Maternal

• Blood volume increases during pregnancy to ensure adequate oxygen supply to the fetus.
• Women may enter pregnancy with pre-existing disorders like cardiac or respiratory illness that can complicate pregnancy
• Nursing care focuses on close observation of maternal health and fetal well-being, educating the woman and her family about danger signs during pregnancy, and minimizing complications
• Illnesses and events that can complicate pregnancy may occur before or during pregnancy
• Cardiovascular Disorder:

  • Pregnancy increases circulatory volume, posing risks for women with cardiac disease
  • Symptoms can occur early in pregnancy or in weeks 28 to 32
  • Assessment includes signs of cardiac decompensation, respiratory infection, heart failure, and pulmonary edema
  • Classification of heart disease determines pregnancy outcome: Class I or II can expect normal pregnancy, Class III may need bed rest, and Class IV are poor candidates for pregnancy
• Hypertensive Disorders:

  • Gestational hypertension and preeclampsia can lead to increased blood pressure and proteinuria
  • Vascular spasm affects organs, reducing blood supply to kidneys, pancreas, liver, brain, and placenta
  • Risk factors include women of color, multiple pregnancies, age extremes, low socioeconomic status, multiple pregnancies, polyhydramnios, and underlying diseases
  • Assessment classifies preeclampsia based on symptoms and severity
• Interventions for Preeclampsia:

  • Preeclampsia without severe features can be managed at home with monitoring and antiplatelet therapy
  • Preeclampsia with severe features requires hospitalization, bed rest, monitoring of maternal and fetal well-being, high-protein diet, IV fluids, antihypertensive medications, and magnesium sulfate to prevent seizures
  • Eclampsia involves seizures and requires immediate intervention, including maintaining airway, administering oxygen, monitoring fetal heart rate, controlling seizures with medications, and preparing for delivery
• After a seizure, insert an oral airway and suction the client's mouth as needed
• Prepare for delivery of the fetus after stabilizing the client, if warranted
• Document the occurrence (duration of seizure), client's response, and outcome
• Cesarean birth is more hazardous for the fetus than vaginal birth due to retained lung fluid
• Preferred method for birth is vaginal with a minimum of anesthesia
• Postpartum preeclampsia may occur up to 10-14 days after birth
• Monitor blood pressure and health care visits for preeclampsia up to 2 weeks post-birth
• HELLP syndrome is a variation of PIH with symptoms: hemolysis, elevated liver enzymes, low platelets
• HELLP syndrome occurs in 4% to 12% of patients with PIH
• Risk factors for HELLP syndrome: primigravids, multigravids, antiphospholipid syndrome
• Assessment for HELLP syndrome includes signs of PIH, epigastric pain, general malaise, bleeding, and laboratory studies
• Complications of HELLP syndrome: cerebral hemorrhage, aspiration pneumonia, hypoxic encephalopathy, fetal growth restriction, preterm birth
• Interventions for HELLP syndrome: transfusion of fresh-frozen plasma or platelets, correction of hypoglycemia, birth as soon as feasible
• Pregnancy causes changes in insulin requirements, leading to gestational diabetes
• Screen pregnant women for gestational diabetes between 24 and 28 weeks of gestation
• Gestational diabetes can be treated with diet alone or insulin if needed
• Predisposing conditions to gestational diabetes: older than 25 years, obesity, history of large babies, family history of diabetes
• Assessment for gestational diabetes includes screening tests and symptoms like excessive thirst, hunger, weight loss
• Complications of gestational diabetes: maternal effects like uteroplacental insufficiency, fetal effects like fetal mortality and hypoglycemia
• Interventions for gestational diabetes: employ diet, medications, exercise, blood glucose monitoring, monitor weight, assess for maternal complications
• Rh incompatibility occurs when mother is Rh-negative and fetus is Rh-positive
• Assessment for Rh incompatibility includes anti-D antibody titer, Coomb's test, and fetal anemia detection
• Interventions for Rh incompatibility: Rh (D) immune globulin administration, intrauterine transfusion for fetal anemia
• Pregnant women are prone to UTI due to ureter dilation, stasis of urine, and minimal glucosuria
• Assessment for UTI includes frequency of urination, suprapubic pain, hematuria, fever, and chills
• Interventions for UTI: encourage high fluid intake, provide warm baths, stress good bladder-emptying schedule, monitor for signs of premature labor, administer prescribed medications
• HIV transmission can occur through sexual exposure, parenteral exposure, or perinatal exposure
• Diagnosis of HIV includes tests like ELISA, Western blot, and IFA
• A positive Western blot or IFA confirms HIV
• A positive ELISA should be confirmed by Western blot or IFA for HIV diagnosis
• A positive Western blot or IFA is considered confirmatory for HIV
• A positive ELISA that fails to be confirmed by Western blot or IFA should not be considered negative and repeat testing should be done in 3 to 6 months
• WHO disease staging system for HIV infection and disease (September 2005):

  • Stage I: HIV disease is asymptomatic and not categorized as AIDS
  • Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections
  • Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections, and pulmonary tuberculosis
  • Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS