DELIVERY ROOM Write Up

(Danger signs of pregnancy)

Submitted To: Annie Mae Ugay Clinical Instructor

Submitted By: Jhess A. Rodriguez BSN-IV-7 group 13 Date of Exposure July 14-16 Shift 7-3

A pregnant body: the center of gravity has shifted, you're carrying more weight, and they tire more quickly. That's why exercise with care and listen closely to their body when exerting there self. *Signs and symptoms to watch out for: 1. Nausea >too much lactic acid, a byproduct of muscle metabolism in the stomach. 2. Dizziness >Persistent dizziness or dizziness accompanied by blurred vision and headaches or heart palpitations can be a symptom of severe anemia or other serious illness that could affect pregnancy. 3. Sudden change in body temperature > When the body overheats, blood flowing to the uterus is diverted to the skin to help the body cool itself off, putting the baby in jeopardy. 4. Heart palpitations >If the mother keeps up her side of a conversation or she sweat buckets while she exercise, shell probably working too hard.

5. Swelling in the calf >If the mother notice calf pain or swelling, it could indicate thrombophlebitis, a type of vein inflammation related to a blood clot. 6. Vaginal bleeding >Early in the pregnancy, it could signal a miscarriage. In the second and third trimesters, bleeding is associated with premature labor and complications with the placenta, such as placenta previa or placenta abruption. 7. Blurred vision >If the eyesight gets hazy in the middle of exercising, a mother may be dehydrated, which sends blood pressure plummeting and the heart into overdrive. As a result, not enough blood may be getting to developing baby's vital organs. It may also be a sign of preeclampsia. Since preeclampsia can severely restrict the flow of blood to the placenta, it can be dangerous for the baby. 8. Fainting >Fainting during pregnancy shouldn't be taken lightly. It could mean something as simple as dehydration or as serious as major circulatory problems. A mother may not be getting enough oxygen to the brain, which means the baby may not be getting enough, either. 9. Sharp, recurring pain in abdomen and chest >It may just be the ligaments stretching, but it could also be having contractions, especially if the pains recur at somewhat regular intervals. A mother needs to be hooked up to a fetal monitor so the healthcare provider can find out whether shes in labor. 10. Fluid leaking from your vagina >If the underpants feel constantly wet or a mother feels leaking or even a gush of watery fluid from the vagina, it could be premature rupture of the membranes and a signal that your body's about to go into labor.

1. Fetal Movement and Bleeding

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A decrease in fetal movement might indicate that the baby is under stress and no longer able to thrive in the womb. Fetal movements begin to follow a basic routine by 28 weeks and should be monitored by twice-daily kick counts. Vaginal bleeding can indicate an impending miscarriage, placental abruption, placenta previa, or the onset of labor.

2. Abdominal Pain and Vomiting

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Abdominal pain is common during pregnancy as the uterus expands, but severe, persistent abdominal pain could indicate an ectopic pregnancy, miscarriage, or placental abruption. Severe vomiting that lasts for more than 24 hours and prevents the mother from keeping down any food or liquid puts her at risk of dehydration.

3. Swelling and Painful Urination

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Most women notice a little swelling in their legs and ankles during pregnancy, but severe swelling, especially in the face or fingers, is cause for alarm. Severe swelling, often accompanied by blurred vision and headaches, may indicate pregnancy-induced hypertension, which is usually treated through an IV and bed rest and may require early delivery.

4. Abdominal Trauma and Contractions

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Any trauma to the abdomen, regardless of cause, requires immediate medical attention as it can cause any number of complications, including preterm labor. Regular contractions before 37 weeks usually indicates the onset of preterm labor

II.

