Care of Mother With Complications During Pregnancy

Republic of the Philippines
Cebu Normal University

Osmeña Blvd. Cebu City, 6000 Philippines
College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph
Module 2
CARE OF MOTHER WITH COMPLICATION DURING PREGNANCY
Course Code: SDG-CON-304-032-02

Course Name/Title: Care of Mother and Child at risk or with Problems (Acute or Chronic)
Level Offering and Academic Year: Level II, Second Semester, A.Y. 2021– 2022
Name/s of Faculty: Prof. Hazel L. Caneda Email @ canedah@cnu.edu.ph,
Messenger: zhel nose, Send it via text message 09323538385
Credit: 6 units LEC
Pre-Requisite Courses: NCM 106
Setting : Google Class
Delivery Dates and Hours: February 3, 2022
Module Overview and Introduction
This module is designed to apply up-to-date maternal and child nursing care concepts (Acute
or Chronic) and actions during the prenatal period holistically specifically on the care of mother
with complication during pregnancy which includes preexisting conditions, gestational
conditions and to mother with special needs.
Desired Learning Outcome/s
Apply appropriate nursing concepts and actions holistically and comprehensively in the Care of
Mother with Complications during Pregnancy.
Enabling Learning Outcomes
When you have studied this module, you should be able to:
1. Explain the preexisting condition and gestational condition of mother during pregnancy.
2. Identify the mother with special needs during pregnancy.
3. Apply appropriate measures for mother with special needs during pregnancy.
(Document Code) Page 1 of 41

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Learning Contents and Activities
1. Pregnancy at Risk: Pre-existing Conditions
1.1 Hyperthyroidism

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Causes of Maternal Hyperthyroidism

Graves Disease - This disease occurs when your
immune system becomes overactive and forms
antibodies (immune proteins) that attack the thyroid.
- This causes the gland to enlarge and make too much

thyroid hormone. Most women with Graves’ disease find
out they have it and get treatment before they become
pregnant.
Transient Gestational Thyrotoxicosis - Women with

severe nausea and vomiting or those expecting twins
may develop temporary hyperthyroidism.
- this hyperthyroidism is due to high levels of a

pregnancy hormone called human chorionic
gonadotropin or hCG. Because it resolves by week 14 to
18 of pregnancy, women do not need antithyroid drugs to
treat this condition.
Sometimes, hyperthyroidism starts during pregnancy

because of nodules (small lumps) in the thyroid. These
nodules make too much thyroid hormone.

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How is hyperthyroidism found?
Low TSH levels plus high levels of T4 (also called

thyroxine) indicate hyperthyroidism.
-Iodine uptake test - another test for hyperthyroidism.
This test measures how much iodine your thyroid
absorbs. The thyroid uses iodine to make thyroid
hormone.
Pregnant and breastfeeding women should not have
this test, so tell your doctor if you are expecting or
nursing.
Most often, women find out they are hyperthyroid

before they become pregnant. To detect
hyperthyroidism, your doctor does a physical exam and

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orders blood tests to measure your thyroid hormone

levels.
Pregnant women with Graves hyperthyroidism or

thyroid nodules should start antithyroid drug treatment
or, if already taking this medication, see their doctor
about the dose. Hyperthyroidism due to Graves disease
most often improves as pregnancy advances but may
worsen during the first six months after birth. Therefore,
your doctor may need to change your dose of antithyroid
medicine both during and after pregnancy.

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Women who are or may be pregnant should not

receive treatment with radioactive iodine. This
radioactive drug usually destroys the patient’s thyroid
gland to stop it from being overactive and can harm the
unborn baby’s thyroid.

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While breastfeeding
Women who are breastfeeding should not get
radioactive iodine treatment. They may continue anti
thyroid drug therapy if they take their medicine as
prescribed.
Will your baby need special care?
Most people with Graves disease have measurable

antibodies in their blood known as thyroid stimulating
immunoglobulins. In pregnant women with Graves
disease, these antibodies can pass across the placenta
to the baby. Though it does not occur often, this can
cause thyroid disease and other medical problems for
the newborn. All newborns of mothers with Graves
disease who are positive for these antibodies should be
checked for signs of thyroid problems and treated if
necessary.
Nursing Interventions:
 Provide adequate rest.
 Administer sedatives as prescribed.
 Provide a cool and quiet environment.
 Obtain weight daily.
 Provide a high-calorie diet.

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 Avoid the administration of stimulants.

 Administer antithyroid medications (propylthiouracil
[PTU]) that block thyroid synthesis, as prescribed.

