High risk pregnancy

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High risk pregnancy
2014-11-16 22:36:26

pregnancy that needs more attention
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  1. Healthy people 2020
    • decrease reduce complication due to preg
    • reduce perineotal mortality 
    • and optimize our pregnancy outcomes

    we can education, assess to prenatal care and identifying patients at risk ie adolescents
  2. High risk
    • jeorpardy to mom fetus or both
    • condition due to pregnancy or results from a condition before pregnancy
    • higher morbidity and mortality
    • risk assessment on the 1st visit and cont on going
  3. Pregnancy complications
    • bleeding during pregnancy
    • hyperemesis gravida
    • Gestational htn
    • HELLP
    • gestational diabetes
    • blood incompatibility
    • amniotic fluid
    • multiple gestation
    • PROM
  4. Early pregnancy bleeding
    What are the causes
    • Fetal factor
    • - defective embryo developement, faulty implantation, failure of the endometrium to accept the fertilize ovum

    • Placental factor
    • Premature separation, abnormal placental implantation, abnormal platelet function

    • maternal factor
    • - severe malnutrition, abnormal reproductive organs, incompetent cervix, endocrine problems (DM), all types of issue etc women who have had alot of cervical procedure, underlying sti, abo incompatibilities, drug problems
  5. Conditions associated with early bleeding during pregnancy
    • spontaneous abortions
    • ectopic pregnancy
    • gestational trophoblastic disease
    • cervical insufficiency
  6. Spontaneous Abortion
    • cause unknown and highly variable
    • 1st trim- r/t to genetic issue/fetal abnormalities, 
    • 2nd usually r/t to mom

    • Nursing assessment
    • vaginal bleeding
    • cramping
    • VS
    • pain level
    • client understand what is going on with her
  7. Types of spontenous abortions
    • threatened- 
    • inevitable
    • incomplete
    • complete
    • missed
    • habitual- keep losing baby u may want to look at the intergrity of the cervix
  8. elective termination of pregnancy
    induced abortion- medical or surgical before viable at the request of mom health concerns

    elective- termination before viable - this is chosen by mom and not for health concerns

    Therapeutic abortion- termination- serious maternal implication or fetal abnormalities 

    think about how u can support mom
  9. spontaneous abortion: nursing management
    • continue to monitor vaginal bleeding, pad count, passage of product of conception, pain level, VS and pain scale
    • support with physical and emotional stress- refer to support group

    • complications:
    • risk- hemorrage infection, sepsis, issues with depressions
    • no fever 
    • no increas abdominal pain

    educate them on discharge

    can u take meds that can cause u to have an abortion, cytotec or prostagladins
  10. ectopic pregnancy
    • ovum implantation outside the uterus
    • obstruction to or slowing passage of ovum thru the tube to uterus

    • Therapeutic management
    • - medical: drug therapy ( methotrexate, prostagladins, misoprotol, and actinomycin)
    • surgery if rupture
    • Rh immonoglobin if woman Rh negative
  11. ectopic pregnancy nursing assessment and management
    • assessment
    • hallmark sign: abdominal pain with spotting within 6-8 weeks after missed period
    • contributing- lab test
    • lab/dx testing: transvaginal u/s, serum beta hcg, additional testing to rule out other conditions

    • management:
    • - if ruptured u can have hemmorhaging 
    • - preparation for treatment
    • - analgesics for pain
    • - meds for medical treatment- can give u meds to dissolve pregnancy
    • - teaching about s/s of rupture
    • - surgery- salpingostomy or salpingectomy 
    • Emotional support and educations 

    • if rupture-
    • hemmoraging
    • VS that will show shock- increase hr and dropped bp
    • distended and tenderness abdomn
  12. Gestational trophoblastic disease
    • two types:
    • hydatidiform mole
    • choroiocarcinoma
    • exact cause is unknown

