments late in pregnancy
are difficult and probably inaccurate because the enlarged uterus process delivered upward into
the ribs and makes it difficult to palpate
fetal assessment and cardiovascular disease
fetuses from women with severe cardiovascular disease typically have low birth weights or are
small for gestational age because of acidosis which develops due to poor oxygen carbon dioxide
exchange or not being furnished with enough nutrients
risk for fetus and cardiac disease
preterm labor because body cannot give it what it needs to grow
Mal responses to labor with cardiovascular disease pregnancy
a fetus may have fetal heart rate decelerations and not respond well to labor a cesarean birth
may be necessary which will be an increased risk for Mom and fetus
when creating outcome evaluations be certain that goals and outcomes established with
heart disease are realistic
not all women with heart disease will be able to complete the pregnancy successfully
some infants of the woman with severe impairments may have neurological or cognitive
challenge as a result
nursing interventions for cardiovascular system high-risk pregnancies during the antipartal
period
promote rest promote healthy nutrition educate regarding medication educate regarding
avoidance of infection
would it be good for a woman to increase her periods of rest to strengthen her heart with
high risk cardiovascular pregnancy
yes
try to eliminate complications by promoting activities of rest
nursing interventions for interpartum period of high-risk cardiovascular pregnancy
and sure the woman is in a good position
use epidural anesthesia and assisted vaginal delivery for these women
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
position change if a woman with pulmonary edema
technically pregnancy we want women on sideline position however with a woman with heart
failure place her in semi-followers position to ease breathing
why use epidural anesthesia assisted vaginal delivery for cardiac patients
we don't want these women to push or Force contractions
the anesthesia decreases sensation of pushing and makes labor and birthless taxing
we don't want to stress her heart out more
postpartum nursing interventions for high risk cardiovascular pregnancy
assess for heart failure
administers anticoagulants and digitoxin therapy
use intermittent pneumonic compression boots
the period immediately after birth is critical for a when with heart disease because
she delivers the placenta and the blood supply to that placenta is released into her general
circulation increasing blood volume by 20 to 40%
normal pregnancy versus cardio pregnancy blood volume adjustment
in normal pregnancy the blood volume adjustment is easier once the placenta is released even
though it's in five minutes
in cardio pregnancy the five minute increase in blood volume the heart must rapidly and
effectively make an adjustment which can be stressful
anticoagulant and digitoxin therapy for cardio pregnancy
helps compensate for circulatory changes
anti-embolitic stockings or ICP boots
increase Venus return from the legs helps cardio pregnancy
prophylactic antibiotics
should be started prior to birth for cardio pregnancies and should be started after birth to
discourage subacute bacterial endocarditis caused by the placental site
thromboemboletic disease in women
pulmonary embolism occur
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
poor Venus return from pressure of the uterus leads to circulatory stasis
thrombophlebitis make occur
increase blood congestion in the pelvis leads to stasis
increased estrogen levels causes increased blood coagulation
why does Venus thromboembolitic disease increase during pregnancy
Stacus of blood and lower extremities from uterine pressure hypercoagulability of blood due to
estrogen levels
pressure of the fetal head at birth damages lower extremity veins
DVT formation and pregnancy
highest in women 30 years of age and older because increased age is a risk factor to thrombus
formation may cause a pulmonary emboli
reduction of thrombus formation and pregnancy
avoiding the use of constrictive knee-high stockings
not sitting with legs crossed at the knee
avoid standing for long periods of time
if a thrombus does occur during pregnancy
woman may not realize the pain and redness in the calf
typically diagnosed by Doppler ultrasonography
treatment includes bed rest and intravenous Heparin for 24 to 48 hours
a woman with diabetes mellitus
an endocrine disorder in which the pancreas cannot produce adequate insulin to regulate blood
glucose levels
effects 3 to 5% of all pregnancies
MOST FREQUENT MEDICAL CONDITION IN PREGNANCY
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
pathophysiology of diabetes mellitus
woman needs to control the balance between her insulin and blood glucose levels to prevent
hyperglycemia or hypoglycemia
both these conditions are dangerous to pregnancy because of long-term effects and the threat
to normal fetal growth
infensive women with unregulated diabetes are
five times more app to be born large for gestational age or with birth anomalies
type 1 diabetes and pregnancy
typically an autoimmune disorder because marker antibodies are present
pancreas fails to produce the insulin for body requirements
type 2 diabetes and pregnancy
gradual loss of insulin production but some ability to produce insulin will be present
gestational diabetes mellis
two to 3% of all women who do not begin pregnancy with diabetes develop this condition
during pregnancy usually at the midpoint of pregnancy when insulin resistance becomes most
noticeable
diabetes during pregnancy
decrease control of glucose regulation
affects feta size infant hypoglycemia and increased incidence of congenital abnormalities
true or false all women during pregnancy are screened for gestational diabetes
true
