NCM 109:

THEORY MODULE 1M

ANTENATAL COMPLICATIONS

Group E2:
Ms. Gornez, Nicole Andrea
Mr. Hagensen, Ed Vincent
Ms. Ibañez, Cziane
Ms. Jumawan, Crisha Reham
Ms. Labao, Kimberly Anne
Mr. Lesigues III, Rolando
Ms. Mariscal, Chelbe Eve
Mr. Millan, Kyle Ian
Ms. Monredondo, Monique
Mr. Noel, Julius
Mr. Noel, Luc
Ms. Objero, Norell
Ms. Ong, Nathalie

Date Submitted: Jan 26, 2023

 ANTENATAL COMPLICATIONS

Placenta Previa
➢ Definition/Description of the disease or complication
Placenta previa is an obstetric complication during pregnancy when the
placenta completely or partially covers the opening of the uterus (cervix). It
classically presents as painless vaginal bleeding.

➢ Etiology/Cause
The exact cause of placenta previa is unknown. However, it is speculated that
pregnant women end up experiencing this due to past uterine surgeries or
past pregnancies with placenta previa. Factors such as age, smoking, and
presence of fibroids in the uterus are also considered. The mentioned
conditions are not the exact cause of placenta previa happening during a
pregnancy but are speculated to contribute to its manifestation.

➢ Types of Placenta Previa

Placenta Previa is identified accordingly:
○ Total placenta previa - placenta is completely covering the internal os
○ Partial placenta previa - placenta is only covering part of the os
○ Marginal placenta previa - m placenta is at the edge of the os and
not covering it. This is also referred to as a low-lying placenta and may
resolve itself before labor

➢ Signs and Symptoms

The main sign of placenta previa is bright red vaginal bleeding, usually
without pain, after 20 weeks of pregnancy. Sometimes, spotting happens
before an event with more blood loss. The bleeding may occur with prelabor
contractions of the uterus that cause pain. The bleeding may also be
triggered by sex or during a medical exam. For some women, bleeding may
not occur until labor. Often there is no clear event that leads to bleeding.

➢ Management (Nursing, Medical, Pharmacologic, Surgical)

Nursing Management
● Ensure the physiologic well-being of the client and fetus.
● Provide client and family teaching
● Addressing emotional and psychosocial needs

Medical Management
● Intravenous therapy. This would be prescribed by the physician to replace the
blood that was lost from blood while bleeding.
● Avoid Vaginal Examination. This may initiate hemorrhage that is fatal for both
mother and the baby.
● Attach external monitoring equipment. To monitor the uterine contractions and
record fetal heart sounds, an external equipment is preferred than caused by
placenta previa.
 Pharmacologic Management
● No medication is of specific benefit to a patient with placenta previa.
● Encourage patients with known placenta previa to maintain intake of iron and
folate as a safety margin in the event of bleeding.

Surgical Management
● There is no surgical treatment to cure placenta previa but there are several
options to manage bleeding.

➢ Relevant Pictures/Videos

➢ One (1) priority Nursing Care Plan

Need, Scientific
Nursing Objectives of Nursing
Problems & Basis or Rationale
Diagnosis Care Actions
Cues Significance
Problem: Deficient fluid Placenta previa General Measures to
Deficient fluid volume related usually occurs Objectives: improve fluid
volume to excessive during the third After a week of volume:
vaginal trimester of student 1. Note the That may
Objective bleeding as pregnancy nurse-client presence of contribute to a
cues: evidenced by where the relationship, the other lack of fluid
- Vaginal body weakness. placenta covers client will be factors. intake or loss of
bleeding the opening of able to display fluid by various
(200 to 500 the uterus or homeostasis as routes.
ml) cervix, thus, the evidenced by
- Pale, cold, fetus cannot be the absence of 2. Estimate or These factors
clammy born vaginally bleeding. measure are used to
skin and cesarean traumatic or determine
- Vital signs: section is Specific procedural degree of
T - 37.1 C recommended Objectives: fluid losses volume
P - 92 to prevent After 8 hours of and note depletion and
RR - 12 postpartum student possible method of fluid
BP - 116/69 hemorrhage. nurse-client routes of replacement.
 relationship, the insensible
Subjective During later client will fluid losses.
cues: stages of 1. Maintain Determine
- Client pregnancy, the fluid volume customary
verbalized bottom part of at a and current
that she is the uterus thins functional weight.
manifesting and spreads to level,
body accommodate possibly 3. Assess vital These changes
weakness the growing evidenced signs, in vital signs are
fetus. If the by noting low associated with
placenta is adequate blood fluid volume
anchored to the urinary pressure–s loss and/or
bottom of the output and evere hypovolemia. In
uterus, this can stable vital hypotension an acute,
cause painless signs. , rapid life-threatening
vaginal heartbeat, hemorrhage
bleeding to the and thready state, cold,
mother. During peripheral pale, moist skin
labor, the cervix pulse. may be noted,
thins and reflecting body
dilates, which compensatory
would normally mechanisms to
allow the baby profound
to exit into the hypovolemia.
vagina,
however, in 4. Review To evaluate the
placenta previa, laboratory body’s
the dilation of data. response to
the cervix bleeding or
further tears the other fluid loss
placenta and and to
causes determine
bleeding. replacement
Because of the needs.
bleeding
episodes, the 5. Weigh Weighing
mother tends to perineal perineal pads
suffer from pads to before and after
body weakness estimate use and
and decreased blood loss. calculating the
blood pressure, difference in
respiratory rate order to
and rapid determine
heartbeat. vaginal blood
loss.

