Nursing Care of The Family Experiencing A Sudden Pregnancy Complication
Nursing Care of The Family Experiencing A Sudden Pregnancy Complication
Nursing Care of The Family Experiencing A Sudden Pregnancy Complication
hypertension
NURSING CARE OF THE FAMILY EXPERIENCING A
- Cerebra edema is so acute that grand mal
SUDDEN PREGNANCY COMPLICATION
or coma occurs
By: Ms. Marvie Joy B. Cabioc, MAN, RN, PhD - Occurs up to 2 weeks after delivery, mostly
2 days after
SYMPTOMS OF ECLAMPSIA
RISK FACTORS FOR GESTATIONAL HYPERTENSION
- Coma or grand-mal seizure
• Affects central nervous system - Includes other signs and symptoms of pre-
• Eyes eclampsia
• Urinary tract - Sharp rise of temperature
• Respiratory system - Aura
• Gastrointestinal and liver
NURSING RESPONSIBILITIES FOR ECLAMPSIA
Management of gestational hypertension
- Maintain airway (turn on side)
• Depends on severity of the hypertension and on - Assess for uterine contractions
the maturity of the fetus - Decision about birth will be made 12-24
hours after seizure (vaginal always
Treatment of gestational hypertension focuses on:
preferred)
• Maintain blood flow to the woman’s vital
Conservative treatment
organs and to the placenta
• Preventing convulsions - Activity restriction
• Magnesium sulfate in gestational HTN/HPN - Maternal assessment of fetal activity
- Action: CNS depressant that blocks - Blood pressure monitoring
acetylcholine. Halts convulsions and halts - Daily weight
premature labor by relaxing smooth muscle. - Checking urine for protein
- Dose: 2-6 g IV over 20 min
Drug therapy
- Therapeutic range: 5-8 mg/100 ml
- 8-10 mg: patellar reflex gone - Magnesium sulfate
- 15-20 mg: lungs fail • Calcium gluconate reverses effects
- 20 mg: cardiac issues occur of magnesium sulfate
- Adverse effects: - Antihypertensive
➢ Absence of deep tendon reflexes,
respiratory depression in neonate BLEEDING INCOMPATIBILITIES
➢ Cardiac issues - Rh-negative blood type is an autosomal
➢ Decreased UO recessive trait
Nursing Responsibilities on Gestational hypertension - Rh-positive blood type is a dominant trait
- Rh incompatibility can only occur if the
- Assess patellar reflex q1-4 h woman is Rh-negative and the fetus if Rh-
- Monitor intake and output positive.
- Monitor serum magnesium level
- Run in a separate IV line HELLP SYNDROME
- Keep calcium gluconate as antidote - Patho: variation of gestational HTN named
Magnesium sulfate toxicity after its symptoms
- Caused by high BP
- Absence of patellar deep tendon reflexes
- Respiratory rate less than 12/min H – Hemolysis
- Cardiac dysrhythmia EL – increase liver enzymes
- Urine output less than 30 ml/hour
- Decreased LOC LP – decrease platelet count
How often should magnesium level be drawn? • 10-20% of severe pre-eclampsia and
eclampsia
1. Before therapy • 1-2/1000 normal pregnancies
2. Every 6-8 hours • Fatigue
ECLAMPSIA • Fluid retention and excess weight
gain
• Headache
• Worsening nausea and vomiting ➢ If woman cannot increase her insulin
• Upper right abdomen pain production she will have periods of
• Blurry vision hyperglycemia
• Nosebleed or other bleeding that ➢ Because fetus is continuously drawing
most stop easily glucose from the mother, she will also
• Seizures or convulsions experience hypoglycemia between
meals and during the night
WHO GETS IT? ➢ During the second and third trimesters,
- Antiphospholipid syndrome or presence of fetus is at risk for organ damage from
anti-phospholipid AB hyperglycemia because fetal tissue has
increased tissue resistance to maternal
ISOIMMUNIZATION insulin action
- Pregestational diabetes mellitus
- The leaking of fetal Rh-positive blood into
➢ Major risk for congenital anomalies
the Rh-negative mother’s circulation,
to occur from maternal
causing her body to respond by making
hyperglycemia during the
antibodies to destroy the Rh-positive
embryonic period of development
erythrocytes
- With subsequent pregnancy, the woman’s FACTORS LINKED TO GDM
antibodies against Rh-positive blood cross
the placenta and destroy the fetal Rh- - Maternal obesity (>90 kg or 198 lbs.)
positive erythrocytes before the infant is - Large infant (>4000 g or about 9 lbs.)
born. - Maternal age older than 25 years
- Previous unexplained stillbirth or infant
ERYTHROBLASTOSIS FETALIS having congenital abnormalities
- History of GDM in previous pregnancy
- Occurs when the maternal anti-Rh
- Family history of DM
antibodies cross the placenta and destroy
- Fasting glucose over 126 mg/dl or post meal
fetal erythrocytes
glucose overdose
- Requires RhoGAM to be given at 28 weeks
- Macrosomic infant
and within 72 hours of delivery to the
mother TREATMENT
- Fetal assessment tests must be done
throughout pregnancy - Diet
- An intrauterine transfusion may be done for - Monitoring blood glucose levels
the severely anemic fetus - Ketone monitoring
- Exercise
PREGNANCY COMPLICATED BY MEDICAL CONDITION - Fetal assessment
- Care during labor of the woman with GDM
- Diabetes mellitus (DM)
- Intravenous infusion of dextrose may be
- Classifies if preceded pregnancy
needed
- Type 1: pathologic disorder
- Regular insulin
- Type 2: insulin resistance; genetic
- Assess blood glucose levels hourly and
predisposition
adjust insulin administration accordingly
- Pregestational DM: type 1 or 2 DM
- Care of the neonate who mother had GDM
- Gestational Diabetes (GDM)
may have the following:
- Glucose intolerance with onset during
o Hypoglycemia
pregnancy
o Respiratory distress
- In true Gestational diabetes, glucose usually
- Injury related to macrosomia
returns to normal by 6 weeks postpartum
- Blood glucose monitored closely for at least
EFFECTS OF PREGNANCY ON GLUCOSE METABOLISM the first 24 hours after birth
- Breastfeeding should be encouraged
- Hormones (estrogen and progesterone),
- Heart disease
insulinase (an enzyme) and increased
prolactin levels have two effects: MANIFESTATIONS
➢ Increase resistance of cells to
- Increased levels of clotting factors
insulin
- Increased risk for thrombosis
➢ Increased speed of insulin
breakdown • If woman’s heart cannot handle
- Gestational diabetes mellitus (GDM) • Increased workload, congestive
heart failure (CHF results)
• Fetus suffers from reduced Treatment
placental blood flow
- Oral doses of elemental iron
SIGNS OF CHF (CONGESTIVE HEART FAILURE) DURING - Continue therapy for about 3 months after
PREGNANCY anemia has been corrected