ACCIDENTAL COMPLICATION Nursing

 Diagnosis    
A. PROLAPSED OF THE CORD   –  a  loop  of  the  umbilical  cord  slips   a. Priority  >  alteration  in  comfort,  acute  pain  r/t  labor  pains  
down  in  front  of  the  presenting  fetal  part,  leading  to  cord  compression   b. Potential  for  maternal  injury  r/t  dysfunctional  labor,  uterine  
because  the  fetal  presenting  part  presses  against  the  cord  at  the  pelvic   atony,  hemorrhage,  abnormal  fetal  position  
brim.   c. Potential   for   fetal   injury   r/t   rupture   of   the   uterus,  
Occurs  most  often  with  the  following  conditions:     malpositioning,  prolapse  of  the  cord  
• Premature  rupture  of  the  membranes   d. Potential   for   impaired   fetal   gas   exchange   r/t   prolonged   head  
• Fetal  presentation  other  than  cephalic   compression,  prolapse  of  the  cord.  
• Placenta  previa   e. Alteration   in   cardiac   output   r/t   repeated   and   prolonged  
• Intrauterine   tumors   preventing   the   presenting   part   from   valsalva  maneuvers,  use  of  anesthesia,  and  medications.  
engaging   f. Potential/   Actual   alteration   in   skin   and   mucous   membrane  
• Small  fetus  ,hydramnios   integrity   r/t   trauma   and   lacerations   in   the   cervix,   perineum  
• CPD  preventing  firm  engagement   and  vagina,  
• Multiple  gestation   g. Potential   for   infection,   r/t   repeated   vaginal   examination,  
Assessment:   prolonged  labor  with  ruptured  membranes.  
• the  cord  may  be  felt  as  the  part  on  vaginal  examination   Related    
• variable  deceleration  of  FHR  pattern     a. Anxiety   r/t   intensity   of   uterine   contractions   ,fear   of   the  
• cord  visible  at  the  vulva   unknown  
Management:   b. Fluid   volume   alterations   r/t   oxytoxic   administration,  
hemorrhage  
• manually  elevating  the  fetal  head  off  the  cord    
c. Knowledge   deficit   r/t   delivery   ,   labor   stages   ,complications  
• placing  the  woman  in  knee-­‐  chest  or  Trendelenburg  position-­‐  
and  treatment  of  conditions  
causes  the  fetal  head  to  fall  back    
d. Activity  Intolerance    r/t  exhaustion  during  the  stages  of  labor  
• O2  at  10  l/min  
,prolonged  labor  ,and      inadequate    rest  
• Tocolytic  to  reduce  uterine  activity  and  pressure  on  the  fetus  
e. Ineffective  Individual  coping  –  r/t  prolonged  labor  
• DO  NOT  attempt  to  push  the  cord  back  into  the  vagina,  may   Interventions    
add  to  compression  by  causing  knotting  or  kinking.  
• Bedrest   –   left   lateral   position   to   reduce   the   frequency   and  
• cover   any   exposed   portion   of   the   cord   with   a   WET   STERILE   intensity  of  the  uterine  contraction.  
SALINE  compress  to  prevent  drying.  
• IV   fluid   and   blood   replacement   –   adequate   hydration  
à If   dilation   is   complete   –   the   infant   may   be   delivered  
minimizes  the  secretion  of  oxytocin.  
quickly  with  forceps  to  prevent  anoxia  
• Fundic  massage    
à If   dilatation   is   incomplete   –   upward   pressure   on   the  
• O2  
presenting  part  by  a  hand  in  the  womans  vagina  to  keep  
• Drug  therapy    
pressure  off  the  cord  then  CS  
à Oxytocin  for  hypotonic  uterine  dysfunction  only.  NEVER  
 