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1.2 Rheumatic Heart Disease
Mitral valve stenosis, also known as mitral stenosis,

occurs when the mitral valve opening is narrowed. This
means that not enough blood can flow through it.
Mitral valve stenosis can lead to a variety of issues,
including fatigue, difficulty breathing, blood clots, and
heart failure.
Scarring caused by rheumatic fever is the leading
cause of mitral valve stenosis.

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Risk factors for the condition are unclear. However, it’s

estimated that women are two to three times more likely
than men to develop the condition.
A congenital heart defect may cause mitral valve
stenosis in a baby. Babies born with this condition
usually need surgery.
In rare cases, calcium may build up and lead to
narrowing of the mitral valve.
Other rare causes of mitral valve stenosis include:
tumors
blood clots
radiation treatments

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Mitral valve stenosis commonly leads to shortness of

breath, especially during exercise or when lying down.

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Tests for heart rhythm irregularities
ECG or EKG — is a recording of your heart’s electrical

activity.
Holter monitoring - heart’s electrical activity is recorded
using a portable monitoring device worn over a period of
time. You’re usually monitored for a period of 24 to 48
hours.
Stress tests - Your doctor may have you perform
moderate aerobic activity, and then monitor you while
you exercise to determine how your heart responds to
physical stress. An exercise stress test is used to
determine how well your heart responds during times
when it’s working its hardest.
During the test, you’ll be asked to exercise — typically on

a treadmill — while you’re hooked up to an
electrocardiogram (EKG)

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Effects of pregnancy on rheumatic heart disease

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Pregnancy can lead to the appearance or worsening

of symptoms including shortness of breath with simple
activity, and waking at night out of breath. For women
with more severe rheumatic heart disease, it could lead
to the development of much more serious symptoms
such as pulmonary edema, atrial fibrillation or clotting.
During any pregnancy there is an increase in blood
volume of 30% - 50% resulting in increased pressure on
the heart valves. For women with rheumatic heart
disease this increased pressure presents increased
maternal and/or foetal risks.
It is not uncommon for women to be unaware that
they have rheumatic heart disease until pregnancy. This
is because the added stress on the heart can result in
symptomatic rheumatic heart disease where previously
there were no symptoms.
These changes begin in the first trimester but peak at
28-30 weeks and are sustained until term, meaning most
women with valvular heart disease become more
symptomatic in the third trimester.

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Additional Consideration of rheumatic heart

disease in pregnancy
 It is important that secondary prophylaxis is still

administered if prescribed, and women are supported
to access the most appropriate service to provide
secondary prophylaxis.
 Reducing stress from isolation should be a
consideration and appropriate supports and family
escorts available whenever possible.
 Pregnancy is an opportunity to support the woman to
establish links with social and support services. This
requires careful coordination and communication
between aboriginal health workers, remote area
midwives, district medical officers, obstetricians and
cardiologists.
 While every woman’s situation is different, it should be
considered that pregnant women with rheumatic heart
disease may also be managing multiple social,
practical and emotional issues. Risk factors of
rheumatic heart disease include poverty, overcrowded
housing, reduced access to medical care, food
security, domestic violence and substance abuse
issues.

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Nursing management of the heart disease during

pregnancy
 nursing assessment - history of dyspnea ,palpation , easily
Fatigability.
 Identify other factor that would increase strain on heart e.g anemia ,
infection , anxiety
 Family history of heart disease
 Determine the function capacity of the heart by talking the woman's
Pulse or respiration and blood pressure.
Nursing Care during Antenatal Period

 assess cardiac status
- assess if symptoms of cardiac decompensation occur
- teach signs and symptoms of deteriorating cardiac status such
as (dyspnea ,orthopnea , cough and hemoptysis )and how to report
them .
 protection from infection
- inform the woman about the importance of the protection
from infection especially upper respiratory infection
- teach patient to report signs and symptoms of infection.
 Decrease exertion reduces fatigue and promotes adequate
ventilation.
 promotion of adequate nutrition
- diet should be rich in Iron , Protein and essential nutrition. -
Low In sodium
 Promotion of rest
- Rest is necessary to reduce the work load on heart .
- 8-10 hrs of sleep are essential with daily rest period
- the patient should be instructed to rest on the left Side.
- lateral recumbent position to facilitate blood flow to the fetus .