    • Therapeutic management:
    • immediate evacuation of uterine contents d/c
    • long term follow up and monitoring of serial hcg levels 

    • Nursing assessment:
    • clinical manifestations similar to spontaneous abortion at 12 weeks
    • u/s visualization molar preg looks different 
    • high hcg- higher than normal
    • they have to go in to remove this which puts them at risk for choriocacinoma recommended not to get pregnant for a yr
    • 80% benign 20% cancer
    • hormones feed cancer

    • Nursing management
    • - preoperative preparation
    • - emotional support
    • education: treatment, serial hcg monitoring, prophylactic chemotherapy 
    • - emotional support
  13. GTD hydatidform mole (complete or partial) and chorocarcinoma
    • Hydatidform mole (complete or Partial)
    • - abnormality or tumor of the placenta 
    • - benign proliferating growth of trophoblast in which the chorionic villi degenerates and becomes transparent vesicles containing clear viscid fluid - looks like grapes)
    • COMPLETE- is develops from an empty egg and fertilized by sperm all 46 chromosomes paternal
    • - embryo is not viable and dies
    • - associated with the development of choriocarcinoma

    • Partial: two sperm fertilize an egg resulting in 69 chromosomes
    • embryo not viable and dies (no worries)
  14. Cervical Insufficiency
    • premature dilation of cervix
    • cause unknown; possibly due to cervical damage
    • cervix can get paper thin
    • incre risk for early dilation 
    • therapeutic management: 
    • - bed rest, pelvic rest, avoidance of heavy lifting
    • - cervical cerclage

    usually occurs if u have done alot with ur cervix, surgeries, abortions
  15. Cerclage
    • u put in a stitch to increase integrity of cervix
    • keeps it closed
    • take out when ready to delivery

    if placenta is hanging out u cannot use this method
  16. Cervical insufficiency Nursing assessment/management
    • Assessment:
    • - risk factors- occurs when u have alot messign with cervix, abortions
    • - pink tinged discharged, or pelvic pressure
    • - shortening of cervix via transvaginal u/s

    • management 
    • - continuing surveillance; close monitoring for preterm
    • - emotional support
    • - education- catch early
  17. Placenta Previa
    • cause unknown; placenta implants over cervical os
    • classification (see fig 19-4)
    • Therapeutic management: dependent on several factors
    • s/s- painless bright red bleedings 2nd/3rd trimester, sponteneous c-section
  18. Placenta Previa nursing management
    • monitor maternal-fetal status
    • vaginal bleedings pad count- no volume depleting 
    • avoid vaginal examine
    • FHR
    • contractions/labor
    • u/s
    • labs
    • support and educate: fetal movement counts, effects of prolonged bed rest (if necessary) s/s to report
    • preparation for possible c-section
  19. Abruptio placenta
    • tearing off uterine wall
    • risk factors:
    • - previous abruptions
    • - HTN disorders
    • - abdominal trauma
    • - cocaine, meth use cigarettes smoking
    • - PROM
    • - uterine abnormalities/fibroids
    • - oliohydraminos- less fluids
    • - low socioeconomic status, poor nutrition
    • - multiple gestation
    • - advance maternal age
  20. Abruptio placentae
    • separation of placenta leading to compromised fetal blood supply
    • cause unknown
    • thera management: assessment, control and restoration of blood loss, positive outcomes, prevention of DIC (disemenation clotacation) seen in pt with trauma etc bad thing
  21. Placenta abruption- nursing assessment
    • compromise- 
    • bleeding dark red
    • pain (knife- like), uterine tenderness, contractions
    • fetal movement decrease
    • FHR
    • Lab/dx- CBC, fibrinogen levels PT/PTT, type and cross-match, non stress test, biophysical profile
  22. Placenta abruption- nursing management
    tissue perfusion left lateral position; strict bed rest, oxygen therapy, vs, fundal height, continous fetal monitoring 

    support and education; empathy, understanding, explanation possible loss of fetus, reduction of reoccurrence
  23. Hyperemesis Gravidarum
    • Severe form of N/V 
    • -symptoms usually gone by 20 week
    • - weight loss > 5% of prepregnancy body weight
    • - dehydration, metabolic acidosis, alkalosis, and hypokalemia

