Special needs maternal

• Women with special needs include

  • Adolescent
  • Over age 40 years old
  • Physically or cognitively challenged
  • Substance dependent
• Prenatal care


  Medical care given to pregnant women before their babies are born
• Factors contributing to the lack of prenatal care

  • Denial she is pregnant
  • Lack of knowledge of the importance of prenatal care
  • Dependence on others for transportation
  • Feeling awkward in a prenatal setting (an adult setting)
  • Fear of a first pelvic examination
  • Difficulty relating to authority figure
• Prenatal assessment


  • Health History- establish individual risks
  • Physical Exam
  • Pregnancy Education
  • Nutrition and supplements
  • Discomforts and changes during pregnancy
  • Appropriate exercises
  • Childbirth Preparation
  • Birth decisions
  • Plans for the baby
• IDA


  Revealed by chronic fatigue, pale mucous membranes, and a hemoglobin level less than 11 g/dl
• Complications for pregnant adolescents

  • Preterm labor
  • CPD
  • Postpartum hemorrhage
  • Inability to adapt postpartum
  • Lack of knowledge about infant care
• Little evidence of serious complications (except for greater incidence of chromosomal abnormality) for pregnant women over age 40 as long as prenatal care begun early in the pregnancy
• Ambivalent during the pregnancy

  May want to continue with community activities yet also want to concentrate on the baby growing inside her
• Prenatal assessment for pregnant women over age 40

  • Health History
  • Physical Exam
  • Chromosomal assessment
  • Pregnancy education
  • Nutrition
  • Prenatal classes
• Complications for pregnant women over age 40

  • Gestational hypertension
  • Failure to progress in labor
  • Difficulty accepting the event
  • Postpartum hemorrhage and lacerations
• Tips on preventing varicose veins

  • Find opportunities to elevate your legs on a foot stool
  • Include vitamin C in your diet
  • Rest in a side-lying position with your body tipped slightly forward
  • Avoid long periods of standing in one place
  • Avoid sitting with your legs crossed
  • Avoid anything constricting on your lower legs
  • Put on support hose before getting out of bed
• Nursing care during pregnancy for a physically and cognitively challenged woman must be designed with these special concerns in mind so the woman's and her family's challenges and needs can be addressed and met
• Modifications for pregnancy for a physically and cognitively challenged woman

  • Explore safety measures
  • Emergency contacts
  • Transportation
  • Mobility
  • Elimination
• Substance abuse


  The inability to meet major role obligations, an 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
• Effects of cocaine use during pregnancy

  • Vasoconstriction leading to premature separation of the placenta, preterm labor or fetal death
  • Infants = intracranial hemorrhage, learning and social interaction defects
• Effects of methamphetamine use during pregnancy

  • Women develop blackened and infected teeth
  • Newborns show jitteriness and poor feeding at birth and may be growth restricted
• Effects of marijuana and hashish use during pregnancy

  • Tachycardia and a sense of well-being
  • Loss of short-term memory and an increased incidence of respiratory infection in adults
• Effects of phencyclidine use during pregnancy

  • Creates a sense of euphoria, but also causes irritation and possibly long-term hallucinations (i.e., flashback episodes)
• Pregnancy complications from narcotic agonist use

  • Gestational hypertension
  • Phlebitis, subacute bacterial endocarditis, and hepatitis B and HIV infection
• Inhalant abuse


  The "sniffing" or "huffing" of aerosol substances
• Inhalant abuse leads to severe respiratory and cardiac irregularities
• Alcohol use during pregnancy can cause birth defects and developmental disabilities
• Trauma and pregnancy


  • Open Wounds
  • Puncture Wounds
  • Animal or Snake Bites
  • Poisoning
  • Choking
• Nursing care for open wounds

  • Halt bleeding by putting pressure on the edges of the laceration
  • Use a local anesthetic such as lidocaine for suturing
• For puncture wounds, tetanus toxoid (Tdap) is administered
• Oral activated charcoal is safe during pregnancy and so is the medication of choice to neutralize stomach poison
• Dehiscence


  A partial or total separation of previously approximated wound edges, due to a failure of proper wound healing
• Evisceration


  Surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision
• Health teaching for cesarean birth

  • Deep Breathing
  • Incentive Spirometry
  • Turning
  • Ambulation
• Classic cesarean incision


  Incision is made vertically through both the abdominal skin and the uterus, high on the uterus
• Disadvantage of classic cesarean incision

  Leaves a wide skin scar and runs through the active contractile portion of the uterus
• Low segment incision


  Incision is made horizontally across the abdomen just over the symphysis pubis
• Low segment incision


  The most common type of cesarean incision used today, also referred to as a Misgav-Ladach or a "bikini" incision
• Low segment incision


  • Less blood loss
  • Easier to suture
  • Decreases postpartal uterine infections
  • Less likely to cause postpartum gastrointestinal complications
• Disadvantage of low segment incision


  Takes longer to perform
• gestational HPN


  blood vessel inelasticity