6. Avoid Because of the

vaginal risk of
examination provoking
s. life-threatening
hemorrhage, a
digital
examination of
the vagina is
absolutely
contraindicated
until placenta
previa is
excluded.
Instruments
 should not be
placed near the
cervix because
uncontrolled
bleeding can
result (Bakker &
Smith, 2018).

7. Position the To ensure an

client adequate blood
supine with supply to the
hips client and fetus,
elevated if place the client
ordered or immediately on
in a left bed rest in a left
side-lying side-lying
position. position as it
decreases
pressure on the
placenta and
cervical os and
improves
placental
perfusion.

8. Administer In instances
blood and where
blood significant
products as bleeding
indicated. ensues, rapid
replacement of
blood products
is a priority.

9. Observe for Too rapid a

sudden or correction of
marked fluid deficit may
elevation of compromise the
blood cardiopulmonar
pressure, y system,
restlessnes causing fluid
s, dyspnea overload and
and moist edema.
cough.

10. Discuss To reduce risk

factors of recurrence.
related to
occurrence
of fluid
deficit as
individually
appropriate.

11. Prepare for Vaginal birth is

a vaginal or always safest
cesarean for the infant. If
birth. the previa is
under 30% by
abdominal or
 transvaginal
ultrasound, it
may be
possible for the
fetus to be born
past it. If over
30% and the
fetus is mature,
the safest birth
method for both
mother and
baby is often
cesarean birth.

Abruptio Placenta
➢ Definition/Description of the disease or complication
Abruptio Placenta (Placental Abruption) is the separation of the placenta from
the lining of the uterus before the completion of the second stage of labor. It
occurs when the maternal vessels tear away from the placenta and bleeding
occurs between the uterine lining and the maternal side of the placenta. As
the blood accumulates, it pushes the uterine wall and placenta apart. The
placenta can partly or completely separate from the inner wall of the uterus
before delivery which can decrease or block the baby’s supply of oxygen and
nutrients since the placenta has these life-sustaining functions. Abruptio
Placenta is one of the causes of bleeding during the second half of pregnancy
and is a relatively rare but serious complication of pregnancy that places the
well-being of the mother and fetus at risk.

➢ Etiology/Cause
The exact etiology of Abruptio Placenta is unknown. However, the following
are its risk factors:
● Smoking
● Cocaine use during pregnancy
● Maternal age over 35 years
● Hypertension
● Placental abruption in a prior pregnancy
● Trauma to the abdomen (e.g. a motor vehicle accident, fall, or violence
resulting in a blow to the abdomen)
Factors specific to the current pregnancy
● Multiple gestation pregnancies
● Polyhydramnios
● Preeclampsia
● Sudden uterine decompression
● Short umbilical cord

➢ Types if Applicable
Classification by presence or absence of vaginal bleeding:
● Revealed Abruption - active vaginal bleeding and blood passes
through cervix and vagina
 ● Concealed Abruption - no vaginal bleeding and blood accumulates
behind placenta with no external bleeding

Classification by degree of separation:

● Total Abruption - detachment of entire placenta
● Partial Abruption - detachment of only part of placenta

Classification by severity of abruption:

● Grade 0 Abruption - asymptomatic and small retroplacental clot
detected
● Grade 1 Abruption - vaginal bleeding, uterine irritability and
tenderness and no signs of fetal or maternal distress
● Grade 2 Abruption - vaginal bleeding, uterine contractions and no
signs of maternal shock but signs of fetal distress present
● Grade 3 Abruption - hypertonic uterus and/or “wooden hard” uterus,
severe bleeding (revealed/concealed), persistent abdominal pain and
signs of maternal shock (often with coagulation) and fetal distress or
death

Classification by site of bleeding:

● Subchorionic Abruption - bleeding between the myometrium and
placental membranes
● Retroplacental Abruption - bleeding between the myometrium and
placenta
● Preplacental Abruption - bleeding between placenta and amniotic
fluid
● Intraplacental Abruption - bleeding within the placenta

➢ Signs and Symptoms

Signs and Symptoms of Abruptio Placenta include:
● Abdominal pain
● Uterine contractions that are longer and more intense than average
labor contractions
● Uterine tenderness or rigidity
● Backache or back pain
● Decreased fetal movement
● Vaginal bleeding, although there might be no visible bleeding

➢ Management (Nursing, Medical, Pharmacologic, Surgical)

Nursing Management
During this emergency situation, the nurse plays a vital role to successfully carry out
the immediate and proper treatment the patient needs. The nurse must be able to
assess the patient accurately to provide the baseline data that other health
practitioners will be needing. In patients with abruptio placenta the nurse should
perform the following:
● Perform Nursing Assessment.
○ Assess for signs of shock,especially when heavy bleeding is
present.
 ○ Monitor for contractions when placental separation occurs
during labor.
○ Check the patient’s vital signs.
○ Assess for the time bleeding started, the amount of blood, and
possible interventions done prior to admission.
○ Assess for the magnitude and quality of pain.
● Formulate a Nursing Diagnosis based on the obtained data from the
patient.
● Create a Nursing Care Plan appropriate for the patient.
● Perform necessary Nursing Interventions to ease the discomfort
○ Let the patient assume lateral position to avoid increasing the
pressure in the vena cava
○ Monitor the fetal heart sounds
● Do Nursing Evaluation.
○ Evaluate maternal vital signs, particularly the patient’s blood
pressure
○ Check the patient’s urine output. Urine output should be more
than 30 mL/hr.
○ Observe for bleeding. Minimal amount to absence of bleeding
must be observed. Assess the uterus. It should not be tense
and rigid.
○ Evaluate for fetal heart sound. It should be within the normal
range.

Medical Management
In the case of Abruptio placentae, several medical procedures are done to
avoid worsening the condition of the patient. These procedures are the
following:
● Intravenous Therapy. This is a medical procedure where a physician
utilizes a large gauge catheter to facilitate the replacement of fluid
loss. This is usually done when the patient starts to bleed.
● Oxygen Inhalation. This medical procedure is delivered via inhalation
masks, preventing fetal anoxia.
● Fibrinogen Determination. This is a medical procedure necessary for
patients who are experiencing heavy bleeding. In the case of abruptio
placentae, this procedure may be taken several times before birth to
determine if Disseminated Intravascular Coagulation (DIC) is present
or not.

Pharmacologic Management
In the events of abruptio placenta, some medications are administered to help
delay the premature delivery of the fetus. This type of medication is called
tocolytics that functions to decrease or inhibit uterine contractions and is
especially helpful to cases when premature complications are less
severe.Examples of medications that are used in tocolytic therapy are the
following:
● Administration of Terbutaline. This is a Beta Sympathomimetic drug
which stimulates beta-2 receptors on uterine smooth muscle, allowing
 a decrease in frequency and intensity of uterine contractions.
However, this medication is no longer advised by the Food and Drug
Administration (FDA) to be used as a tocolytic agent because of the
significant risks it poses to both the unborn child and the mother.
● Magnesium Sulfate. This is a Calcium Antagonist drug that allows
relaxation of the smooth muscle of the uterus. In abruptio placenta,
this medication is the drug of choice for tocolysis.

Surgical Management
When all other non-surgical options have been exhausted and both the
mother and her unborn child's lives are in great danger, that is when surgical
operations are put into action. Below are the two procedures that could be
done in patients with abruptio placenta.
● Cesarean Delivery. When birth is impending, the safest option for this
case is to deliver the baby via cesarean delivery.
● Hysterectomy. This is a surgical procedure done to remove all parts of
the uterus of the mother. This is usually done when the mother has
already developed DIC. Hysterectomy is performed to avoid extreme
blood loss or exsanguination.

