Maternal and Child Health Care

Framework for Maternal and

Child Health Nursing (MCN)
Focusing on At-Risk, High Risk,
And Sick Clients
Guide Questions:
1.What is maternal and child Health nursing?
2.What are the issues of maternal and Child health
nursing?
3.What is the current status of Maternal and Child
Nursing?
 Maternal and Child Health Nursing
Maternal and Child health Nursing includes care of Pregnant women, child
and family. The primary goal is promotion and maintenance of optimal family health
care from childbearing to child rearing.

Philosophy of Maternal and Child nursing:

1. Family Centered
2. Community centered.
3. Research Oriented.
4. Evidence-based practice.
5. Advocates the right of family including fetus.
6. Teaching and counselling
7. Promoting health.
Maternal and Child Health Nursing in the
Community
Maternal and Child Health Nursing in the
Hospital
 Issues of maternal and Child health
Nursing
1. Personal, cultural and Religious belief.
2. Ethical issues
3. Communication Approach
4. Impact of Pandemic
5. Safety Measures
Current status of Maternal and Child Nursing-
Locally and Globally

The COVID-19 global outbreak is challenging health

systems worldwide that has disrupted family planning,
maternal and newborn health services globally, and also in
the Philippines. Utilization of facilities for Prenatal check-up
delivery and Post natal care is declining, because of service
disruption, difficulty in commuting, and their fear of
contracting COVID-19.
 Statistics on MCN
7th Annual Report of DOH as of 2020
 Statistics on MCN
7th Annual Report of DOH as of 2020
 Statistics on MCN
7th Annual Report of DOH as of 2020
 The Nursing Role in
Genetic Assessment and
Counseling
GENETIC DISORDERS
➢ Inherited or genetic disorders are disorders that can be passed from one
generation to the next because they result from some disorder in the gene or
chromosome structure.

Genetics
➢ is the study of the way such disorders occur.

Cytogenetics
➢ is the study of chromosomes by light microscopy and the method by which
chromosomal aberrations are identified.
Instances of Genetic Disorder

• Disorders occur at the moment an ovum and sperm fuse or even earlier, in the
meiotic division phase of the ovum or sperm when the chromosome count is
halved from 46 to 23.

• Disorders occur in some ethnic groups more than others because people tend
to marry within their own cultural group.

• Disorders may occur due to occupational hazards, such as toxic substances in

the environment of workplaces.

• Other genetic disorders do not affect life in utero, so the result of the disorder
only becomes apparent at the time of fetal testing or after birth.
 Nature of Inheritance
• Genes are the basic units of heredity that determine both the physical and
cognitive characteristics of people.
• Composed of segments of DNA, they are woven into strands in the nucleus of
all body cells to form chromosomes.

• A person’s phenotype refers to his or her outward appearance or the

expression of genes. A person’s genotype refers to his or her actual gene
composition.
• A person’s genome is the complete set of genes present.

• Imprinting refers to the differential expression of genetic material and

allows researchers to identify whether the chromosomal material has come
from the male or female parent.
Mendelian Inheritance: Dominant and
Recessive Patterns
Discovered and described by Gregor Mendel, an Austrian naturalist, in the 1800s and
are known as mendelian laws.

Mendelian inheritance patterns refer to observable traits, not to genes. A trait

caused by the gene which can express itself in the Presence of even another gene is
known as the dominant trait. A trait caused by the gene which can express itself in
the Presence of only an identical gene is known as the recessive trait.

How do you explain dominant and recessive traits?

If someone has a brown eyed gene and a blue eye gene, they will have brown eyes.
They will only have blue eyes if both genes are blue. The brown eyed gene is called
the dominant gene and the blue eyed gene is the recessive gene.
Inheritance of Disease
Autosomal dominant disorders occur when only one defective copy of an
autosomal gene is required to cause disease.
What is an example of autosomal dominant inheritance?
If someone is diagnosed with an autosomal dominant disease, their parents should also be
tested for the abnormal gene. Examples of autosomal dominant disorders include Marfan
syndrome (is a genetic condition that affects connective tissue, which provides support for
the body and organs. Marfan syndrome can damage the blood vessels, heart, eyes, skin,
lungs, and the bones of the hips, spine, feet, and rib cage) and neurofibromatosis type 1(is a
genetic condition that causes tumors to grow along your nerves. The tumors are usually
benign but may cause a range of symptoms.)
Is autosomal dominant male or female?
To sum this up, autosomal recessive and autosomal dominant disorders affect males and
females equally. However, autosomal recessive disorders skip generations or occur
sporadically, whereas autosomal dominant disorders often occur in every generation.
Marfan Syndrome
Autosomal recessive inheritance is a way a genetic trait or condition can
be passed down from parent to child. A genetic condition can occur when the child
inherits one copy of a mutated (changed) gene from each parent. The parents of a
child with an autosomal recessive condition usually do not have the condition.

What is an example of autosomal recessive?

Examples of autosomal recessive disorders include cystic fibrosis, sickle cell anemia,
and Tay Sachs disease.
X-linked dominant inheritance refers to genetic conditions associated
with mutations in genes on the X chromosome. A single copy of the mutation is
enough to cause the disease in both males (who have one X chromosome) and
females (who have two X chromosomes).

What is X linked inheritance give an example?

Examples of X-linked recessive conditions include red-green color blindness and

hemophilia A: Red-green color blindness. Red-green color blindness simply means
that a person cannot distinguish shades of red and green (usually blue-green).
X-linked recessive inheritance refers to genetic conditions associated
with mutations in genes on the X chromosome. A male carrying such a mutation
will be affected, because he carries only one X chromosome. A female carrying a
mutation in one gene, with a normal gene on the other X chromosome, is generally
unaffected.

What are X-linked recessive traits in human?

Examples of X-linked recessive conditions include red-green color blindness and

hemophilia A: Red-green color blindness. Red-green color blindness simply means
that a person cannot distinguish shades of red and green (usually blue-green). Their
visual acuity (ability to see) is normal.
Y-linked inheritance is a form of inheritance for the genes located on the Y
chromosome. In humans and other mammalian males, the sex chromosomes are
the X and Y chromosome. The y chromosome is smaller than the X chromosome
and thus, carries relatively fewer genes.

Hypertrichosis of the ears, webbed toes, and porcupine man are examples of Y-
linked inheritance in humans. Hypertrichosis of the ears (or hairy ears) is a
condition wherein there is a conspicuous growth of hair on the outside rim of the
ear.
Multifactorial inheritance means that "many factors" (multifactorial) are
involved in causing a birth defect. The factors are usually both genetic and
environmental, where a combination of genes from both parents, in addition to
unknown environmental factors, produce the trait or condition.

What is an example of a multifactorial polygenic trait?

For example, height is thought to be polygenically inherited, but a person's stature

also is significantly affected by adequacy of diet while growing. Cleft lip with or
without cleft palate is probably an example of a polygenic trait with a threshold
effect.
Mitochondrial genes are inherited only from the mother. If there is a
mutation in a mitochondrial gene, it is passed from a mother to all of her children;
sons will not pass it on, but daughters will pass it on to all of their children, and so
on.
What are some examples of mitochondrial diseases?

• Alpers's Disease.
• Autosomal Dominant Optic Atrophy (ADOA) Barth Syndrome
• Chronic Progressive External Ophthalmoplegia (CPEO)
• Co-Enzyme Q10 Deficiency.
• Creatine Deficiency Syndromes
• Friedreich's Ataxia.
• Kearns-Sayre Syndrome (KSS)
• Lactic Acidosis
• Leigh Syndrome.
• MELAS.
• Mitochondrial Myopathy.
 Chromosomal Disorders
(Cytogenic Disorders)

The disorder occurs not because of dominant or recessive gene patterns but
through a fault in the number or structure of chromosomes, which results in
missing or distorted genes.

When chromosomes are photographed and displayed, the resulting arrangement

is termed a karyotype.
 Nondisjunction Disorders
Meiosis is the type of cell division in which the number of chromosomes in a cell
is reduced to the haploid (half) number for reproduction (reduced to 23 rather than
46 chromosomes).
Chromosomal disorders occur if the division is uneven or nondisjunction.
Deletion Disorders
Deletion disorders are a form of chromosome disorder in which part of a chromosome breaks during
cell division, causing the affected person to have the normal number of chromosomes plus or minus
an extra portion of a chromosome, such as 45.75 chromosomes or 47.25. For example, in cri-du-chat
syndrome,

Translocation Disorders
Translocation disorders are perplexing situations in which a child gains an additional chromosome
through yet another route. A form of Down syndrome occurs as an example of this.

Mosaicism
Mosaicism is an abnormal condition that is present when the nondisjunction disorder occurs after
fertilization of the ovum as the structure begins mitotic (daughter-cell) division. Children with Down
syndrome who have near-normal intelligence may have this type of pattern.
Isochromosomes
If a chromosome accidentally divides not by a vertical separation but by a
horizontal one, a new chromosome with mismatched long and short arms can
result. This is an isochromosome. It has much the same effect as a translocation
disorder when an entire extra chromosome exists. Some instances of Turner
syndrome (45XO) may occur because of isochromosome formation.
 COMMON CHROMOSOMAL DISORDERS RESULTING IN
PHYSICAL OR COGNITIVE DEVELOPMENTAL DISORDERS
Trisomy 13 Syndrome Trisomy 18 Syndrome Cri-du-Chat Syndrome Turner Syndrome

Klinefelter Syndrome Fragile X Syndrome Down (Trisomy 21)Syndrome

Trisomy 13, also called Patau syndrome, is a chromosomal condition
associated with severe intellectual disability and physical abnormalities
in many parts of the body.

• often have heart defects, brain or spinal cord abnormalities

• Microphthalmia
• a cleft lip
• a cleft palate
• Hypotonia

Due to the presence of several life-threatening medical problems,

many infants with trisomy 13 die within their first days or weeks of life.
Only five percent to 10 percent of children with this condition live past
their first year.

Trisomy 13 occurs in about 1 in 16,000 newborns. Although women of

any age can have a child with trisomy 13, the chance of having a child
with this condition increases as a woman gets older.
Trisomy 18 Syndrome have three copies of chromosome 18.

• small for gestational age

• have markedly low-set ears
• a small jaw
• congenital heart defects
• misshapen fingers and toes (the index finger deviates or crosses
over other fingers).
• the soles of their feet are often rounded instead of flat (rocker-
bottom feet).

As in trisomy 13 syndrome, most of these children do not survive

beyond infancy.
Cri-du-chat syndrome is the result of a missing portion of
chromosome 5.

• an abnormal cry, which sounds much more like the sound of a

cat
• than a human infant’s cry
• tend to have a small head
• wide-set eyes,
• a downward slant to the palpebral fissure of the eye
• a recessed mandible

They are severely cognitively challenged.

Turner syndrome (gonadal dysgenesis), has only one
functional X chromosome.

• (small and nonfunctional) ovaries

• secondary sex characteristics do not develop at puberty.
• hairline at the nape of the neck is low set
• the neck may appear to be webbed and short

A newborn may have appreciable edema of the hands and feet

and a number of congenital anomalies, most frequently
coarctation (stricture) of the aorta, as well as kidney disorders.
Klinefelter syndrome are males with an extra X chromosome.
Characteristics of the syndrome may not be noticeable at birth.

• secondary sex characteristics do not develop

• the child’s testes remain small and produce ineffective sperm
• Affected individuals tend to develop gynecomastia (increased
breast size) and have an increased risk of male breast cancer.
Fragile X syndrome is the most common cause of cognitive
challenge in males. It is an X-linked disorder in which one long arm of
an X chromosome is defective, which results in inadequate protein
synaptic responses.