    • Therapeutic management
    • - conservative (diet and lifestyle changes
    • - hospitlization with parenteral therapy

    • Etiology 
    • - endocrine theory: incre Hcg and or estrogen
    • - metabolic theory: Vit B6 deficiency
    • - pyschological theory: stress increase symptoms

    • Nursing Assessment
    • - onset, duration, course of N/V, diet history, risk factors, weight, associated symptoms, perception of situation
    • - liver enzymes, CBC, BUN, electrolytes, urine specific gravity, u/s

    • Nursing management:
    • - comfort and nutrition (NPO, IV fluids, hygiene, oral care, I7O)
    • - support and education: reassurance; home care f/u
    • teach
  24. Hypertensive disorders of pregnancy
    Gestational hypertension: blood pressure elevated > 140/90. identified after 20 weeks gestation with proteinuria. blood pressure returns to normal 12 weeks postpartum 

    Preelampsia: hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks

    eclampsia: seizure activity in a woman with preclampsia- worry about lost of oxygen to mom and baby

    Chronic hypertension: these pt was dx before 20 weeks. they had this underlying condition before getting pregnant. just have to make sure it is safe for them to cont on meds. 20% morbitity rate when this pt becomes preeclampsia 

    • htn in post partum this is red flag
    • certain labs we look at...

    can get preeclampsia post partum

    urine- do a 24hr urine sample
  25. Gestational Hypertension management
    • Mild preeclampsia management:
    • - bed rest, bp monitoring and fetal movement counts
    • - hospitalization: IV Mg sulfate during labor if this progresses

    • Severe preeclampsia management:
    • - 160/100 we have to deliver them. oxytocin and mg sulfate

    • Eclampsia management
    • - seizure management- mg sulfate, antihypertensive agent, get seizure controlled before u delivery baby
  26. Gestational HTN Nursing assess and management
    Nursing Assessment: risk factors, monitor bp, nutritional intake, weight gain, swollen, urine and protein, lans

    • Nursing management
    • - education about home management
    • - hospital for severe preeclampsia; quiet enviroment, sedatives, seizure precautions, antihypertensive, DTR testing (bc w/mg sulfate this gets depressed), assessing mg toxicity and labor
    • - seizure management for eclampsia: fetal monitoring, uterine  contraction monitoring preparation for birth- f/u

    • fetal monitoring:
    • see how baby is doing
    • htn may cause placenta not to profuse
    • prevent seizure
  27. Chronic hypertension
    • hypertension before pregnancy, < 20 weeks, or > 12 weeks postpartum 
    • therapeutic management- preconception counseling, lifestyle changes, antihypertension agents for sever htn, fetal movement monitoring, serial u/s
    • nursing management: reccomend dash diet, frequent visit, non stress test, monitoring for placenta abruption, preeclampsia, daily rest periods, home bp monitoring, close monitoring during delivery and birth and post partum 
  28. Preeclampsia v eclampsia
    • mild: bp , spilling protein about 300 (as u spill more protein it tells me that our kidneys are working harding. 
    • u should not seiz, dtr brisk, not gaining weight too fast,

    severe: seizure or coma. hyperreflexes, ankle clonus, blurred vision, headache, epigastric (now the liver is involved)

    eclampia- generalized headache, renal failure, hellp syndrome, seizure, coma
  29. Patella and ankle clonus
    we check these with preeclampsia

    Clonus is not a normal finding- CNS is stimulating
  30. Therapeutic management of htn pre/eclampsia
    • medication
    • - apresoline of labetalol to reduce htn