➢ Relevant Pictures/Videos

Suggested Video to Simply Explain Abruptio Placenta:

Placental abruption - causes, symptoms, diagnosis, treatment, pathology

➢ One (1) priority Nursing Care Plan

Need, Scientific
Nursing Objectives of Nursing
Problems & Basis or Rationale
Diagnosis Care Actions
Cues Significance
Problem: Acute pain: Labor General 1. Assess and 1. Place and
Physiologic Uterine contractions are Objective: monitor vaginal observe external
Overload contractions as the periodic After a week of bleeding fetal monitoring
evidenced by tightening and nurse-patient for signs of fetal
verbal report of relaxing of the interaction, the distress
Objective pain and uterine muscle, patient will no
Cues: muscle tension the largest longer express 2.Place patient 2. This position
- Abdominal muscle in a any sign of on bed rest in helps avoid
guarding woman's body. pain. lateral position pressure on the
- Muscle Something vena cava to
tension triggers the Specific avoid decreased
- Uterus is pituitary gland Objectives: cardiac output
tense and rigid. to release a 1. After 8 hours
- Heavy hormone called of patient-nurse
bleeding oxytocin that interaction, the
stimulates the patient will be 3. Assess 3. Uterus may be
Vital signs uterine able to abdomen for tender upon
taken: tightening. It is demonstrate uterine palpation, tense
T: 37.3 difficult to use of tenderness and and rigid. Fundal
P: 95 predict when relaxation skills contractions massage may
R: 22 true labor and other help to slow
BP: 100/70 contractions will methods to bleeding from the
begin. promote uterine wall.
Subjective comfort.
Cues:
The patient 4. Monitor 4. Watch for signs
verbalized maternal vitals of hypovolemia to
sharp pain on for signs of include
the upper shock tachycardia,
uterine fundus. tachypnea and
hypotension

5. Place and 5. This allows you

observe external to monitor fetal
fetal monitoring heart rate and
for signs of fetal contractions to
distress observe for
variability and
responsiveness of
the fetal heart
rate. A lack of
variability or
decelerations
indicate fetal
distress.

Hypersensitivity disorder of pregnancy

➢ Definition/Description of the disease or complication
Refers to undesired immune system reactions, such as when there is altered
reactivity, in which the body reacts with an excessive immune response to
what is seen as a foreign material that is ordinarily harmless termed
allergens.

➢ Etiology/Cause
When the invading organism is an allergen rather than an immunogen, an
excessive antigen-antibody reaction occurs.

Environmental allergy
● Dust
● Pollen
 Reaction from taking of meds
● Antibiotics

➢ Types if Applicable
● Type 1: Immediate
a. IgE
b. Anaphylaxis
I. Exposure to allergen
II. Allergies, asthma, dermatitis
III. Extreme vasodilation = circulatory shock
IV. Extreme bronchoconstriction \
● Type 2: Cytotoxic Response
a. IgG or IgM
b. Hemolytic anemia
c. Transfusion reaction
d. Erythroblastosis fetalis
● Type 3: Immune Complex
a. IgG or IgE
b. Rheumatoid arthritis
c. Systemic lupus erythematosus
● Type 4: Cell-mediated hypersensitivity/ Delayed
a. T lymphocytes
I. Calls lymphokines = Calls macrophages
b. Contact dermatitis
c. Transplant graft reaction

➢ Signs and Symptoms

● A pink or red rash with or without pus filled bumps or blisters
● Scaly, flaky skin
● Fever
● Facial swelling
● Swollen or tender lymph nodes
● Swollen saliva glands
● Dry mouth
● Abnormalities in your white blood cell counts
● Difficulty moving normally
● Headache
● Seizures
● Coma

➢ Management (Nursing, Medical, Pharmacologic, Surgical)

Nursing Management
● Reduce exposure to allergen (food, etc.)
● Environmental Control
● Replacing carpets with hardwood. Goal is to decrease allergic triggers in the
environment.
● Promote good nutrition, since the woman has still to continue her usual
pregnancy nutrition. Pay particular attention in lowering sodium intake
 ● Assess the patient for the presence of edema on the face, fingers, and upper
extremities.
● Provide information about signs/symptoms indicating worsening of condition,
and instruct patients to notify health care providers.

