NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
INFECTIONS
A. URINARY TRACT
INFECTIONS
- Caused by: E. coli,
Klebsiella, Proteus
- S/S: Asymptomatic
Bacteriuria = (+) bacteria in
urine
- Example: no symptoms
Rx: Early pregnancy, oral
sulfonamides Bactrim
- Late: Ampicillin, furoclantin
- If left untreated, infection
led to acute, pyelonephritis
B. CYSTITIS (Lower UTI)
S/S: Dysuria, urgency,
frequency, low grade fever,
clean catch leukocytes >10,000
counts
- Same as UTI, occurs in
bladder
C. ACUTE
PYELONEPHRITIS
- Infection of kidney, caused
by same microorganisms
S/S: Chills, fever, flank pain,
dysuria, low urine
D. MONILIAL VAGINAL
INFECTION
- Caused by: 80% candid
ablicans – caused by change
in normal vaginal pH – pH
<5 – acidic
S/S: thick white discharge
severe itching dysuria. Wet
mount hyphae, budding yeast
Risk factors:
- HIV, DM, pregnancy
Tx: Intravaginal micronamole
suppository at hours of sleep for
1week
- Implication: fetus may
contact thrush during
delivery
- Infant with oral nystatin 1 cc
< every 6 hours
- Teach: no douching; cotton
underwear
E. BACTERIAL VAGINITIS
- Overgrowth of gardenella
(normal vaginal flora
- Loss of protective Dx – vaginal or urine culture
lactobacilli bacteria (aka DDH notifies partners
vaginitis) Rx with Rocephin IM
- Thin, watery vaginal (ceftriaxone), Zithromax
delivery with clue cells seen (azithromycin) 1 g single dose
under microscope vaginal for amoxicillin PO
pH >5
Tx: with flagus (metronidazole PID (Pelvic Inflammatory
500 mg BID x 7 days) avoid Disease)
intake of alcohol similar to
Antabuse – severe - Cramping, fever, chills,
- Risk factor for PROM purulent discharge, N/V
uterine swelling adnexal and
TRICHOMONIASIS cervical tenderness
(“strawberry” cervix) - Multiple sex partners no
- Different organism caused condoms
by parasite trichomonas Tx with doxycycline i.o
vaginalis. Vaginal discharge (contraindicated in pregnancy)
(thin, greenish, yellow and Rocephin IM
discharge or foamy) clindamycin/gentamycin/Rocep
- An STI hin if pregnant may need
Same Tx as BV for PTL and hospitalization
PROM
HERPES (Herpes Genetalis)
F. STIs
- Viral infection – no cure
(Chlamydia) - HSV 1 – oral (cold, sore)
outer lesion
- Caused by: bacterium - HSV 2 – genital painful,
chlamydia trachomatous open lesion
- Most common STI in USA - Vesicles rupture and appear
- Often asymptomatic: tight after exposure or
thin/virulent discharge within 20 days
burning and frequency with - Burning sensation with
urination lower and pain urination is 1st sign
- Pregnant women: Zithromax - Prodrome “tingling” occurs
1 g single dose amoxicillin x before new outbreak
7 days Dx: vaginal seen or blood test
Rx: acyclovir or Valtrex 500 mg
NEWBORN once a day during pregnancy
CONJUNCTIVITIS reduces viral load enough to
(erythromycin ointment) deliver vaginally
neonatal pneumonia, PTL, fetal
death, Perinatal transmission SYPHILIS: Treponema
occurs in 50% infants where Palladium (Spirochete)
mom is infected at time of
delivery - Primary stage: painless
sores “chancre”,
GONORRHEA (Endocrine approximately 2-3 weeks
Gonorrhea) after initial exposure, fever,
malaise
- Caused by: Neisseria - Secondary stage: 6 weeks to
Gonorrhea, Bacteria STI 6 months, skin eruptions,
- Can lead to PID > infertility arthritis, liver enlarged, sore
green frothy discharge throat
- Often asymptomatic in Tx:
females, males have burning - < 1 year 2.4 million
with urination and penile benzathine penicillin x 1
damage dose IM
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
- > 1-year same medication 1 - Denial – guilt, fear of legal TOBACCO
x per week x 3 weeks consequences, loss of - Impaired O2 delivery
- Sexual partners screened for custody of children nicotine-induced
treatment - History taking, maternal vasospasm, carbon
- If allergic to penicillin tx testing after informed monoxide, other chemicals,
ceftriaxone > 1 trimester
st
consent, etc. chromosomal instability
- 40% chance of still birth or - Be sensitive and respectful lung development
death > birth – infant may in interviewing - Preterm delivery, low birth
be born with “congenital - Ask about frequency, time weight (<2,500 g), small for
syphilis” of last use, route gestational age, PPROM,
- Ophthalmia neonatorum: administration placenta previa, abruption,
can cause blindness appears Risk factors: IUFD
as conjunctivitis in newborn o Late prenatal care - SIDS, asthma, otitis media
o Missed prenatal visit - Idiopathic mental
GENITAL WARTS – virus - DOBHx: miscarriage, retardation, ADHD
(aka Condyloma) IUGR, premature birth - Pharmacotheraphy to those
- Child with unlikely to quit
- Soft pink lessions on vulva, neurodevelopmental
vagina, cervix, anus problems B. MARIJUANA
“cauliflower appearance” - Child not living with mother - Most common illicit
- HPM, type 6 and 1 cause History of drug substance used in pregnancy
90% of genital warts - Detectable in urine for
- 120 strains HCV Management: weeks
Tx: Trichloroacetic acid-aldara - Counselling - Adverse effects
Category C - Social learners inconclusive: association
- Benefits (pregnancy) maybe - Testing for stos with sleep disturbance
acceptable over potential - Frequent prenatal visits, - Small fetal head circulation
risk education - Decreased intelligence,
- Contacts occur during - Early ultrasound autinomic loss stability
vaginal birth. Infant may - Antepartum fetal - Betablockers
have laryngeal warts surveillance contraindicated
- Conforming pediatrics of - Leukemia,
