2 Nursing Care of The High Risk Pregnant Client

30/03/2022
Definition of a High-Risk Pregnancy
A high-risk pregnancy is one in which a concurrent

disorder, pregnancy-related complication, or external
factor jeopardizes the health of the woman, the fetus,
or both.
Nursing Care of a Family

Experiencing a Pregnancy
Complication From a Preexisting
or Newly Acquired Illness
Copyright © 2018 Wolters Kluwer · All Rights Reserved
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Nursing Process Related to Care of a Establishing a Baseline When Caring for

Woman With a High-Risk Pregnancy a Woman With a High-Risk Pregnancy
 Assessment
o Objective data
o Subjective data
 Nursing diagnoses
 Outcome identification and planning
 Implementation
 Outcome evaluation
Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved
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2020 National Health Goals Related to High-Risk Pregnancy: Cardiovascular

Complications of Pregnancy System
 Reduce the rate of fetal deaths to 5.6 per 1,000 live  Cardiovascular disease complicates only 1% of
births from a baseline of 6.2 per 1,000 live births. pregnancies but accounts for 5% of maternal
deaths.
 Reduce the rate of maternal deaths to 11.4 per
100,000 live births from a baseline of 12.7 per  Blood volume and cardiac output increase up to
100,000 live births. 50%% during pregnancy (peaks at 28 to 32 weeks),
which places stress on a compromised heart.
 Reduce the rate of maternal illness and complications
during pregnancy to 28 per 100 births from a  New York Heart Association criteria is commonly
baseline of 31.1 per 100 births. used to categorize severity of heart disease.
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High-Risk Pregnancy: Common High-Risk Pregnancy: Cardiovascular

Cardiovascular Clinical Findings Issues
 Left-sided heart failure  Valve damage with or without valve replacement

o Orthopnea  Congenital anomalies
Paroxysmal nocturnal dyspnea
 Coronary artery disease (CAD)
o
 Right-sided heart failure

 Chronic hypertensive vascular disease
o Distended liver and spleen
 Venous thromboembolic disease
o Ascites
o Peripheral edema  Peripartum heart disease
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High-Risk Pregnancy: High-Risk Pregnancy: Cardiovascular System

Cardiovascular System Assessment Nursing Diagnosis (Example)
 Level of exercise
Deficient knowledge regarding steps to take to reduce
 Presence of cough or edema the effects of maternal cardiovascular disease on the
pregnancy and fetus
 Comparison of baseline vital signs
 Liver size (right-sided heart failure involvement)
 ECG/echocardiogram
 Fetal size (small for gestational age) and poor
response to labor (FHR decelerations)
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High-Risk Pregnancy: Cardiovascular System High-Risk Pregnancy: Cardiovascular System

Nursing Interventions During Antepartal Nursing Interventions During Intrapartum
Period and Postpartum Periods
 Promote rest.  Intrapartum period

 Promote healthy nutrition. o Positioning
Epidural anesthesia and assisted vaginal delivery
 Educate regarding medication. o
 Educate regarding avoidance of infection.  Postpartum period

o Assess for heart failure
o Anticoagulant and digoxin therapy
o Intermittent pneumatic compression boots
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Quality & Safety Education for Nurses Reducing Risk of Thromboembolic Disease
(QSEN) Through QSEN Competencies
 Patient-Centered Care
 Teamwork & Collaboration
 Evidence-Based Practice
 Quality Improvement
 Safety
 Informatics
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High-Risk Pregnancy: Endocrine System High-Risk Pregnancy: Endocrine System

#1 #2
 Diabetes mellitus  Diabetes during pregnancy—(cont.)

o Pathophysiology and clinical manifestations o Screening during pregnancy
o Classification o Monitoring during pregnancy
o Gestational diabetes
 Diabetes during pregnancy

o Decreased control of glucose regulation
o Effect on fetal size, infant hypoglycemia, and increased
incidence of congenital anomalies
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High-Risk Pregnancy: Endocrine System High-Risk Pregnancy: Endocrine System

#3 #4
 Diabetes during pregnancy—(cont.)  Diabetes during pregnancy—(cont.)

