Infections during pregnancy (HIV,STD,ECT...)

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dsherman
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Infections during pregnancy (HIV,STD,ECT...)
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2011-11-28 17:04:15
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Infections during pregnancy HIV STD ECT
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Infections during pregnancy (HIV,STD,ECT...)
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  1. HIV/AIDS during pregnancy overview
    HIV is transmitted from the mother to a neonate perinatally through the placenta and postnatally through the breast milk

    Early identification and treatment significantly decreases the incidence of perinatal transmission

    Testing is also recommended in the third trimester of patients who are at an increased risk

    Procedures, such as amniocentesis and an episiotomy, should be avoided due to the risk of maternal blood exposure

    use of internal fetal monitors, vacuum extraction, and forceps during labor should be avoided because of the risk of fetal bleeding

    administering injections and blood testing should not take place until the first bath is given to the neonate
  2. Risk factors for HIV/AIDS during pregnancy
    • IV drug use
    • Multiple sexual partners
    • disexuality
    • maternal history of multiple STD's
    • Blood transfusion (rare occurance)
  3. Assessment data for HIV/AIDS during pregnancy
    • Subjective data:
    • Fatigue

    • Objective data:
    • diarrhea
    • weight loss
    • anemia

    • Laboratory test
    • obtain informed maternal consent prior to testing (patient has the right ot refuse). Testing begins with an antibody screening test such as enzyme immunoassay. Confirmation of positive results is confirmed by a Western blot testing

    screen the client for STD's such as, gonorrhea, Chlamydia, syphilis, and hepatitis B

    obtain frequent viral load levels and CD4 cell counts throughout the pregnancy
  4. Collaborative care for HIV/AIDS during pregnancy
    • Nursing care:
    • provide counseling prior to and after testing
    • refer the patient for a mental health consultation, legal assistance, and financial resources
    • use standard precautions
    • administer antiviral combination therapy as prescribed
    • obtain prescribed laboratory testing

    • Medication:
    • Retrovir (Zidovudine)
    • antiviral agent
    • nucleoside reverse trancriptase inhibitor
    • administer retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor or cesarean birth
    • administer retrovir to a neonate following delivery and for 6 weeks following

    • Discharge instructions:
    • instruct the patient not to breastfeed
    • discuss HIV and safe sexual relations with the patient
  5. TORCH infections during pregnancy overview
    TORCH is an acronym for a group of infections that can negitive affect on a woman who is pregnant. These infections can cross the placenta and have teratogenic affects on the fetus.

    TORCH doesn't include all the major infections that present risks to the mother and fetus
  6. Risk factors for TORCH infections
    Toxoplasmosis is caused by consumption of raw or undercooked meat or handling cat feces the symptoms are similar to influenza or lymphadenopathy

    Rubella (German measles) is contracted through children who have rashes of neonates who are born to mothers who had rubella during pregnancy

    Cyomegalovirus (member of herpes virus family) transmitted by droplet infection from person to person, a virus found in semen, cervical and vaginal secreations, breast milk, placental tissue, urine, feces, and blood. Latent virus may be reactivated and cause disease to the fetus in utero or during passage through the birth canal

    Herpes simplex virus (HSV) spread by direct contact with oral or genital lesions. Transmission to the fetus is greatest during vaginal birth if the woman has active lesions
  7. Assessment for TORCH infections during pregnancy
    • Subjective data:
    • Toxoplasmosis symptoms similar to influenza or lymphadenopathy
    • Malaise, muscle aches, (flu-like symptoms)
    • Rubella joint and muscle pain
    • Cytomegalovirus has asymptomatic or mononucleosis-like symptoms

    • Objective data:
    • Signs of rubella include rash, mild lymphedema, fever, and fetal consequences, which include miscarriage, congenital anomalies, and death
    • Herpes simplex virus initially presents with lesions
    • Signs of toxoplasmosis include fever and tender lymph nodes

    • Laboratory tests
    • for herpes simplex, obtain cultures from women who have HSV or are at or near term

    • Diagnostic procedures:
    • TORCH screen is an immunologic survey that is used to identify the existence of these infections in the mother (to identify fetal risks) or in her newborn (detection of antibodies against infections)
    • prenatal screenings
  8. Collaborative care for TORCH infections during pregnancy
    • Nursing care:
    • monitor fetal well-being
    • educate the patient on prevention practices including food hand hygine and cooking meat properly

    • Medications:
    • administer antibiotics as prescribed
    • toxoplasmosis treatment includes sulfomamides or a combination of pyrimethamine and sulfadiazine (potentially harmful to the fetus, but parasitic treatment essential)

    • Patient education:
    • Rubella, vaccination of women who are pregnant is contraindicated, because rubella infection may develop. These woment should avoid crowds of young children. Women with low titers prior to pregnancy should receive immunizations

    • Because no treatment for cytomegalovirus exists, tell patient to prevent exposure by frequent hand hygiene before eating, and avoiding crowds of youn children
    • emphasize to the client the importance of compliance with prescribed treatment

    • provide client with emotioal support
    • instruct patients to avoid crowds of children examples day care centers, schools ect....