    • Mg sulfate: 
    • for the treatment and prevention of eclamptic seizures 
    • blocks neuromuscular transmission and is a vasodilator
    • continuous IV must be piggyback

    • loading dose: 4-6g in 100ml of fluid administration over 15-20 mins. 
    • continous infusion 2-4 g/hr (usually on for 24hr)
    • always refer to hosp policy
    • labs: Mg serum- 4-6 hr after the treatment, kidneys, I&O, and should be profusing your kidneys, 5-8 levels high- we need these levels high so they don't seiz...
    • normal 1.8-2.6

    Antidote: calcium gluconate

    continue post partum 

    pt on this gets bp, dtr, LOC every hr
  31. HELLP syndrome
    Acronym Hemolysis (fragmented rbc thru damage blood vessels), Elevated Liver Enzyme, low platelets

    Hemolysis: fragmented RBC thru damage blood vessels- H&H will decrease hematocrit is our gas, hemoglobin- oxygen

    Elevated Liver  enzyme: reduce blood flow to the liver 2ndary to obstruction from fibrin deposits. increase bilirubin levels r/t to liver impairment

    Low platelet: vascular damage result the results of vasospasm, results in thrombocytopenia 

    PIH panel- we are doing this to rule out HELLP syndrome (H&H, SGOT, ALT, kidneys, platelet level)

    telling us we are running trouble.
  32. RH D
    • occurs when mother is RH-
    • and fetus is RH+ 

    if our blood mixes- are body will then attack the fetus. 

    administer rhogam at 28 weeks and 72hrs after delivery only if baby is rh+ 

    • do not give to 
    • rh + women
    • rh - women who is sensitized (u were already exposed)
    • birth to rh- baby
    • baby daddy don't need this

    abdominal trauma procedure u would get rhogam if rh -
  33. Blood Incompatibility 
    • ABO is ur blood type
    • we see this most the time in mothers who are O type and fetus is A or B. 

    Our baby is going to attack baby

    when born this baby will be more prone to jaudice. early on jaundice before 24hr of age we are looking for the cause. rh coombs

    • antibodies were built to attack the baby. 
    • nursing assessment: maternal blood type and Rh status
    • nursing mana- rhogam at 28 weeks 
  34. Hydramnios
    • too much fluid
    • > 2000ml
    • therapeutic manage- close monitoring, identify is there a problem going on with baby, remove fluid, indomenthacin (decr fluid by decreasing fetal urinary output)

    • Nursing assessm, risk factors, fundal height, abdominal discomfort, difficulty palpating fetal parts or FHR, 
    • nursing manage- ongoing assessment and monitoring, assisting with therapeutic amniocentensis 

    during labor when the water breaks there is a concern that the cord will come out bc of all this pressure. baby can have fetal distress

    oligomnios- cord compression <500ml less fluids
  35. Multiple gestation
    • Therapeutic management: serial u/s, close monitoring during labor, operative delivery common
    • Nursing assessment: uterus larger than expected for EDB, do u/s to confirm
    • nursing management: educate and support anteparttally, labor management with perinatal team on standby; postpartum assessment for possibly hemorrhage 
  36. Multiple gestation pregnancies
    monozygotic- one egg then divided in the first week of gestation

    dizygotic- fertilization of two zygotes

    • placental
    • - monochoronic or dichoronic 

    • amniotic sac
    • monoamniotic (1%), diamniotic 
  37. Multiple gestation pregnancy
    • Maternal risk
    • Gestational htn
    • gestational dm
    • hydramnios 
    • placenta previa
    • PROM
    • premature separation of the placenta
    • preterm labor
    • anemia
    • post partum bleeding from the over distended uterus
    • c-section

    • Fetal risk
    • premature birth
    • respiratory distress
    • low birth weight
    • intrauterine growth restriction congenital anomalities
    • sharing placenta twin twin tranfusion 
    • cord in tangle 
  38. Multiple gestational pregnancy
    • Assessment
    • higher fundal height, u/s, elevated hcg, and alpha-fetal protein could be off