• demonstrate maladaptive behaviors such as hyperactivity,

aggression, or autism.
• reduced intellectual functioning, with marked deficits in speech
and arithmetic
• a large head,
• a long face with a high forehead,
• a prominent lower jaw,
• large protruding ears,
• and obesity.
• Hyper extensive joints and cardiac disorders may also be present.
• After puberty, enlarged testicles may become evident. Affected
individuals are fertile and can reproduce.
Trisomy 21, the most frequently occurring chromosomal
disorder, occurs in about 1 in 800 pregnancies. In women who
are older than 35 years of age, the incidence is as high as 1 in
100 live births.

• The nose is broad and flat

• The eyelids have an extra fold of tissue at the inner canthus (an
epicanthal fold)
• palpebral fissure (opening between the eyelids) tends to slant
laterally upward.
• The iris of the eye may have white specks, called Brushfield
spots.
• The tongue is apt to protrude from the mouth because the oral
cavity is smaller than usual.
• The back of the head is flat,
• the neck is short,
• extra pad of fat at the base of the head causes the skin to be so
loose it can be lifted easily and so thin it can be revealed on a
fetal sonogram.
• The ears may be low set.
• Muscle tone is poor, giving the newborn a rag-doll appearance

Children with Down syndrome are usually cognitively challenged

to some degree. The challenge can range from an intelligence
quotient [IQ] of 50 to 70. To a child who is profoundly affected (IQ
less than 20).
 GENETIC COUNSELING AND TESTING

• Provide concrete, accurate information about the process of

inheritance and inherited disorders.
• Reassure people who are concerned their child may inherit a
particular disorder that the disorder will not occur.
• Allow people who are affected by inherited disorders to make
informed choices about future reproduction.
• Allow people to pursue potential interventions that may exist such
as fetal surgery.
• Allow families to begin preparation for a child with special needs.
Couples who are most apt to benefit from a referral for
genetic testing or counseling include:
• A couple who has a child with a congenital disorder or an inborn error of
metabolism.
• A couple whose close relatives have a child with a genetic disorder such as a
translocation disorder or an inborn
• error of metabolism.
• Any individual who is a known balanced translocation carrier.
• Any individual who has an inborn error of metabolism or chromosomal disorder.
• A consanguineous (closely related) couple.
• Any woman older than 35 years of age and any man older than 55 years of age.
• Couples of ethnic backgrounds in which specific illnesses are known to occur.
Nursing Responsibilities

• The individual or couple being counseled needs a

clear understanding of the information provided.
• It is never appropriate for a health care provider
to impose his or her own values or opinions on
others.
 The Assessment for Genetic Disorders
• History

• Physical Assessment -Dermatoglyphics (the study of surface markings of the skin) is

also helpful because unusual fingerprints, abnormal palmar creases, hair whorls, or
coloring of hair are also present with some disorders.

• Diagnostic Testing
✓ Nuchal Translucency Screening -The nuchal (say "NEW-kuhl") translucency
screening is a test done during pregnancy. It uses ultrasound to measure the
thickness of the fluid buildup at the back of the developing baby's neck. If this
area is thicker than normal, it can be an early sign of Down syndrome, trisomy
18, or heart problems.
 The Assessment for Genetic Disorders
✓ Maternal Serum Screening-Maternal Serum Screening (MSS) is a blood test
offered to pregnant women who want to find out if they may be at increased
risk of having a baby with Down syndrome, trisomy 18 or neural tube defects
(such as spina bifida).
✓ Karyotyping-Karyotyping is a test to examine chromosomes in a sample of cells.
This test can help identify genetic problems as the cause of a disorder or
disease.
✓ Chorionic Villi Sampling-Chorionic villus sampling (CVS), or chorionic villus
biopsy, is a prenatal test that involves taking a sample of tissue from the
placenta to test for chromosomal abnormalities and certain other genetic
problems.
 The Assessment for Genetic Disorders
✓ Amniocentesis-Amniocentesis is a test you may be offered during pregnancy to
check if your baby has a genetic or chromosomal condition, such as Down's
syndrome, Edwards' syndrome or Patau's syndrome. It involves removing and
testing a small sample of cells from amniotic fluid, the fluid that surrounds the
baby in the womb (uterus).
✓ Percutaneous Umbilical Blood Sampling-this quick test — also called
cordocentesis, fetal blood sampling, or umbilical vein sampling — takes fetal
blood directly from the umbilical cord. Doctors use it to check for disorders in
the fetus.
✓ Fetal imaging-An imaging study in which high-frequency sound waves create
pictures of a fetus inside the uterus. For viewing the fetus during pregnancy. It is
also utilized to guide procedures such as amniocentesis or chorionic villus
sampling.
 The Assessment for Genetic Disorders
✓ Fetoscopy-Fetoscopy is a technique that utilizes a small camera or scope to
examine and perform procedures on the fetus during pregnancy. The scope is
introduced through a small incision on the mother's abdomen and placed into
the amniotic sac through the uterus.

✓ Preimplantation Diagnosis-Pre-implantation genetic diagnosis (PGD) is a

laboratory procedure used in conjunction with in vitro fertilization (IVF) to
reduce the risk of passing on inherited conditions.

✓ Newborn Screening-using a few drops of blood from the newborn's heel, for
certain genetic, endocrine, and metabolic disorders, and are also tested for
hearing loss and critical congenital heart defects (CCHDs) prior to discharge from
a hospital or birthing center.
 Legal and Ethical Aspects of Genetic
Screening and Counseling

• Participation by couples or individuals in genetic screening must be elective.