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 The woman should understand her condition

- Signs of decompensation
- any medication she is taking and how to use it
- Reason for the need to decrease activity if symptoms occur
 When therapy is being initiated the nurse must assist the patient by
- Providing oxygenation
- Providing skin care
- Ensuring that constipation is avoided
- Promoting good nutrition .
 Implementation of supportive therapy
- Use of prophylactic antibiotic on doctors order
- Oxygen by mask if dyspnea occur
- Administration of Diuretics to reduce the venous return to the
heart and there by decrease the pulmonary and left atrial blood
pressure so reducing pulmonary congestion
Sedative to help to alleviate anxiety and decrease the voluntary
muscles activity during the second stage of Labor.
1.3 Asthma
Asthma is a condition in which your airways narrow

and swell and produce extra mucus.For some people,
asthma is a minor nuisance.
Coughing, wheezing, shortness of breath, and chest
tightness are classic asthma symptoms. Severe asthma
can make it hard to talk or be active. Some people refer
to asthma as "bronchial asthma."

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Asthma is a chronic lung condition. If you're pregnant,

asthma can have an impact on your health and your
baby's health.
Asthma is a serious -- even dangerous -- disease that

affects about 25 million Americans and causes nearly 2
million emergency room visits every year. With proper
treatment, you can live well. Without it, you might have to
make frequent visits to the emergency room and even
stay at the hospital, which can affect your home life and
ability to work.

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Symptoms of Asthma:
1. Airway obstruction - When breathe normally, the

bands of muscle that surround airways are relaxed
and air moves freely. But when you have asthma,
those bands of muscle tighten. Air can’t move freely.
When there’s less air in the lungs, feel short of breath.
The air moving out through your tightened airways
causes wheezing.
2. Inflammation - have red and swollen bronchial tubes.
This inflammation can damage the lungs. Treating this
inflammation is key to managing asthma in the long
run.
3. Airway irritability - People with asthma have sensitive
airways that tend to overreact and narrow due to even
the slightest triggers.
Asthma Causes and Triggers

 Infections like sinusitis, colds, and flu
 Allergens such as pollens, mold, pet dander, and dust
mites
 Irritants like strong odors from perfumes or cleaning
solutions
 Air pollution
 Tobacco smoke

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 Exercise
 Cold air or changes to the weather, such as changes
in temperature or humidity
 Strong emotions such as anxiety, laughter, crying, or
stress

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Peak Flow - Although they’re less accurate than

spirometry, they can be a good way to test your lungs at
home -- even before you feel any symptoms.

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You can get ipratropium in an inhaler or as a solution

for a nebulizer, a device that turns liquid medicine into a
mist that you breathe in through a mouthpiece.
Tiotropium bromide comes in a dry inhaler, which lets
you breathe the medicine in as a dry powder.

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You’re more likely to get steroids injected directly into

a vein if you wind up in the hospital for a bad asthma
attack. This will get the medication into your system
more quickly.

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Why is asthma during pregnancy a concern?
Severe or poorly controlled asthma during pregnancy

might increase the risk of various problems, including:
 A pregnancy complication characterized by high blood
pressure and signs of damage to another organ
system, often the kidneys (preeclampsia)
 Restricted fetal growth
 Premature birth
 The need for a C-section
Can pregnancy make asthma worse?

While pregnancy can cause asthma to worsen,
improve or remain unchanged, research suggests that
asthma severity during pregnancy is related to asthma
severity before pregnancy. Symptoms are more likely to
worsen in people with severe asthma.
If asthma gets better, the improvement is generally
gradual as the pregnancy progresses. If asthma
worsens, the increase in symptoms is most noticeable
during the first and third trimesters of pregnancy.

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Is it safe to take asthma medication during

pregnancy?
Any medication you take during pregnancy can
potentially have risks. Some concerns have been raised
about the use of systemic glucocorticoids — a type of
steroid — during pregnancy. They have been linked with
an increased risk of infant oral clefts, preeclampsia,
gestational diabetes, low birth weight and adrenal
problems. However, most asthma medications can be
safely used during pregnancy.
It's safer to take asthma medications during
pregnancy than it is to experience asthma symptoms or
an asthma attack. If you're having trouble breathing, your
baby might not get enough oxygen.
If you need medication to control your asthma
symptoms during pregnancy, your health care provider
will prescribe the safest medication at the most
appropriate dosage.
Take the medication as prescribed. Don't stop taking
the medication or adjust the dosage on your own.
Depending on the type of medication you're taking and
your symptoms, your health care provider might be able
to monitor your asthma control during your prenatal
visits. In other cases, you might need to consult your
family doctor or asthma specialist throughout the
pregnancy.
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Nursing Management
The immediate nursing care of patients with asthma
depends on the severity of symptoms. The patient and