    • antepartal management
    • - frequent visit, monitoring for preterm, prom, anemia
    • - may need to be on bed rest
    • - frequent fetal survellance, u/s, NST, BPP 

    • Intrapartum medical management
    • - continuous fetal monitoring for both fetus's 
    • - delivery method, vag or c-section or both
  39. PROM
    • PROM: women beyond 37 weeks gestation
    • PPROM: women less than 37 weeks
    • puts u more at risk to have problem

    nursing manage- reason for rupture, FHR, always a risk for cord collapse, color of fluid tells story, babies should not poop in utero could mean the baby is stressed. 

    Depending on gestation age, no unsterile exam until active labor, fetal has immature lungs 

    nursing assessment: risk factors signs and symptoms of labor, electronic FHR monitoring, amniotic fluid charasteristics- nitrazine paper (turn blue ph), fern test (take fluid and put under slide looks like a fern plate, u/s (risk to go into premature labor)

    baby comes 1st

    MD should be doing this...
  40. Rupture of amniotic fluid membranes
    • Spontaneous rupture of membrane 
    • may be sudden gush or trickle. fluid should be clear
    • assessment
    • - time, odor, color (yellow/green indicate meconium)
    • - meconuim stained fluid may indicate fetal hypoxia
    • maternal temp is taken q hour (biggest risk is infection)
  41. PROM nursing management
    • infection prevention 
    • identify is there is any uterine contraction
    • educate and support
    • discharge home (PPROM) if no labor within 48 hours
    • - leakage slows down and they are stable
    • - may be on preventative meds like steriods to help with lung maturity (2 doses of steriods)
  42. Conditions causing at risk pregnancies
    • DM
    • Cardiac and respiratory disorders
    • Anemia
    • Autoimmune disorders
    • specific infection
  43. DM: classifications
    • typical classification
    • Type 1
    • type 2
    • Impaired fasting glucose and impaired glucose tolerance
    • gestational DM

    • classification during pregnancy
    • - pregestational diabetes
    • - gestational 
  44. DM: pathophysiology and pregnancy
    • fetal demands
    • role of placental hormones 
    • changes in insuline resistance
    • effects on mother
    • effects of fetus (at risk for congenital conditions cardiac problems)
  45. DM: therapeutic management
    • preconception counseling
    • blood glucose level control (A1c < 7)
    • glycemic control
    • nutritional management
    • hypoglycemic agents (teach about s/s)
    • close maternal and fetal surveillance 
    • management during labor and birth (if on insulin need on insulin drip. check bs q hr)

    oral agents at first but if cant be managed then insulin
  46. DM: Assessment
    Health Hx: physical examination; risk factors

    screening at first prenatal visit: additional screening at 24 to 28 weeks for women considered at risk

    maternal surveillance: urine for protein, ketones, nitrates, and leukocyte esterase; evaluation of renal function/trimester; eye exam in 1st trimester; A1c q 4-6 weeks

    fetal surveillance: u/s, alpha fetoprotein levels, biophysical profile, nonstress test, amniocentesis

    DM 1 mom babies can end up congenital conditions
  47. DM: nursing management
    • optimal glucose control
    • - blood glucose levels; medication therapy
    • - nutritional therapy
    • Measures during labor and birth; postpartum
    • prevention of complication (see nursing care plan 20.1)
    • client education and counseling 

    good glycemic control (need to educate our mom) need to know..more prone to infection delayed healing, affecting eye, kidneys...