• People desiring genetic screening must sign an informed consent for the
procedure.
• Results must be interpreted correctly yet provided to the individuals as quickly
as possible.
• The results must not be withheld from the individuals and must be given only to
those persons directly involved.
• After genetic counseling, persons must not be coerced to undergo procedures
such as abortion or sterilization. Any procedure must be a free and individual
decision
Definition of Terms:
1. Gravida - refers to pregnant woman.
2. Gravidity - refers to the number of pregnancies.
3. Nulligravida - a woman who has never been pregnant.
4. Primigravida - First time pregnancy.
5. Multigravida - in at least of her second pregnancy
6. Parity - number of births.
7. Nullipara – who has not had a birth at more than 20 weeks of gestation.
8. Primipara - who has had one birth that occurred after the 20th week of gestation.
9. Multipara – who has had two or more pregnancies resulting in viable offspring.
10. Nagale’s Rule – requires that the woman have a regular 28 day cycle.
11. Quickening – first perception of fetal movement.
12. Hegar’s sign – softening and thinning of the lower uterine segment.
13. Goodell’s sign – softening of the cervix.
14. Chadwick’s sign – bluish coloration mucus membranes of the cervix, vagina and vulva.
15. Ballottement – rebounding of the fetus against the examiner’s fingers on palpation
16. Braxton Hick’s contraction - a tightening in your abdomen that comes and goes
 Physiological Maternal Changes
CARDIOVASCULAR STSTEM GASTROINTESTINAL SYSTEM
o Circulating blood volume increases o Nausea and vomiting
o Physiological anemia o Poor appetite
o Iron requirements Increases o Alterations in taste
o Heart size increases o Constipation
o Pulse increases o Flatulence and heartburn
o Blood pressure slightly decreases in o Hemorrhoids
2nd semester o Gum Tissue
o Fluid retention may occur o Ptyalism

RESPIRATORY RATE
RENAL SYSTEM
o Oxygen consumption increases
o Frequency in urination
o Diaphragm is elevated
o Decreased bladder tone
o Respiratory rate unchanged or slightly
o Renal threshold
increases
o SOB may be experience
 Physiological Maternal Changes
ENDOCRINE SYSTEM
o Basal metabolic rase increase
o Anterior lobe of pituitary gland
enlarges
o Thyroid slightly enlarges
o Parathyroid increases in size
Aldosterone gradually increases

REPRODUCTIVE SYSTEM
o Uterus enlarges
o Cervix become shorter, elastic, and larger
in diameter
o Secretions of thick mucus
o Ovaries secretes progesterone
o Hypertrophy and thickening muscle of
vagina
o Breast changes occurs
 Physiological Maternal Changes
SKIN
o Increased Pigmentation
o Linea Nigra
o Chloasma
o Striae
o Vascular spider nevi
o Rate of hair growth
 Physiological Maternal Changes
SKELETAL SYSTEM

o Center of gravity and Postural

changes

METABOLISM

o Metabolic Function Increases

 Discomforts of Pregnancy
❑ Nausea and vomiting
❑ Syncope
❑ Urinary urgency and
frequency
❑ Breast Tenderness
❑ Increase vaginal Discharge
❑ Nasal stuffiness
❑ Fatigue
❑ Heartburn
❑ Ankle Edema
❑ Varicose veins
❑ Headaches
❑ Hemorrhoids
❑ Backache
❑ Leg Cramps
❑ SOB
Nursing Care of the Pregnant
Client (RISK RELATED TO
PREGNANCY)
ABORTION – a pregnancy that ends before 20
weeks gestation, spontaneously or electively.
Threatened:
Spotting and cramping
occur without cervical
change.
Inevitable: Spotting
and cramping occur
and cervix begins to
dilate and efface.
Incomplete: Loss of
some of the products of
conception occurs, with
part of the products
retained (most often
placenta is retained).
Complete: Loss
of all products of
conception.
Missed: Products
of conception are
retained in utero
after fetal death.
 Types of Abortions

Spontaneous: Pregnancy ends because of natural

causes.

Induced: Therapeutic or elective reasons exist for

terminating pregnancy.

Habitual: Spontaneous abortions occur in 3 or

more successive pregnancies.
Assessment:

1.Spontaneous vaginal bleeding

2.Low uterine cramping or contractions
3.Blood clots or tissue through the vagina
4.Hemorrhage and shock can result if
bleeding is excessive.
Interventions:
1. Maintain bed rest as prescribed.
2. Monitor vital signs.
3. Monitor for cramping and bleeding.
4. Count perineal pads to evaluate blood loss, and
save expelled tissues and clots.
5. Maintain intravenous (IV) fluids as prescribed;
monitor for signs of hemorrhage or shock.
6. Prepare the client for dilation and curettage as
prescribed for incomplete abortion.
7. Administer Rho(D) immune globulin, as prescribed, for an Rh-
negative woman.
8. Provide psychological support.
HUMAN IMMUNO DEFFICIENCY VIRUS AND
ACQUIRED IMMUNO DEFFICIENCY SYNDROME -
HIV virus is a causative agent o f AIDS.
Assessment:
1.Women infected with HIV may first show signs and symptoms
at the time of pregnancy or possibly develop life-threatening
infections because normal pregnancy involves some
suppression of the maternal immune system.
2.Repeated exposure to the virus during pregnancy through
unsafe sex practices or IV drug use can increase the risk of
transmission to the fetus.
Transmission:
• Sexual exposure to genital secretions of an
infected person.
• Parenteral exposure to infected blood and
tissue
• Perinatal exposure of an infant to infected
maternal secretions through birth or breast-
feeding.
❖ The mother with HIV is managed as high risk
because she is vulnerable to infections.
Diagnosis:
1. ELISA TEST
Interventions:
1. Prenatal period
a) Prevent opportunistic infections.
b) Avoid procedures that increase the risk of perinatal
transmission, such as amniocentesis and fetal scalp
sampling.
2. Intrapartum period
a) If the fetus has not been exposed to HIV in utero, the
highest risk exists during delivery through the birth canal.
b) Avoid the use of internal scalp electrodes for monitoring of
the fetus.
Interventions:
c) Avoid episiotomy to decrease the amount of maternal
blood in and around the birth canal.
d) Avoid the administration of oxytocin because contractions
induced by oxytocin can be strong, causing vaginal tears or
necessitating an episiotomy.
e) Place heavy absorbent pads under the mother’s hips to
absorb amniotic fluid and maternal blood.
f) Minimize the neonate’s exposure to maternal blood and
body fluids; promptly remove the neonate from the mother’s
blood after delivery.
Interventions:
c) Avoid episiotomy to decrease the amount of maternal
blood in and around the birth canal.
d) Avoid the administration of oxytocin because contractions
induced by oxytocin can be strong, causing vaginal tears or
necessitating an episiotomy.
e) Place heavy absorbent pads under the mother’s hips to
absorb amniotic fluid and maternal blood.
f) Minimize the neonate’s exposure to maternal blood and
body fluids; promptly remove the neonate from the mother’s
blood after delivery.
Interventions:
g) Suction fluids from the neonate promptly.
h) Prepare to administer zidovudine as prescribed to the
mother during labor and delivery.
3. Postpartum period
a) Monitor for signs of infection.
b) Place the mother in protective isolation if she is
immunosuppressed.
c) Restrict breast-feeding.
d) Instruct the mother to monitor for signs of infection and
report any signs if they occur.
The newborn and HIV
• Neonates born to HIV-positive clients may test positive
because antibodies received from the mother may persist for
18 months after birth; all neonates acquire maternal antibody
to HIV infection, but not all acquire infection.
• use of antiviral medication, reduced exposure of the neonate
to maternal blood and body fluids, and early identification of
HIV in pregnancy reduce the risk of transmission to the
neonate.
Interventions:
a. Bathe the neonate carefully before any invasive
procedure, such as the administration of vitamin K, heel
sticks, or venipunctures; clean the umbilical cord stump
meticulously every day until healed.
b. The newborn can room with the mother.
c. Administer zidovudine to the newborn as
prescribed for the first 6 weeks of life.
d. All HIV-exposed newborns should be treated
with medication to prevent infection by Pneumocystis
jiroveci.
e. HIV culture is recommended at 1 and 4 months after birth;
infants at risk for HIV infection should be seen by the HCP at birth
and at 1 week, 2 weeks, 1 month, 2 months, and 4 months of age.
f. The child may be asymptomatic for the first several years of life
and should be monitored for early signs of immunodeficiency.

Infants at risk for HIV infection need to receive all

recommended immunizations on the regular schedule;
however, no live vaccines should be administered.
ANEMIA – iron deficiency anemia is a condition
that develops as a result of an inadequate amount
of serum iron.
Assessment
1. Fatigue
2. Headache
3. Pallor
4. Tachycardia
5. Hemoglobin value is usually less than 10 g/dL(100 mmol/L);
hematocrit value is usually less than 30%.
Interventions:

1. Monitor hemoglobin and hematocrit levels every 2

weeks.
2. Administer and instruct the client about iron and
folic acid supplements.
3. Instruct the client to take iron with a source of
vitamin C to increase its absorption and to avoid taking
iron with tea, milk products, or caffeine. Iron is
absorbed best if taken between meals.
4. Instruct the client to eat foods high in iron, folic acid,
and protein.
5. Teach the client to monitor for signs and symptoms of
infection.
6. Prepare to administer parenteral iron or blood
transfusions; this may be prescribed for severe anemia.
7. Prepare for the administration of oxytocic
medications in the postpartum period if excessive
bleeding is a concern.
CARDIAC DISEASE- The pregnant client with cardiac
disease maybe unable physiologically to cope with the added
plasma volume and increased cardiac output that occur during
pregnancy.
Assessment:
1. Signs and symptoms of cardiac decompensation
a. Cough and respiratory congestion
b. Dyspnea and fatigue
c. Palpitations and tachycardia
d. Peripheral edema
e. Chest pain
2. Signs of respiratory infection
3. Signs of heart failure and pulmonary edema
Interventions
1. Monitor vital signs, fetal heart rate, and condition of the fetus.
2. Limit physical activities, and stress the need for sufficient rest.
3. Monitor for signs of cardiac stress and decompensation, such as
cough, fatigue, dyspnea, chest pain, and tachycardia; also monitor
for signs of heart failure and pulmonary edema.
4. Encourage adequate nutrition to prevent anemia,
which would worsen the cardiac status; in addition, a low-sodium
diet may be prescribed to prevent fluid retention and heart failure.
5. Avoid excessive weight gain.
Interventions
During labor, prepare to do the following:
a. Monitor vital signs frequently.
b. Place the client on a cardiac monitor and on
an external fetal monitor.
c. Maintain bed rest, with the client lying on her
side with her head and shoulders elevated.
d. Administer oxygen as prescribed.
e. Manage pain early in labor.
f. Use controlled pushing efforts to decrease cardiac stress.
Excessive weight gain places stress on the heart. In addition, obesity
places the client at increased risk for complications during pregnancy.
CHORIOAMNIONITIS – a bacterial infection
of the amniotic cavity.
Assessment:

1. Uterine tenderness and contractions

2. Elevated temperature
3. Maternal or fetal tachycardia
4. Foul odor to amniotic fluid
5. Leukocytosis
Interventions:
1. Monitor maternal vital signs and fetal heart rate.
2. Monitor for uterine tenderness, contractions, and fetal
activity.
3. Monitor results of blood cultures.
4. Prepare for amniocentesis to obtain amniotic fluid for Gram
stain and leukocyte count.
5. Administer antibiotics as prescribed after cultures are
obtained.
6. Administer oxytocic medications as prescribed to increase
uterine tone.
7. Prepare to obtain neonatal cultures after birth.
DIABETES MELLITUS – pregnancy places
demands on carbohydrate metabolism and causes
insulin requirements to change.

