NCM 2208 - Care of Mother and Child at Risk or With Problems (Acute and Chronic) (PRELIMS

CARE OF MOTHER AND CHILD AT RISK OR NCM 2208
WITH PROBLEMS (ACUTE AND CHRONIC) A.Y. 2022-2023

2nd Semester
Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E
FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING FOCUSING ON AT-RISK, HIGH RISK, AND SICK CLIENTS
A. NATIONAL HEALTH SITUATION ON MCN

WHO supports the Government of the Philippines to
HEALTH SITUATION - PHILIPPINES foster well-being through action by the health
sector and across sectors.
The Philippines has made significant investments and
WHO convenes platforms for health involving
advances in health in recent years. Rapid economic
multiple stakeholders and in addressing the social,
growth and strong country capacity have contributed to
economic and environmental determinants of
Filipinos living longer and healthier. However, not all the
health. WHO also takes the lead in coordinating with
benefits of this growth have reached the most vulnerable
other health partners to ensure all stakeholders are
groups, and the health system remains fragmented.
aware of health issues and activities in the country.
Health insurance now covers 92% of the population.
Maternal and child health services have improved, with
more children living beyond infancy, a higher number of
women delivering at health facilities and more births
being attended by professional service providers than B. STATISTICS ON MCN
ever before.
Access to and provision of preventive, diagnostic and SUMMARY OF STATISTICS
treatment services for communicable diseases have
improved, while there are several initiatives to reduce Population (May 1, 2020)
illness and death due to noncommunicable diseases 109, 035, 343
(NCDs).
Despite substantial progress in improving the lives and Vital Statistics (January - July 2022)
health of people in the Philippines, achievements have Birth - 545, 255
not been uniform and challenges remain. Deep inequities Marriage - 221, 848
persist between regions, rich and the poor, and different Death - 311, 921
population groups. Many Filipinos continue to die or
suffer from illnesses that have well-proven, cost-effective Health (June 2020)
interventions, such tuberculosis, HIV and dengue, or About 7% of Filipino family members got ill/sick or injured
diseases affecting mothers and children.
Many people lack sufficient knowledge to make informed Gender (October 2020)
decisions about their own health. Rapid economic Number of working children aged 5-17 years old
development, urbanization, escalating climate change, Boys - 581.5
and widening exposure to diseases and pathogens in an Girls 290.8
increasingly global world increase the risks associated
with disasters, environmental threats, and emerging and Poverty (2021)
re-emerging infections. Incidence of
Families - 13.2%
Population - 18.1%
HEALTH POLICIES AND SYSTEMS
The Government’s vision for the Philippines has been Trade (September 2022)
translated by the Department of Health into the FOB Value (in billions)
Philippine Health Agenda 2016-2022. Exports - $7.16
Universal Health Coverage - Under the motto All for Imports $11.98
Health Towards Health for All, is the platform for Balance of Trade - $-4.82
health and development in the Philippines—driven
by action within and outside the health sector. National Accounts - Growth Rate (3rd quarter in 2022)
Reducing health inequities is singled out as the GDP - 7.6%
most important result of 3 health guarantees: GNI - 10.5%
ensuring financial protection for the poorest
people Income & Expenditures (January - December 2021)
improving health outcomes with no disparities Average family Income - ₱307, 190
building health service delivery networks for
more responsiveness Prices (November 2022)
Inflation Rate - 8.0%
COOPERATION FOR HEALTH Labor (October 2022)

Employment Rate - 95.5%
The global vision of the world in 2030, spelled out in
the Sustainable Development Goals, aligns with the
Philippines’ 25-year vision AmBisyon Natin 2040.
There is an ongoing process of integrating SDGs
into AmBisyon Natin 2040 and into national,
sectoral and subnational plans and frameworks.
2nd Semester
2020 CENSUS OF POPULATION AND HOUSING HEALTH

(2020 CPH) POPULATION COUNTS
DECLARED OFFICIAL BY THE PRESIDENT About 7% of Filipino Family Members Got Ill/Sick or Injured
in June 2020 (Results from the 2020 Annual Poverty
Reference Number: 2021-251 Indicators Survey (APIS))
Release Date: Wednesday, July 7, 2021
Health Status of Family Members
The Philippine Statistics Authority (PSA) announced today Based on the 2020 Annual Poverty Indicators Survey
that based on the 2020 Census of Population and (APIS), 7.0% of the total family members reported that
Housing (2020 CPH), the total population of the they got ill/sick or injured in the past month preceding
Philippines as of 01 May 2020 is at 109,035,343. This count is the survey; that is, from 01 to 30 June 2020. Of those
declared official for all purposes by the President of the family members who got ill/sick or injured, 5.3 percentage
Philippines, pursuant to Proclamation No. 1179 dated 06 points had it once; 1.0 percentage point, twice; and less
July 2021. than one percentage point, thrice (0.2%) or more than
The Philippine population represents the total number of thrice (0.5%).
persons living as of 12:01 AM on 01 May 2020 in the 17
administrative regions of the country. It also includes Annual Poverty indicators Survey (APIS)
Filipinos in Philippine embassies, consulates, and a nationwide survey conducted by the Philippine
missions abroad. Statistics Authority (PSA) that is designed to provide non-
The Philippine population increased by 8,053,906 from income indicators related to poverty at the national level
100,981,437 in 2015, which translates to an annual also gathered data on the socio-economic profile of
population growth rate (PGR) of 1.63%. By comparison, the families and other information related to their living
rate at which the country’s population grew during the condition
period 2010 to 2015 was higher at 1.72%. ln the 2020 APIS, around 44,000 sample households were
In light of the COVID-19 pandemic, the PSA has proudly covered nationwide.
overcome unprecedented challenges to collect and
produce high-quality data that are critical in decision- Health and Nutrition Status
making for good governance, development planning, risk The 2020 APIS included questions related to health status
reduction and crisis response, social welfare programs, which is essential for health planners in the formulation
and business market analyses, among others. of plans and programs to improve public health service
deliveries. This report presents the health status of family
members and whether the illness/sickness or injury have
VITAL STATISTICS: BIRTH, MARRIAGE been the reason for their absence from work or school or
AND DEATH STATISTICS FOR 2022 not being able to perform daily activities one month
(PRELIMINARY, AS OF 31 AUGUST 2022)
preceding the survey.
Release Date: Wednesday, October 26, 2022 This report relates to the unhealthy condition a family
member experienced during the past month.
Monthly Release of Vital Statistics Illness ← feeling of certain unhealthy condition on a
The data on the number of births, marriages, and deaths person’s body or mind due to disease or fatigue
(vital events) presented in this regular monthly release Injured ← sustained bodily damages, hurts, or loss of a
were obtained from the vital events registered, either person
timely or belatedly, at the appropriate Office of the Information on Operation “Timbang” were also collected
City/Municipal Civil Registrar throughout the country and to provide data on the improvement of policy
subsequently submitted for encoding to the Office of the instruments of the Philippine Plan of Action for Nutrition
Civil Registrar General through the Provincial Statistical (PPAN). This report also presents the number of family
Offices (PSOs) of the Philippine Statistics Authority (PSA). members aged 0 to 5 years old who were weighed during
The information presented includes provisional vital the past 12 months preceding the survey and the number
events that occurred from January to July 2022 based on of times they were weighed.
data files received by the PSA - Civil Registration Service Measurement of weight among children included in this
(CRS) from the PSOs and has undergone initial processing report are those done in government facilities like health
as of 31 August 2022. Thus, the figures presented herein centers, rural health units, day care centers, schools,
are still preliminary and may differ from the final count. (1) house-to-house weighing, in private clinics, or hospitals
The vital events of Filipinos abroad are not yet included Government health facilities, measurement was taken by
in this release, but Filipinos whose usual residence is barangay health workers
abroad and foreign nationals with vital events occurring barangay nutrition scholars
in the country during the reference period were included nurses and doctors in the barangay
in this report. Private institutions, measurement was taken by
nurses
doctors
other health workers
Weight measurement of children who were done by their
parents/caregiver using their own weighing scale or tape
measure were not included in this report.
2nd Semester
GENDER: WORKING CHILDREN LATEST RELEASES

AND CHILD LABOR SITUATION
Adolescent Pregnancy in the Philippines: 2016-2020
Reference Number: 2021-484 About 1 out of 10 babies are born to adolescent mothers
Release Date: Wednesday, December 15, 2021 The number of registered live births to adolescent
mothers or those aged 10-19 years showed a decreasing
Proportion of working children 5-17 years old was trend in the past five years. A decline of -22.7% in
estimated at 2.8% adolescent births was observed from 2016 to 2020 with
The total population of children 5-17 years old was 203,085 and 157,060 births, respectively. These births
estimated at 31.17 million in 2020. consistently made up about one-tenth of all live births in
This was higher than the total number of Filipino the country.
children 5 to 17 years of age registered in 2019 at 30.50 Most births to adolescent mothers are fathered by men
million. older by 3-5 years
Of the estimated 31.17 million children 5-17 years old in From 2016 to 2020, majority of registered adolescent live
2020, 872 thousand or 2.8% were working. This was lower births were fathered by men 3-5 years older than the
than the proportion of working children 5-17 years old in mother. These births accounted for more than 1/4 of the
2019 estimated at 3.4%. total births to adolescent mothers each year.
The population of children aged 5 to 17 years old in 2020 Furthermore, fathers who are more than 10 years older
was estimated at 31.17 million. This was higher than the than the adolescent mothers are responsible for about 6-
total number of Filipino children 5 to 17 years of age in 7% of births, every year, from 2016 to 2020. However,
2019 at 30.50 million. almost 1 in 5 adolescent births do not have information
Working children in 2020 were estimated at 2.8 percent of on the age of the father
the 31.17 million children 5 to 17 years old. This was lower F4 in 5adolescent births are first-order births
than the registered working children in 2019 at 3.4 Majority of births to mothers 10-19 years old, in the period
percent. 2016 to 2020, were first-order births accounting for more
In terms of the distribution of working children by broad than 80.0% of the total adolescent births in the country
industry group, agriculture sector remained dominant in each year. On the other hand, between 15.0-17.0% of the
2020, followed by services sector, while industry sector births are second-born to mothers 10-19 years old, while
remained the lowest contributor to the total working the remaining 1-2% were third or higher-order births.
children.
Of the 872,000 working children in 2020, 597,000 or 68.45 Birth, Marriage and Death Statistics for 2022
were child laborers. Of these estimated child laborers, (Preliminary, as of 30 September 2022)
73.3% were in age group 15-17 years. Moreover, 63.6% of The data on the number of births, marriages, and deaths
the 597,000 child laborers were found in the agriculture (vital events) presented in this regular monthly release
sector. were obtained from the vital events registered, either
timely or belatedly, at the appropriate Office of the
City/Municipal Civil Registrar throughout the country and
POVERTY: PROPORTION OF POOR FILIPINOS subsequently submitted for encoding to the Office of the
WAS RECORDED AT 18.1% IN 2021 Civil Registrar General through the Provincial Statistical
Offices (PSOs) of the Philippine Statistics Authority (PSA).
Reference No.: 2022-350 The information presented includes provisional vital
Release Date: 15 August 2022 events that occurred from January to August 2022 based
on data files received by the PSA - Civil Registration
Based on the Preliminary Results of the Family Income Service (CRS) from the PSOs and has undergone initial
and Expenditure Survey (FIES) in 2021, poverty incidence processing as of 30 September 2022. Thus, the figures
among population, defined as the proportion of Filipinos presented herein are still preliminary and may differ from
whose per capita income cannot sufficiently meet the the final count. (1) The vital events of Filipinos abroad are
individual basic food and non-food needs, was recorded not yet included in this release, but Filipinos whose usual
at 18.1%. This translates to around 19.99 million Filipinos residence is abroad and foreign nationals with vital
who lived below the poverty threshold of about ₱12,030 events occurring in the country during the reference
per month for a family of 5. period were included in this report.
The subsistence incidence, defined as the proportion of
Filipinos whose income is not enough to meet even just Causes of Deaths in the Philippines for 2022
the basic food needs, slightly increased to 5.9%in 2021. It (Preliminary as of 30 September 2022)
was estimated that a family of five needs at least ₱8,379 Figures in this release, specifically for deaths due to
per month to meet their basic food requirements Coronavirus disease 2019 (COVID-19), may differ from the
Among families, around 3.50 million families or 13.2% were one released by the Department of Health (DOH)
considered poor in 2021. On the other hand, the because the figures in this release were obtained from
subsistence incidence among families was observed at the certificates of death particularly the descriptions
3.9%, which is equivalent to 1.04 million poor families written on the medical certificate portion therein as
below the food poverty line. reviewed by the health officer of the local government
unit concerned. On the other hand, the figures released
by the DOH were obtained through a surveillance system.
2nd Semester
MEASURING MATERNAL AND CHILD HEALTH