    • U don't heal as well
    • high sugar more prone to grow bacteria
    • DM stress your kidneys
    • macrosomic- big babies (usually dm mom)
  48. DM extra
    insulins interfers with ur HPL(interfer with ability to make blood sugar) (which comes from placenta) the placenta has more demands in the 2nd and 3rd. Usually in the first trimester u dont need as much because ur demands are different. 
  49. Congenital heart condition affecting pregnancy
    • tetralogy of fallot
    • atrial septal defect (ASD)
    • ventricular septal defect (VSD)
    • patent ductus arteriosus

    these pt are consider a really high pregnancy
  50. Acquired heart condition affecting pregnancy
    • mitral valve prolapse- pretty common problem
    • mitral valve stenosis
    • aortic stenosis
    • peripartum cardiomyopathy
    • myocardial infarction
    • protocols for how we handle this

    can have a heart attack during pregnancy and post delivery (if u have a hemorrhage) 
  51. Functional classification system (cardiac disease) assess...
    • Class I: asymptomatic; no limitation of physical activity (id heart problem but ok)
    • Class II: symptpmatic (dyspnea, chest pain) with increase activity
    • Class III: symptomatic (palpitation, fatigue) with normal activity Red flag
    • Class IV: symptomatic at rest or with any physical activity

    • as u up symptoms gets worst.
    • real problem is when a pt is having SOB at rest and they have never had this before...
    • when the volume of blood incre (max at 32 weeks) these pt maybe more symptomatic
  52. Congenital and acquired heart disease
    • Pathophysiology
    • - hemodynamic changes over stressing woman's cardiovascular system
    • Therapeutic management:
    • - risk assessment, prenatal counseling, incre frequency of clinic visit
    • Nursing Assessment:
    • - VS, heart sounds, weight, fetal activity, lifestyle, O2 stat, how is baby growing
    • - S/S of cardiac decompensation 

    if mom heart is stress- mom might not be prefusing as well
  53. Respiratory complications
    • outcomes goal for women with respiratory complications
    • - early detection of respiratory compromise- bc we have to circulate oxygen to baby

    we can have moms that have pneumonia (viral or bacterial and these can affect the baby to get the infection) and asthma (bronchoconstriction, might not breathing treatments)
  54. Asthma
    • Pathophysiology
    • - effect of normal physiologic changes of pregnancy on respiratory system
    • Therapeutic manage:
    • - drug therapy budesonide, albuterol, salmeterol)
    • Nursing Assessment:
    • - asthma triggers (home environment), lung ausculation
    • Nursing management 
    • - client education, teaching
    • - o2 stat, during labor
  55. TB
    • Therapeutic mana:
    • - medications: combo od isoniazid, rifampin, ethambutol
    • Nursing assess:
    • - risk factors, s/s of TB
    • Nursing manage:
    • - compliance with med
    • - education health promotion activities
    • - transmission prevention (any pt at risk would be placed in a negative pressure room)
  56. Infections
    • Cytomegalovirus 
    • rubella 
    • herpes simplex virus
    • Hepatitis B virus
    • Varicella zoster virus
    • parvovirus B19
    • Group B strep
    • Toxoplasmosis
    • HIV
  57. TORCH
    • Toxoplasmosis
    • Other- varicella, sti, hiv
    • Rubells
    • cytomehalovirus
    • Herpers simplex virus- very prevelant u see this alot
  58. TORCH infections are viral
    Cytomehalovirus ( placental tramission) sometimes mom doesn't know she has it...asymptomatic but when babies are born they have small heads microcephalic. assessment- baby may not look right, small, Intrautrine growth restriction, baby could be blind, mental retardation delays. growth and development gets evaluated as they start to grow

    • Rubella (placenta tramission);
    • get titer- if negative u give this to mom after she delivers

    • Herpes vaginal transmission:
    • open active lesions- puts baby at risk during vaginal delivery. might do c-section so baby doesn't get. A babies who gets herpes can get very sick
  59. TORCH viral hep b, varicella, parovirus b19
    • hep B- vaginal transmission
    • pt needs to be identify, babies will not be giving any injections until given bath. bc of mom's blood. hep vaccine at birth and hep immoglubin which gets them a boost so they won't contract it. then follow baby and do titers. still get vaccine