Gardasil Vaccine: 3 doses possible neonatal phadomyosarcoma
- HPV Types 16 and 18 – withdrawal
(80% cervical cancer) and C. COCCAINE
types 6 and 11 (90% genital A. ALCOHOL - Crosses the placenta and
warts) - No level is safe fetal blood-brain barrier
- Can be given to males - Spontaneous abortions, - Vasoconstriction
stillbirth due to fetoplacental hypertension
deflection small for - Crack babies – tremors, high
Substance Abuse gestational age – pitched cry, irritability,
 4% of pregnant we elicit - ADHD, oppositional defiant excessive suck,
substances disorder conduct disorder hyperalertness, autonomic
 Half of substance - Binge drinking disorder in stability
abusing women continue adult offspring - Betablockers
using during pregnancy - Future drinking problem contraindicated
 An even larger - Associated with delayed
proportion Abule FETAL ALCOHOL cognitive, language
tobacco or alcohol SYNDROME development
 Pregnant women DISORDER (FASD)
typically lightly - Diagnostic criteria requires D. HEROINE
motivated to modify all times - Pre-eclampsia, third
behavior to help their - Growth problems trimester bleeding
unborn child - Facial dysmorphia - Neonatal abstinence
- Thin vermilion syndrome
Screening - Short palpebral fissures - Increased autonomic
- Substance abusers come - CNS abnormalities reactivity with withdrawal
from all socioeconomic symptoms begin 24 hours
statuses, ages and races after birth, 40 hours with
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
methadone or organ damage d/t systemic If the two types of blood
buprenorphine vasoconstriction mix, the body will make
- Premature – reduced risk - Headache: visual changes; antibodies
- Supportive therapy confusion, abdominal pain; S/S: severe anemia, liver
- Methadone treatment impaired liver function with dysfunction, kidneys, severe
- Bulimorphine hyperbilirubinemia; baby jaundice (management for
oliguria; proteinuria; jaundice = phototherapy)
Nursing Considerations: pulmonary edema;
hemolytic anemia; RHOGAM
 Ask – at each visit thrombocytopenia; fetal - 28 weeks
 Advise – cessation growth retardation - 10 prevent from producing
 Assess – willingness - Eclampsia (seizures) may antibodies
 Assist – establish a plan follow - 11 prevent mother from
 Arrange – follow, being sensitize
referrals, support Nursing Intervention: for a
woman w/ mild PIH: GESTATIONAL DIABETES
 Clients with mild pre- AKA “GDM”
PRE-ECLAMPSIA eclampsia can be - Glucose intolerance
- BP > 140/90 managed at home with beginning in pregnancy’
- Presents with hypertension, fragment following care - GDM occurs 20th with no
proteinuria, edema of face,  Monitor antiplatelet incidence of anomalies
hands ankles therapy - 2% have undiagnosed type
- Occur anytime > 20th weeks  Promote bed rest II entering pregnancy
of pregnancy  Promote good nutrition - Type 1&2 have anomalies
- Usually occurs closer to due  Provide emotional d/t organogenesis (1st
date, will not resolve until support monitor FHR trimester)
after birth can progress to  Deliver close to EDC - 4% of pregnant affected
help syndrome - Maternal Risk: HTN
 Monitor BP
- Dip stick – to know if there disorders, polyhydramnios,
is protein in urine macrosomia (c/s rate)
BP: 160/90 – give magnesium
o Diagnostic: to know - Infant risks: Birth trauma,
sulfate IM @ buttocks
if there is protein in shoulder dystocia,
Antidote: calcium gluconate
urine (+) hypoglycemia,
- AC should be full blast
o 24-hour urine hyperbilirubinemia, fetal
- Turn on electric fan
death
collection - Icepacks
o Greater than 5 grams
Risk factors:
is considered Drugs for Pre-eclampsia
M – maternal age over 25 years
proteinuria 1. Magnesium Sulfate –
old
muscle relaxant;
O – overweigh >25 /obesity
GENERAL SIGN OF PRE- prevents seizure
>30
ECLAMPSIA (loading dose (4-6g
M – Macrosomia (large babies)
- Rapid weight gain; swelling maintenance dose
> 9 lbs
of arms/face 1-2g/hIV)
M – multiple pregnancy
- Headache; vison changes 2. Hydralazine –
A – a history of previous of
(blurred vision, feeling antihypertensive (5-
GDA family Hx GDM
double, seeing spots) 10mg/IV) administer
- Dizziness /faintness/ ringing slowly to avoid sudden
Screening & Diagnosis of
of ears/confusion; seizures fall in blood pressure.
GDM
- Abdominal pain, decrease 3. Diazepam (Valium) –
- Screen all women @ 24-28
production of urine: nausea, halt seizures (5-10
weeks
vomiting blood or blood in mg/IV)
- Higher risks patients
urine 4. Calcium gluconate –
screened in 1 semester/ 1st
st
antidote for magnesium
prenatal visit and @ 24-28
Mild: intoxication (1g/IV – 10
weeks
- mild HTN, no end-organ ml of a 10% solution)
damage; minimal
1st do:
proteinuria RH SENSATION
- 1 hour glucose challenge
Severe: - You may have Rh-negative
test (GCT) – 50g oral
- Significant HTN, severe blood and your baby may
glucola no fasting needed
proteinuria (>50 g/d); end you have Rh-positive blood.
NCM 105
Instructor: Mrs. Glady’s Reina M. Maitem
- Recommended GCT value
<140 mg/dl (detects 80%)
- Follow GCT >/ = 140 mg/dl
with diagnostic 8 hours.
GTT (glucose tolerance
test) 100g. glucona
- Do fasting 1hr, 2hr, 3h
serum. Fast at least 8 hours
with at least 150g carb
intake 3 days prior to test &
normal activity level
GTT diagnostic Thresholds:
- Teach monitoring of fasting
and post prandial levels
If diet can’t control glucose,
start insulin
- Regular and intermediate
acting insulin for breakfast
and dinner
- Does not cross placenta
- Dose base in weight &
gestational age
- Chose patients with
increased dose