Furthermore, figures in this release for deaths due to
COVID-19 refer to both confirmed and probable cases as Measuring maternal and child health is not as simple as
of registration. The coding of causes of death is based defining a client as ill or well. Individual clients and health
on the World Health Organization’s (WHO) International care practitioners may have different perspectives on
Statistical Classification of Diseases and Related Health illness and wellness.
Problems revision 10 (ICD-10). With the emergence of For example, some children with chronic but controllable
COVID-19, the WHO issued two new emergency codes asthma think of themselves as well; others with the same
(Code U07.1 and Code U07.2) to be used when coding degree of involvement consider themselves ill.
causes of death for statistical purposes. Although pregnancy is generally considered a well state,
Code U07.1 or COVID-19-virus identified is used when some women think of themselves as ill during this period.
COVID-19 is confirmed by a laboratory test. Code U07.2 or A more objective view of health is provided by national
COVID-19-virus not identified is used for suspected or health statistics.
probable cases as well as clinically-epidemiologically
diagnosed COVID-19 cases where testing was not Birth Rate ← number of births per 1,000 population
completed or inconclusive.1 Thus, the figures in this Sixteen births per thousand population
release for deaths due to COVID-19 include both Code Crude Birth Rate (CBR)
U07.1 and Code U07.2 while the figures released by the In 2019, a total of 1,673,923 live births were registered,
DOH, on the other hand, include deaths from confirmed which is equivalent to a crude birth rate (CBR) of 15.6 or 16
cases only or Code U07.1. births per thousand population.
Ischemic heart diseases, cerebrovascular diseases, and On the average, about 4,586 babies were born daily. This
neoplasms lead the causes of death in the Philippines is equivalent to about 191 babies born per hour or
The top 3 causes of death in the country from January to approximately three (3) babies born per minute.
August of 2022 were ischemic heart diseases, The number of registered live births showed a generally
cerebrovascular diseases, and neoplasms. decreasing trend, noticeably from 2013 to 2018. A
also the leading causes of death in the same period decrease of 6.5% in the registered live births was noted in
in 2021. the past 7 years, from 1,790,367 in 2012 to 1,673,923 in 2019.
From January to August of 2022, ischemic heart diseases More males born than females
were the leading cause of death with 67,601 cases or 18.4 In 2019, more males (871,750 or 52.1%) were born than
percent of the total deaths in the country. On the other females (802,173 or 47.9%), resulting in a sex ratio at
hand, cerebrovascular diseases came in second with birth of 109 males per 100 females.
37,936 deaths (10.3% share).
Neoplasms, commonly known as “cancer”, were the 3rd Fertility Rate ← reflects what proportion of women who
leading causes which accounted for 37,470 recorded could have babies are having them
cases (10.2% share) from January to August 2022. Deaths fertility rate is currently at 64.8%, a healthy reproductive
due to diabetes mellitus recorded 23,602 cases or 6.4 rate for a country (NCHS, 2005)
percent share, making it the fourth leading cause of
death, while deaths due to hypertensive diseases, which Fetal Death Rate ← death in utero of a child (fetus) weighing
ranked fifth recorded 21,160 cases or 5.8 percent share. 500g or more, roughly the weight of a fetus of 20 weeks or
COVID-19 ranks among the leading causes of death more gestation
Registered deaths due to COVID-19 accounted for a Fetal deaths may occur because of maternal factors
total of 12,772 deaths or 3.5 percent of the total (e.g., maternal disease, premature cervical dilation,
registered deaths from January to August 2022. By maternal malnutrition) or fetal factors (e.g., fetal disease,
classification, COVID-19 with virus identified and chromosome abnormality, poor placental attachment).
COVID-19 virus not identified were both included in the Many fetal deaths occur for reasons unknown.
20 leading causes of death. COVID-19 with virus The fetal death rate is important in evaluating the health
identified was the 11th leading cause of death in the of a nation because it reflects the overall quality of
country with 8,963 cases or 2.4 percent of the total maternal health and prenatal care. The emphasis on
deaths. both preconceptual and prenatal care has helped to
Meanwhile, registered deaths due to COVID-19 with virus reduce this rate from a number as high as 18% in 1950 to
not identified accounted for 3,809 or 1.0 percent of the 6.4% at present (NCHS, 2005).
total deaths, making it the 19th leading cause of death.
3 regions report more than a thousand COVID-19 deaths Neonatal Death Rate
Among the 17 regions, National Capital Region (NCR) The first 28 days of life are known as the neonatal period,
registered the highest number of deaths due to and an infant during this time is known as a neonate.
COVID-19 with 3,176 or 24.9 percent of the total COVID- The neonatal death rate reflects not only the quality of
19 deaths from January to August 2022. Region IV-A care available to women during pregnancy and
(CALABARZON) ranked second with 2,017 deaths childbirth but also the quality of care available to infants
(15.8%), while Central Luzon came in third with 1,690 during the first month of life.
deaths (13.2%). On the other hand, BARMM reported The leading causes of infant mortality during the first 4
the least number of registered COVID-19 deaths with weeks of life are prematurity (early gestational age), low
only 35 cases. birthweight (less than 2,500g), and congenital anomalies.
Number of Registered Deaths Due to COVID-19 by Region Approximately 80% of infants who die within 48 hours
of Usual Residence, Philippines: January to August 2022 after birth weigh less than 2,500g (5.5 lbs.)
(as of 30 September 2022)
2nd Semester
The proportion of infants born with low birthweight is A particularly disturbing mortality statistic is the high
about 7% of all births. incidence of suicide in the 15-to-24-year-old age group
This number rises slightly each year as better prenatal more girls than boys attempt suicide
care allows infants who would have died in utero boys are more successful
(fetal death) to be born and survive (Martin et al., Although school-age children and adolescents may not
2005). voice feelings of depression or anger during a health
care visit, such underlying feelings may actually be a
Perinatal Death Rate ← sum of the fetal and neonatal rates primary concern.
The perinatal period is defined in a number of ways. Nurses who are alert to cues of depression or anger can
Statistically, the period is defined as the time beginning be helpful in detecting these emotions and lowering the
when the fetus reaches 500g (about week 20 of risk of suicide. The high incidence of homicide (1.5% in
pregnancy) and ending about 4 to 6 weeks after birth. school-age children and 20% in adolescents) and an
increase in the number of adolescents infected with
Maternal Mortality Rate ← number of maternal deaths that human immunodeficiency virus (HIV) are also growing
occur as a direct result of the reproductive process per concerns.
100,00 live births
Early in the 20th century, this rate in the United States Childhood Morbidity Rate
reached levels as high as 600 per 100,000 live births. It is Health problems commonly occurring in large
still that high in developing countries. proportions of children today include respiratory
In the United States at present, the maternal mortality disorders (including asthma and tuberculosis),
rate has declined to a low of 6.5 per 100,000 live births gastrointestinal disturbances, and consequences of
(NCHS, 2005). injuries. As more immunizations become available, fewer
This dramatic decrease can be attributed to improved children in the United States are affected by common
preconceptual, prenatal, labor and birth, and childhood communicable diseases. For instance, the
postpartum care, such as the following: incidence of poliomyelitis (once a major killer of children)
Greater detection of disorders such as ectopic is now extremely low (almost zero), because almost all
pregnancy or placenta previa and prevention of children in the United States are immunized against it
related complications through the use of ultrasound (NCHS, 2005).
Increased control of complications associated with Measles flared in incidence in the early 1990s but now is
hypertension of pregnancy scheduled as a disease to be completely eradicated by
Decreased use of anesthesia with childbirth 2010. It is important that this happen, because measles
For most of the 20th century, uterine hemorrhage and encephalitis can be as destructive and lethal as
infection were the leading causes of death during poliomyelitis. Continued education about the benefits of
pregnancy and childbirth. This has changed because of immunization against rubella (German measles) is also
the increased ability to prevent or control hemorrhage needed, because if a woman contracts this form of
and infection, and now hypertensive disorders are the measles during pregnancy, her infant may be born with
leading causes of death in childbirth. Pregnancy-induced severe congenital anomalies.
hypertension adds to preexisting hypertensive disorders, Although the decline in the overall incidence of
especially in older women. Nurses who are alert to the preventable childhood diseases is encouraging, as many
signs and symptoms of hypertension are invaluable as 50% of children younger than 4 years of age in some
guardians of the health of pregnant and postpartum communities are still not fully immunized (NCHS, 2005).
women. There is a potential for childhood infectious diseases to
increase again if immunization is not maintained as a
Infant Mortality Rate ← index of its general health, because high national priority.
it measures the quality of pregnancy care, nutrition, and
sanitation as well as infant health
This rate is the traditional standard used to compare the STATISTICAL TERMS USED TO REPORT MCN
state of national health care with that of previous years
or of other countries. Birth rate ← number of births per 1,000 population
Fertility rate ← number of pregnancies per 1,000 women
Childhood Mortality Rate of childbearing age
Like the infant mortality rate, the childhood mortality rate Fetal death rate ← number of fetal deaths (over 500g) per
in the United States is also declining. 1,000 live births.
In 1980, the mortality rate was about 6.4% for children Neonatal death rate ← number of deaths per 1,000 live
aged 1 to 4 years and 3.1% for children aged 4 to 14 births occurring at birth or in the first 28 days of life
years Perinatal death rate ← number of deaths of fetuses more
today, it is 3.0% and 1.8%, respectively (NCHS, 2005). than 500 g and in the first 28 days of life per 1,000 live
The risk of death in the first year of life is higher than that births
in any other year before age 55. Maternal mortality rate ← number of maternal deaths
Children in the prepubescent period (age 5 to 14 years) per 100,000 live births that occur as a direct result of the
have the lowest mortality rate of any child age group reproductive process
(NCHS, 2005). Infant mortality rate ← number of deaths per 1,000 live
births occurring at birth or in the first 12 months of life
Childhood mortality rate ← number of deaths per 1,000
population in children, 1 to 14 years of age
2nd Semester
TRENDS IN THE MATERNAL C. GENETICS AND GENETIC COUNSELING

AND CHILD HEALTH NURSING POPULATION
KEY TERMS
The maternal and child population is constantly
changing because of changes in social structure,
Alleles
variations in family lifestyle, and changing patterns of
pairs of genes
illness. There are several social changes that have
There are 2 genes for every human trait:
occurred over the past 20 to 30 years that have altered
from the ovum and the sperm
health care priorities for maternal and child health
nurses.
Chromosomes
Today, client advocacy, a philosophy of cost
located in the nucleus of the cell
containment, an increased focus on health education,
carry the hereditary material that determines the
and new nursing roles are ways in which nurses have
individual’s physical characteristics
adapted to these changes.
threadlike strands of DNA
deoxyribonucleic acid - the genetic information that
every parent passes on to their biological children
TRENDS IMPLICATIONS FOR NURSING
Cytogenetics
Families are smaller than in Fewer family members are
study of inheritance in relation to the structure and
previous decades present as support in a time of
function of chromosomes
crisis. Nurses must fulfill the
role more than ever before.
Dermatoglyphics
study of skin markings or patterns on fingers, hands, and
Single parents are increasing A single parent may have feet, and its application, especially in criminology
in number. fewer financial resources; this
is more likely if the parent is a Genes
woman. Nurses need to inform small segments of DNA contained in the chromosomes
parents of care options and to dominant, recessive, sex-linked
provide a backup opinion
when needed. Genetics
branch of biology
An increasing number of Health care must be study of genes, genetic variation, and heredity in
women work outside the scheduled at times a working organisms
home. parent can bring a child for deals with the heredity and variation of organisms
care. Problems of latch-key The genetic makeup and phenomena of an organism,
children and the selection of type, group, or condition.
child care centers need to be
discussed. Genome
complete set of genetic information in an organism
Families are more mobile than Good interviewing is provides all of the information the organism requires to
previously: There is an necessary with mobile families function
increase in the number of so a health database can be In living organisms, the genome is stored in long
homeless mother and children. established; education for molecules of DNA called chromosomes.
health monitoring is an organism's complete set of genetic instructions
important. Each genome contains all of the information needed to
build that organism and allow it to grow and develop
Abuse is more common than Screening for child and
ever before. intimate partner abuse should Genotype
be included in family contacts. refers to the genetic makeup of an organism
Be aware of the legal an organism's complete set of genes
responsibilities for reporting Humans are diploid organisms, which means that they
abuse. have 2 alleles at each genetic position, or locus, with one
allele inherited from each parent.
Families are more health- Families are ripe for health
conscious than previously. education: providing this can
Heterozygous
be a major nursing role
state of having inherited different forms of a particular
gene from each one of your biological parents
Health care must respect cost Comprehensive care is Now, by different forms we generally mean that there are
containment. necessary in primary care different portions of the gene where the sequence is
settings because referral to different.
specialists may no longer be
an option. Homozygous
a genetic condition where an individual inherits the same
alleles for a particular gene from both parents
2nd Semester
Imprinting Other genetic disorders do not affect life in utero, so the