Medical Management
● Medication: Insert epinephrine related to constriction of airway.
● Immunotherapy/ hyposensitization
● Continuous exposure to reduce
● sensitization to allergen.

Pharmacologic Management
● Rx Commercial preparation of passive Rh (D) antibodies against the Rh
factor
● RhIG (RhoGAM) given again via injection in the first 72 hours after birth of a
Rhpositive child to prevent formation of natural antibodies.
● Pharmacologic therapy Intranasal steroids
● 2nd & 3rd generation antihistamines (Cetirizine/ Zyrtec, Loratadine/ Claritin)
Decongestants (pseudoephedrine)

Surgical Management
• No surgical interventions are needed as the interventions listed above
should suffice.

➢ Relevant Pictures/Videos
 ➢ One (1) priority Nursing Care Plan

Scientific
Need, Problem Nursing Objectives of Nursing
Basis or Rationale
& Cues Diagnosis Care Actions
Significance
Physiologic Ineffective When a person General 1. Check - To have an
Deficit Airway is experiencing Objective: patients for any overview on
Clearance an allergic In 1 week of prior how to handle
Problem: Secondary to reaction, patient-nurse anaphylaxis or the situation
Allergic histamines are interaction, the allergic reaction based on the
Reaction substances patient will be history. history of the
Ineffective released by the free from patient.
Airway body. In allergic
Clearance relevance, reactions. 2. Monitor - to gain a
histamines work patient’s vital comprehensive
Objective Cues: with the nerves Specific signs understanding
to produce Objectives: of a patient's
BP: 80/50 itching and can In 1 day of well-being and
mmHG affect a patient-nurse health changes.
RR: 30 bpm person’s interaction, the
breathing patient will 3. Provide - Oxygen saves
- Trouble pattern as the manifest the oxygen to the lives when used
breathing airways narrow. following: patient as appropriately to
- Skin Also, having a needed. correct
hives/rashes swollen throat - Breathing hypoxaemia.
- Low blood may also result pattern returns
pressure in difficulty in to normal. 4. Check the - To relieve
(hypotension) breathing. - Free from skin patient's airway patients from
- Swollen throat Moreover, it is a hives/rashes clearance if breathing
responsible - Blood there are any difficulty.
Subjective mediator of pressure obstructions.
Cues: hypersensitivity returns to
“I am having response which normal. 5. Provide - To promote
breathing causes the - Relieved from sufficient patient’s
problems and blood vessels to swollen throat. information to awareness in
my skin itches at expand causing the patient dealing with the
times.” vasodilation about condition.
that leads to signs/symptoms
hypotension. indicating
worsening of
condition

6. Administer - Cetirizine is an
cetirizine as antihistamine
prescribed by medicine that
the physician. helps the
symptoms of
allergies. It can
relieve skin
hives/rashes.

7. Advise the - The condition

patient not to may get worse
scratch their if you scratch
skin. the hives or
rashes.

8. Promote a - Sodium
patient's chloride triggers
nutrition by the production
paying of a type of
particular immune cell
attention in that promotes
lowering allergies and
sodium intakes. can irritate and
swollen the
throat.

9. Assess the - Experiencing

patient if she/he nausea is a
 experiences symptom of low
nausea blood pressure.

10.Educate - The most

patients on the frequent food
avoidance of allergens that
allergic foods. result in allergic
reaction include
peanuts, tree
nuts, seafood,
wheat, milk,
and eggs.

Isoimmunization
➢ Definition/Description of the disease or complication
Isoimmunization (Sometimes called Rh sensitization, hemolytic disease of the
fetus, Rh incompatibility) is a condition that happens when the maternal
immune system is exposed to a foreign antigen therefore creating antibodies
to the specific antigen. This is clinically pertinent to a pregnancy in which the
mother is exposed to a new antigen of the fetus expressed specifically when
the mother's Rh negative and the fetus is Rh positive. It makes the mother's
body create antibodies that can harm the baby's blood cells.