• Gestational
Diabetes mellitus
• Maternal glucose crosses the placenta, but insulin does
not.
• The fetus produces its own insulin and pulls glucose
from the mother, which predisposes the mother to
hypoglycemic reactions.
• The newborn of a diabetic mother may be large in size,
but has functions related to gestational age rather than
size.
• The newborn of a diabetic mother is at risk for
hypoglycemia, hyperbilirubinemia, respiratory distress
syndrome, hypocalcemia, and congenital anomalies.
Gestational diabetes occurs in pregnancy (during the
second or third trimester) in clients not previously
diagnosed as diabetic and occurs when the pancreas
cannot respond to the demand for more insulin.

Gestational diabetes frequently can be treated by

diet alone; however, some clients may need insulin.
Predisposing conditions to gestational
diabetes:
1. Older than 35 years
2. Obesity
3. Multiple gestation
4. Family history of diabetes mellitus
5. Large for gestational age fetus
Assessment:
1. Excessive thirst
2. Hunger
3. Weight loss
4. Frequent urination
5. Blurred vision
6. Recurrent urinary tract infections and vaginal yeast infections
7. Glycosuria and ketonuria
8. Signs of gestational hypertension
9. Polyhydramnios
10. Large for gestational age fetus
Predisposing conditions to gestational
diabetes

1. Older than 35 years

2. Obesity
3. Multiple gestation
4. Family history of diabetes mellitus
5. Large for gestational age fetus
Interventions:

• Employ diet, medications (if diet cannot control blood

glucose levels), exercise, and blood glucose
determinations to maintain blood glucose Levels
• Observe for signs of hyperglycemia, glycosuria and
ketonuria, and hypoglycemia.
• Monitor weight.
• Increase calorie intake as prescribed, with adequate
insulin therapy so that glucose moves into the cells.
• Assess for signs of maternal complications such as
preeclampsia (hypertension and proteinuria).
• Monitor for signs of infection.
• Instruct the client to report burning and pain on
urination, vaginal discharge or itching, or any
other signs of infection to the health care
provider.
• Assess fetal status and monitor for signs of fetal
compromise.
Interventions during labor:

1. Monitor fetal status continuously for signs of

distress and, if noted, prepare the client for
immediate cesarean section.
2. Carefully regulate insulin and provide glucose
intravenously as prescribed because labor depletes
glycogen.
Interventions during the postpartum period

1. Observe the mother closely for a hypoglycemic reaction

because a precipitous decline in insulin requirements
normally occurs (the mother may not require insulin for the
first 24 hours).
2. Reregulate insulin needs as prescribed after the first day,
according to blood glucose testing.
3. Assess dietary needs, based on blood glucose testing and
insulin requirements.
4. Monitor for signs of infection or postpartum hemorrhage
DISSEMINATED INTRAVASCULAR
COAGULATION (DIC) – is a maternal condition in which
the clotting cascade activated, resulting in the formation of
clots in the microcirculation.
Predisposing Conditions for Disseminated
Intravascular Coagulation
▪ Abruptio placentae
▪ Amniotic fluid embolism
▪ Gestational hypertension
▪ HELLP syndrome
▪ Intrauterine fetal death
▪ Liver disease
▪ Sepsis
Assessment
1. Uncontrolled bleeding
2. Bruising, purpura, petechiae, and ecchymosis
3. Presence of occult blood in excretions such as stool
4. Hematuria, hematemesis, or vaginal bleeding
5. Signs of shock
6. Decreased fibrinogen level, platelet count, and
hematocrit level
7. Increased prothrombin time and partial
thromboplastin time, clotting time, and fibrin
degradation product.
Interventions
1. Remove underlying cause.
2. Monitor vital signs; assess for bleeding and signs of
shock.
3. Prepare for oxygen therapy, volume replacement,
blood component therapy, and possibly heparin therapy.
4. Monitor for complications associated with fluid and
blood replacement and heparin therapy.
5. Monitor urine output and maintain at least 30 mL/
hour (renal failure is a complication of DIC).
ECTOPIC PREGNANCY – Implantation of the fertilized
ovum outside of the uterine cavity. t common location is the
ampulla of the fallopian tube.
Assessment:
1. Missed menstrual period
2. Abdominal pain
3. Vaginal spotting to bleeding that is dark red
or brown
4. Rupture: Increased pain, referred shoulder
pain, signs of shock
Interventions:
1. Obtain assessment data and vital signs.
2. Monitor bleeding and initiate measures to prevent
rupture and shock.
3. Methotrexate, a folic acid antagonist, may be prescribed
to inhibit cell division in the developing embryo.
4. Prepare the client for laparotomy and removal of the
pregnancy and tube, if necessary, or repair of the tube.
5. Administer antibiotics; Rho(D) immune globulin is
prescribed for Rh-negative women.
ENDOMETRITIS – is an infection of the lining of the uterus
occurring in the postpartum period and caused by bacteria that
invade the uterus at the placental site.
Assessment
1. Chills and fever
2. Increased pulse
3. Decreased appetite
4. Headache
5. Backache
6. Prolonged, severe afterpains
7. Tender, large uterus
8. Foul odor to lochia or reddish brown lochia
9. Elevated white blood cell count.
Interventions
1. Monitor vital signs.
2. Position the client in Fowler’s position to facilitate drainage of lochia.
3. Provide a private room for the mother; inform the mother that isolation
of the newborn from the mother is unnecessary.
4. Instruct the mother in proper hand-washing techniques.
5. Initiate contact precautions as necessary.
6. Monitor intake and output and encourage fluid intake.
7. Administer antibiotics as prescribed.
8. Administer comfort measures such as back rubs and position changes
and pain medications as prescribed.
9. Administer oxytocic medications as prescribed to improve uterine tone.
10. Provide psychological support
FETAL DEATH IN UTERO – The death of a
fetus after 20th week of gestation and before birth.
Assessment
1. Absence of fetal movement.
2. Absence of fetal heart tones.
3. Maternal weight loss
4. Lack of fetal growth or decrease in fundal
height.
5. No evidence of fetal cardiac activity
6. Other characteristics suggestive of fetal
death noted on ultrasound.
Interventions:
1. Prepare for the birth of the fetus.
2. Support the client’s decision about labor,
birth, and the postpartum period.
3. Accept behaviors such as anger and hostility
from the parents.
4. Refer the parents to an appropriate support
group.
HEPATITIS B – is transmitted through blood,
saliva, vaginal secretions, semen, breast milk and
across the placental barrier.
Interventions:
1. Minimize the risk for intrapartum ascending
infections (limit the number of vaginal
examinations).
2. Remove maternal blood from the neonate
immediately after birth.
3.Suction the fluids from the neonate immediately
after birth.
4. Bathe the neonate before any invasive
procedures.
5. Clean and dry the face and eyes of the neonate before
instilling eye prophylaxis.
6. Infection of the neonate can be prevented by the
administration of hepatitis B immune globulin and
hepatitis B vaccine soon after birth.
7. Discourage the mother from kissing the neonate until
the neonate has received the vaccine.
8. Inform the mother that the hepatitis B vaccine will be
administered to the neonate and that a second dose
should be administered at 1 month after birth and a third
dose at 6 months after birth.
HYDATIDIFORM MOLE – the mole presents as an
edematous grape – like cluster that may be non malignant or
may develop into choriocarcinoma .
Assessment
1. Fetal heart rate not detectable
2. Vaginal bleeding, which may occur by the fourth week or not
until the second trimester; may be bright red or dark brown in
color and may be
slight, profuse, or intermittent
3. Signs of preeclampsia (elevated blood pressure and
proteinuria) before the twentieth week of gestation
4. Fundal height greater than expected for gestational date
5. Elevated human chorionic gonadotropin levels
6. Characteristic snowstorm pattern shown on ultrasound
Interventions:
1. Prepare the client for uterine evacuation (before evacuation,
diagnostic tests are done to detect metastatic disease).
2. Evacuation of the mole is done by vacuum aspiration; oxytocin
is administered after evacuation to contract the uterus.
3. Monitor for post procedure hemorrhage and infection.
4. Tissue is sent to the laboratory for evaluation, and follow-up is
important to detect changes suggestive of malignancy.
5. Human chorionic gonadotropin levels are monitored every 1 to
2 weeks until normal pre-pregnancy levels are attained; levels are
checked every 1 to 2 months for 1 year.
ECLAMPSIA– characterized by generalized
seizure.
Predisposing conditions
1. Primigravida
2. Women younger than 19 years or older than 40
years
3. Chronic renal disease
4. Chronic hypertension
5. Diabetes mellitus
6. Rh incompatibility
7. History of or family history of gestational
hypertension
 Complications of gestational
hypertension:

1. Abruptio placentae
2. Disseminated intravascular coagulation
HELLP syndrome (a laboratory diagnosis for
severe preeclampsia
Interventions for mild hypertension
1. Monitor blood pressure.
2. Monitor fetal activity and fetal growth.
3. Encourage frequent rest periods, instructing the client to lie in
the lateral position.
4. Administer antihypertensive medications as prescribed; teach
client about the importance of the medications.
5. Monitor intake and output.
6. Evaluate renal function through prescribed studies such as
blood urea nitrogen, serum creatinine, and 24-hour urine levels
for creatinine clearance and protein.
Interventions for mild preeclampsia
1. Provide bed rest and place the client in the lateral position.
2. Monitor blood pressure and weight.
3. Monitor neurological status because changes can indicate cerebral hypoxia or
impending seizure.
4. Monitor deep tendon reflexes and for the presence of hyperreflexia or clonus,
because hyperreflexia indicates increased central nervous system irritability
5. Provide adequate fluids.
6. Monitor intake and output; a urinary output of 30 m L/hour indicates
adequate renal perfusion.
7. Increase dietary protein and carbohydrates with no added salt.
8. Administer medications as prescribed to reduce blood pressure; blood
pressure should not be reduced drastically because placental perfusion can be
compromised.
9. Monitor for HELLP syndrome.
Interventions for severe preeclampsia
1.Maintain bed rest.
2.Administer magnesium sulfate (use a controlled
3.infusion device) as prescribed to prevent seizures; magnesium
sulfate may be continued for 24 to 48 hours postpartum.
4.Monitor for signs of magnesium toxicity, including flushing,
sweating, hypotension, depressed deep tendon reflexes, urine
output, and central nervous system depression including
respiratory depression; keep antidote (calcium gluconate)
available for immediate use, if necessary.
5.Administer antihypertensives as prescribed.
6.Prepare for the induction of labor.
Eclampsia
1. Seizure typically begins with twitching around the mouth.
2. Body then becomes rigid in a state of tonic muscular
contractions that last 15 to 20 seconds.
3. Facial muscles and then all body muscles alternately
contract and relax in rapid succession (clonic phase may last
about 1 minute).
4. Respiration ceases during seizure because diaphragm
tends to remain fixed (breathing resumes shortly after the
seizure).
5. Postictal sleep occurs.
 Eclampsia
PRIORITY NURSING ACTIONS
Eclampsia Event
1. Remain with the client and call for help.
2. Ensure an open airway, turn the client on her side, and
administer oxygen by face mask at 8 to 10 L/ minute.
3. Monitor fetal heart rate patterns.
4. Administer medications to control the seizures as prescribed.
5. After the seizure has ended, insert an oral airway and suction
the client’s mouth as needed.
6. Prepare for delivery of the fetus after stabilization of the
client, if warranted.
7. Document occurrence, client’s response, and outcome.
MULTIPLE GESTATION – results from fertilization of two
ova (fraternal) or splitting of one fertilized ovum (identical).
Assessment
1. Excessive fetal activity
2. Uterus large for gestational age
3. Palpation of 3 or 4 large parts in the uterus
4. Auscultation of more than 1 fetal heart rate
5. Excessive weight gain
Interventions
1. Monitor vital signs.
2. Monitor fetal heart rates, activity, and growth.
3. Monitor for cervical changes.
4. Prepare the client for ultrasound as prescribed.
5. Monitor for anemia; administer supplemental vitamins as
prescribed.
6. Monitor for preterm labor, and treat preterm labor promptly.
7. Prepare for cesarean delivery for abnormal presentations.
8. Prepare to administer oxytocic medications after delivery to
prevent postpartum hemorrhage from uterine overdistention.
TUBERCULOSIS – caused by Mycobacterium
tuberculosis transmitted by airborne route.
Transmission:
1. Transplacental transmission is rare.
2. Transmission can occur during birth
through aspiration of infected amniotic
fluid.
3. The newborn can become infected from
contact with infected individuals.
Assessment
2. Neonate
1. Mother
a. Possibly asymptomatic
a. Fever
b. Fever and chills b. Lethargy
c. Night sweats c. Poor feeding
d. Weight loss d. Failure to thrive
e. Fatigue e. Respiratory distress
f. Cough with hemoptysis or f. Hepatosplenomegaly
green or yellow g. Meningitis
sputum h . Disease may spread to
g. Dyspnea
h . Pleural pain
all major organs
Interventions:
1. Pregnant client
a. Administration of isoniazid, pyrazinamide, and rifampin
daily for 9 months (as prescribed); ethambutol is added if
medication
resistance is likely.
b. Pyridoxine should be administered with isoniazid to the
pregnant client to prevent fetal neurotoxicity caused by
isoniazid.
c. Promote breast-feeding only if the client is
noninfectious.
Newborn
a. Management focuses on preventing disease and treating early
infection.
b. Skin testing is performed on the newborn at
birth, and the newborn may be placed on isoniazid therapy; the
skin test is repeated in 3 to 4 months, and isoniazid may be stopped
if the skin test results remain negative.
c. If the skin test result is positive, the newborn should receive
isoniazid for at least 6 months (as prescribed).
d. If the mother’s sputum is free of organisms, the newborn does
not need to be isolated
from the mother while in the hospital.
URINARY TRACT INFECTION – can occur during
pregnancy and if left untreated can lead to pyelonephritis .
Predisposing conditions