an epigenetic phenomenon that causes genes to be result of the disorder becomes apparent only at the time
expressed in a parent-of-origin-specific manner of fetal testing or after birth. In the near future, it may be
These epigenetic marks are established ("imprinted") possible not only to identify aberrant genes for disorders
in the germline (sperm or egg cells) of the parents and but also to insert healthy genes in their place using stem
are maintained through mitotic cell divisions in the cells. Gene replacement therapy is encouraging in the
somatic cells of an organism. treatment of blood, spinal cord, and immunodeficiency
syndromes (Jones et al., 2003).
Isochromosome
an unbalanced structural abnormality in which the arms
of the chromosome are mirror images of each other GENERAL PRINCIPLES INFLUENCING
Consequently, there is partial trisomy of the genes FETAL GROWTH AND DEVELOPMENT
present in the isochromosome and partial monosomy of
A. Chromosomal Structure
the genes in the lost arm.
Chromosomes in the nucleus of the cell, carry the
Karyotype hereditary material that determines the individual’s
an individual's collection of chromosomes physical characteristics. They are threadlike strands of
a laboratory technique that produces an image of an DNA.
individual's chromosomes Genes are small segments of DNA contained in the
chromosomes
Phenotype dominant
an individual's observable traits, such as height, eye recessive
color, and blood type sex linked
The genetic contribution to the phenotype is called the Alleles are pairs of genes
genotype. 1 from ovum
1 from sperm
Meiosis Phenotype is an individual’s physical appearance
a type of cell division that reduces the number of determined by the alleles.
chromosomes in the parent cell by half and produces Genotype refers to the individual’s actual gene
four gamete cells composition.
This process is required to produce egg and sperm cells Normal embryonic cell tissue contains 46 chromosomes
for sexual reproduction. (23 pairs):
44 homologous (22 pairs)
Mosaicism 2 sex (1 pair) chromosomes
a condition in which cells within the same person have a Each chromosome contains 22 autosomes and one sex
different genetic makeup chromosome (Y) from the male and 22 autosomes and
This condition can affect any type of cell, including: one sex chromosome (X) from the female.
Blood cells, Egg and sperm cells Fetal cells and organs develop from chromosomes.
Human life begins as a single cell, a zygote, that
Nondisjunction reproduces itself (as each new cell).
failure of homologous chromosomes or sister chromatids The sex of the fetus is determined at the time of
to separate subsequent to metaphase in meiosis or fertilization by the combination of the sex chromosomes
mitosis so that one daughter cell has both and the other of the sperm (X or Y) and the ovum (X or X). The resulting
neither of the chromosomes pair of sex chromosomes is either XX (female) or XY (male)
B. Nature of Inheritance/Inheritance Patterns

GENETIC ASSESSMENT AND COUNSELING The science of genetic disorders seeks to explain the
Genetic Disorders underlying causes of disorders present at birth. It also
Inherited or genetic disorders are disorders that can be explores the patterns in which inherited disorders pass
passed from one generation to the next from one generation to the next.
They result from some disorder in gene or chromosome A person who has 2 genes for a trait is homozygous for
structure. that trait.
Genetics is the study of the ways such disorders occur. A person who has 2 genes that differ (one dominant, one
can occur at the moment an ovum and sperm fuse or is recessive) is heterozygous for that trait.
even earlier, in the meiotic division phase of the gametes Dominant gene ← expressed for any trait
(ovum and sperm) Recessive gene ← expressed only if both genes in the
Some genetic abnormalities are so severe that normal allele carry them
fetal growth cannot continue. This results in early Mendelian laws ← allow us to predict inheritance of
spontaneous abortion. characteristics such as eye and hair color
Genetic disorders are so common that as many as 50% of can also predict whether the child will be born with a
first-trimester spontaneous miscarriages may be the genetic disorder
result of chromosomal abnormalities
2nd Semester
Neurofibromatosis
PRINCIPLE OF MENDELIAN INHERITANCE
genetic disorder that causes tumors to form on nerve
Law of Segregation tissue
2 alleles for each gene are placed in different These tumors can develop anywhere in your nervous
gametes system, including your brain, spinal cord and nerves
usually diagnosed in childhood or early adulthood
Law of Independent Assortment
inheritance of 1 gene does not affect the inheritance Polycystic kidney disease (PKD)
of any other gene an inherited disorder in which clusters of cysts develop
primarily within your kidneys, causing your kidneys to
Law of Dominance enlarge and lose function over time.
when 2 different alleles are present, only one is Cysts are noncancerous round sacs containing fluid. The
dominant and will be expressed cysts vary in size, and they can grow very large
Achondroplasia
C. Chromosomal Inheritance Disorder a form of short-limbed dwarfism
The word achondroplasia literally means "without
Modes of Inheritance
cartilage formation."
Autosomal dominant
Cartilage ← tough but flexible tissue that makes up much
Autosomal recessive
of the skeleton during early development
X-Linked Dominant
X-Linked Recessive
Multifactorial
AUTOSOMAL RECESSIVE DISORDER
The clinical expression of a gene when both alleles at a
AUTOSOMAL DOMINANT DISORDER
given chromosome locus are mutant (homozygous).
The clinical expression of a gene when one allele at a To have an autosomal recessive disorder, you inherit two
given chromosome locus is mutant (heterozygous). mutated genes, one from each parent.
More than half of Mendelian phenotypes are autosomal These disorders are usually passed on by 2 carriers.
dominant Their health is rarely affected, but they have one
either a person has 2 unhealthy genes (homozygous mutated gene (recessive gene) and one normal gene
dominant) or is heterozygous, with the gene causing the (dominant gene) for the condition.
disease stronger or more dominant than the
corresponding healthy recessive gene for the same trait. Thalassemia
Most of those that do occur cause structural disorders Both types of thalassemia are inherited in the same
Locus ← a unique chromosomal location defining the manner
position of an individual gene or DNA sequence The disease is passed to children by parents who carry
To have an autosomal recessive disorder, you inherit two the mutated thalassemia gene.
mutated genes, one from each parent. These disorders A child who inherits 1 mutated gene is a carrier, which is
are usually passed on by two carriers. Their health is sometimes called "thalassemia trait."
rarely affected, but they have one mutated gene Most carriers lead completely normal, healthy lives.
(recessive gene) and one normal gene (dominant gene) Hemoglobin ← protein affected in thalassemia
for the condition. made of heme, alpha globins, and beta globins.
At least 9 different genes direct the production of
Familial Hypercholesterolemia heme.
a disorder that is passed down through families Changes in these genes may lead to disorders of
causes LDL (bad) cholesterol level to be very high heme production, a group of conditions separate
The condition begins at birth and can cause heart from the thalassemia.
attacks at an early age Alpha thalassemia ← occurs when a mutation in the gene
that codes for alpha globin results in reduced or absent
Myotonic dystrophy production of alpha globins.
a type of muscular dystrophy (a group of long-term Beta thalassemia ← occurs with a corresponding change
genetic disorders that impair muscle function) in the beta globin gene.
Symptoms include gradually worsening muscle loss and Thalassemia is a result of quantitative mutations in the
weakness. Muscles often contract and are unable to globin genes.
relax.
Cystic Fibrosis
Huntington's disease (HD) an example of a recessive disease with lung and
fatal genetic disorder that causes the progressive pancreatic involvement
breakdown of nerve cells in the brain a person must have a mutation in both copies of the
deteriorates a person's physical and mental abilities CFTR gene to have CF.
usually during their prime working years and has no cure If someone has a mutation in only one copy of the
CFTR gene and the other copy is normal, he or she
does not have CF and is a CF carrier.
2nd Semester
caused by mutations in the gene that produces the 2 abnormal genes - may develop hemochromatosis; can
cystic fibrosis transmembrane conductance regulator also pass the mutation on to your children
(CFTR) protein But not everyone who inherits 2 genes develops
This protein is responsible for regulating the flow of problems linked to the iron overload of
salt and fluids in and out of the cells in different parts hemochromatosis.
of the body. 1 abnormal gene - unlikely to develop hemochromatosis;
however, you are considered a gene mutation carrier
Galactosemia and can pass the mutation on to your children
an autosomal recessive genetic disorder causing But your children wouldn't develop the disease unless
difficulty in regulating sugar found in milk they also inherited another abnormal gene from the
Accumulation of galactose-1-phosphate is thought to other parent.
cause the other signs and symptoms of disease.
an inherited disorder (passed down through families) Congenital Adrenal Hyperplasia (CAH)
both parents carry a nonworking copy of the gene an inherited condition caused by mutations in genes that
that can cause galactosemia, each of their children code for enzymes involved in making steroid hormones in
has a 25% (1 in 4) chance of being affected with it the adrenal glands
Lactose intolerance ← inability to break down the milk The most common enzyme defect, 21-hydroxylase
sugar lactose deficiency, leads to excess amounts of male hormones
Galactosemia ← inability to metabolize the milk sugar being produced by the adrenal glands.
component galactose More than 1,500 autosomal recessive disorders have
Arginine supplementation does not appear helpful in been identified.
patients win galactosemia In contrast to structural disorders, these tend to be
biochemical or enzymatic. Such diseases do not occur
Sickle cell disease unless two genes for the disease are present (i.e. a
A person with sickle cell disease makes a different kind of homozygous recessive pattern).
hemoglobin called “sickle” hemoglobin. Many inborn errors of metabolism are recessively
Instead of being round and smooth, cells with sickle inherited in this way.
hemoglobin become hard and sticky and look like a Examples
banana or a sickle. cystic fibrosis
These cells have trouble moving through small blood adrenogenital syndrome
vessels. Sometimes they clog up these blood vessels. albinism
This prevents the blood from bringing oxygen to the Tay-Sachs disease
tissues. It can cause pain or damage to the areas that galactosemia
are not getting oxygen. phenylketonuria
limb-girdle muscular dystrophy
Hurler’s Syndrome Rh-factor incompatibility
also known as mucopolysaccharidosis Type IH (MPS-IH), When family genograms are assessed for the incidence
Hurler's disease, and formerly gargoylism, of inherited disease, situations commonly discovered
a genetic disorder that results in the buildup of large when a recessively inherited disease is present in the
sugar molecules called glycosaminoglycans (GAGs, or family include the following:
mucopolysaccharides) in lysosomes. Both parents of a child with the disorder are clinically
Differential diagnosis: Hurler-Scheie syndrome; free of the disorder.
Causes: Deficiency of the alpha-L iduronidase The sex of the affected individual is unimportant in
Frequency: 1 in 100,0000 terms of inheritance
Symptoms The family history for the disorder is negative- that is,
clouding of the front part of the eye (corneal no one can identify anyone else who had it (horizontal
clouding) transmissions pattern).
frequent upper respiratory infections. A known common ancestor between the parents
enlarged tonsils and/or adenoids. sometimes exists. This explains how both male and
distinct facial features (coarse facial features) female came to possess a like gene for the disorder.
hernias
Hemochromatosis
gene called HFE is most often the cause of hereditary
hemochromatosis
You inherit one HFE gene from each of your parents.
The HFE gene has 2 common mutations
C282Y
H63D
Genetic testing can reveal whether you have these
mutations in your HFE gene.
HFE gene homeostatic iron regulator
2nd Semester
X-LINKED DOMINANT INHERITANCE/DISORDER X-LINKED RECESSIVE INHERITANCE/DISORDER