given   in   hypertonic   uterine   Dysfunction   because   the  
B. INVERSION OF THE UTERUS   –  a  highly  fatal  accident  of  labor  
uterus   is   in   constant   state   of   increased   muscle   tone   and  
in  which  after  birth  of  the  infant,  the  uterus  turns  inside  out.  Bleeding  
the  drug  will  even  cause  an  even  greater  resting  tension  
occurs=shock  
which  might  interfere  with  fetal  oxygenation.  
Causes:  
à Barbiturates  –  (Phenobarbital)  helps  promote  rest    
• short  umbilical  cord  
à Analgesic  –  MgSO4,  Demerol    
• fundal  pressure  when  the  uterus  is  relaxed   • Tocolytic  therapy  –  prevents  premature  contractions    
• traction  on  the  cord  before  separation   à Ethyl  Alcohol  (Ethanol)  the  first  tocolytic  agent  given  IV.  
Management:   However,   high       levels   needed   to   suppress   uterine  
• Hysterectomy   contractions  causes  intoxication  to  the  mother  and  the  
• Blood  replacement   fetus.  
• Antibiotics   à Beta  –adrenergic  agonists  –  relaxes  bronchial,  vascular,  
Related  factors:   and  uterine  smooth  muscle  
• short  umbilical  cord,  and  adherent  placenta   -­‐ Ex   –   a.   Ritodrine   (yutopar),   Terbuline   (bricanyl),  
• placenta  accreta   Isoxsuprine  (vasodilan)  
• Pulling  of  the  cord  and  expressing  the  placenta  or  blood  clots   à Mg  SO4  –  relaxes  smooth  muscles  and  decreases  blood  
from  the  uterus   pressure  
• Injudicious   use   of   analgesia   –   excessive   and   to   early   à Prostaglandin  Synthetase  Inhibitors  –    
administration   -­‐ Ex.   =   Indomethacin,   Aspirin   –   reduces   uterine  
• Post  maturity  and  a  large  size  infant   activity  
• Multiparity  –  causes  overdistention  of  the  uterus     à Calcium  antagonists    
• Maternal  age  –  old  primigravida  ,  pregnant  adolescent   -­‐ Ex.  Nifedipine  stops  uterine  contractions  with  a  few  
• Maternal  disease     side  effects.  
• Smoking   -­‐ Antibiotics  –  used  during  rupture  of  the  uterus  
• High  altitudes     -­‐ Hydrocortisone  –  decreases  pulmonary  edema  
  -­‐ Digoxin  –  used  in  heart  failure  with  embolism  
  • External   Version   –   done   in   late   pregnancy   or   early   labor  
  indicated  in  transverse  Presentation  
  • Internal  Podalic  Version  and  extraction    
  • Surgery      
  -­‐ CS  
  -­‐ Amniotomy  –  hypotonic  dysfunction  
 -­‐ Forcep  delivery  –  the  application  of  pipen  forceps   NORMAL  MECHANISMS  OF  LABOR  (cardinal  movements)      
-­‐ Laparotomy  –  for  inverted  uterus  ,  if  the  uterus  cannot   a. Descent  –  the  head  enters  the  inlet  in  the  occiput  tranverse  
be  placed  back  from  below   or   oblique   position   because   the   pelvic   inlet   is   widest   from  
-­‐ Ligation  of  the  uterine  and  hypogastric  artery  –  to  stop   side  to  side.  
the  bleeding  due  to  utrine  atony   b. Flexion  –  fetal  head  descends  and  meets   resistance  from  the  
-­‐ Hysterectomy  –  last  recourse  for  uterine  atony   soft  tissue  of  the  pelvis  and  Muscles  
-­‐ Repair   of   the   perineum   and   debridement   of   the   c. Internal  Rotation  –  fetal  head  rotates  to  fit  the  diameter  of  
hematoma  –  when  there  is  perineal  lacerations   the  pelvic  cavity    =  occiput    rotates  usually  from  left  to  right  
-­‐ Episiotomy   an  arc  of  90’        
(Hypotonic   uterine   contraction-­‐   the   number   of   contractions   is   d. Extension  –  resistance  of  the  pelvic  floor  and  the  movement  
unusually   infrequent   (not   more   than   2   or   3   occurring   in   a   10-­‐minute   of   the   vulva     =   extension   of   the   head   as   it   passes   under  
