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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 20Nursing Management of the Pregnancy at
Risk: Selected Health Conditions andVulnerale Populations
Maternity and Pediatric Nursing
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
KEY TERMS
acquired immunodeficiency syndrome (AIDS)
Adolescence
anemia
fetal alcohol spectrum disorder (FASD)
gestational diabetes mellitus
glycosylated hemoglobin(HbA1C) leel
human immunodefciency irus (HI!)
impaired fasting glucose
impaired glucose tolerance
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
KEY TERMS
neonatal astinence syn!rome
perinatal !rug ause
"ica
"re#gestational !iaetes
teratogen
type $ !iaetes
type 2 !iaetes
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Mellitus
! "ypical classification
# "ype $
# "ype 2
# %mpaired fasting glucose and impaired glucosetolerance
# &estational diaetes! Classification during pregnancy
# Pregestational diaetes
# &estational
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Mellitus (contd)
! Pathophysiology and pregnancy
# 'etal demands# Role of placental hormones
# Changes in insulin resistance
# (ffects on mother
# (ffects on fetus )see "ale 20*$+
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Mellitus (contd)
! "herapeutic management
# Preconception counseling# ,lood glucose le-el control )H.$C /1+
# &lycemic control
# Nutritional management# Hypoglycemic agents
# Close maternal and fetal sur-eillance
# Management during laor and irth
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7/31Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Mellitus (contd)
! .ssessment
# Health history physical e3amination risk factors
# Screening at first prenatal -isit additional
screening at 24 to 25 6eeks for 6omenconsidered at risk
# Maternal sur-eillance: urine for protein7 ketones7nitrates7 and leukocyte esterase e-aluation of
renal function8trimester eye e3am in $st
trimester H.$c 9 4* 6eeks
# 'etal sur-eillance: ultrasound alpha*fetoproteinle-els iophysical profile nonstress testingamniocentesis
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8/31Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diabetes Mellitus (contd)
! Nursing management )see Nursing Care Plan 20*$+
# ;ptimal glucose control! ,lood glucose le-els medication therapy
! Nutritional therapy
! Measures during laor and irth postpartum
# Pre-ention of complications
# Client education and counseling )see "eaching
&uidelines 20*$+
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9/31Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
%s the follo6ing statement "rue or 'alsecra-ings=
! ,= "here is progressi-e resistance to the effects of
insulin=
! C= Hypoinsulinemia de-elops early in the Krst trimester=
! A= &lucose le-els decrease to accommodate fetal gro6th=
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Re,ie
! "he correct response is ,:
! caused le-els of the hormone hP )insulin antagonist+progressi-ely rise throughout pregnancy7 and additional insulinis needed to o-ercome its resistance= Ha-ing a carohydratecra-ing is not associated 6ith gestational diaetes=Hyperinsulinemia in the fetus de-elops in response to themother>s high lood glucose le-els= &lucose le-els are di-ertedacross the placenta for fetal use7 and thus maternal le-els arereduced in the first trimester= "his lo6er glucose le-el doesn>tlast throughout the gestation7 Just the first trimester= 'or theremaining t6o trimesters7 the maternal glucose le-els are highecause of the insulin resistance y hP=
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Re,ie
! Ghen pro-iding prenatal education to a pregnant6oman 6ithasthma7 6hich of the follo6ing 6ould eimportant for thenurse to dos glucosele-els7 unless she also has diaetes= ,ronchodilators usuallyare inhaled7 not gi-en sucutaneously7 so instruction aout thisroute of administration 6ould not e necessary=
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Re,ie
! Ghich of the follo6ing conditions 6ould most likely causea pregnant 6oman 6ith type $ diaetes the greatest
difKculty during her pregnancy
! = Hyperemesis gra-idarum
! c= .ruptio placentae
! d= Rh incompatiility
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Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Re,ie
! "he correct response is ,:
! "he highest percentage of H%V transmission results fromse3ual acti-ity7 follo6ed y intra-enous drug use="ransmission can occur despite a lo6 -iral load in thelood of the infected person= Pregnant 6omen 6ho takeantiretro-iral therapy during their gestation significantlyreduce the chances of transmitting H%V to their ne6orn=
"he use of standard precautions 6ill minimi?e the risk oftransmission of H%V to health care 6orkers= . -ery smallpercentage of nurses contract H%V through needlesticks ifusing appropriate precautions=
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T$e End// Questions00