Some genes for disorders are located on, and therefore a mode of inheritance in which a mutation in a gene on
transmitted only by the female sex chromosome (x the X chromosome causes the phenotype to be always
chromosome). expressed in males (who are necessarily homozygous for
There are about 300 known x-linked disorders the gene mutation because they have one X and one Y
transmission is called x-linked inheritance chromosome) and in females who are homozygous for
If the gene is dominant, only one x chromosome with the the gene mutation, (see zygosity).
trait need be present for symptoms of the disorder to be Females with 1copy of the mutated gene are carriers.
manifested. the gene causing the trait or the disorder is located on
Family characteristics seen with this type of inheritance the X chromosome
include the following: Females have 2 X chromosomes while males have 1 X and
All individuals with the gene are affected. one Y chromosome.
All female children of affected men are affected; all Carrier females who have only 1 copy of the mutation do
male children of affected men are unaffected. not usually express the phenotype, although differences
It appears in every generation in X-chromosome inactivation (known as skewed X-
All children of homozygous affected women are inactivation) can lead to varying degrees of clinical
affected. Fifty percent of the children of heterozygous expression in carrier females, since some cells will
affected women are affected. express one X allele and some will express the other. The
The terms dominant and recessive in x-linked traits refer current estimate of sequenced X-linked genes is 499, and
only to women. Men, having only 1 x chromosome and the total, including vaguely defined traits, is 983.
one y chromosome , will always be affected if they inherit When family genograms are assessed for inherited
an x-linked mutant gene. disorders, the following findings usually are apparent if
x-linked dominant disorders are rare but appear in an x-linked recessive inheritance disorder is present in
every generation of an affected family the family:
Women, having 2 x chromosomes, will be affected if Only males in the family will have the disorder.
heterozygous or homozygous for an x-linked A history of girls dying at birth for unknown reasons
dominant trait. often exists (females who had the affected gene on
both x chromosomes).
Fragile X Syndrome (FXS) Sons of an affected man are unaffected.
a genetic disorder characterized by mild-to-moderate The parents of affected children do not have the
intellectual disability disorder.
The average IQ in males is under 55, while about 2/3 of Women will be asymptomatic for a trait if
affected females are intellectually disabled (half are of heterozygous for an x-linked recessive trait.
normal intelligence, only 1/4 have an IQ under 70) and few Women will be affected if homozygous for an x-linked
have autistic symptoms although they tend to be shy recessive disorder.
and quiet
a cognitively challenged syndrome Hemophilia A
Physical features - long and narrow face, large ears, an inherited bleeding disorder in which the blood does
flexible fingers, and large testicles not clot normally
Other names - FXS, FRAXA Syndrome, Fra(x) Syndrome, People with hemophilia A will bleed more than normal
Marker X Syndrome, Martin-Bell Syndrome, X-linked after an injury, surgery, or dental procedure. This disorder
Mental Retardation, Macroorchidism can be severe, moderate, or mild.
Martin-Bell - first person
Hemophilia B
Vitamin D-resistant rickets also known as factor IX deficiency or Christmas disease
a disorder in which the bones become painfully soft and a blood-factor deficiency
bend easily due to low levels of phosphate in the blood. the second most common type of hemophilia
Symptoms usually begin in early childhood and can The disorder was first reported in the medical literature in
range in severity. 1952 in a patient with the name of Stephen Christmas.
Hypophosphatemic rickets (previously called vitamin D- The most famous family with hemophilia B was that of
resistant rickets) Queen Victoria of England.
Alport’s Syndrome Color Blindness

a progressive kidney failure disorder occurs when you are unable to see colors in a normal
In 80% of cases, it is inherited in an X-linked manner and way
is caused by mutations in the COL4A5 gene. also known as color deficiency
In the remaining cases, it may be inherited in either an often happens when someone cannot distinguish
autosomal recessive, or rarely in an autosomal dominant between certain colors; usually happens between greens
manner. and reds, and occasionally blues
a genetic condition caused by a difference in how one or
more of the light-sensitive cells found in the retina of the
eye respond to certain colors
Cones ← sense wavelengths of light, and enable the
retina to distinguish between colors
2nd Semester
Duchenne Muscular Dystrophy (DMD) Clubfoot

a severe type of muscular dystrophy that primarily a condition in which a newborn's foot or feet appear to
affects boys be rotated internally at the ankle
Muscle weakness usually begins around the age of four, The foot points down and inwards, and the soles of the
and worsens quickly. feet face each other.
Muscle loss typically occurs first in the thighs and pelvis known as talipes equinovarus (TEV) or congenital talipes
followed by the arms. This can result in trouble standing equinovarus (CTEV)
up. In 50% of cases, both feet are affected
Symptoms: Muscle weakness, trouble standing
Frequency: 1 in 5,000 males at birth; much rarer Neural tube defects
Causes: Genetic (X-linked recessive) birth defects of the brain, spine, or spinal cord
Diagnostic method: Genetic testing They happen in the first month of pregnancy, often
before a woman even knows that she is pregnant.
2 most common neural tube defects
Y-LINKED INHERITANCE spina bifida ← fetal spinal column doesn't close
completely
Although genes responsible for features such as height anencephaly ← baby is born without parts of the brain
and tooth size are found on the Y chromosome, no known and skull
disease genes are inherited by Y-chromosome
transmission Pyloric Stenosis
Y chromosome causes a fetus to become male. Any gene narrowing of the opening from the stomach to the first
on the Y chromosome will only be passed on to male part of the small intestine (pylorus)
children Other names: Pylorostenosis, infantile hypertrophic
Exception: CAIS, an XY individual who is female pyloric stenosis
Symptoms: Projectile vomiting after feeding
Complications: Dehydration, electrolyte problems
MULTIFACTORIAL (POLYGENIC) INHERITANCE Risk factors: Cesarean section, preterm birth, bottle
feeding, first born
"many factors" (multifactorial) are involved in causing a
birth defect Cleft Lip
The factors are usually both genetic and environmental, an opening or split in the upper lip that occurs when
where a combination of genes from both parents, in developing facial structures in an unborn baby don't
addition to unknown environmental factors, produce the close completely
trait or condition. unilateral or bilateral
Involves traits and disorders resulting from the A baby with a cleft lip may also experience a cleft in the
interaction of many genetic factors (polygenic roof of the mouth (cleft palate)
inheritance) or the interaction of genetic and
environmental factors. Cleft Palate
Diseases caused by multiple factors do not follow the an opening or split in the roof of the mouth that occurs
mendelian laws of inheritance, probably because more when the tissue doesn't fuse together during
than a single gene or HLA (human leukocyte antigen) is development in the womb
involved. A cleft palate often includes a split (cleft) in the upper lip
Environmental influences may be instrumental in (cleft lip) but can occur without affecting the lip
determining whether the disorder is expressed. It maybe
difficult to parents to understand this disorders because Developmental dysplasia of the hip (DDH)
their occurrence is so unpredictable. A family history for condition where the "ball and socket" joint of the hip
instance, may reveal no set pattern. Some of these does not properly form in babies and young children
conditions have a predisposition to occur more It's sometimes called congenital hip dislocation or hip
frequently in one sex (e.g. cleft palate occurs more often dysplasia.
in girls), but they can occur in either sex. The hip joint attaches the thigh bone (femur) to the
Human Leukocyte Antigen (HLA) system ← cluster of gene pelvis.
complex encoding the major histocompatibility complex
(MHC) proteins known as antigens located on the cell
membrane of leukocytes in humans from which its name MITOCHONDRIAL INHERITANCE
was derived
Mitochondria ← cell organelles that are found outside the
Congenital Heart Defects cell nucleus.
problem with the structure of the heart inherited solely from the cytoplasm of the ovum
present at birth serve as markers for genetic testing
the most common type of birth defect Male carriers cannot pass a disorder carried in the
The defects can involve the walls, valves of the heart, mitochondria to any of their children.
and the arteries and veins near the heart Females will pass a mitochondrial disorders to 100% of
their children.
A number of rare myopathies (muscle diseases) are
inherited in this way.
2nd Semester
IMPRINTING OTHER CHROMOSOMAL ABNORMALITIES

(CYTOGENIC DISORDERS)
Genetic Imprinting
Deletion Abnormalities
the ability of a gene to be expressed depends upon the
Deletion ← a part of a chromosome is missing or "deleted"
sex of the parent who passed on the gene
A very small piece of a chromosome can contain many
In some cases, imprinted genes are expressed when the
different genes. When genes are missing, there may be
are inherited from the mother.
errors in the development of a baby since some of the
This occurs because genes located in this region
"instructions" are missing.
undergo genomic imprinting.
Translocation Abnormalities
a type of chromosomal abnormality in which a
CHROMOSOMAL ABNORMALITIES
(CYTOGENIC DISORDERS) chromosome breaks and a portion of it reattaches to a
different chromosome
Cause: hereditary or nonhereditary Chromosomal translocations can be detected by
Contributing factors include: analyzing karyotypes of the affected cells.
exposure to teratogens, such as radiation, certain "swapped" with another chromosome
drugs, viruses, toxins and chemicals
advanced maternal age at conception Mosaicism
In some instances of genetic disease, the abnormality, a person has 2 or more genetically different sets of cells
occurs not because of dominant or recessive gene in their body
patterns but through a fault in the number or structure of A person with mosaicism may have some cells in their
chromosomes. body with 46 chromosomes.
Karyotype ← chromosomes are photographed and Chromosomes are stick-shaped structures in the middle
displayed of each cell in the body. Each cell has 46 chromosomes
Specific parts of chromosomes can be identified by grouped in 23 pairs.
karyotyping or by a process termed Fluorescent In Situ
Hybridization (FISH). Isochromosomes
Chromosome abnormalities can be numerical or chromosomes composed of mirror images of one of the
structural. arms of the chromosome
As a result, the opposite chromosome arm may be
TYPES OF CHROMOSOMAL ABNORMALITIES deleted and the cells only have a single copy of the
genetic material in the arm present in the normal
Numeric abnormalities member of the homologous pair.
either missing 1 of the chromosomes from a pair or
has more than 2 chromosomes instead of a pair
usually too many, too few chromosomes usually SPECIFIC: NONDISJUNCTION ABNORMALITIES
results in miscarriage in s ex hormones and
autosomes Down Syndrome (Trisomy 21, 47XX21+ or 47XY21+)
Examples: a genetic condition caused by an extra chromosome
Klinefelter and turner syndromes Most babies inherit 23 chromosomes from each parent,
Trisomy 13, 18, 0r 21 for a total of 46 chromosomes.
Babies with Down syndrome end up with 3 chromosomes
Structural disorders at position 21, instead of the usual pair.
the chromosome's structure has been altered in one The incidence of Down Syndrome increases with
of several ways increasing maternal age and is highest if the mother is
deletions (cri du chat syndrome) older than 35 years of age and the father is older than 55,
translocations ← aberrations that result when part thus aging seems to present an obstacle to clean cell
of a chromosome is transferred to a different division.
chromosome The incidence is
1 : 100 in women older than 40 years of age
Nondisjunction abnormalities 1 : 1,500 in women younger than 20 years
Nondisjunction ← failure of paired chromosomes to Other examples of cell nondisjunction include trisomy 13
separate (to disjoin) during cell division, so that both and trisomy 18 (cognitive challenged syndromes).
chromosomes go to one daughter cell and none go Physical features (so marked that fetal diagnosis is
to the other possible by sonography in utero):
causes errors in chromosome number, such as nose is broad and flat,
trisomy 21 (Down syndrome) and monosomy X eyelids have an extra fold of tissue at the inner
(Turner syndrome) canthus (an epicanthal fold)
results in variations in chromosome number the palpebral fissure (opening between the eyelids)
tends to slant laterally upward
Brushfield spots ← iris of the eye may have white
specks
tongue is apt to protrude from the mouth because the
oral cavity is smaller than usual
back of the head is flat
2nd Semester
neck is short Assessment of the general medical history of the