    • Expected outcomes: patient will remain free from infection
  9. Streptococcus B-Hemolytic, Group B overview
    Strephtococcus B-Hemolytic, Group B (GBS) is a bacterial infection that can be passed to a neonate during labor and delivery
  10. Streptococcus B-Hemolytic, Group B risk factors during pregnancy
    • history of positive culture with previous pregnancy
    • Risk factors for GBS
    • Positive culture with pregnancy
    • prolonged rupture of membranes
    • preterm delivery
  11. Streptococcus B-Hemolytic Group B assessments during pregnancy
    • Objective data:
    • Positive GBS may have maternal and fetal effects including
    • Premature rupture of membranes
    • Preterm labor and delivery
    • Chorioamnionitis
    • Infections of the urinary tract
    • maternal sepsis

    • laboratory test:
    • vaginal and rectal cultures are performed at 35-37 weeks of gestation
  12. Streptococcus B-Hemolytic Group B collaborative care
    • Nursing care:
    • administer prophylaxis antibiotics during labor

    • Medications:
    • Penicilin G or ampicillin (Principen) may be prescribed to treat positive GBS
    • administration penicillin 5 million units initially IV bolus, followed by 2.5 million units intermittent IV bolus every 4 hrs. the patient may be prescribed ampicillin 2 grams IV initailly, followed by 1g every 4 hrs.
    • Bactericidal antibiotic is used to destroy the GBS

    instruct the patient to notigy the laor and delivery nurse of GBS status

    • expected outcomes:
    • newborn's blood culture is negative for GBS with no clinical signs of sepsis
  13. Chlamydia during pregnancy overview
    bacterial infection caused by chlamydia trachomatis

    it is the most common STD

    often difficult to diagnose because it is typically asymptomatic

    according to current guidelines from the Centers for disease control and prevention all women and adolescents ages 20-25 who are sexually active should be screened for STD's
  14. Risk factors for Chlamydia
    • multiple sexual partners
    • unprotected sexual practices
  15. Assessment for Chlamydia
    • Subjective data:
    • vaginal spotting
    • vulvar itching

    • Objective data:
    • white, watery vaginal discharge

    • Laboratory tests
    • endocervical culture
  16. Collaborative care for Chlamydia infections during pregnancy
    • Nursing care:
    • instruct the patient to take the entire prescription as prescribed
    • identify and treat all sexual partners
    • patients who are pregnant should be retested 3 weeks after completing the prescribed regimen
    • Azithromycin (Zithromax), amoxicillin (Amoxil), and erythromycin (Ery-Tab) are prescribed during pregnancy
    • broad-spectrum antibiotic
    • bactericidal action
    • Administer erythromycin (Romycin) to all neonates following delivery
    • This is the medication of choice for ophthalmia neonatorum.
    • This antibiotic is both bacteriostatic and bactericixdal, thus if provides prophylaxis against Neisseria gonorrhoea and Chlamydia trachomatis

    • instruct the patient to take all prescriptions as prescribed
    • educate the patient about the possibility of decreasing effectiveness of oral contraceptives
  17. Gonorrhea during pregnancy overview
    bacterial infection that is primarily spread by genital to genital contact

    it can also be spread by anal to genital contact or oral to genital contact

    transmitted to a neonate during delivery

    women are frequently asymptomatic
  18. Risk factors for Gonorrhea
    • Multiple sexual partners
    • unprotected sexual practices
  19. Assessments for Gonorrhea
    • Subjective data:
    • MALE: urethral discharge, painful urination, frequency
    • FEMALE: lower abdominal pain, dysmenorrhea

    • Objective data: MALE/FEMALE
    • urethral discharge
    • yellowish-green vaginal discharge
    • reddened vulva and vaginal walls
    • if gonorrhea is left untreated, it can cause pelvic inflammatory disease, heart disease, and arthritis

    • Laboratory test:
    • urethral and vaginal cultures
    • urine culture
  20. Collaborative care for Gonorrhea
    • Nursing care:
    • provide patient education regarding disease transmission
    • instruct the patient to take the entire prescription as prescribed
    • identify and treat all sexual partners

    • Medications:
    • Ceftriazine (Rocephin) IM or azithromycin (Zithromax) PO
    • Given for 7 days
    • Broad-Spectrum antibiotic
    • Bactericidal action

    instruct patient to repeat the culture to assess for medication effectiveness, take all medications as perscribed, educate patient regarding sefe-sex practices

    • expected outcomes:
    • patient will remain free of infection
  21. Candida Albicans during pregnancy
    • fungal infection caused by Candida albicans
    • Risk Fators:
    • diabetes mellitus
    • oral contraceptives
    • recent antibiotic treatment
    • Assessment:
    • Subjective data: vulvar itching
    • Objective data: thick, creamy white vaginal discharge, vulvar redness, white patches on vaginal walls, gray-white patches on the tongue and gums (neonate),

    • Laboratory test:
    • wet prep

    • Diagnostic procedures:
    • Potassium hydroxide (KOH) prep
    • presence of hyphae and pseudohyphae indicates positive findings
  22. Collaborative care for Candida Albicans during pregnancy
    • medications
    • Fluconazol (Diflucan)
    • antifungal agent
    • fungicidal action
    • over-the-counter treatments, such as clotrimazole (Monistat), is avaliable to treat candidiasis (however it is important that the physician diagnosis candidiasis initally)

    instruct the patient to avoid tight-fitting clothing

    • expected outcomes:
    • patient will temain free from infection

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