RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
1.
2.
3.
Behavioral Objectives
Apply the terms listed in the content
column appropriate to the client
situations.
Compare and contrast the normal
anatomy and physiology to the
physical and physiological changes
of a pregnant woman.
Analyze factors included in the
assessment of the client experiencing
complex problems of pregnancy.
I.
Content Outline
Applications of terms
A. Abortion
B. Cephalopelvic disproportion
C. Dystocia
D. Cystitis
E. Erythroblastosis fetalis
F. Exchange transfusion
G. Hydatidiform mole
H. Hydramnios
I. Hydrops fetalis
J. Hypertonicity
K. Hypotonicity
L. Incompetent cervix
M. Kernicterus
N. Polynephritis
O. Trophoblastic disease
II. Anatomy & Physiology of the Female
Reproductive System
A. Developmental considerations
1. Non-pregnant
2. Pregnant
B. Review normal physiologic adaptation to
pregnancy
III. Assessment of the pregnant client
A. Interview
1. Chief complaint
2. Precipitating event
3. Gynecologic history
4. Pregnancy history
a.
Current
b.
Past
5. Medical history
6. Family/Social history
7. Religious/culture history
Clinical Objectives
Identify priorities and make
judgments concerning the needs
of multiple clients in order to
organize care.
Learning opportunities
Readings:
Lehne (2010)
Manage care for multiple
clients.
VCR:
#1091 – Electronic Fetal Monitoring –
Interpreting the Tracing
Apply management concepts in
assigning and/or delegating
nursing care to other members
of the nursing team.
Use critical thinking as a basis
for decision-making in nursing
practice.
Prioritize client care and followup on problems that warrant
investigation.
Serve as a member of voluntary
health care and community
teams to provide services to
individuals and communities
and unmet needs.
Promote collegiality among
interdisciplinary health care
team members.
Collaborate with members of
nursing and other health care
organizations to promote the
profession of nursing.
McKinney (2009)
Computer Simulations:
#2105 Analgesia and
Anesthesia/Maternity Client
Review Cardiovascular Unit Level III
1) Rheumatic Heart Disease
a. Congenital Heart Disease
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
Content Outline
8. Occupational history
9. Partner’s history
10. Medication histpry
a.
Prescription
b.
Non-prescription
B. Physical exam
1. Respiratory
2. Cardiovascular
3. Neuro
4. G.I.
5. Abdomen
6. Breast
7. Edema
8. Weight
9. Vital signs
C. Diagnostic tests
1. Lab
a.
CBC
b.
HBG/HCT
c.
PT
d.
PTT
e.
Bleeding time
f.
Coagulation
g.
Fibrinolytic activity
h.
Rh factor/type
i.
Alpha-fetoprotein (AFP)
j.
Glucose
k.
Blood urea nitrogen (BUN)
l.
Creatine
m.
Total protein
n.
Electrlytes
o.
Liver enzymes
2. Urine
a.
Urinalysis
b.
Culture
3. Amniocentesis
4. Lecithin/sphingomyelin (L/S)
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
4.
Differentiate between the etiology,
pathophysiology, and clinical
manifestations of selected complex
problems of pregnancy.
Content Outline
5. Phosphatidylglycerol (PG)
6. Nonstress test (NST)
7. Contraction stress (CST)
8. Fetal activity
9. Biophysical profiles
10. Electronic fetal monitoring
D. Cultural influences
1. Hereditary/genetic
2. Environmental
3. Health belief/practice
E. Developmental influences
1. Age specific
a.
Pregnant adolescent
b.
Over 35
IV. Complex problems of pregnancy
A. Gestational onset
1. Abortion
2. Ectopic pregnancy
B. Fertility issues
C. Hypertension
1. Pregnancy Induced Hypertension
(PIH)
2. Chronic hypertension
3. Chronic persistent with
superimposed PIH
4. Late/transient hypertension
5. HELLP syndrome (hemolysis,
elevated liver function, low platelet)
D. Endocrine
1. Diabetes Mellitus
a.
Pregestational
b.
Gestational
2. Hyperemesis gravidarum
E. Infectious
1. Prenatal
a.
Toxoplasmosis, rubella,
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
5.
Discuss analysis, planning,
implementation and evaluation of
nursing management of clients with
complex problems of pregnancy
Content Outline
cytomegalovirus (TORCH)
2. Postpartal
a.
Endometritis
b.
Mastitis
F. Preterm labor
G. Post term labor
H. Hemorrhage/clotting disorders
1. Placenta previa
2. Placenta abruption
3. Disseminated intravascular
coagulopathy (DIC)
4. Postpartum hemorrhage
I. Perinatal loss
J. Post partum psychiatric disorders
1. Depression
2. Psychosis
V. Selected nursing
diagnoses/interventions/evaluation
A. Knowledge deficit of home health
maintenance/diversional activity deficit
(Home Care)
1. Independent interventions
a.
Physical Assessment
1) Edema
2) Vital signs
3) Weight
b.
Home assessment
1) Client responsibilities
2) Dependents
3) Support system
4) Sleep/rest
5) Leisure activity
6) Socio/economic status
c.
Assess knowledge
level/readiness to learn
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
Content Outline
d.
Teach
1) Bed position
2) Stress/Relaxation
3) Exercises
4) Nutritional needs
5) Medication
6) Recognition
7) Signs/symptoms
8) Community Resources
e.
Encourage family support
2. Collaborative interventions
a.
Administer medications &
monitor for signs and
symptoms
1) Sedatives
2) Antihypertensives
3) Diuretics
4) Anti-depressant
3. The client will remain compliant
with home care regimen as
evidenced by:
a.
In bed, on left side 90% of
the time
b.
Participating in diversionary
activities (TV, puzzles,
reading, and crafts)
c.
Performing gentle exercise
4 times/day
d.
Utilizing relaxation
techniques to cope with
stress
e.
Allowing family to assist in
care of house and children
4. Risk for complications (Hospital
care).
a.
Independent intervention
1) Physical Assessment
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
Content Outline
a) Neuro status
b) Respiratory status
c) Deep tendon
reflexes (DTR)
d) Edema
e) Vital signs
f) Weight
g) Fluid volume
balance
h) Urine
(1) output
(2) protein
(3) specific gravity
2) Monitor pertinent labs
3) Maintain seizure
precautions
4) Monitor blood glucose
5. Collaborative interventions
a.
Administer medications &
monitor for desired
effects/adverse effects/side
effects
1) Sedatives
2) Antihypertensives
3) Diuretics
4) Anticonvulsive
5) Tocolytics
6) Steroids
7) Insulin
8) Calcium gluconate
9) Magnesium sulfate
6. The client will not develop seizures
or signs that indicate her condition is
deteriorating as evidenced by:
a.
Develops no seizures
b.
Reflexes are 1+ or 2+ (scale
0-4+)
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit VII – Care of the Client Experiencing Complications of Pregnancy
Behavioral Objectives
N\ADN Spring 09/RNSG 4214 Unit VII Pregnancy
Content Outline
c.
No clonus beat are observed
d.
Respiration are >12
breaths/minute
e.
Urine output is >30 ml/hr
f.
Reports no headaches or
visual disturbances
g.
Reports no abdominal
tenderness
h.
Reports no vaginal bleeding
i.
Reports no nausea,
vomiting, fatigue, or
anorexia
j.
Fetus has no late
decelarations
k.
Fetus has a heart rate of
120-160 BPM
l.
Nonstress test (NST) is
reactive
m.
Contraction Stress test
(CST) is negative
Clinical Objectives
Learning opportunities
Reviewed 06/11