an extra pad of fat at the base of the head causes couple and the couple’s family members (including
the skin to be so loose it can be lifted easily and so those who are deceased) are important.
thin it can be revealed on a fetal sonogram Asking the mother’s age is also important because risk
often increase with age.
Turner syndrome
a condition that affects only females
results when one of the X chromosomes (sex B. NURSING DIAGNOSIS
chromosomes) is missing or partially missing
can cause a variety of medical and developmental Knowledge deficit
problems, including: Decisional conflict
short height Anticipatory grieving
failure of the ovaries to develop
heart defects
C. PLANNING AND OUTCOME IDENTIFICATION
Klinefelter syndrome The couple will receive education about genetic
a genetic condition in which a boy is born with an extra X problems that may affect their children, including risks
chromosome for having a child with a problem and treatment options
Instead of the typical XY chromosomes in men, they have for the particular problem.
XXY, so this condition is sometimes called XXY syndrome. The couple will receive emotional support throughout the
Men with Klinefelter usually don't know they have it until genetic testing process
they run into problems trying to have a child
D. IMPLEMENTATION
SPECIFIC: DELETION ABNORMALITIES Provide Education
Cri-du-chat syndrome (46XY5q-) Describe the couple’s risk for having a child with an
cat's cry syndrome, also known as 5p- syndrome inherited disorder.
a chromosomal condition that results when a piece of Provide sufficient and correct information about the
chromosome 5 is missing. Infants with this condition often genetic problem in question.
have a high-pitched cry that sounds like that of a cat Explain the genetic testing required.
they are severely cognitively challenged Provide information about possible treatments of the
Physical features: disorder (if any).
small head Provide information about available resources.
wide-set eyes
a downward slant to the palpebral fissure of the eye Provide emotional support
recessed mandible identify the counseling needs of families with a history of
small chin inherited disorders.
flat nose Provide risk-appropriate health care and counseling.
protruding teeth Assist the couple in coping with the results of genetic
thin build testing.
moon facies Refer the couple to appropriate health care providers,
hypertelorism support group and community resources for help in
bilateral epicanthic folds managing the crisis in their lives.
Serve as a liaison between the genetic counselor and the
family.
NURSING PROCESS OVERVIEW
FOR GENETIC PRINCIPLES INFLUENCING
FETAL GROWTH AND DEVELOPMENT E. OUTCOME EVALUATION
The couple states that they received adequate
A. ASSESSMENT information about patterns of inheritance, their risk in
Health History having a child with an inherited disorder, information
Laboratory and diagnostic studies concerning the disorder itself, and information about
Health history should focus on determining the couple’s treatments and available resources.
risk for having a baby with an inherited disorder The couple demonstrates positive coping skills and
A relevant preliminary genetic history, being alert to states that they are able to make reasonable choice
information indicating the need for referral to genetic about the outcome of genetic testing and counseling.
counseling, is important. Note if any genetic disorders
are present in family members of both the mother
and father. It may be necessary to assess other
members of the family as well as the couple.
Ethnic background is important because certain
disorders occur more frequently in some ethnic
groups compared to others.
2nd Semester
PRINCIPLES OF COUNSELING
Refer to client to a Guidance Counselor or a Psychiatrist
Principle of Individualization when client’s condition calls for it.
each person is unique Refer when:
requires you to understand your client’s unique The problem is more serious that you feel
characteristics uncomfortable handling.
Recognition of this unique characteristics gives him/her You are extremely busy or you are experiencing stress
the feeling that he/she is treated and respected as an in your life and are unable to handle other request to
individual. help.
You have talked to the client and helped as much as
Principle of Purposeful Expression of Feelings you can but further assistance is needed.
The counselor must be especially concerned with You think that your personal feelings about the client
creating and maintaining an atmosphere that is will interfere with your objectivity.
conducive to free expression of feelings. The client asks for information or assistance that you
The atmosphere you create should include the trust and are unable to provide.
confidence of your client in you.
Principle of Controlled Emotional Involvement GENETIC COUNSELING

Avoid being overwhelmed by your client’s emotions
Anyone concerned about the possibility of transmitting a
during the counseling process.
disease to his or her children should have access to genetic
As a counselor, one should be sensitive and responsive to
counseling for advice on the inheritance of disease.
his/her client’s feelings without being too emotionally
involved.
Such counseling can serve the following purposes:
To empathize with him/her does not mean that you
Provide concrete, accurate information about inherited
should be too emotionally involved in his/her case.
disorders.
Reassure people who are concerned that their child may
Principle of Acceptance
inherit a particular disorder that the disorder will not
When you take your client as he/she really is a person
occur.
with dignity, personal worth with positive and negative
Allow people who are affected by inherited disorders to
characteristics, you are actually putting into practice the
make informed choices about future reproduction.
principle of acceptance.
Educate people about inherited disorders and the
It is important to recognize the positive and negative
process of inheritance.
aspects in your client’s personality and be able to accept
Offer support by skilled health care professionals to
him/her as he/she really is.
people who are affected by genetic disorders.
Principle of Non-Judgmental Attitude
The need for the counselor to be free of preconceived GOALS OF GENETIC COUNSELING
notions. Enables individuals or couples to make informed
He/she should consciously avoid presenting options reproductive decisions.
without clear understanding of his/her client’s problem. Provides psychological support for decision-making.
He/She should also avoid comparing the client with Provides clients with information about the defect in
another person who has a similar problem. question.
Communicates to clients the risk of transmitting the
Principle of Client Self-Determination defect in question to future children.
The right and need of the counselee to be free to make
his/her own choices and decision.
While helping him/her see his/her problem in the right Genetic counseling may result in making individuals feel
perspective, the counselor may also offer the client “well” or free of guilt for the first time in their lives. They may
options or alternatives upon which to base the client’s discover that the disorder they were worried about was not
decision. an inherited one but was rather a chance occurrence. Even
However, this should not always be done if the case does if a couple decides not to have any more children, it is
not call for it. important that they know that genetic counseling is
available should their decision change. They also should be
Principle of Confidentiality aware that as their children reach reproductive age, they
Confidentiality ← preservation of secret information too may benefit from genetic counseling.
disclosed by the client during the counseling process.
The responsibility of the counselor to safeguard any Couples who are most apt to benefit from a referral for
confidential information shared by the counselee during genetic testing or counseling include the following:
the counseling session. A couple who has a child with a congenital disorder or an
Ensuring privacy is a concrete manifestation of the inborn error of metabolism.
counselor’s adherence to this principle. A couple whose relatives have a child with a genetic
disorder, including a congenital disorder or inborn error
of metabolism.
Any individual who is a known balanced translocation
carrier.
2nd Semester
Any individual who has an inborn error of metabolism or Maternal serum alpha-fetoprotein (MSAFP) screen ←
chromosomal disorder. selectively done when an open neural tube defect is
A consanguineous (closely related) couple. suspected (MSAFP is not ; there is, however, a 5% to 10% risk
Any woman older than 35 years of age and any man of the defect when MSAFP is elevated at 16 to 18 weeks’
older than 45 years of age. gestation)
Couples of ethnic backgrounds in which specific illnesses
are known to occur. Triple screening ← analysis of three indicators from maternal
serum alpha-fetoprotein, estriol, and human chorionic
gonadotropin. This method yields more reliable results than
INDICATION FOR PRENATAL GENETIC SCREENING MSAFP.
Parent is a carrier of, or is affected by, a chromosomal or Chorionic villi sampling ← retrieval of chorionic villi for
metabolic disorder chromosomal analysis.
Family history of genetic disorders, including family with It maybe done as early as the fifth week of pregnancy.
an ethnic back ground that is highly susceptible to It is more often done between the 8th and 10th week of
certain inherited disorders pregnancy.
(eg. Tay-Sach disease in Jews of Eastern European Results of this analysis are extremely accurate.
(Ashkenazil descent, sickle-cell disease in people of This test cannot detect all inherited diseases.
African descent, and beta-thalassemia (Cooley
anemia) in people of Mediterranean descent). Amniocentesis ← withdrawal of a sample of amniotic fluid (2
Previous birth of child with a congenital abnormality or to 5 ml) transabdominally for genetic analysis.
with multiple anomalies who has had no chromosomal usually done with ultrasound visualization between 14
studies done and 16 weeks
Advanced maternal age It may be used to analyze skin cells, alpha-fetoprotein, or
History of spontaneous abortion acetylcholinesterase (a breakdown product of blood).
Willingness to interrupt pregnancy if an abnormal fetus Acetylcholinesterase ← helps decrease false-positive
is detected results.
Percutaneous umbilical blood sampling ← is removal of

NURSING RESPONSIBILITIES
blood from the umbilical vein.
Nurses play important roles in assessing for signs and Blood studies include karyotyping, complete blood count
symptoms of genetic disorders, in offering support to (CBC), direct Coombs test, and measurement of blood
individuals who seek genetic counseling, and in helping with gases.
reproductive genetic testing procedures. It uses a technique similar to amniocentesis to obtain the
blood sample.
Nurses can be instrumental in the following ways: An Rh-negative mother should be given RhoGAM
Alerting a couple to what procedures they can expect to because blood may enter maternal circulation after the
undergo. procedure as a result of oozing at the puncture site.
Explaining how different genetic screening tests are done
and when they are usually offered. Sonography ← a diagnostic tool that is used to assess a
Supporting a couple during the wait for tests result fetus for general size. It can also be used to examine
Assisting couples in values clarification, planning, and structural disorders of the internal organs, spine, and limbs.
decision making based on test results. It uses sound waves to create a “picture”.
Fetoscopy ← involves the insertion into the mother’s uterus of

SCREENING FOR GENETIC TRAITS AND DISEASE a fiberoptic fetoscope through a small incision in her
abdomen.
Goal of screening it is used to inspect for fetal anomalies or confirm an
to prevent tragic genetic diseases and offer various ultrasound finding
reproductive options to at-risk couples. Accurate It can be used to remove fetal skin cells for DNA analysis.
screening hinges on the education and advocacy of It also may be used to perform corrective surgery for
physicians and nurses caring for people of reproductive congenital anomalies.
age.
SPECIFIC TESTS INCLUDE:

Karyotyping ← visual display of the individual’s actual
chromosome pattern.
Heterozygote screening ← directed at detecting clinically

normal carriers of a disease-causing mutant gene,
particularly in people of ethnic groups with high frequency
of the mutant gene under investigation.
2nd Semester
CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD
ANTEPARTUM COMPLICATIONS
Physical examination
Vital signs
ESSENTIAL CONCEPTS Measure weight for excessive loss and gain
Although most pregnancies progress to successful delivery Measure for increased blood pressure
without complications, various factors can alter the Measure for rapid pulse
physiologic processes of pregnancy and compromise the Measure for increased temperature
well-being of the mother or the developing fetus. Inspection
Assess for vaginal bleeding
These complications may occur at any time during Inspect for premature rupture of the membranes
pregnancy and can result from pre-existing maternal (PROM)
medical problems or from the pregnancy itself. Assess the skin for rash, pale, dry skin, or edema
Inspect the oral cavity for overall dental health and
Significant complications of pregnancy include: signs of poor nutrition (e.g.. Rough, tender tongue,
Spontaneous abortion fissures at the corners of the mouth, pale mucous
Gestational trophoblastic disease ( hydatidiform mole) membrane, and swollen or inflamed gingiva).
Ectopic pregnancy Palpation
Incompetent cervix Palpate the uterus to determine whether it is
Hyperemesis gravidarum abnormally soft or hard, and whether it is larger or
Anemia smaller than expected for gestational age.
Placenta previa Palpate the cervix to detect preterm cervical dilation.
Abruptio placenta Auscultate the fetal heart rate (FHR) to detect
Preeclampsia and eclampsia abnormally fast or slow rates.
Gestational diabetes
Hemolytic disease of the fetus and newborns Laboratory studies and diagnostics tests
Infections Complete blood count (CBC) ← most routinely performed
test in the laboratory
Maternal conditions that can significantly affect the fetus or provides information about the number, type, and
the progress of pregnancy include diabetes mellitus, health of red blood cells (RBCs) and white blood cells,
cardiac disease, hypertensive disease, hematologic and the hematocrit and hemoglobin value
disorders (e.g.. Anemia or hemoglobinopathies), infections, Pregnancy test ← may be performed on maternal urine or
sexually transmitted diseases, smoking, and substance serum
abuse. A positive test indicates that a pregnancy probably
exists.
Major goals of prenatal nursing are screening for, and other factors that can yield a positive result
preventing, complications and developing therapeutic Medications, tumors, premature menopause,
interventions. blood in the urine
i.e. Human chorionic gonadotropin (hCG)
Early and consistent prenatal care results in improved fetal Serum alpha-fetoprotein measurement ← measured in
and maternal outcome, regardless of complications that maternal serum or in amniotic fluid
may occur. Evaluate each pregnancy to identify at-risk Alpha-fetoprotein - predominant protein in fetal
clients as early as possible. Remember that risk assessments plasma. A small amount crosses the placenta into the
must be updated throughout the pregnancy because a maternal serum, and some is excreted into the
gestation categorized as low risk initially may become high amniotic fluid.
risk later. An abnormal concentration of alpha-fetoprotein in
either amniotic fluid or maternal serum is associated
with such fetal anomalies as open neural tube
NURSING PROCESS OVERVIEW defects (anencephaly and spina bifida).
FOR ANTEPARTUM COMPLICATIONS Maternal serum alpha fetoprotein (MSAFP) elevated in
the following conditions:
A. ASSESSMENT wrong gestational age
open neural tube defects (NTDs)
Health history multiple pregnancy
Elicit a description of symptoms, including onset, IUFD
duration, location, and precipitating factors, if known, anterior abdominal wall defects
Cardinal signs and symptoms of antepartum renal abnormalities
complications may include: low levels are found in trisomies (Down's Syndrome)
Dizziness and gestational trophoblastic disease
Nausea and vomiting Ultrasound ← use of high-frequency sound waves passed
Headache through the maternal abdomen
Fatigue These sound waves are deflected by fetal structures and
Abdominal pain and cramping allow visualization of fetal movement, fetal heart
Uterine labor contractions before the estimated date movement, fetal heart movement, and respiratory effort.
of delivery. can also be used throughout pregnancy to determine
Explore personal and family history for risk factors for fetal age, visualize the placenta, and locate pockets of
antepartum complications. amniotic fluid for amniocentesis
2nd Semester
Blood glucose ← indicates the concentration of glucose D. IMPLEMENTATION