period).   The   resting   tone   of   the   uterus   remains   less   than   10mmhg,and   symphysis  pubis    
the  strength  of  contraction  does  not  rise  above  25mmhg.   e. Restitution   –   shoulders   inters   the   pelvis   inlet   obliquely   and  
remain   oblique   when   the   head   rotates   to   the   anterion  
Hypertonic   uterine   contraction-­‐   are   marked   by   an   increase   in   resting   posterior   diameter   through   internal   rotation.   =   neck  
tone  to  more  than  15  mmhg.)   becomes   twisted   =the   head   is   born   –   the   neck   untwists  
Criteria   Hypertonic   Hypotonic   turning  the  head  to  one  side    and  aligns  with  the  position  of  
the  back  of  the  birth  canal    
Most  common  phase  of   Latent   Active  
f. External     Rotation   –   shoulder   rotates   to   the   AP     in   the   pelvis  
Occurrence  
=  head  turns  further  to  one  side  
g. Expulsion  –  through  pushing,  =  anterior  shoulder  meets  the  
Symptoms   Painful   Limited  pain   undersurface   of   the   Symphysis   pubis   and   slips   under   it.   =  
Medications  used   Unfavorable   Favorable  reaction   anterior  shoulder  is  born  =  body  follows  quickly    
(Oxytocin)   reaction   -­‐ with   good   contraction,   adequate   flexion,   and   a  
Sedation   Helpful   Little  value   baby   of   average   size,   cases   of   occiput   posterior  
  undergo  spontaneous  rotation  through  the  135’  as  
GENERAL  NURSING  MANAGEMENT     soon   as   the   head   reaches   the   pelvic   floor   as   in  
a. Fetal  and  maternal  monitoring   normal  labor.  
b. Provide  emotional  support  to  the  client  and  family   Assessment  findings  
c. Position  the  patient  properly   • intense   back   pain,   dysfunctional   labor   pattern,   arrest   of  
à Fowler’s  position  for  amniotic  fluid  embolism   dilatation,  or  arrest  of  fetal  descent,  
à Trendelenburg,   knee   –chest   position   elevating   the   hips   • Prolonged   first   and   second   stage   of   labor   because   more  
with  a  pillow  for  prolapse  of  the  cord   contractions  and  explosive  efforts  of  the  mother  are  needed  
à Modified  trendelenburg  –  in  shock  due  to  rupture  of  the   to  rotate  the  head  a  large  arc  
uterus  and  hemorrhages   Nursing  Diagnosis  –  
d. Avoid  unnecessary  vaginal  manipulations  –  teach  the  mother   • Acute   pain   r/t   back   discomfort   secondary   to   the   OP   (occiput  
to  restrict  coitus  during  the  last  three  months  of  pregnancy   posterior)  position  
to  avoid  preterm  labor   • Ineffective   individual   coping   r/t   unanticipated   discomfort  
e. Stay   with   the   patient   and   massage   uterus   vs   q   15  min.   (in   pt.   and  slow  progress  of  labor.  
With  uterine  atony)    
f. Apply  ice  bag  on  the  perineum  in  case  of  hematoma   2. BREECH PRESENTATION
g. Iv  fluids  and  blood  transfusion  as  ordered   • the   infant’s   buttocks  are   the   presenting   parts   which   occurs  
h. Medications  as  ordered     only  in  a  small  number  of  births  especially  when  the  baby  is  
i. If   patient   is   going   into   shock,   position   correctly   and   apply   premature  or  in  case  of  multiple  gestation  
warm  blanket   • associated   with   preterm   labor,   preterm   birth,   placenta  
j. For   discomforts   due   to   malpositioning   of   the   fetal   head,   previa  hydramnios,  multiple  gestation  
relieve   back   pain   by   sacral   pressure   back   rubs   ,frequent  
changes  in  position.  
 