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family are often frightened and anxious because of the

patient’s dyspnea. Therefore, a calm approach is an
important aspect of care.
1. Assess the patient’s respiratory status by monitoring

the severity of symptoms, breath sounds, peak ﬂow,
pulse oximetry, and vital signs.
2. Obtain a history of allergic reactions to medications
before administering medications.
3. Identify medications the patient is currently taking.
4. Administer medications as prescribed and monitor
the patient’s responses to those medications;
medications may include an antibiotic if the patient
has an underlying respiratory infection.
5. Administer ﬂuids if the patient is dehydrated.
Learning Outcomes Assessment/s
At the end of this module, learning outcome assessment will

be given in the Google Classroom on February 8, 2021
Assessment of 25 item quizlet is graded and to accomplished
individually in the google classroom.

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Telephone No.: (+63 32) 254 4837
Learning Enhancement or Extension
Why is Thyroid common in pregnancy and what are its ill

effect….You want to learn more watch the video below:
https://youtu.be/salvKjr5sYc
Learn more why Asthma is Dangerous in Pregnancy…

Watch the video below:
https://youtu.be/dOiZhdMlT9k
For your inquiries and submission of activities,Please
Message me and/or submit all your activities via:
Email @ canedah@cnu.edu.ph
Messenger: zhel nose
Send it via text message 09323538385
References
Electronic Source:
https://www.hormone.org/diseases-and-conditions/pregnancy-and-
thyroid-disease/hyperthyroidism-and-pregnancy
https://www.healthline.com/health/mitral-stenosis#symptoms
Recertification
Recertification due
due date:
date: 24
24 January
January 2021
2021
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certificate please
please access
access
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check and
and type
type the
the
College of Nursing
Telephone No.: (+63 32) 254 4837
https://www.rhdaustralia.org.au/news/clinical-update-rheumatic-heart-
disease-pregnancy
https://www.webmd.com/asthma/what-is-asthma#5
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/
in-depth/pregnancy-and-asthma/art-20047303
Module Evaluation
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feedback regarding this module. Kindly rate each parameter with a scale of 1-
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Evaluation Parameters Rating (1-5)

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All the concepts that I need to know are in the module.
The contents speak to me clearly about the topic.
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The time allotted in each section is enough for me to develop what
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2021
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Comments/Suggestion: Constructive feedback is very much welcome.

___________________________________________________________________________
___________________________________________________________________________
______________
Congratulations for completing this lesson May the learning you derived from this session
contribute to your development as an effective nurse. Have fun while learning!
Prepared by:
HAZEL L. CAÑEDA
Facilitator
Approved:
Dr. Emiliano Ian B. Suson II

Dean,College of Nursing
Reviewed and recommended by the CN IMRC dated February 12, 2021

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Care of Mother With Complications During Pregnancy

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Care of Mother With Complications During Pregnancy

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Republic of the Philippines

Cebu Normal University

CARE OF MOTHER WITH COMPLICATION DURING PREGNANCY

Course Code: SDG-CON-304-032-02

Module Overview and Introduction

Desired Learning Outcome/s

Enabling Learning Outcomes

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Learning Contents and Activities

1. Pregnancy at Risk: Pre-existing Conditions

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Causes of Maternal Hyperthyroidism

- This causes the gland to enlarge and make too much

Transient Gestational Thyrotoxicosis - Women with

- this hyperthyroidism is due to high levels of a

Sometimes, hyperthyroidism starts during pregnancy

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How is hyperthyroidism found?

Low TSH levels plus high levels of T4 (also called

Most often, women find out they are hyperthyroid

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orders blood tests to measure your thyroid hormone

Pregnant women with Graves hyperthyroidism or

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Women who are or may be pregnant should not

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Will your baby need special care?

Most people with Graves disease have measurable

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 Avoid the administration of stimulants.

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1.2 Rheumatic Heart Disease

Mitral valve stenosis, also known as mitral stenosis,

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Risk factors for the condition are unclear. However, it’s

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Mitral valve stenosis commonly leads to shortness of

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Tests for heart rhythm irregularities

ECG or EKG — is a recording of your heart’s electrical

During the test, you’ll be asked to exercise — typically on

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Effects of pregnancy on rheumatic heart disease

Pregnancy can lead to the appearance or worsening

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Additional Consideration of rheumatic heart

 It is important that secondary prophylaxis is still

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Nursing management of the heart disease during

Nursing Care during Antenatal Period

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 The woman should understand her condition

Asthma is a condition in which your airways narrow

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Asthma is a chronic lung condition. If you're pregnant,

Asthma is a serious -- even dangerous -- disease that

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