a fasting plasma glucose greater than or equal to
126 mg per DL or non-fasting plasma glucose greater than or equal to 200 mg per deal means
the threshold for diagnosis of diabetes and does not need confirmation
50 g glucose challenge test
a test given between 24 and 28 weeks of gestation to determine the risk for gestational diabetes
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
if the result of the test is greater than 140 mg per DL woman will need to do 3-hour glucose
tolerance test
3-hour glucose tolerance test
a fasting Lucas sample is obtained in a woman drinks oral 100 g of glucose solution
her blood is drawn for glucose determination of one hour two hour and three hours later
if two of the four blood samples collected for this test or abnormal or the fasting value is above
95 diabetes is diagnosed
steps diabetic women during pregnancy should take
woman should meet with her physician to plan pregnancy
measure her hba1c over four to six weeks
do a urine culture for asymptomatic UTIs due to high glucose
perform eye exams to assess for retinal etc macular edema and retinal hemorrhage
interventions for a diabetes during pregnancy
educate patient regarding nutrition during her pregnancy
educate patient regarding exercise during her pregnancy
nutrition education for diabetics during pregnancy
carp consumption and dietary education reduction and saturated fats and cholesterol and
increase in dietary fiber
encourage her to use snacks to maintain adequate blood pressure and prevent hypo and
hyperglycemia
calorie should be 20% from protein 40 to 45% from carbohydrates and 30% from fats
exercise education for women with pregnancy
best to start walking 30 minutes a day and adjust her food and snacks to her exercise time
what type of snack should a diabetic woman eat prior to exercise
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
a protein or a complex carb
therapeutic management of diabetes during pregnancy
educate the patient related to monitoring her blood glucose
educate the patient related to what type of insulin needs she has and her dosage amounts
educate the woman related to pump care and use if applicable
educate the woman related to recording her fetal movements to test for placental function and
fetal well-being
educate woman to manage postpartum blood glucose as well
because blood glucose levels near normal help minimize the risk of maternal fetal
complications
both women with gestational diabetes and those with overt diabetes need more frequent
prenatal visits to ensure monitoring of their condition
what are most pregnant woman given to treat their diabetes
insulin usually needed less earlier in pregnancy and increased later in pregnancy
blood glucose monitoring for diabetic pregnancies
take a fasting and a postprandial four times a day
insulin therapy pumps for pregnant women
maybe consider depending on if patient needs continuous rate of insulin given through pump
because women with diabetes tend to have infants higher than normal incidents of birth
abnormalities
a serum a feta protein level will be obtained 15 to 17 weeks to assess for neural tube defects
an ultrasound will be performed 18 to 20 weeks to detect gross abnormalities
creatine clearance test for diabetic pregnancies
ordered each trimester to assure the woman's vascular system is intact and kidney function is
normal
placental functioning assessment for diabetic pregnancy
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
weekly non-stress test or biophysical profile during last trimester of pregnancies may occur if a
woman is in good control
a daily non-stress test may occur for regulation is poor
why do diabetic patients do self-monitoring fetal well-being
to evaluate if their fetus is doing well 10 kicks per hour
ultrasound at week 28 and week 36 to 38 for diabetic pregnancies
determine fetal growth amniotic fluid volume placental location bypartal diameter a Lego
hydraminos or polyhydraminus
oligohydramnios with diabetic pregnancy
small amount of amniotic fluid indicate fetal growth restriction and fetal renal abnormality
polyhydramnios and diabetic pregnancies
excessive amount of amniotic fluid and indicates gastrointestinal malformation and poorly
controlled disease
after pregnancy type one and type two diabetics
and learner medication returns to pre-pregnancy needs
gestational diabetic treatment after pregnancy
no further diet or insulin therapy is needed
assessing a pregnant woman with renal disease
elevated blood pressure from poor kidney function
proteinuria frequency burning bacteria if urinary infection is present.
flank pain if phyllo nephritis
elevated serum creatine from decreased kidney function
renal and urinary disorders and pregnancy
adequate kidney function is important for a successful pregnancy outcome because a woman is
excreting products not only for herself but for the fetus
Downloaded by Ianah Lim (ianahlim8@gmail.com)
lOMoARcPSD|33538472
the stool function May interfere with kidney or urinary function and make be serious
Reno and urinary tract disorders interventions for pregnancy
employ nutritional consults and monitor fluid intake
encourage perineal hygiene
encourage frequent voiding after sexual intercourse as well to prevent urinary stasis
encourage intake of cranberry juice to prevent UTIs
4 to 10% of non-pregnant women have
a symptomatic bacteruria
this means organisms are present within the urine without symptoms of a UTI infection
pregnancy and urinary tract infection
ureters daily because effect of progesterone and stasis of urine can occur
minimal presence of abnormal amounts of glucose provides ideal medium for organisms to
grow
10 to 15% of pregnant women
have a symptomatic UTIs that are potentially dangerous cuz they can progress to filon nephritis
and are associated with preterm labor and premature rupture of membranes
Downloaded by Ianah Lim (ianahlim8@gmail.com)