➢ Etiology/Cause
When the proteins on the surface of the baby's red blood cells are different
from the mother's protein, the mother's immune system produces antibodies
that fight and destroy the baby's cells. Red cell destruction can make the baby
anemic well before birth. Although the Rh(D) protein is the most common one,
several other proteins can cause this problem, including proteins KELL, Kidd,
Duffy, and others. Rh isoimmunization can happen if the baby's Rh positive
blood enters the mother's blood flow. This may happen during:
● Miscarriage
● Trauma
● Ectopic pregnancy
● Induced abortion
● Amniocentesis or other pregnancy procedures.
The mix in blood happens most often at the end of pregnancy. This means it
is rarely a problem in a woman's first pregnancy. The mother's antibodies
could affect a future pregnancy with a baby with Rh-positive blood even if the
blood is not mixed. A woman can also become sensitized to Rh-positive blood
if she has a blood transfusion that is not a match.

➢ Types if Applicable
An Rh incompatibility occurs when a mother is Rhnegative and her unborn
child is Rhpositive. Potential birth injuries that result from an untreated Rh
incompatibility can range from mild to fatal:
● Mild injuries - Might include jaundice, low muscle tone and lethargy.
● Severe injuries - Might include stillbirth, heart failure, a brain
syndrome called kernicterus as a result of high bilirubin levels, fluid
 buildup in the body, seizures and other movement or cognitive
impairment.

➢ Signs and Symptoms

The mother will not have symptoms from isoimmunization but for the baby
symptoms can range from mild to dangerous. Even mild, the incompatibility
causes destruction of the red blood cells without showing other effects. When
the process is severe enough, the baby can become very anemic and, in
some cases, may die. After birth, the baby's skin and whites of the eyes will
appear yellow (jaundice) and the baby will have low muscle tone (hypotonia)
and lethargy.

➢ Management (Nursing, Medical, Pharmacologic, Surgical)

Nursing Management
Nurses do share responsibilities with the other healthcare team members in
the early detection, proper management, patient education and follow-up or
further evaluation of the health conditions of both the mother and the baby. In
the case of Isoimmunization,a perinatal nurse who are in charged in the care
of the sensitized woman are expected to help manage the patient's condition
by doing the following:
● Assist the patient in undergoing screening for blood ABO and Rh groups
during the first antenatal visit. If negative, advised her to let her husband’s
blood ABO and Rh group be obtained.
● Assist the patient while undergoing the same screening test at her 35th week.
If negative, observe her until the delivery.
● Collect previous medical history.
● Administer Human Rh Anti-D within 72 hours
● Send the baby for grouping and Rh typing including test for serum bilirubin to
detect neonatal jaundice
● Observe and check for the baby’s sucking reflex, jaundice, anemia ,and
irritability
● Observe the child’s stool and urine characteristics
● Educate and counsel the parents/patient when blood transfusion or
phototherapy is necessary
● Perform the phototherapy to the baby as ordered

Medical Management
● Detection of maternal sensitization. The presence of Rh bodies in the
maternal circulation confirms maternal sensitization and this is done through
titre technique where all Rh-negative pregnant women undergo blood test for
Rh antibodies during their 1st antenatal visit and in their 28th and 34th weeks
of gestation.
● Management of affected fetus through uterine and intravascular transfusion.
This is a medical procedure done to the baby where blood is given by a
needle through the mother’s abdomen.

Pharmacological Management
● Administration of Prophylactic Anti-D Immunoglobulin
 ➢ Relevant Pictures/Videos

