chapter 24 maternal semi finals

• Pregnant woman with special needs

  • Adolescent
  • Over age 40 years old
  • Physically or cognitively challenged
  • Substance dependent
• Pregnant adolescent

  • Earlier age of menarche
  • High rates of sexual activity
  • Lack of knowledge or failure to use contraceptives
  • Desire by young girls to have a baby
• Developmental tasks of adolescents

  • Establish a sense of self worth or a value system
  • Emancipate from parents
  • Adjust to a new body image
  • Choose a vocation
• Prenatal assessment for pregnant adolescent

  1. Health History

  2. Physical Exam

  3. Pregnancy Education (nutrition, discomforts, exercises)

  4. Childbirth Preparation

  5. Birth decisions

  6. Plans for the baby

  
• Pregnant woman over age 40

  • Little evidence of serious complications (except greater incidence of chromosomal abnormality)
  • Adjustment as to how pregnancy and childbirth fit into and change her life

  
• Developmental tasks of pregnant woman over 40

  • Ambivalent during pregnancy (wants to continue community activities yet concentrate on baby)
• Prenatal assessment for pregnant woman over 40

  1. Health History

  2. Physical Exam

  3. Chromosomal assessment

  4. Pregnancy Education (nutrition, prenatal classes)

  
• Tips on preventing varicose veins during pregnancy
• Pregnant woman who is physically and cognitively challenged

  • Nursing care must be designed to address her and her family's challenges and needs
• Modifications for pregnancy with physical/cognitive challenges

  • Explore safety measures (emergency contacts, transportation, mobility, elimination)
• Substance abuse

  Inability to meet major role obligations, increase in legal problems or risk-taking behavior, or exposure to hazardous situations because of an addicting substance
• Substance dependence

  A person has withdrawal symptoms following discontinuation of the substance
• Cocaine


  • Derived from Erythroxylum coca plant
  • Absorbed across mucous membranes, affects central nervous system (vasoconstriction, increased respiratory/cardiac rates, BP)
  • Leads to premature placental separation, preterm labor, fetal death
  • Causes intracranial hemorrhage, learning/social defects in infants
• Amphetamines (methamphetamine/ice)


  • Neurostimulant and neurotoxin
  • Produces blackened, infected teeth in women
  • Causes jitteriness, poor feeding, growth restriction in newborns
• Marijuana and hashish


  • Obtained from hemp plant
  • Produces tachycardia and sense of well-being
  • Associated with loss of short-term memory, increased respiratory infections
• Phencyclidine (PCP)


  • Creates euphoria but also irritation and possible long-term hallucinations
• Narcotic agonists (opiates)


  • Used for pain relief but widely abused for euphoric effect
  • Pregnancy complications include gestational hypertension, phlebitis, endocarditis, hepatitis, HIV
• Inhalants


  • Sniffing or huffing of aerosol substances (glue, sprays, cleaners)
  • Leads to severe respiratory and cardiac irregularities
• Alcohol


  • Causes birth defects and developmental disabilities
• Trauma and pregnancy


  1. Open wounds (lacerations, puncture wounds, animal/snake bites)

  2. Poisoning (use of oral activated charcoal)

  3. Choking
• Cesarean birth

  • 2 types: elective/scheduled and emergent

  Complications: dehiscence, evisceration

  
• Health teaching for cesarean birth

  1. Deep breathing

  2. Incentive spirometry

  3. Turning

  4. Ambulation
• Types of cesarean incisions

  • Classic vertical incision

  Low segment/transverse incision (most common, less likely to rupture in future)
• Cesarean birth


  Birth accomplished through an abdominal incision into the uterus
• Cesarean birth is one of the oldest types of surgical procedures known
• Cesarean birth is always slightly more hazardous than vaginal birth, but compared with other surgical procedures, it is one of the safest types of surgeries and one with few complications
• The word "cesarean"


  Derived from the Latin word "caedore" which means "to cut"
• There was a popular belief that Julius Caesar was born by a cesarean birth and the procedure was named for him, but this is unlikely as Caesar was born before antibiotics and sterile surgical technique
• Cesarean birth

  A birth more than a surgical procedure
• National Health Goals related to cesarean birth

  • Reduce the rate of cesarean births among low-risk women having their first child to 15% of live births
  • Reduce the rate of cesarean births among women who have had a prior cesarean birth to 63% of live births
• Nursing role in achieving National Health Goals

  • Encourage women who fulfill the criteria for vaginal birth after cesarean (VBAC) to attempt a vaginal birth with a second child
  • Conduct nursing research on the effect of nursing practice and the cesarean birth rate, effective pain management for cesarean birth, and measures to help the family adjust smoothly from the hospital to the home setting after a cesarean birth
• The same important outcome applies to a woman giving birth by cesarean as a woman giving birth vaginally: a healthy mother and a healthy child
• Because cesarean birth decisions can be made suddenly, planning can be limited to only a few minutes
• Plans must include discharge instructions and home care, because a woman will remain in the health care facility only 2 or 3 days
• For a woman who knows in advance that she will have a cesarean birth, helpful Web sites to use for referral are the March of Dimes and the International Cesarean Awareness Network
• It is imperative that a woman and her support person feel confidence in the health care personnel who will care for them, otherwise they could have difficulty coping with the additional insult of surgery
• Coordination of health care team members such as an anesthesiologist, surgeon, pediatrician or neonatologist, and recovery room or nursery personnel is particularly important if the surgery will be performed in a hospital surgery department rather than in a labor and birthing suite, or if the infant will be transferred to an intensive care nursery or a distant site for intensive care after the birth
• Many interventions focus on teaching and support, because the more a woman understands about what is happening, the more she can accept and cooperate with procedures
• During surgery, sterile technique is essential. A postpartal infection can be devastating to a woman who already has made many other physical adaptations
• After surgery, be sure to provide adequate "talk time" to allow a woman time to review what has happened and integrate it into what she and her partner expected