in the blood.
Ensure that appropriate physical needs are addressed and
Represented in mL of glucose per dL of blood.
monitor for additional complications.
Glycosylated hemoglobin ← measures the amount of
Assist the woman to plan for adequate rest, activity, and
glucose attached to hemoglobin
nutrition.
reflects the average blood glucose level over the past
Assist the couple to set realistic goals based on the
4 to 6 weeks and is usually reported as a single digit.
mother’s health and the restrictions required by the
Indirect Coombs test ← used in the search for
compliance.
agglutination of Rh-positive RBCs to determine whether
antibodies are present in maternal blood
Address emotional and psychosocial needs.
used to anticipate hemolytic disease of the newborn
Assess the client’s feeling about herself and the
Amniocentesis ← aspiration of a sample of amniotic fluid
pregnancy and assist the woman to maintain her self-
for examination of fetal cells
esteem.
may be used to determine chromosomal
Encourage verbalization of any grief, loss and potential
abnormalities or fetal lung maturity, or to diagnose
guilt feelings.
fetal hemolytic disease
Offer emotional support to the client and her family as
Serologic tests ← used to determine the presence and
they go through a normal grieving process due to a crisis
type of sexually transmitted diseases.
to their pregnancy, or a loss of their pregnancy.
Cultures ← disease and site specific, and are used to
Evaluate the client and her family’s support system.
determine the type of infectious agent present and to
Assess for an appropriate coping response.
identify medications to which these agents are
susceptible.
Provide client and family teaching.
Provide information about the actual complication and
B. NURSING DIAGNOSIS the expected outcome, if possible.
Instruct the couple about specific signs and symptoms to
Both general and complications specific are listed. Planning, report.
and outcome identification, implementation, and outcome Provide printed instructions on various self-care
evaluation are focused on general diagnoses. measures (e.g., use of medications, dietary and activity
restrictions, and rest) to manage the existing problem
General diagnoses and prevent additional complications.
Pain Explain the need, purpose, and procedure for various
Anxiety diagnostic tests.
Fear
Ineffective individual coping Promote compliance.
Ineffective family coping: compromised Allow for choice among alternative treatments when
Altered family processes possible.
Powerlessness Include the partner and other family members in decision
Noncompliance making when possible.
Complication-specific diagnoses
Fluid volume deficit E. OUTCOME EVALUATION
Anticipatory grieving
Dysfunctional grieving The client and fetus (if applicable) recover fully and do
Risk of infection not develop additional complications.
Situational low self-esteem The client and family express their fears and anxieties,
Altered nutrition: less than body requirements and exhibit functional grieving.
Altered nutrition: less than body requirements The client and family understand the complications and
Constipation treatment regimen.
Activity Intolerance The client and family comply with the treatment regimen.
Decreased cardiac output
Altered tissue perfusion: uteroplacental
A. NURSING CARE OF THE PREGNANT CLIENT
C. PLANNING AND OUTCOME IDENTIFICATION RISK FACTORS FOR PREGNANT WOMEN

The client and fetus (if applicable) will make a full Risk factors include, but are not limited to, the following:
recovery and will not develop additional complications. Mother is younger than 19 years old or older than 35 years
The client and family will express their fears and old
anxieties, and will exhibit functional grieving Mother is underweight or overweight for height
The client and family will understand the complication Mother has anemia (low red blood cell count) and poor
and treatment regimen. nutrition status
The client and family will comply with the treatment Low socioeconomic status
regimen. Previously given birth more than four times
Previous preterm birth (birth before 37 weeks)
2nd Semester
PSYCHOLOGICAL SOCIAL PHYSICAL

Previous birth of a very large or very small baby
Obesity Pelvic inflammatory
Previous pregnancy loss disease
Mother has anemia (low red blood cell count) and poor
History of inherited disorder
nutrition status Small stature
Low socioeconomic status
Potential of blood
Previously given birth more than four times
incompatibility
Previous preterm birth (birth before 37 weeks) Younger than age 18 years or
Previous birth of a very large or very small baby older than 35 years
Previous pregnancy loss PREGNANCY
Family history of genetic disease or previous baby with a
Loss of support person Refusal of or neglected Subject to trauma
birth defect prenatal care
Substance use (cigarettes, alcohol, drugs)
Illness of a family Exposure to environmental Fluid or electrolyte
Pre-existing medical conditions including diabetes
member teratogens imbalance
mellitus, high blood pressure, and heart disease
Infertility medications or treatments (more likely to result Decrease in self-esteem Disruptive family incident Intake of teratogen such as
a drug
in multiple births)
Drug abuse (including Decreased economic support Multiple gestation
alcohol and cigarette
Other external conditions: smoking)
High temperature - can lead to strokes, dehydration
Poor acceptance of Conception less than 1 year A bleeding disruption
Radiation exposure - teratogenic
pregnancy after last pregnancy or Poor placenta formation or
High altitudes - may increase the need for more oxygen pregnancy within 12 months position
consumption of the first pregnancy Gestational diabetes
Nutritional deficiency of
iron, folic acid, or protein
VULNERABLE GROUPS Poor weight gain
Marginalized because of: Pregnancy-induced

Poverty hypertension
Unemployment
Lack of education Infection
Exposure to teratogens due to occupation Amniotic fluid abnormality
Victims of abuse or domestic violence, rape and incest
Postmaturity
Single or separated mothers
LABOR AND DELIVERY
Severely frightened by Lack of support person Hemorrhage

FACTORS THAT CATEGORIZE labor and delivery Inadequate home to infant Infection
A PREGNANCY AS HIGH-RISK experience care
Inability to participate Unplanned caesarean birth Fluid and electrolyte

PSYCHOLOGICAL SOCIAL PHYSICAL due to anesthesia imbalance
Dystocia
ANTEPARTUM
Separation of infant at Lack of access to continued Precipitous birth
History of drug Occupation involving Visual or hearing
birth health care Lacerations of cervix or
dependence handling of toxic substances challenges
vagina
(including alcohol) (including radiation and Pelvic inadequacy or
anesthesia gases misshape
Lack of preparation Lack of access to emergency Cephalopelvic
Environmental contaminants Uterine incompetency,
personnel or equipment disproportion
at home position or structure
Isolated Secondary major illness Internal fetal morning
(heart
Retained
History of intimate Lower economic level disease, diabetes mellitus,
partner abuse Poor access to kidney disease,
transportation for care hypertension, chronic
infection such as
PRE-GESTATIONAL MEDICAL CONDITION

tuberculosis,
History of mental illness High altitude hemopoietic or blood

disorder,
COVID-19 LINKED TO HIGHER RISK OF
History of poor coping High mobile lifestyle malignancy PREGNANCY COMPLICATIONS
mechanisms
Pregnant people with COVID-19 are more likely to
Cognitively challenged Poor housing Poor gynecologic or
obstetric history experience serious health problems—like blood clots or
respiratory conditions—than pregnant people without
Survivor of childhood Lack of support people
sexual abuse
COVID-19.
Now, research supported by the Eunice Kennedy Shriver
History of previous poor Cigarette smoker
National Institute of Child Health and Human
pregnancy outcome (
miscarriage, stillbirth, Development (NICHD) and the National Center for
intrauterine fetal death) Advancing Translational Sciences (NCATS) has found
History of child with Substance abuser
that COVID-19 is associated with a higher risk of
congenital anomalies pregnancy-related complications.
2nd Semester
What did the researchers do? Vaccination prevents COVID-19 and reduces the risk of
Researchers studied more than 14,000 women who gave severe disease.
birth from March 1, 2020, to December 31, 2020, in 17 Vaccines are very effective against SARS-CoV-2 variants.
hospitals participating in the NICHD Maternal-Fetal The antibodies your body makes after vaccination can
Medicine Units (MFMU) Network’s Gestational Research travel to the baby before birth or through breastmilk
Assessments for COVID-19 (GRAVID) study. after birth.
Of the women in the study, 2,352 tested positive for SARS- The CDC strongly recommends COVID-19 vaccination
CoV-2 (the virus that causes COVID-19) during pregnancy either before or during pregnancy.
or within six weeks of giving birth. The researchers
compared those women’s pregnancy and postpartum How you can help advance research
health outcomes with the outcomes of women who had People who are pregnant or just gave birth may join NIH
no known SARS-CoV-2 infection. research studies so that scientists can gather more data
on vaccine safety and effectiveness in pregnancy.
What did the researchers learn? Scientists are also using data from people who got
Pregnant women who had moderate to severe COVID-19 pregnant while participating in earlier vaccine studies.
during their pregnancy were more likely than uninfected
pregnant women to die or develop health problems from Do vaccines cause infertility?
complications, including postpartum hemorrhage, There is no evidence currently that any vaccines,
problems related to high blood pressure (such as including COVID-19 vaccines, cause female or male
eclampsia), and other infections (such as sepsis). fertility problems. The CDC recommends COVID-19
In addition, women who had moderate to severe COVID- vaccines for people who are pregnant or are trying to
19 during their pregnancy were more likely to miscarry, get pregnant.
give birth before their due date, require a cesarean birth
(C-section), or have a newborn die shortly after birth Do stress and anxiety from the pandemic affect my
when compared to uninfected pregnant women pregnancy?
Notably, mild or asymptomatic COVID-19 was not Stress, anxiety, and depression can affect your health
associated with higher rates of pregnancy and the health of your baby. During the pandemic, many
complications. Race and ethnicity were also not found to pregnant people said they felt lonely or had anxiety or
be associated with higher rates of pregnancy PTSD.
complications from COVID-19. In one NIH study, women reported that the pandemic
raised their stress levels, causing problems with
Why is this research important? childbirth, bonding with their babies, and breastfeeding.
The findings from this study underscore the need for Use an action plan during pregnancy or after birth to find
pregnant people to take preventive measures against out if what you are feeling is depression or an anxiety
SARS-CoV-2. Several studies have shown that COVID-19 disorder and if you should seek help.
vaccines are safe and effective for pregnant people. The most important thing is to let someone know that
By following health and safety guidelines, pregnant you’re having trouble coping. Many people feel the same
people can lower their risk of health problems for way.
themselves and their babies. If you are thinking about harming yourself or your baby,
or if you are concerned about someone, call 9-1-1 now.
Where can I go to learn more? Learn more about caring for your mental health.
How COVID-19 Affects Pregnancy?
Should you get the vaccine during pregnancy? Does the Is my risk for blood clots higher during pregnancy if I get
vaccine cause infertility? NIH research is helping to COVID-19?
answer these questions and more. Possibly. Both pregnancy and COVID-19 increase the risk
of developing blood clotting problems.
Is my baby at risk if I test positive for COVID-19? Talk to your doctor about your personal risk.
Pregnant people with COVID-19 are more likely to get If you are hospitalized for COVID-19, you may get
seriously ill, which can lead to pregnancy problems such medicine to lower the risk of dangerous blood clotting.
as preterm birth. The CDC recommends that pregnant Some of these medicines are safe for women who are
people get vaccinated to protect against serious illness. breastfeeding their babies.
NIH Study of COVID-19 Testing during Pregnancy If I have COVID-19, will it spread to my baby during
NIH is supporting a study of pregnant women to see if pregnancy?
and when they were exposed to SARS-CoV-2, the virus Only a few newborns have tested positive for COVID-19
that causes COVID-19. The researchers hope to identify a shortly after birth. It is unknown if these newborns got the
COVID-19 testing strategy to improve pregnancy care virus before, during, or after birth. Most newborns who
tested positive for COVID-19 had mild or no symptoms
Is it safe to get a COVID-19 vaccine when pregnant or and recovered.
breastfeeding?
Research shows that vaccines, including the Pfizer and
Moderna mRNA vaccines, are safe and effective while
pregnant or breastfeeding.
2nd Semester
NIH Studies on the Placenta rash often appears on genitals or the anus
NIH research has shown that the cells of the placenta can be transmitted through sexual contact
don’t allow SARS-CoV-2 to travel to a developing baby. Pregnant women can also transmit the virus to their fetus
Because of this, the chance that your baby will be born through the placenta.
with COVID-19 is very low There’s no indication that the virus originated with
The NIH supports research on the placenta, including a monkeys, despite its name
study using magnetic resonance imaging (MRI) to see it was given the name after the first known cases
what happens when SARS-CoV-2 tries to enter the emerged in 1958 in a colony of monkeys kept for
placenta’s cell research. It wasn’t reported in humans until 1970
Can breastfeeding protect my baby from getting COVID-19? Should I worry about getting monkeypox in pregnancy?
Breastmilk provides protection against many illnesses. Monkeypox cases are climbing in the U.S.—and around
This also seems to be true for COVID-19. the world—but there are very few cases among pregnant
An NIH-supported study found that when a pregnant women.
person has antibodies against SARS-CoV-2 after being This is good, but makes it difficult to know exactly how
vaccinated or having COVID-19, those antibodies may be vulnerable pregnant women are to the virus, or
transferred to the baby through breastmilk. The whether it causes more serious symptoms during
antibodies help babies gain immunity that can protect pregnancy.
them from COVID-19. What we do know about monkeypox is that some
pregnant women have experienced pregnancy loss and
Can COVID-19 during pregnancy affect my child long term? preterm delivery while infected with monkeypox.
It’s unlikely that your baby will get COVID-19 while you are However, because of the low case counts among
pregnant, and COVID-19 during pregnancy rarely causes pregnant women, it's unclear whether these
serious short-term problems for the pregnant woman or complications are typical among pregnant women with
her child monkeypox.
Severe COVID-19 during pregnancy does raise the risk of While you shouldn't panic, it's important to stay up to
pregnancy problems, such as preterm birth, that can date with the latest health information and to talk with
affect your baby’s development your provider if you're pregnant.
Studying COVID-19 in Children Symptoms of monkeypox in pregnancy:

Any infection during pregnancy, including COVID-19, can So far, the symptoms of monkeypox are similar in those
trigger the body’s immune response and cause who are pregnant and those who aren't.
inflammation. It’s also possible that your infant may get Most commonly, monkeypox causes fever and chills,
COVID-19 after being born. headaches, full-body aches, congestion, cough, and a
NIH is supporting a study on possible effects of the sore throat.
pandemic on inflammation in women’s bodies and on The symptom that sets monkeypox apart from other
their children's brain development. viruses is a rash commonly found on or around genitals
and the anus. The rash might show up on the hands and
feet, face, or torso.
SHOULD PREGNANT WOMEN It isn’t uncommon to experience a rash during
WORRY ABOUT MONKEYPOX? pregnancy. In fact, many women experience eczema,
The monkeypox virus is spreading in the U.S. and has now dermatitis, or pruritic urticarial papules and plaques of
been declared a health emergency by both the Biden pregnancy (PUPPP), during pregnancy.
administration and the World Health Organization. The virus If you have a rash while you're pregnant, it's unlikely to
causes painful rashes, fever, body aches, cough, and be monkeypox, and more likely to be some of the other
congestion, and if you're pregnant, you may be wondering if more common types of rash. But even though your
it's time to worry. Right now, there's limited research chances of having monkeypox are low, it's always a
available on monkeypox and the impact it may have on your good idea to talk to your provider about new or
pregnancy and baby. However, experts do know the virus concerning symptoms, like a rash, when you're pregnant.
can pass to your fetus or newborn, so you may need to take
extra precautions if you're pregnant or breastfeeding. Will having monkeypox during pregnancy and
breastfeeding affect my baby?
What is Monkeypox? It's hard to say for sure how having monkeypox during
Monkeypox ← a virus characterized by a painful rash with pregnancy could affect your baby, because only a
small, pimple-like bumps along with fever, chills, body handful of cases among pregnant women have been
aches, and congestion. reported so far. Some women have had normal
Although it's in the same family as smallpox, monkeypox pregnancies, while others with monkeypox have
is generally considered far less dangerous as it's rarely experienced miscarriage and stillbirth.
associated with death. Because monkeypox can pass to the fetus, and because
Ways of transmission pregnant women are considered high-risk, meaning
close contact with those who have symptoms there is a higher chance of developing complications
contact with the rash through close physical contact with many viruses or diseases, healthcare providers are
exposure to the respiratory droplets of someone who prioritizing monkeypox treatment for pregnant women.
is sick with the virus
2nd Semester
HYPEREMESIS GRAVIDARUM
If you have monkeypox, it could impact breastfeeding
because isolating from your newborn is highly Case Scenario/ Situation:
recommended. If isolating isn't feasible or possible, your K.L. has been admitted to the hospital with a diagnosis of
healthcare team will walk you through precautionary hyperemesis gravidarum. She is in the second trimester of
measures you'll need to take to protect your baby, such her pregnancy and has lost 5% of her prepregnant weight.
as avoiding all skin-to-skin contact and wearing a face She cannot tolerate oral fluids or food, and she is receiving
mask around your baby. lactated Ringer’s solution intravenously (IV).
Will monkeypox affect my labor and delivery? Hyperemesis gravidarum ← severe and excessive nausea
Exposure to monkeypox is unlikely at this time. But if and vomiting during pregnancy, which leads to electrolyte,
you're diagnosed with the virus during pregnancy, it metabolic, and nutritional imbalances in the absence of
could affect your labor and delivery. other medical problems.
If you have monkeypox, you'll isolate from friends and sometimes called pernicious or persistent vomiting
family until the virus resolves. You'll need to follow your Mild nausea and vomiting are common during the early
hospital's isolation protocol during your labor and part of pregnancy.
delivery. Your partner may or may not be allowed in the Commonly called “morning sickness”
room with you, but this will depend on your specific thought to be due to elevated progesterone,
hospital. And if you give birth and still have symptoms, it's estrogen, and human chorionic gonadotropin (hCG)
recommended that you isolate from your infant to avoid levels
exposing them to the virus. Symptoms may be aggravated by fatigue, cooking
odors, and emotional stress. Woman need
How is monkeypox treated in pregnancy? reassurance that nausea and vomiting are normal
Most cases of monkeypox are mild and resolve on their and will usually disappear in the 3rd month.
own without any treatment within 2 to 4 weeks. However, a more serious condition that requires medical attention
pregnant women are considered high risk, so treatment begins in early pregnancy and may continue throughout
is recommended. the pregnancy
Treatment of monkeypox currently includes two antiviral Cause: unknown
medications and one vaccinia immune globulin. These women with the disorder may have increased thyroid
drugs have been used in the past to treat both function because of the thyroid-stimulating
monkeypox and smallpox. Studies are limited among properties of human chorionic gonadotropin (hCG).
pregnant women with monkeypox, but in animal studies Some studies reveal it is associated with Helicobacter
at least one of the drugs appears to be safe for the fetus. pylori, the same bacteria that causes peptic ulcers
While this immune globulin has not been studied Highest incidence: primigravidas, multifetal pregnancies,
specifically in the pregnant population, other similar and women with psychiatric disorders
immunoglobulins are used for various conditions and Hospitalization is recommended if symptoms cannot be
appear to be safe. controlled at home.
•Your provider can walk you through your treatment
options, so you can make a decision based on your
ETIOLOGY
specific circumstances. They'll discuss the risks of you –
and potentially your baby – having monkeypox, so you obscure, suggested causative factors include:
can weigh those against any risks involved in treatment. High levels of HCG in early pregnancy
Metabolic or nutritional deficiencies
How to reduce your risk of getting monkeypox while More common in unmarried white women and first
pregnant: pregnancies
Avoiding exposure to the virus is the best way to prevent Ambivalence toward the pregnancy or family-
monkeypox during pregnancy. It's important to avoid related stress
contact with individuals or pets who have the virus, and Thyroid dysfunction
to make sure you steer clear of anyone with an
undiagnosed rash.
Regular handwashing can also help prevent the spread, PATHOPHYSIOLOGY
and practicing safe sex is always a healthy choice,
pregnant or otherwise; doing so can help lower the Continued vomiting results in dehydration and
transmission of monkeypox. ultimately decreases the amount of blood and
The bottom line: Right now, monkeypox during pregnancy nutrients circulated to the developing fetus.
is uncommon, and taking these precautionary measures Hospitalization may be required for severe
can help lower your risk of getting it. But if you do get symptoms when the client needs intravenous
monkeypox, your provider can walk you through hydration and correction of metabolic imbalances.
treatment options, how your labor and delivery might
change, and what to expect if you're planning to
breastfeed.
2nd Semester
carries certain risks to both the woman and her fetus

ASSESSMENT FINDINGS
Those risks increase if the woman does not have
Signs and symptoms occur during the first 16 weeks of adequate blood sugar control during the perinatal
pregnancy and are intractable. period.
Impaired glucose metabolism is influenced by the
Clinical manifestations include: hormones of pregnancy but may have been present
Unremitting nausea and vomiting before pregnancy.
Vomitus initially containing undigested food, bile, Strict adherence to dietary restrictions and monitoring of
and mucus; later containing blood and material blood glucose is key to successful management of this
that resembles coffee grounds. disease during pregnancy.
Weight loss Complications that occur as a result of GDM:
large for gestational age (LGA) infants
Other common signs and symptoms include: ketoacidosis (can be life-threatening)
Pale, dry skin polyhydramnios
Rapid pulse respiratory distress syndrome
Fetid, fruity breath odor from acidosis Approximately 30% of pregnant women died due to
Central nervous system effects, such as confusion, diabetic ketoacidosis, and the perinatal mortality rate
delirium, headache, and lethargy, stupor or coma was between 60% and 70%.
Today, complications due to GDM have dramatically
declined because of advances in research and
NURSING MANAGEMENT successful management of blood glucose levels during
pregnancy.
Promote resolution of the complication. In the Philippines: a total of 627 pregnant women have
Make sure that the client is NPO until cessation of already been enrolled in the study, 196 of whom have
vomiting GDM, “indicating an estimated 31 percent prevalence of
Administer intravenous fluids as prescribed; they GDM, based on data collected from February 2018 to
may be given on an ambulatory basis when March 2020.”
dehydration is mild. It is also recommended that women with GDM undergo
Measure and record fluid intake and output. reclassification of the disease 6 weeks postpartum.
d. Encourage small frequent meals and snacks once Cause: inability of the beta cells of the pancreas to
vomiting has subsided. partially or completely secrete insulin needed to
Administer antiemetics as prescribed. transport glucose across cell membranes
Address emotional and psychosocial needs. When glucose is unable to enter the cell, it remains in
Maintain a nonjudgmental atmosphere in which the the bloodstream, resulting in high blood sugar levels,
client and family can express concerns and resolve or hyperglycemia.
some of their fears. The basal metabolic rate of a pregnant woman
increases in response to fetal growth, resulting in higher
utilization of glucose which crosses the placental
membrane by diffusion.
GESTATIONAL DIABETES MELLITUS (GDM) Insulin does not cross the placental membrane.
Diabetes Type 2: developmental disease from medicine,
Case Scenario/ Situation: pancreatic disease,
K.C. is 34 years old. She is gravida 2, para 0. Her first stress, overweight
pregnancy ended in a stillbirth. At her first prenatal visit her
diabetes screening was negative. However, in her second
MATERNAL COMPLICATIONS
trimester , she is diagnosed with gestational diabetes. She is
normal weight for her height, and her weight gain has Diabetic Ketoacidosis
followed the recommended pattern thus far in pregnancy. Pregnancy-induced hypertension or preeclampsia
Urinary tract infections and Pyelonephritis
Gestational diabetes ← onset of impaired glucose or Difficult labor, vaginal trauma, or cesarean birth
carbohydrate metabolism that is diagnosed during Polyhydramnios, which may lead to preterm labor
pregnancy Progression of chronic systemic complications
the most common medical complication in pregnancy
carries certain risks to both the woman and her fetus,
those risks increase if the woman does not have FETAL AND INFANT RISKS
adequate blood sugar control during the perinatal
period Macrosomia
had a high maternal mortality rate in the past Intrauterine growth retardation
diagnosed during the 24th to 28th week of pregnancy Respiratory distress syndrome
and values generally return to normal after delivery Birth trauma or shoulder dystocia due to large for
occurs in less than 10% of all pregnancies in the U.S today gestational age
but a woman with a previous history of GDM has a 60- Hypoglycemia caused by withdrawal of maternal
70% risk of developing it with subsequent pregnancies. glucose
All women should be screened during their 24th to 28th
week of pregnancy and again 6 weeks postpartum.
2nd Semester
RHEUMATIC HEART DISEASE (RHD)

