Lesson 1: NCM 109

• Care is given to a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness utilizing the nursing care plan.
• The assessment in the nursing care plan for a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness focuses on the signs and symptoms of the illness, which can include subjective data like exhaustion and objective data like vital signs and the extent of edema.
• A nursing diagnosis for a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness can include ineffective tissue perfusion related to poor heart function secondary to mitral valve prolapse during pregnancy, pain related to pyelonephritis secondary to uterine pressure on ureters, social isolation related to prescribed bed rest during pregnancy secondary to concurrent illness, ineffective role performance related to increasing levels of daily restrictions secondary to chronic illness and pregnancy, knowledge deficit related to normal changes of pregnancy versu
• The outcome in the nursing care plan for a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness should be related to the entire family’s health.
• For chronic illness, the outcome should be to maintain woman’s health during pregnancy so she can remain at home as long as possible, thereby minimizing hospitalization and family disruptions.
• For new illness, the outcome should allow a woman to choose among alternatives to help her to participate in her own care and also to maintain self-esteem as well as helps her move a step toward parenthood and assuming care for her family.
• Implementation in the nursing care plan for a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness can include teaching the woman on her new or additional measures to maintain health during pregnancy.
• Depression that persists during pregnancy can make it hard for a woman to care for herself and her baby.
• Many women have some nausea or vomiting, or “morning sickness,” particularly during the first 3 months of pregnancy.
• The cause of nausea and vomiting during pregnancy is believed to be rapidly rising blood levels of a hormone called HCG (human chorionic gonadotropin), which is released by the placenta.
• Screening and treatment for these infections, and vaccinations against viruses, such as hepatitis B and human papillomavirus, can prevent many bad outcomes.
• Hyperemesis gravidarum can lead to weight loss and dehydration and may require intensive treatment.
• Certain heart problems that are common among infants with Down syndrome need to be corrected with surgery immediately after birth.
• Having depression before pregnancy also is a risk factor for postpartum depression.
• Getting treatment is important for both mother and baby.
• Hyperemesis gravidarum occurs when there is severe, persistent nausea and vomiting during pregnancy—more extreme than “morning sickness.”
• Knowing a fetus has Down syndrome before birth can help healthcare providers and parents be prepared to give treatment right away.
• Symptoms of depression include a low or sad mood, loss of interest in fun activities, changes in appetite, sleep, and energy, problems thinking, concentrating, and making decisions, feelings of worthlessness, shame, or guilt, and thoughts that life is not worth living.
• Infections with HIV, viral hepatitis, STDs, and TB can complicate pregnancy and may have serious consequences for a woman, her pregnancy outcomes, and her baby.
• If you have a history of depression, it is important to discuss this with your healthcare provider early in pregnancy so that a plan for management can be made.
• Some women experience depression during or after pregnancy.
• Physical factors that can categorize a pregnancy as high risk include visual or hearing challenges, pelvic inadequacy or misshape, uterine incompetency, position, or structure, subject to trauma, fluid or electrolyte imbalance, hemorrhage, infection, fluid and electrolyte imbalance, and secondary major illnesses such as heart disease, diabetes mellitus, kidney disease, hypertension, chronic infection such as TB, hemopoietic or blood disorder, malignancy.
• Psychological factors that can categorize a pregnancy as high risk include a history of drug dependence, intimate partner abuse, mental illness, poor coping mechanisms, cognitive challenges, survivor of childhood sexual abuse, loss of support person, illness of a family member, decreased self-esteem, drug abuse, poor acceptance of pregnancy, severely frightened by labor and birth experience, inability to participate due to anesthesia, separation of infant at birth, lack of labor preparation, birth of an infant who is disappointing in some way, and illness in the newborn.
• Social factors that can categorize a pregnancy as high risk include an occupation involving handling of toxic substances, refusal of or neglected prenatal care, exposure to environmental teratogens, lack of support person, inadequate home for infant care, environmental contaminants at home, disruptive family incident, unplanned cesarian birth, lack of access to continued health care, isolated, lower economic level, poor access to transportation for care, decrease economic support, lack of access to emergency personnel or equipment, high altitude, highly mobile lifestyle, poor housing, history
• Outcome evaluation in the nursing care plan for a mother experiencing a pregnancy complication from a pre-existing or newly acquired illness can include the patient stating she rests for 2Hours morning and afternoon; dependent edema remains at 1+ or less at next prenatal visit, family members stating they are all participating in an exercise program since the mother developed gestational diabetes, and the patient reporting no burning on urination or flank pain at the next prenatal visit.
• High-risk pregnancies are those concurrent disorders, pregnancy-related complications, or external factors that endanger the health of the woman and the fetus.
• More than one factor can contribute to the classification of a high-risk pregnancy.
• Women who already have a disorder before the pregnancy are termed to have a greater than normal risk.
• The factors that categorize the woman’s pregnancy as high risk were classified into minimal, moderate, or extensive.
• Several factors can make a pregnancy high risk, including existing health conditions, the mother’s age, lifestyle, and health issues that happen before or during pregnancy.
• Problems during pregnancy may include physical and mental conditions that affect the health of the mother or the baby.
• Stopping medicines that you need could be more harmful than the risks posed should you become pregnant.
• It is very important for women to have their blood pressure checked at every prenatal visit so that healthcare providers can detect any changes and make decisions about treatment.
• Uncontrolled high blood pressure can damage the mother’s kidneys and increase the risk for low birth weight or pre-eclampsia.
• If you don’t have diabetes at that time, continue to get tested every 1 to 3 years to make sure your blood sugar levels are in a healthy range.
• Many problems are mild and do not progress; however, when they do, they may harm the mother or her baby.
• High blood pressure can be risky for the mother and fetus, but most women with slightly high blood pressure and no other diseases have healthy pregnancies and healthy deliveries because they get their blood pressure under control before pregnancy.
• Kidney disease can cause difficulties getting and staying pregnant as well as problems during pregnancy, including preterm delivery, low birth weight, and preeclampsia.
• You may have a UTI if you have pain or burning when you use the bathroom, fever, tiredness, or shakiness.
• Some medicines used to treat health problems could be harmful if taken during pregnancy.