C. MALPOSITION/MALPRESENTATION OF THE FETUS

1.PERSISTENT OCCIPUT POSTERIOR AND TRANSVERSE ARREST

• The  most  common  fetal  malformation,  
• The  occiput  of  the  fetal  head  is  directed  toward  the  back  of  
the  maternal  pelvis      
• If   the   condition   is   incomplete,   the   head   then   becomes  
arrested   in   a   transverse   position   resulting   in   transverse  
arrest.  
• These   two   condition   represents   deviations   from   the    
normalmechanisms  of  labor.  
 
 
 
 
 
 
  
4. FACE / BROW PRESENTATION
A. Face Presentation   –the   face   is   the   presenting   part,   occurs   when  
there  is  a  factor  that  favors      the  extension  of  the  head  and  prevent  
head  flexion  such  as  in  contracted  pelvis  .  
• facial   edema   is   often   present   which   may   produce   purplish  
discoloration  of  the  face.  
• I  in  600  births,most  frequently  in  multiparas  ,preterm  births  
and  in  anencephaly  
Risks            
• maternal  ;  increased  risk  of  CPD  and  prolongation  of  labor  
• increased  risk  of  infection  (  with  prolonged  labor)  
  • cesarean  birth  if  fetal  chin  is  posterior  
Classification    
• fetal  ;  cephalohematoma  of  the  face  
a. Complete   –   the   buttocks   present   with   the   thigh   flexed   on  
• edema  of  the  face  and  the  throat  if  the  facial  chin  is  anterior    
the  abdomen  and  the  legs  are  on  the  thighs  
• pronounced  molding  of  the  head  
b. Frank   –   the   buttocks   presents   with   hips   flexed   and   the   legs  
Nursing  Diagnosis    
extended   against   the   abdomen   and   the   chest   -­‐   the   most  
common  type  this  type  of  breech  presentation.   • Fear   r/t   unknown   outcome   of   the   labor   and   the   possible  
c. Incomplete  –  one  or  both  feet  and  the  knee  extended  below   instrument  –assisted  birth  
the   buttocks.   This   type   of   presentation   is   also   known   as   • Risk   for   injury   to   the   newborn’s   face   r/t   edema   secondary   to  
single  or  double  footling  breech.   the  birth  process.  
d. Compound   –   the   buttocks   present   together   with   another    
part  such  as  hand.   B. Brow presentation   –   the   forehead   of   the   fetus   becomes   the  
Complications       presenting  part.    
• Prolapse  of  the  uterus   –  likely  compressed  during  delivery  in   • military   presentation   =   fetal   head   is   between   flexion   and  
footling  presentation   extension  
• tentorial  tears  with  subsequent  intracranial  hemorrhage   • occipitomental   presentation   =   fetal   head   enters   the   birth  
• lesions   of   the   spinal   cord   and   extrusion   of   the   medulla   into   canal  with  the  widest  diameter  of  the  head    
the  foramen  magnum   -­‐ occurs   most   often   in   multiparas   than   in   nulliparas   due  
to  abdominal  and  pelvic  musculature  
• buttocks   of   the   baby   may   be   bruised   and   the   labia   or  
Risks    
scrotum  may  be  quite  swollen  for  a  few  days  after  delivery    
• Maternal;   longer   labor   due   to   ineffective   contractions   and  
• lacerations  of  the  birth  canal    
slow  of  arrested  Fetal  descent    
Nursing  Diagnosis  
• Cesarean  birth  if  brow  presentation  persist    
• Impaired   gas   exchange   in   the   fetus   r/t   interruption   in  
Fetal    
umbilical  blood  flow  secondary  to  Compression  of  the  cord  .  
• increased   mortality   due   to   cerebral   and   neck   compression  
• knowledge   deficit   r/t   lack   of   information   about   the  
and  damage  to  the  trachea  and  larynx  
implications  of  breech  presentation  For  the  mother  and  the  
 
fetus.  
C. Compound presentation   –   when   an   extremity   prolapsed   along  
 
3. SHOULDER OR TRANSVERSE LIE side  and  enters  the  pelvis  at  the  same  time  as  the  presenting  part    
• occurs  when  the  infant  lies  crosswise  in  the  uterus  instead  of   • the  most  common  combination  is  for  an  upper  extremity  to  
longitudinally.   prolapse   along   side   the   head.   Prolapse   of   a   leg   in   cephalic  
presentation   or   an   arm   in   breech   presentation   does   occur  
• The  shoulder  is  usually  the  fetal  part  in  the   brim  of  the  inlet  
,but  it  is  uncommon  
but  sometimes    It  may  back  ,abdomen,or  flank  depending  on  
Complication  
how  the  infant  is  positioned.  
• increased  incidence  of  prolapse  of  the  umbilical  cord  
• associated   with   grand   multiparity     with   relaxation   of   the  
 
abdominal   wall   ,     abnormal   fetus   ,   excessive   amniotic  
fluid,placenta  previa  and  contracted  pelvis   D. Multiple gestation  –  two  or  more  embryo  develops  in  the  uterus  
at   the   same   time   is   considered   a   complication   of   pregnancy  
 
Management     because   the   woman’s   body   must   adjust   to   the   effect     of   more  
than   one   fetus   to   an   increase   in   maternal   mortality   and  
• before  term  =  “watchful”    
morbidity.  
• cesarean  birth    -­‐  if  external  cephalic  version  is  unsuccessful.  
 