    • Varicella zoster virus (placental transmission)
    • preventable with preconception

    parovirus b19- placental transmission
  60. TORCH non viral toxoplasmosis, 
    • Placental transmission
    • parastic infection- u get this from uncooked meat and cat feces (so moms no changing that litter box)
    • hand to mouth
  61. Group B Strep
    • Vaginal transmission
    • all women screen at 35-37 weeks to see if u are growing bacteria..not harmful to mom but to the baby...
    • when ur water breaks- this opens up door for baby to get infection Group B sepsis
    • GBS + in active labor needs to be treated with antibiotic- ampillcin 2gram
  62. Iron Deficiency Anemia
    • usually due to inadequate dietary intake
    • therapeutic manage
    • eliminate symptoms, correct deficiency, replenish iron stores
    • Nursing assessment
    • fatigue, weakness, malaise, anorexia, susceptibility to infection (frequent colds), pale mucous membranes, tachycardia (bc i dont have enough oxygen so my heart works harder), pallor, 
    • abnormal labs
    • low H&H, low iron, low serum ferratin
  63. anemia nursing management
    • Iron during pregnancy
    • constipation- good fiber in diet
    • iron pills with colace 
    • education on drug therapy
    • compliance with drug therapy is hard.
    • take iron with orange juice - increase absorption
  64. sickle cell anemia
    RBC sickle in shape. u dont get as much oxygen. vaso occulative crisis- certain parts of the body is blocked by blood flow

    painful- legs abdomen

    • u want to make sure the baby is getting profused
    • assessment- s/s evidence of crisis
    • management- support educate f/u
    • - labor: rest pain management, oxygen and IV fluids
    • close FHR monitoring 
    • postpartum: antiembolism stockings, family planning options
  65. Types of Autoimmune diseases
    • u can have disease that target ur organs or it could be systemic (so one organ or multiple organs)
    • like lupus 
  66. HIV
    • impact on pregnancy HIV- threats to self, fetus, newborn
    • Therapeutic manage- antiretroviral drus twice daily from 14 weeks until birth; IV administration during labor; oral syrup for newborn in 1st 6 weeks of life testing in nursery and in peds visit; decision for birthing method
    • nursing assess: history and physical examination; HIV antibody testing. testing sti
  67. Women who are HIV positive: nursing management
    • pretest and posttest counseling
    • education
    • support
    • preparation for labor, birth, and afterward
    • elective ceaseran birth
    • compliance with antiretroviral meds even post delivery
    • family planning methods

    make sure to be careful with babies..no open skin with moms fluid
  68. Vulnerable population
    • adolescents
    • pregnant over 35
    • obeses pregnant women
    • women who are positive for HIV
    • women abuses substances
  69. pregnancy adolescent: nursing assessment
    • vision of self in future
    • realistic role models; emotional support
    • level of child developement- education level
    • financial and resource manaement: work and education experience
    • anger and conflict resolution skills
    • knowledge of health and nutrition for mom and baby
    • challenges of parenting role
    • community resources 
    • father around
  70. adolescent after
    • support
    • future planning (return to school, career or job counseling)
    • frequent evaluation of physical and emotional well-being
    • stress management= self care
    •  education 
  71. Older women over 35
    • at risk for having a baby with downs syndrome
    • education on healthy pregnancy is important
    • issues with HTN, DM and good screening
  72. Substance abuse
    • identify what they are taking, how long, get them in a treatment program,
    • pt addicted to opiates can go on methodone 
    • caffiene and niocotine
    • cocaine- heart attack, less profusion of placenta
    • marijuana- 
    • sedative meth
    • antidepression- can affect the baby. 

    • assessment- be non judgemental hx and physical assessment
    • encourage counseling and support. might be screened or may not go home with baby. 
  73. surgery- dont worry
    can be done but they try not to do it.