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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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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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KEY TERMS

neonatal astinence syn!rome

perinatal !rug ause

"ica

"re#gestational !iaetes

teratogen

type $ !iaetes

type 2 !iaetes


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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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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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! "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


7/31Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins


! .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




! 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*$+



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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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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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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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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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

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