➢ One (1) priority Nursing Care Plan

Need, Scientific
Nursing Objectives of Nursing
Problem & Basis or Rationale
Diagnosis Care Actions
Cues Significance
Knowledge Deficient The occurence General Measures to - The indirect
Deficit: knowledge of ABO Objective: enhance Coombs test
related to incompatibility After 1 week of knowledge: identifies
Deficient insufficient (blood type nurse-patient paternal
Knowledge prenatal care as incompatibility interaction, the 1. Determine zygosity at the
evidenced by between mother patient will the blood Rh gene locus,
Objective statement of and infant) and display groups and and an
Cues: misconceptions Rh improvement in blood types of ultrasonography
- ABO incompatibility knowledge by the mother and can aid in
incompatibil (Rh positive verbalizing the infant detecting
ity between mother’s enhanced through isoimmunization
mother and immune system understanding methods such through
 infant produces of Neonatal as indirect identifying
- Rhesus antigens that hyperbilirubine Coombs test alterations in
(Rh) will destroy Rh mia. and the umbilical
incompatibil negative ultrasonography cord, placenta,
ity between infant’s cells) Specific . and amniotic
mother and may lead to Objectives: fluid volume;
infant instances of After 1 day of which may
fetal injury or nurse-patient indicate for
Subjective even for the interaction: further maternal
Cues: fetus to be 1. The mother and fetal
- “I don’t incompatible and family testing.
think it's a with life. One will
problem effect of demonstrat - Promotes
since untreated Rh e improved understanding
parents can incompatibility prenatal and willingness
have is Neonatal care to gather
different hyperbilirubine strategies. 2. Provide information
blood types mia. This 2. The mother information on regarding the
as their condition is the and family pathophysiologi condition.
kids.” accumulation of will be able cal factors,
conjugated to verbalize health
bilirubin in the and identify implications,
blood signs and possible
circulation of a and/or indicators for
neonate that symptoms neonatal - This will
occurs after 24 that require hyperbilirubine promote
hours of life; immediate mia. willingness to
wherein the medical seek
bilirubin levels attention. 3. Assist in professional
are less than 15 3. The mother scheduling/plan medical aid for
mL/dL. The and family ning visits and achieving
increased will be able checkups for optimal health.
bilirubin levels to plan and tests and
may then lead schedule screening. - This will help
to to essential develop an
kernicterus, a screening understanding
type of brain tests during for the
damage that pregnancy. 4. Explain importance of
may cause 4. The mother necessary the necessary
athetoid and family procedures and procedures to
cerebral palsy, will their respective undergo.
hearing loss, demonstrat results to the
and lethargy. e sufficient mother and - This promotes
execution in family. a feeling of
following security,and as
instructions well as a bridge
from health 5. Establish for
professional options for dissemination
s. contact and of reliable
5. The mother communication information to
and family between the the family.
will be able family and the
to establish health care - This aids the
sufficient professionals. family to focus
support and on executing
information therapeutic
systems. 6. Encourage practices.
the practice of
successful - This
interventions. preparation
 should be given
at 28 weeks of
7. Determine pregnancy then
the need for again within 72
administering hours after birth
Rh Immune (only to be
Globulin given when
(RhIG). mother and
infant are
determined to
be Rh
incompatible)

- This is done to
inform the
family of their
course of action
8. Discuss when neonatal
possible effects hyperbilirubine
of neonatal mia is evident.
hyperbilirubine
mia and needed - This is to be
interventions. demonstrated
for the family to
determine signs
9. Demonstrate and symptoms
assessment that indicate an
techniques for increase in
increasing bilirubin levels.
bilirubin levels
of the infant. - This promotes
understanding
of the condition,
and home
10. Discuss interventions to
home manage it prior
interventions for to seeking
managing professional
moderate/mild aid.
symptoms of
neonatal
hyperbilirubine
mia

Iron Deficiency Anemia

➢ Definition/Description of the disease or complication
Iron deficiency anemia is a common type of anemia caused by low iron levels
in which the blood does not have adequate healthy red blood cells to carry
adequate oxygen to her body tissues and as well to her baby. The body uses
iron in order to make hemoglobin that functions in carrying the oxygen
throughout the body. If there are low iron levels, this will lead the body to
produce fewer hemoglobins, hence the body receives less oxygen. Pregnant
mothers must intake nearly double the amount of iron taken by a nonpregnant
woman to also meet the demand for the baby.
➢ Etiology/Cause
Our body uses iron to make hemoglobin and hemoglobin is a protein in the
red blood cells that carries oxygen to our tissues. So, during pregnancy, as
the blood volume of a pregnant mother increases, and so does the amount of
iron she need. If this increased demand of iron will not be met, then this will
result in what we called iron deficiency anemia. The pregnant mother’s body
uses the iron to produce more hemoglobin in order to also supply oxygen to
her baby.

➢ Types if Applicable
N/A since Iron Deficiency Anemia belongs to the types of the GENERAL ANEMIA.

➢ Signs and Symptoms

● Brittle nails
● Chest pain, tachycardia or shortness of breath
● Cold hands and feet
● Extreme fatigue
● Headache, dizziness or lightheadedness
● Inflammation or soreness of your tongue
● Pale skin
● Poor appetite
● Unusual cravings for non-nutritive substances, such as ice, dirt or starch
● Weakness

➢ Management (Nursing, Medical, Pharmacologic, Surgical)