1. History of urinary tract infections

2. Sickle cell trait
3. Poor hygiene
4. Anemia
5. Diabetes mellitus
 RISK RELATED TO PREGNANCY

INFECTIONS:
Infections(TORCH
Complex Acronym)
• Toxoplasmosis
• German Measles (rubella)
• Cytomegalovirus
• Genital herpes
• Group B streptococcus
• Toxoplasmosis -Transmitted to the mother through raw meat or handling of cat
litter of infected cat. Organism is transmitted to the fetus across the placenta.
• German Measles (rubella) - Teratogenic in the first trimester. Organism is
transmitted to the fetus across the placenta. Causes congenital defects of the eyes,
heart, ears, and brain.
• Cytomegalovirus - Organism is transmitted through close personal contact; it is
transmitted across the placenta to the fetus, or the fetus may be infected through
the birth canal. The mother may be asymptomatic; most infants are asymptomatic
at birth.
• Genital herpes - Herpes simplex virus affects the external genitalia, vagina, and
cervix and causes draining, painful vesicles. No vaginal examinations are done in
the presence of active vaginal herpetic lesions.
• Group B streptococcus - GBS is a leading cause of life-threatening perinatal
infections. Early-onset newborn GBS occurs within the first week after birth,
usually within 48 hours, and can include infections such as sepsis, pneumonia, or
meningitis; permanent neurological disability can result.
RISK RELATED TO PREGNANCY

SEXUALLY TRANSMITTED
DISEASE
• Chlamydia
• Syphilis
• Gonorrhea
• Condyloma acuminata
• Bacterial vaginosis
• Vaginal candidiasis
• Trichomoniasis
• Chlamydia -increased risk for premature birth, stillbirth, neonatal
conjunctivitis, and newborn chlamydial pneumonia. Usually
asymptomatic. Bleeding between periods or after coitus
• Syphilis - Syphilis is a chronic infectious disease caused by the organism
Treponema pallidum. The infection may cause abortion or premature labor
and is passed to the fetus after the fourth month of pregnancy as
congenital syphilis.
• Gonorrhea - Gonorrhea is an infection caused by Neisseria gonorrhoeae,
which causes inflammation of the mucous membranes of the genital and
urinary tracts. : Usually asymptomatic; vaginal discharge, urinary
frequency, and lower abdominal pain possible.
• Condyloma acuminata - caused by human papillomavirus. Infection affects
the cervix, urethra, anus, penis, and scrotum. Human papillomavirus is
transmitted through sexual contact. Infection produces small to large
wartlike growths on the genitals.
• Bacterial vaginosis - Caused by Haemophilus vaginalis
(Gardnerella vaginalis) and transmitted via sexual contact.
Associated with premature labor and birth. Client complains of
“fishy odor” to vaginal secretions and increased odor after
intercourse.
• Vaginal candidiasis - Candida albicans is the most common
causative organism. White, lumpy, cottage cheese–like discharge
from vagina.
• Trichomoniasis - is caused by Trichomonas vaginalis and is
transmitted via sexual contact. Yellowish to greenish, frothy,
mucopurulent, copious, malodorous vaginal discharge.
Inflammation of vulva, vagina, or both may occur.