o Nursing diagnoses and related interventions o Therapeutic management
 Nursing diagnosis: “Deficient knowledge related to a  Insulin needs and dosage adjustments
therapeutic regimen necessary during pregnancy”  Education related to blood glucose monitoring
 Interventions:  Insulin pump therapy
 Education regarding nutrition during pregnancy  Education related to pump care and use
 Education regarding exercise during pregnancy  Tests for placental function and fetal well-being
 Education related to recording fetal movement
 Postpartum management of blood glucose
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High-Risk Pregnancy: Interventions Related

High-Risk Pregnancy: Renal and Urinary to Prevention of Renal and Urinary Tract
System Assessment Disorders3
 Nutritional consults and monitoring fluid intake

 Hygiene
 Voiding frequently and after sexual intercourse
 Cranberry juice intake
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Caring for Woman With Multiple Threats Caring for Woman With Multiple Threats
to Her Pregnancy #1 to Her Pregnancy #2
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Question #1 Answer #1
Which statement by a woman who is 8 weeks B. “Ihave gained 4 lb during the last week, but I’m
pregnant and has cardiac disease would you most not eating more than before.”
likely follow up closely?
Rationale: Constipation and nausea are common during the first
A. “I have been really constipated for the last few trimester. Fetal movement (quickening) is not usually felt until
the second trimester. Weight gain of 4 lb within a week during
weeks.” the first 8 weeks of pregnancy without additional intake could
signal increased circulatory fluid and impending heart failure.
B. “I have gained 4 lb during the last week, but I’m
not eating more than before.”
C. “I have not felt any fetal movement as yet.”
D. “I have had episodes in the morning when I have
almost thrown up.”
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What is the most accurate statement regarding D. Ideally, dietary calorie intake should be
exercise and nutrition during pregnancy for a woman approximately 20% from protein, 40% to 50% from
with diabetes? carbohydrates, and up to 30% from fats.
A. Extreme exercise may cause hypoglycemia; therefore, it Rationale: This caloric balance allows for good glycemic
should be avoided. control. Because exercise programs may cause glucose
B. During the last trimester, caloric intake should be fluctuations, they need to be initiated before pregnancy.
decreased to less than 1,800 calories to control fetal weight Extreme exercise can cause hyperglycemia because of glucose
gain. release by the liver to compensate for energy need and lack of
insulin to metabolize it. Intake of less than 1,800 calories may
C. Exercise reduces the need for insulin; therefore, beginning
an exercise regimen during pregnancy is recommended. result in fat breakdown and acidosis.
D. Ideally, dietary calorie intake should be approximately 20%

from protein, 40% to 50% from carbohydrates, and up to
30% from fats.
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Which is the most accurate and reliable outcome A. A fasting glucose level of 85 mg/dl
measure for evaluating an intervention?
A. A fasting glucose level of 85 mg/dl Rationale: Fasting glucose level is the only measure of an
B. An oral intake measurement of 720 ml of fluids within 8 hours outcome. The other three choices are evaluation of activities
(processes), which may or may not result in a desired
C.An exercise diary indicating the pregnant woman walked 30 outcome.
minutes every day for a week
D. The statement by a pregnant woman, “Iunderstand why folic
acid is important for red blood cell formation.”
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30/03/2022

Definition of a High-Risk Pregnancy

A high-risk pregnancy is one in which a concurrent

Nursing Care of a Family

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Nursing Process Related to Care of a Establishing a Baseline When Caring for

2020 National Health Goals Related to High-Risk Pregnancy: Cardiovascular

High-Risk Pregnancy: Common High-Risk Pregnancy: Cardiovascular

 Left-sided heart failure  Valve damage with or without valve replacement

 Right-sided heart failure

High-Risk Pregnancy: High-Risk Pregnancy: Cardiovascular System

High-Risk Pregnancy: Cardiovascular System High-Risk Pregnancy: Cardiovascular System

 Promote rest.  Intrapartum period

 Educate regarding avoidance of infection.  Postpartum period

High-Risk Pregnancy: Endocrine System High-Risk Pregnancy: Endocrine System

 Diabetes mellitus  Diabetes during pregnancy—(cont.)

o Classification o Monitoring during pregnancy

 Diabetes during pregnancy

High-Risk Pregnancy: Endocrine System High-Risk Pregnancy: Endocrine System

 Diabetes during pregnancy—(cont.)  Diabetes during pregnancy—(cont.)

High-Risk Pregnancy: Interventions Related

 Nutritional consults and monitoring fluid intake

D. Ideally, dietary calorie intake should be approximately 20%

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