• a  serious  complication  that  increases  the  hazards  of  delivery.   Maternal  Implications  
• an  arm  may  prolapse  into  the  vagina  making  the  problem  of   • increased   physical   discomfort   ,other   associated   problems  
delivery  more  difficult  .If  neglected  ,this  presentation  results   such   as   UTI   ,preeclampsia,         Preterm   labor   and   placenta  
in  rupture  of  the  uterus  and  death  of  both  mother      and  the   previa    
fetus   -­‐ fetal  –neonatal  implications  –  mortality  is  10x    greater  
for  twins  than  in  a  single  fetus  
Assessment  Findings     -­‐ fetal   problems   includes   –   fetal   anomalies   ,   increased  
• Abdomen   is   unusually   wide   from   side   to   side   and   the   fundus   risk  for  prematurity  ,  cerebral  palsy  
scarcely  extends  above    the  umbilicus    
   
   
   
   
Classification       Complications    
a. Identical  or  Monozygotic  twins  –  comes  from  a  single  egg,  “  single   • Toxemia   ,   polyhydramnios,anemia   ,   abruptio   placenta   ,  
ovum  twins  “   prematurity  ,  post  partum  hemorrhage    
• twins  begin  with  a  single  ovum  and  sperm  ,but  in  the  process   Related  factors  
of  fusion  or  in  one  of  the  first  cell  division  the  zygote    divides   a. Drugs    
into  two  identical  individuals.   1. Di   –ethylstilbestrol   –   can   cause   multiple   pregnancy   and  
• Characteristics     teratogenic  effects  ,abortion  
à always  the  same  sex   2. Clomiphene   Citrate   (clomid)   –   stimulates   and   increases   the  
à with   two   amnions   ,one   chorion   ,   two   umbilical   cords   and   output   of   pituitary     gonadotropins   which   affect   the   growth   of  
one  placenta  fused  in  one.   graafian  follicles  with  more  chances  of  multiple  pregnancy    
  3. Menotropins   (Pergonal)   –   injected   in   sequence   with   human  
b. Dizygotic  /  Fraternal  or  Non  –  Identical  Twins     chorionic   gonadotropin   to   obtain   ovulation   in   patients   with   low  
• two   separate   ova   are   fertilized   by   two   different   sperms,   fertility  
hence  they  are  called    “double  ovum  twins”     b. Microorganisms    -­‐  rubella  ,  syphilis  ,  UTI  
• they  are  two  siblings  growing  at  the  same  twin  in  utero.   c. Genetics  –  inherent  defects  in  the  embryo  (  abortion)  
• Characteristics     d. Acute  infections  –  pneumonia  ,  Typhoid  fever  
à may  or  may  not  be  of  the  same  sex   e. Injury  or  trauma  to    the  abdomen  or  anywhere  else    
à with   two   amnions   ,two   chorions,   two   placenta   ,    
and  two  umbilical  cords    
   
c. Triplets  and  Quadruplets        
• may   either   fraternal   or   identical   ,but   single   ovum    
pregnancies  are  least  frequent      
• there   may   be   mixed   groups   with   a   set   of   mono   –   ovular    
infants  and  one  or  two  di-­‐  ovular  infants    
   
d. Quintuplets  or  sextuplets-­‐    
• very   rare   for   a   single   ovum   pregnancies   to   produce   many    
infants  .    
• in   most   cases   ,   either   two   or   three   distinct   placentas   or    
masses  of  two  or  three  have  fused  together.    
• this   type   of   pregnancy   is   often   linked   to   drugs   that   stimulate    
the  ovary  ,resulting  hyper-­‐  ovulation    
   
e. Siamese  Twins    
 
• occurs   with   identical   twinning   ,the   failure   in   some   cases   to  
 
separate   completely   during   early   development   so   that   the  
 
infants  are  born  conjoined.  
 