Fasting blood sugar: 95 mg/dl Intrapartum: monitor glucose

Drink 100g glucola levels every 2 hours (insulin
given @ 100 mg per dl <
1 hour: 180 mg/dl plasma level
2 hours: 155 mg/dl Postpartum: most return to
3 hours: 140 mg/dl normal after delivery
- Diagnosis of GDM if 2 or - 50 % patients with GDM
more values than above develop type II later in life
plasma levels - 6-weeks pp serum glucose
- Children of GDM patients
Management: increase for obesity in
- May try standard diabetic childhood adolescence.
diet 1st depending on lab
values
- Initiate insulin for fasting
>95 and 2 hours
postprandial
- 120 mg/dL

Intervention: Antepartum

Goal: Strict glucose control

- Provide immediate
education to patient or
family
- Standard diabetic diet
(2000-2500 cal/day)

Distribution of calories: 40-

50% carbs, 20% protein, 30-
40% fat (<1/3 from saturated
fat, 1/3 polyunsaturated, rest
monosaturated)

Recommended: 3 meals and 3

snacks evenly spaced to avoid
swings in blood glucose. Snack
at bedtime 1,200 mg/day
calcium, 30 mg/day iron, 400
mcg/day folate

- Exercise (walking,
swimming) 30 minutes, 3.4
x per week
- Teach daily glucose self-
monitoring and urine testing