Danger Signs of Pregnancy

Heavy Bleeding in the First Two Months Heavy bleeding and severe pain in the pelvis, typically within the first two months of pregnancy, can indicate an ectopic pregnancy. Ectopic pregnancies occur when the fertilized egg implants in the fallopian tubes rather than making its way to the uterus where it has space to grow and develop. If not detected and treated promptly, it can result in death, according to the American Pregnancy Association. Abdominal Cramping with Spotting Abdominal cramping accompanied by spotting or bleeding is an indication of a miscarriage. Miscarriages occur in 20 percent of all pregnancies and generally take place before a woman even realizes she is pregnant. It can happen, however, as late as the 20th week of pregnancy. In most cases, a miscarriage cannot be prevented. Intense Feelings of Sadness Intense feelings of sadness that do not go away are indicative of depression, a condition that can occur during and/or after pregnancy. Additional symptoms include changes in appetite, feeling hopeless, becoming irritable or having thoughts of harming ones self or the baby. Treatment usually includes therapy, medication and support groups. Excessive Thirst, Frequent Urination Gestational diabetes typically occurs during the second trimester of pregnancy and is due to the mother's inability to produce enough insulin. If any symptoms occur, they usually include extreme thirst or hunger, frequent urination and fatigue. Pills are rarely an option while pregnant, therefore many doctors choose to treat with diet or insulin. Vaginal Bleeding Accompanied by Cramping When a woman experiences vaginal bleeding along with abdominal pain, cramping and tenderness in the uterus, she may be experiencing placental abruption. This is a condition in which the placenta pulls away from the wall of the uterus, depriving the fetus of oxygen. If the case is mild, bed rest may be all that is needed. If it is a more severe situation, however, and more than half the placenta has separated, early delivery of the baby may be needed to save its life.

Contractions and Vaginal Discharge Women who give birth any time prior to 37 weeks of pregnancy are considered to be in preterm labor. Signs of this include abdominal cramping that radiates around to the back, contractions, pressure in your pelvis and an increase in vaginal discharge. Women's Health states that while some medications can help slow or stop preterm labor from progressing, bed rest is often prescribed. High Blood Pressure High blood pressure is a sign of toxemia, also know as preeclampsia. It is a condition occurring after 20 weeks of pregnancy and its most common symptoms include high blood pressure, blurred vision, headaches and stomach pain. In most cases, the only treatment is delivery of the baby. This is not a problem if the mother is closer to 37 weeks; however, if she is still too early in her pregnancy, the doctor may choose to treat with bed rest and medication to lower her blood pressure. Constant Fatigue Anemia is a condition that occurs when the red blood cell count is lower than what it should be. Its symptoms include constant fatigue or feeling faint, becoming short of breath and looking pale. The doctor may prescribe folic acid and iron supplements to help treat the problem. If it becomes severe, a blood transfusion may be necessary. Constant Nausea and Vomiting Constant nausea and vomiting are signs of hyperemesis gravidarum, a condition that mirrors morning sickness. It is, however, more severe and does not end after the first few weeks. Because of the constant nausea and vomiting, dehydration and weight loss may result. The doctor might first recommend switching to a bland diet (e.g dry toast, rice), but if this is unsuccessful, the mother could require hospitalization in order to receive fluids via an intravenous line. Late-Term Vaginal Bleeding Late-term vaginal bleeding is an indication of a condition known as placenta previa, which causes the placenta to cover part or all of the cervical opening inside the uterus. Some women experience no symptoms, while others experience vaginal bleeding without pain

during the second or third trimester. If not controlled through bed rest, this can lead to hospitalization or preterm labor.

Nursing Management During Pregnancy: Taking History Current pregnancy- any problems Past pregnancy-problems, type of delivery,newborn info Current/past medical hx Family-Religion-Culture Age-old vs. young Identify high risk problems early

Vocabulary Nagles rule minus three months + 7days Ab- before 20 weeks Nullipara- no births before 20 weeks Primpara -one birth after 20 weeks Gravida- pregnancy regardless of duration P- after 20 weeks before 37 wks Living- number of living children

Head to Toe Head and Neck- Evaluate thyroid, dental Chest- HR, murmur, SOB, breast exam Abdomen- check fundal hgt

Extremities- varicosities, edema, calfs Pelvic exam-Lesions, discharge, hematomas Pelvimetry- gynecoid, assess for adequate pelvis Labs- CBC, Rh, Rubella, Hepatitis, HIV, VDRL,RPR

Prenatal Care Visits Every 4 wks to 28wks Every 2 wks to 36 wks Every week to delivery All visits Eval. BP Urine fundal hgt. FM/FHR Edema S/S of PTL 24-28 wks 1hr GTT Anticipatory guidance

