Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 1
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
1. Formulate a plan for nursing in the
management of teenage pregnancy.
2. Describe the effects on and
management of substance abuse on
the childbearing family.
3. Analyze prenatal responses when an
infant is born with congenital
anomalies.
4. Formulate a nursing care plan for
families experiencing a pregnancy
which doesn’t result in a live birth.
5. Illustrate nursing care for clients
undergoing the various methods of
elective abortion.
6. Discuss the various ethical and legal
considerations of elective abortion.
7. Differentiate among causes, signs
and symptoms, possible
CONTENTS
I. The childbearing family with special
needs:
A. Adolescent pregnancy
1. Incidence
2. Factors associated with
teenage pregnancy
3. Socioeconomic, psychological
and health implications.
B. Substance Abuse
1. Maternal and Fetal Effects
2. Fetal death
C. Loss and Grief
1. Imperfect baby
2. Fetal death
D. Elective Abortion
1. Medical
2. Surgical
LEARNING ACTIVITY
REQUIRED READINGS
Carpenito: Potential
Complications: Reproductive
Wong, pp. 213-216
Wong, pp. 270-272, 647-653,
pp. 514-523
Required Video:
Gestational Age Assessment
RG 613.5647
Wong, pp. 121-123
Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 2
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
complications, and management of
spontaneous abortion, ectopic
pregnancy, incompetent cervix and
hydatiform mole.
8. Compare and contrast the
pathophysiology, medical
management, and nursing
management of clients diagnosed or
suspected of having placenta previa
and abruptio placenta.
9. Describe the pathophysiology
medical treatment, nursing care
goals and interventions associated
with disseminated intravascular
coagulation (DIC).
10. Discuss the effects and management
of hyperemesis gravidarum.
11. Describe the pathophysiology of
pregnancy induced hypertension.
(pre-eclampsia).
12. Differentiate between the
management of the woman with
mild pre-eclampsia and the women
with severe pre-eclampsia.
13. Describe HELLP Syndrome,
including appropriate nursing
actions.
CONTENTS
LEARNING ACTIVITY
Wong, pp. 290-305
II. Complication
A. Hemorrhagic Disorders
1. Early pregnancy
a. Spontaneous abortion types
b. Ectopic pregnancy
c. Incompetent Cervix
d. Hydatiform Mole
2. Late Pregnancy
a. Placenta Previa
b. Abruptio Placentae
3. Disseminated Intravascular
Coagulation
Wong, pp. 288-290
B. Hyperemesis gravidarum
C. Hypertensive disorders
1. Pathophysiology/current
theories
2. Characteristic Symptoms
a. Mild
b. Severe
Wong, pp. 275-288
Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 3
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
14. Compare Rh and ABO
incomptability in terms of etiology
and fetal-neonatal complications.
15. Plan care for a pregnant woman
with diabetes either gestational or
pre-existing.
16. Describe the effect on pregnancy
and its management for the woman
who has heart disease.
17. Describe the effects of and
CONTENTS
3. Goals, principals, rationale of
nursing care
4. Magnesium Sulfate
Administration
5. Effects of PlH on fetus.
D. Rh, ABO Incompatibility
1. Erythroblastosis fetalis
E. Diabetes Mellitus
1. Classification of diabetes in
pregnancy
2. Effects of diabetes on
pregnancy, and pregnancy on
diabetes.
3. Medical and nursing
management
F. Cardiovascular disease
1. Etiology
2. Review of normal physiologic
alterations of cardiovascular
function.
3. Classification of heart disease
4. Medical and nursing
management.
LEARNING ACTIVITY
Wong, pp. 653-657
Wong, pp. 242-255
Wong, pp. 256-266
Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 4
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
treatments for anemias during
pregnancy.
18. Describe the effects and treatments
of sexually transmitted diseases and
infections on pregnant women and
the fetus.
19. Analyze factors that increase a
woman’s risk of preterm labor.
20. Describe the management of
preterm labor and premature
rupture of membranes.
21. Discuss the management of
Dysfunctional Labor patterns.
22. Describe the common deviations in
CONTENTS
G. Anemias
1. Folic acid deficiency
2. Iron deficiency
3. Sickle cell anemia.
H. Sexually Transmitted Diseases
1. Chlamydia
2. Gonorrhea
3. Syphilis
4. HIV
I. Infections
1. TORCH
2. Condylomata (HPV)
3. Trichomonas
4. Group B Streptococci
III. Intrapartum Complications
A. Premature labor
1. Maternal and fetal factors
2. Nursing Implications
3. Medications
B. Dysfunctional Labor
1. Hypertonic
2. Hypotonic
LEARNING ACTIVITY
Wong, pp. 75-89
Wong, pp. 305-308, pp. 642-647
Wong, pp. 410-424
Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 5
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
the power, the passage, the
passenger, the position, or the
psyche that can cause dystocia.
23. Discuss the problems associated
with post-term pregnancies.
24. Describe common intra-partum
emergencies and management.
25. Identify non-reassuring fetal heart
patterns.
26. Describe appropriate nursing
responses to non-reassuring fetal
heart rate patterns.
27. Describe postpartum hemorrhage
interms of predisposing factors,
causes, complications, clinical signs
and therapeutic management.
28. Describe thromboembolic disorders
including incidence, etiology, sign
and symptoms, and management.
29. Describe the signs and symptoms
CONTENTS
LEARNING ACTIVITY
3. Precipitate
C. Dystocia
1. Alterations in pelvic structure
2. Fetal causes
3. Position of the Woman
4. Psychological Response
D. Common emergencies of labor
Management
1. Prolapsed umbilical cord
2. Uterine rupture/eversion
3. Amniotic fluid
4. Shoulder dystocia
E. Non-reassuring heart rate
patterns
1. Tachycardia & Bradycardia
2. Variable & late decelerations
IV. Postpartum Complications
A. Post Delivery Hemorrhage
1. Uterine Atony
2. Lacerations of birth canal
3. Retained placenta
B. Thromboembolic disease
1. Superficial venous thrombosis
Wong - pp. 438-443
Wong – pp. 353-364
Wong – pp. 498-506
Course Number: RNSG 2514
Care of the Client with Complex Health Needs
Page 6
UNIT V
Review normal physiological changes of pregnancy, and normal labor and delivery.
BEHAVIORAL OBJECTIVES
and management of postpartum
infections.
30. Describe the complications of and
management of problems that may
result from the premature birth.
31. Compare the problems of the large
for-gestational age infant with those
of the small-for-gestational infant.
CONTENTS
LEARNING ACTIVITY
2. Deep venous thrombosis
3. Pulmonary embolism
C. Postpartum infections
1. Puerperal sepsis
2. Wound Infections
3. UTI’s
V. High Risk Newborn
A. Complications associated with
prematurity
1. Respiratory distress syndrome
2. Bronchopulmonary dysplasia
3. Rationopathy of prematurity
4. Periventricularintraventricular hemorrhage
5. Necrotizing enterocolitis
Wong – Chap. 27