• Suspect  multiple  pregnancy  if;    
 
à there  is  faster    rate  of  increase    in  uterine  size    
 
à on   quickening,   there   are   several   flurries   of   action  
 
in  different  abnormal  positions  
 
à on   auscultation   ,   two   sets   of   fetal   heart   tones   are  
 
heard    
 
à there  is  marked  weight  gain  ,not  due  to  toxemia  or  
 
obesity  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Post partal period  
4. PERITONITIS  –  A  condition  that  usually  accompanies  pelvic  cellulites  
1. BLEEDING DUE TO PLACENTAL RETENTION when  the  peritoneum  is  involved  .  
• Small   ,partially   separated   fragments   of   the   placenta   or   •  mild   –   the   peritoneal   covering   of   the   broad   ligaments   may  
tissues  of  the  amniotic  sac  may  be                Retained  in  the  uterus   be  the  only  area  involved  
and   imterfere   with   the   proper   uterine   contraction,resulting   •  severe  –  widespread  generalized  abdominal  infection  
to  post            Partum  haemorrhage      
• if   placental   expulsion   does   not   occur   ,a   manual   removal     is   5. PELVIC INFLAMMATORY DISEASE – PID
attempted     •  an   inflammatory   condition   of   the   pelvic   cavity     that   may  
• intravenous   sedation   may   be   required   due   to   the   discomfort   involve   the   fallopian   tube   (salphingitis);   ovaries   (oophiritis),  
caused  by  the  procedure   pelvic  peritoneum  or  pelvic  vascular  system  
• failure   to   remove   the   placenta   via   manual   removal   usually   •  more   common   in   women   who   have   had   multiple   sexual  
necessitates  surgical  removal    by  curettage.   partners.  History  of  PID,  early  onset  of  sexual  activity  .IUD  
•    
2. PUERPERAL INFECTION  –  Post  partum  infection  due  to  bacterial   6. MASTITIS
infection  and  invasion   • the  inflammation  of  the  breast  connective  tissue  that  occurs  
  primarily  to  lactating  woman    
a. Endometritis     • caused  by  staphylococcus  aureus  ,  HAemophilus  
• localized  inflammation  /infection  of  the  lining  membrane  of   parainfluenzae  ,  H.Influenza  
the  uterus.   • common  source  of  pathogenic  microorganism  is  the  infants  
• manifested   within   48   -­‐72   hours   post   delivery   in   which   the   nose  and  throat  or  hands  of  the  mother  
bacteria  invade  the  placental  site    and  may  spread  to  involve   • Candida  albicans(neonatal  oral  thrush)  may  be  the  causative  
the  entire  endometrium.   agent  ,through  a  small  abrasion  on  the  nipple  
Assessment  Findings    
• Mild  rise  in  tempreture  –  38.4  for  several  days   Assessment    
• Virulent  infection  chills   • fever  –  38.5  or  higher,chills  ,  headache  ,flulike  muscle  ache  
• Increasing  pulse  rate   • malaise,warm  reddened  ,painfull  area  of  the  breast    
• Malaise,   loss   of   appetite,   headache,   backache,   general   • affected  skin  becomes  pink,flaking  and  pruritic  
discomfort  and  insomnia    
• Severe  prolonged  after  pains   Factors  Associated  with  the  Development  of  Mastitis  
• Abdominal  tenderness   • milk  stasis  
• Uterus   is   large   but   not   contracted,   extremely   tender   when   • actions  that  promote  access  /  multiplication  of  bacteria    
palpated   • breast  nipple  trauma  –  incorrect  positioning  during  breast  
• Dark  brown,  foul  smelling  lochia,  =decreased  in  amount.   feeding,poor  latch-­‐on,incorrect/aggressive  pumping  
-­‐ With  haemolytic  streptococcus,  lochia  is  odorless   • obstruction  of  ducts  –restrictive  clothing,constricting  
  bra,underwire  bra,  
b. Thrombophlebitis     • change  in  feeding/failure  to  empty  breast  –  attempted  
• An   infection   of   the   lining   of   the   blood   vessel   with   the   weaning,  missed  feeding,  
formation  of  clots   • lowered  maternal  defense  –  fatigue  ,  stress  
       Causes      
• An  extension  of  endometritis   Management    
• Clots   of   trombi   may   form   in   the   pelvis   secondary   to   cs   or   • bed   rest   for   24   hours,   increased   fluid,supportive   bra,local  
lower   extremities   due   to   a   sluggish   circulation       =   common   application  of  warm  ,moist  heat  compress,  
site  of  occurrence  is  the  thigh  or  calf   • analgesic   compatible   with   breastfeeding,   Penicillin   or  
Assessment  findings     cephalosporin  
• Pain  ,stiffness  and  redness  in  the  affected  part  of  the  leg   • candida  infection  –  antifungal  creams    
• Swelling   below   the   lesion   due   to   obstruction   of   venous   • Oral   DIFLUCAN:   the   infant   is   abruptly   weaned   if   abscess  
circulation     develops  
• Positive   homan’s   sign   –   pain   in   the   calf   when   foot   is   • I  &  D  for  breast  abscess    
dorsiflexed.    
  Nursing  Diagnosis  
3. PARAMETRITIS or PELVIC CELLULITIS  –       • Health   seeking   behaviors   r/t   lack   of   information   about  
• Infection   that   extends   along   the   blood   vessel   and   lymphatics   appropriate  breastfeeding  practices  
to   the   loose   connective   tissue   of   the   broad   ligaments   or   • Ineffective  breastfeeding  r/t  pain  secondary  to  development  
other  pelvic  structures.   of  mastitis  
• Causes  -­‐  cervical  laceration  and  endometritis      
Assessment  findings    
• persistent  fever  with  chills  ,malaise  and  lethargy    
• boggy    and  tender  uterus    
• marked  abdominal  pain  on  palpation    
• elevated  pulse  and  WBC    
• abscess  in  the  center  of  cellulites    
   