Nursing Management
● Assessment of nutritional intake and status
● Assess for fatigue, pallor, sore tongue, anorexia, nausea and vomiting,
stomatitis, some signs of infection, and severe pain (due to veno- occlusive
crisis
● Observe and monitor hematologic laboratory results
● Encourage the client to eat foods high in iron and folic acids like green leafy
vegetables, fish, meat, poultry, eggs, and legumes.
● Teach how to prepare food in order to minimize the loss of iron and folic acid
(steaming with small amount of water)
● Encourage to take foods high in Vitamin C for iron absorption
● Emphasize diet high in fiber and fluids to avoid constipation (a side effect of
iron intake)
● Emphasize also good hygiene to avoid urinary tract infection
● Teach the client to watch out for signs of preterm labor
● Observe and monitor the fetal well being
● Allow the client to rest as much as possible and provide emotional support

Medical Management
● Iron therapy - oral ferrous iron salts are the effective medication for the
treatment of iron deficiency anemia
● Management of hemorrhage
● Diet
 Pharmacologic Management
● Iron products to provide adequate iron for hemoglobin synthesis and to
replenish body stores of iron
● Parenteral iron

Surgical Management
● Blood transfusion
● Blood and marrow stem cell transplants

➢ Relevant Pictures/Videos

What are the effects of iron deficiency anemia on pregnancy outcome? - Dr. Teena S T…

➢ One (1) priority Nursing Care Plan

Need, Scientific
Nursing Objectives of Nursing
Problem & Basis or Rationale
Diagnosis Care Actions
Cues Significance
Problem: Impaired gas Hypoxia is a General 1. Assess - Rapid and
Hypoxia exchange state in which Objective: respiratory shallow
related to oxygen is not After 2 days of rate, depth, breathing
Objective decreased available in providing the and effort, patterns and
cues: hemoglobin sufficient necessary including the hypoventilatio
- tachypnea and amounts at care, the use of n affect gas
- dyspnea diminished the tissue patient will: accessory exchange.
- use of oxygen-carryin level to - patient will muscles, Increased
accessory g capacity of maintain manifest nasal flaring, respiratory
muscles the blood adequate resolution or and abnormal muscles,
- noisy homeostasis; absence of breathing nasal flaring,
breathing this can result symptoms of patterns. abdominal
- flaring of from respiratory breathing, and
 nostrils inadequate distress a look of panic
- pursed oxygen in the patient’s
lips delivery to the Specific eyes may be
- bluish/gra tissues either Objectives: seen with
y skin due to low After 6 hours hypoxia
color blood supply of continued
- unable to or low oxygen intensive care: 2. Monitor Changes in
speak in content in the - patient’s behavior and
full blood. As a The patient behavior and mental status
sentences result, it will maintain mental status can be early
- loss of causes optimal gas for the onset signs of
conscious symptoms like exchange as of impaired gas
ness confusion, evidenced by restlessness, exchange.
- restlessne restlessness, usual mental agitation,
ss/anxiety difficulty status, confusion, and
breathing, unlabored (in the late
Vital signs rapid heart respirations at stages)
taken: rate, and 12 - 20 per extreme
<100/min HR bluish skin. minute, lethargy.
< 24/min RR oximetry
results within 3. Observe for Central
Subjective normal range, nail beds, cyanosis of
cues: blood gases cyanosis in tongue and
- The client within normal the skin; oral mucosa
verbalized range, and especially indicted
feeling baseline HR note the color severe
faint for patient. of the tongue hypoxia and is
and oral a medical
mucous emergency.
membranes.

4. Monitor To detect
oxygen changes in
saturation oxygenation
continuously, and ensure
using a pulse that that
oximeter oxygen
saturation is
<90%

5. Position This position

patient with allows
head of the increased
bed elevated, thoracic
in a capacity, total
semi-Fowler’s descent of the
position (head diaphragm,
of the bed at and increased
45 degrees lung
when supine) expansion
as tolerated. preventing the
abdominal
contents from
crowding.

6. Encourage Ambulation
or assist with facilitates lung
ambulatonas expansion and
per the stimulates
physician’s deep
order. breathing

7. Encourage This technique

slow deep promotes
breathing deep
using an inspiration,
incentive which
spirometer as increases
indicated oxygenation
and prevents
actelectasis

8. Provide Anxiety
reassurance increases
and reduce dyspnea,
anxiety respiratory
rate, and work
of breathing

9. Pace Activities will

activities and increase
schedule rest oxygen
periods to consumption
prevent and should be
fatigue planned, so
the patient
does not
become
hypoxic.

10. Administer Provide

medications medication
as prescribed that improve
oxygenation to
the body.
 References

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