Fetal Movement Used to determine fetal well being Cardiff- lie or sit, count 10 fetal movements Call healthcare provider if more than 1 hour Sadovsky- lie on left after eating. Should feel 4 movements in 1 hr

Count movements second hr. Call HCP if criteria not met

Assessment of Fetal Well Being UTZ- Low risk assessment tool Doppler Flow-Eval for absent or reversed diastolic flow AFP-16-18wks Eval for NTD or Downs Marker Screening test- AFP ,unconjugated estriol, hCG and Inhibin A- more accurate Amniocentisischromosomes and metabolic defect

Assessment of Fetal Well Being Nsg-Consent, risk of AB, empty bladder Assess for FHT and UC- Rhogam? Give labor precautions CVS-Tissue sample- Get results sooner Nsg- same as amniocentisis PUBS- blood collected from fetus High Risk- Monitor fetus NSG-FKC- S/S of infection, cramping NST- Fetal Movement = Fetal Well Being Reactivity= 2 accelerations above baseline lasting 15 seconds within 20 minutes Nsg- Apply monitors, give marker, displace uterus to left lateral Need for NST determined by risk factors

CST- Ability of fetus to tolerate stress and fetal reserve Decrease in oxygenation with ucs Initiate 3 ucs in 10 minutes Eval. FHR for variations Negative results are GOOD Positive - 50% of ucs = late decelerations

Biophysical Profile Use UTZ to assess fetal well being Fetal tone-Breathing- Body movement-Amniotic fluid- Reactive NST Score 8/10=good 6/10= concerning Nsg- explain procedure, results, keep informed

Promotion of Self-Care Treat holistically-promote well being Personal Hygiene/Dental Hygiene Breast Care- Sears or J.C. Penny Clothing- loose comfortable Balance exercise with rest Pelvic Tilt and Kagels Sleep- use pillows- limit fluids Sexual activity- encourage intimacy Employment- evaluate risk factors

Travel- move q 2 hrs Immunizations- no live vaccines OTC meds- should consult HCP

Classifications of Drugs A- controlled studies- no fetal risks B- use frequently- r/t little harm C- likely to cause harm risk vs. benefits D- fetal risk benefits outweigh risk X risks outweigh benefits

Promotion of Self Care Promotion of Self Care Urinary frequency-need 2000 cc/day. Limit 2-3 hrs before bed Fatigue- feel best 2nd trimester N/V- Avoid foods and smell. Crackers, sit up, rise slowly- S/S of dehydration Constipation- increase fiber-Do not strain Nasal- epitaxis-use air vaporizer Cravings- Weight? Avoid sodium/sugar

Promotion of Self Care Second Trimester Backache- Good body mechanics Leg cramps-increase calcium/magnesium Ankle edema- common- legs above heart

Hemorrhoids- avoid straining Constipation- bulk in diet- prune juice Flatulence- avoid carbonation, cheese

Promotion of Self Care Third Trimester Diet 30 mg ferrous sulphate/600mcg of folic acid Normal weight gain 25-35 pounds Alterations in weight- thin vs. obese Culture variations Special Diets- Lactose Intolerant- Vegans Use Dieticians Evaluate for Pica SOB-pressure on diaphragm, sit up, avoid large meals- Lightening Constipation- hydration- fruits and vegetables Heartburn- sit up, avoid large meals Ankle edema- eval for PIH Braxton Hicks- Cervix preparing for labor

Perinatal Education Knowledge = Better Birth Experience Lamaze- psychophrophylactic- Breathing controls pain Bradley-Enjoy process of childbirth-no pain medications Dick Read- Break cycle of Fear-Tension-Pain

Birth Options Hospital Based Care-Birthing Suites Family Centered Care Birthing Center- No Rush- Midwife Home Birth- Must be low risk Choosing a health care provider Doula- Continuous support during labor and birth

Breast vs. Bottle Breast is best Bonding Less infection Promotes involution Less allergies Less obesity More digestible

Bottle Need more to get same nutrition Expensive Less digestible No microwave Do not prop bottle Father can feed

Danger Signs of Pregnancy

First Trimester-Spotting- bleeding-persistent vomiting- lower ab. Pain

Second- UCs- calf pain-PROM- decrease in fetal movement Third- Edema- H/A- epigastric pain visual changes- decrease in fetal movement