   
   
THE  DRUG  DEPENDENT  PREGNANT  WOMAN     Physical  Signs    
• Occurs   when   an   individual   experience   difficulties   with   • dilated  or  constricted  pupils  
work,family,   social   relations,and   health   as   a   result   of   drug   • inflamed  nasal  mucosa  
use  .   • evidence  of  needle  track  marks  or  abscesses  
• usage  varies    by  age  with  higher  rates  among  women  ages  15   • poor  nutritional  status  
-­‐25   • slurred  speech  or  staggering  gait  
  • odor  of  alcohol  on  breath  
ABUSED DRUGS AND ITS AFFECT TO THE FETUS • memory  lapses  
1. Narcotics (heroin)  –CNS  depressant  ,that  alters  perception  and   • signs  of  depression  
produces  euphoria   • suicidal  gestures    
• Withdrawal  syndrome  ,convulsion,  intrauterine  growth   Implementation  
restriction,  tremors,    irritability,  sneezing,  vomiting,  fever,   • establish  trust  and  support  
diarrhea,  and  abnormal  respiratory  function   • individual  counseling  
  • referral  for  in  –depth  assessment  to  specialist  
2. Methadone  –fetal  distress  ,  meconium  aspiration,with  abrupt   •  pain  medication  (psychoprophylaxis)or  local  anesthesia  
termination  of  the    drug,severe  withdrawal  syndrome,preterm   Nursing  Diagnosis    
labor,rapid  labor,  abruption  
• Imbalanced   Nutrition:less   than   body   requirementsr/t  
 
inadequate  food  intake    secondary  to  substance  abuse  
3. Barbiturates( phenobarbital )  –withdrawal    symptoms  ,fetal  
• Risk   for   infection   related   to   use   of   inadequately   cleaned  
growth  restrictions  
syringes  and  needle  secondary  to  intravenous  drug  use  
 
• Risk   for   ineffective   health   maintenance   r/t   to   a   lack   of  
4. Tranquilizers (phenothiazine derivatives)  –  withdrawal,  delayed  
information   about   the   impact   of   substance   abuse   on   the  
respiratory  onset,  hyperbilirubinemia,  hypotonia,  or  hyperactivity  
fetus  
decreased  platelet  count  
 
 
THE ALCOHOLIC PREGNANT WOMAN with ALCOHOLIC SYNDROME
5. Diazepam (valium)  –  hypotonia,  low  apgar  score  ,respiratory  
• a  potent  CNS  depressant  and  a  potent  teratogen  
depression  ,poor  sucking  reflex,  possible  cleft  lip  
• there  is  no  definitive  answer  as  to  how  much  alcohol  the  
 
woman  will  consume  during  pregnancy  
6. Antianxiety drugs(lithium)  –  congenital  anomalies  
• feeding  is  not  contraindicated,although  alcohol  is  excreted  in  
 
breastmilk  
7. Stimulants/amphetamines Amphetamine sulfate (Benzedrine)  –  
generalized  arthritis,  learning  disabilities,  poor  motor   • excessive  alcohol  consumption  may  intoxicate  the  infant  and    
coordination  ,  transposition  of  the  great  vessel,  cleft  palate   inhibit  the  maternal  letdown  reflex  
(Hypotonia-­‐  flaccid  muscle  tone  or  muscle  weakness.  When  present  at   • an  infant  of  the  alcoholic  mother  may  be  alcohol  dependent  
birth  the  infant  is  referred  to  as  “floppy”.  )   • when  the  infant’s  connection  with  the  maternal  blood  supply  
  is  stoped,the  newborn  may  suffer  withdrawal.  
8. Dextroamphitamine sulfate (dexedrine)  –  congenital  heart   Effects  on  the  Infant  
defects,biliary  atresia,  limb  defects   • First  week  –  sleeplessness  ,excessive  arousal  
  state,unconsolable  cry,abnormal  reflexes,hyperactivity,low  
9. Cocaine-  Cerebral  Infarction  ,microcephaly,learning   ability  to  maintain  alertness  ,jitteriness,abdominal  
disabilities,decreased  interactive    behavior,  CNS  anomalies   distension,hyperactive  rooting      
,Cardiac  anomalies,genitourinary  anomalies,  SIDS       • FETAL  ALCOHOL  SYNDROME(FAS)  –  cognitive  
  difficulties,facial  and  structural  malformations    
10. Nicotine (half – one pack cigerretes/day )–  increased  rate  of   • organic  and  inorganic  failure  to  thrive    
spontaneous  abortion  ,  increased  rate  of  placental  abruption  ,SGA   • delay  in  oral  feeding  development  but  with  normal  
,  small  head  circumference,  decreased  length,  SIDS,  Attention   progression  of  oral  motor  function  
Deficit  Hyperactivity  Disorder(ADHD)in  school  age  children   • nurse  poorly  and  persistent  vomiting  until  6  -­‐7  month  of  age  
  • difficulty  in  adjusting  to  solid  food  and  poor  interest  to  food    
11. Psychotropics • hypotonicity  and  increased  placidity  
• Phencyclidine(  PCP)‘angel  dust”  –hallucinogen,smoked  or   • severe  mental  retardationor  normal  intelligence  
taken  orally  or  IV  withdrawal  symptoms  ,newborn  behavioral   • cognitive  impairment,speech  and  language  abnormalities  
and  developmental  abnormalities   • distinctive  facial  abnormalities  –  epicanthal  folds,broad  nasal  
• Overdose  –  hypertension  ,hyperthermia.diaphoresis,possible   bridge,short  upturned  or  beaklike  
coma   nose,micrognalia(abnormal  small  lower  jaw)  
12. LSD (marijuana)  –  Chromosomal  breakage,Intra  Uterine  Growth   Management      
Restriction(IUGR)   • avoid  heat  loss,provide  adequate  nutrition  ,limit  
  environmental  stimuli  
Assessment  –     • monitor  for  seizurea  ctivity  and  respiratory  distress  
• history  of  vague  or  unusual  medical  complaint   Nursing  Diagnosis  –    
• family  history  of  addiction   • Altered  nutrition  ;less  than  body  requirements  r/t  decreased  
• history  of  childhood  sexual  ,physical  ,or  emotional  abuse   food  intake  and  hyperirritability  
• history   of   cirrhosis,pancreatitis,   hepatitis,gastritis,sexually   • Alteration  in  neurodevelopmental  status  r/t  CNS  
transmitted  infections   involvement  secondary  to  maternal  alcohol  use  
• history  of  high  risk  sexual  behavior   • Ineffective  coping  r/t  dysfunctional  family  dynamics  and  
• psychiatric  history  of  treatment  /hospitalization   substance  dependent  mother