CLINICAL FEATURES
Case Scenario/ Situation:
The case was a 27-year-old patient in her first pregnancy Sore throat 1-5 weeks earlier is reported in two-
with severe mitral stenosis. Caesarean section was done for thirds of cases
fetal distress and she delivered a small for gestational age Fever, abdominal pain, and epistaxis
baby. She was closely monitored postpartum and was Migratory large-joint polyarthritis starting in the
stable on discharge. She presented with supraventricular lower limbs in 75% of cases
tachycardia and died in the coronary care unit 4 weeks Pancarditis in 50 % of cases with features of acute
postpartum. heart failure, mitral and aortic regurgitation, an
apical, and pericarditis
Rheumatiuc Heart Disease ← serious inflammatory disease Pancarditis ← inflammation of all the structures
that may occur in an individual 1-4 weeks following an of the heart
untreated throat infection. (sore throat) Chorea in 10-30%, usually 1-6 months after the index
Causative agent: Group A Beta-Hemolytic Streptococcus pharyngitis
bacteria
Can permanently affect the structure and function of the
heart, especially the heart valves. EFFECT ON THE MOTHER
Common areas of occurrence: mitral and aortic valve
A woman with cardiovascular disease needs an NOTE: Depends on the level of stenosis
interprofessional team approach to care during
pregnancy. She should visit her pregnancy care provider Pulmonary congestion leading to dyspnea
for preconception care so her state of health and Pulmonary HPN
baseline data when she is not pregnant can be Dizziness and fatigue due to decreased L ventricular
established. output
She should begin prenatal care as soon as she Dysrhythmia
suspects she is pregnant (1 week after the first missed Decreased perfusion of the renal system
menstrual period or as soon as she has a positive
home pregnancy test) so her general condition and
circulatory system can be monitored from the EFFECT ON THE FETUS
beginning of pregnancy.
The danger in a woman with cardiac disease occurs Decreased perfusion of the major organs including
because of increase in circulatory volume. the placenta
Intrauterine growth restriction
Nutritional requirements are not met resulting to
SGA babies
Perfusion ← the act of spreading or pouring over or through,

specifically the artificial passage of fluid through an organ
or tissue by way of the blood vessels.
The process whereby oxygen is carried from the lungs to
body tissues and carbon dioxide is carried from the
tissues to the lungs.
PATHOPHYSIOLOGY Pulmonary ← means lungs
Mitral Valve Stenosis ← Narrowing of the valve Deoxygenate ← to deprive an organism of oxygen
between the LA and LV
Congestion ← abnormal accumulation of blood in a part or
Narrowed Orifice an organ; Hyperemia
↓
Increase contraction of the Left atrium Stenosis ← abnormal narrowing or stricture of any canal or
↓ orifice
Left atrium pumping is inefficient
↓
Dysrhythmia ← disordered or abnormal rhythm
Left atrium Blood pulling
↓
Backflow of blood to the lungs & right side of the heart Small for gestational age (SGA) ← because of acidosis, which
↓ ↓ develops due to poor oxygen/carbon dioxide exchange or
Increased blood not enough nutrients. This results in preterm labor
Effect: Decreased
pressure, Peripheral
cardiac output
vasoconstriction
↓ ↓
Decreased stroke volume Increased heart rate
2nd Semester
PREGNANCY-INDUCED HYPERTENSION (PIH)

MANAGEMENT
Team approach in management S.J. is a 38-year-old primigravida at 32 weeks gestation. She
Prevention is the best strategy in RHD is a single mother, living with her parents and two sisters. She
Early prenatal for detection has a high-stress sales job being paid by commissions only.
Accurate assessment for s/s She admits that she doesn’t “eat right”. She says she doesn’t
Referral and follow-up have time to prepare meals and eats mostly fast foods and
Elevate head of bed while sleeping to relieve “junk food”. Her mother does cook for the family, but the
dyspnea meals are high in fat and sodium. S.J. is 5ft. 2 in. tall and her
Antihypertensive to control hypertension prepregnant weight was 180 lbs. S.J. has edema of the feet,
Decreased sodium diet ankles and hands.
UTZ and NST-ultrasound and non stress test
Balloon valve angioplasty Pregnancy-Induced Hypertension (PIH)
Anticoagulants occurs in 6-8% of all pregnancies and is the second-
Prophylaxis leading cause of maternal deaths
Ending the pregnancy and delivering the infant is a way
Balloon valve angioplasty ← procedure that widens a to treat the disease.
narrow or obstructed blood vessel using a balloon characterized by hypertension, edema, and proteinuria
catheter It is serious because of the arteriolar vasoconstriction,
used to treat atherosclerosis ← blood vessels systemic vasospasms, and vascular changes that occur.
obstruction Vasospasms ← result in fluid volume excess, resulting
in fluid retention
Prophylaxis classified as preeclampsia or eclampsia, depending on
Against rheumatic recurrences (long-acting the severity of the symptoms.
penicilin)
Also used against infective endocarditis RISK FACTORS
Medical treatment of:
heart failure Family history of hypertension
arrhythmia Weight extremes
infective endocarditis Diabetes
Captoprile (After load reducing agent) Multiple Pregnancy
Surgical treatment (Annuloplasty or valve Inadequate prenatal care
replacement) is indicated in severe mitral regurge Previous history of PIH
with Chronic renal disease
Recurrent heart failure RH incompatibility
cardiomegaly with pulmonary hypertension
Occurrence:
higher among primiparas
Surgical Management younger than 20 or older than 35
When heart failure persists or worsens after with chronic hypertension, diabetes mellitus, or
aggressive medical therapy for acute RHD, surgery renal failure
to decrease valve insufficiency may be life-saving women in lower socioeconomic groups
40% of patient with acute RHD subsequently
develop mitral stenosis as adults
Commissurotomy can be done to widen the valve DIAGNOSTIC TESTS AND LAB
In patients with critical stenosis, mitral valvulotomy,
percutaneous balloon valvuloplasty, or mitral valve Hemoglobin/ hematocrit
replacement may be indicated CBC
Liver enzymes
A woman with cardiovascular disease needs an Platelets
interprofessional team approach to care during D/C profile, clotting studies
pregnancy. She should visit her pregnancy care Chemistry panel, including: BUN, creatinine, glucose,
provider for preconception care so her state of health uric acid
and baseline data when she is not pregnant can be
established. She should begin prenatal care as soon as Preeclampsia ← characterized by hypertension with
she suspects she is pregnant (1 week after the first proteinuria or edema developing after 20 weeks gestation
missed menstrual period or as soon as she has a
positive home pregnancy test) so her general condition Eclampsia ← progression of preeclampsia characterized by
and circulatory system can be monitored from the epigastric pain, grand mal seizures, and coma
beginning of pregnancy. The danger in a woman with
cardiac disease occurs because of increase in
circulatory volume.
2nd Semester
Preeclampsia
COMPLICATIONS
Blood pressure: 140/90 or an increase of 30mmHg systolic
or 15mmHg diastolic PIH is a major cause of maternal and fetal death
Edema: 1+ pitting edema after being on bed rest for 12 Maternal complications: hemorrhage, cardiac
hours difficulties, disseminated vascular coagulation (DIC)
Sudden excessive weight gain (5 or more lbs a week) Eclampsia is associated with an increased risk for
Swelling of the feet, hands, and face that does not maternal death rate related to pulmonary edema,
resolve after bed rest for 12 hours organ failure, cardiac failure, or cerebral
Proteinuria (1+ or 2+, or greater than 3g/L in 24-hour hemorrhage.
specimen) Fetal complications of PIH include intrauterine
growth retardation (IUGR) and fetal distress caused
Eclampsia by hypoxia
Seizures (grand mal) or coma (preceded by further HELPP syndrome reflects severity of the disease
increase in BP, Headache, blurred vision, epigastric pain, Hemolysis, Elevated, Liver enzymes, Low,
and nausea and vomiting) Platelets
Severe Preeclampsia
Blood pressure of 160/110 or higher
Extensive edema, including pulmonary INFECTIONS IN PREGNANCY
Cyanosis
Decreased urine output
VIRAL SEXUALLY-TRANSMITTED INFECTIONS
Continuing weight gain of more than 2 pounds/ week
Nausea and vomiting Case Scenario/ Situation:
Headache A 30-year old G3P2 woman presents for antenatal care (ANC)
Epigastric pain (sign that disease is worsening) at 16 weeks of gestation. Her previous pregnancies were
Increased hematocrit uneventful. She complains of a yellowish foul-smelling
Proteinuria (3+ or 4+ or greater than 4g/L in 24 hours) vaginal discharge. She reports no other previous or current
health problem. Physical examination was normal.
THERAPEUTIC NURSING MANAGEMENT Hemoglobin was 30g/dl, RPR negative, HIV negative and Rh
positive. She gives a sigh of relief with the HIV test result. You
Take vital signs frequently, especially blood
manage her as a “case of vaginal discharge syndrome in a
pressure.
pregnant woman”. You write a contact slip for the sexual
Assess edema and document 1+, 2+, 3+, 4+.
partner, advise safe sex and order repeat HIV test of the
Record daily weight
possibility of a window period.
Encourage a high protein diet
Position client on left side
Viral sexually-transmitted infections
Test urine for protein/ specific gravity every 8 hours
also known as sexually transmitted diseases
Measure and record intake and output
Can occur as a result of direct intimate contact, such as
Assess deep tendon reflexes every 2-4 hours
kissing with an infected individual
Insert Foley catheter (as ordered)
Viruses - highly transmissible during the shedding period
Implement seizure precautions
It is impossible to know when the virus is shedding, but
Assess for increasing symptoms
it is important to know that transmission is highest
Assemble oral airway, suction, and oxygen
when there is visible lesion
equipment at bedside
Causative organisms: viral, bacterial or protozoan can
Assess fetal status by FHR and fetal movement
coexist
sheet
Approximately 15 million new cases are diagnosed
Ensure bed rest or restricted activity
annually, with the incidence of STIs peaking during
Decrease environmental stimuli
adolescence.
Prepare client for non-stress tests (NST) to assess
The prevalence of viral STIs exceeds that of bacterial
fetal well-being
STIs.
If situation becomes critical, prepare client for
Some STIs are chlamydia and gonorrhea, if left
immediate C-section.
untreated, can lead to long-term health problems
such as pelvic inflammatory disease, infertility,
chronic pelvic pain and ectopic pregnancy.
PHARMACOLOGIC MANAGEMENT
Magnesium sulfate (MgSO4) ← to control seizures Herpes Simplex Virus (HSV-1) ← occurs generally in the mouth
BURP - BP decreased, Urine output decreased, but can be transmitted to the genital area during oral sex
respirations <12, patella reflex absent cold sores
antidote: Calcium gluconate HSV-2 can also be transmitted to other areas of the body
during intimate contact
The first time a woman contracts an HSV-2 infection,
systemic involvement occurs. The virus spreads into
the bloodstream (viremia) and, if a woman is
pregnant, can cross the placenta to a fetus, thus
posing substantial fetal risk.
2nd Semester
BACTERIAL SEXUALLY-TRANSMITTED INFECTIONS

Human Papilloma Virus (HPV) ← has over 80 strains, some
which have oncogenic potential often co-exist and many times do not have outward
There is now a vaccine available to prevent two known symptoms of infection. If left untreated, these infections
types of HPV which cause cervical cancer. can impact on a woman’s ability to bear children due to
scarring from untreated infections.
RISK FACTORS If a woman does not, she is infected, she can
unknowingly pass the infection to someone else. It is
sexually active (anal, oral, or vaginal) with multiple
important that every partner is treated before engaging
sexual partners w/ or w/o barrier contraception
in sexual activity again.
substance abuse
gay or bisexual males
Chlamydia
those not in a mutually monogamous relationship
called a “silent” or “invisible” infection
those who exchange sex for money or drugs
it shows almost no external symptoms but internally
those who have been previously infected with an STI
may cause a mucopurulent cervical discharge and
slight cervical redness
can cause pneumonia or conjunctivitis in a newborn
TYPES OF VIRAL STI
The incubation period is 1 to 5 weeks; symptoms include a
Herpes heavy, grayish-white discharge and vulvar itching.
Causative Organism: Herpes simplex virus (HSV) Long-term effects of chlamydial infections: PID, possibly
Signs and Symptoms: Prodrome pain, burning, leading to subfertility.
itching at site, tiny vesicles or ulcerations; flulike or Causative Organism: Chlamydia trachomatis
urinary tract infection symptoms. Signs and Symptoms: Usually asymptomatic, irregular
Diagnosis: clinical exam - HSV culture (Tzanck menses, postcoital spotting, purulent cervical discharge,
smear) or Herpes Select (serum) dysuria
Management and Treatment: Valacyclovir, Diagnosis: Culture, DNA probe, enzyme immunoassay,
acyclovir, Famciclovir, prevention of secondary nucleic acid amplification
bacterial infections Management and Treatment: Azithromycin single dose;
doxycycline, erythromycin or amoxicillin in pregnant
Human papilloma virus (HPV)
Causative Organism: Over 80 strains identified Gonorrhea
Signs and Symptoms: Perineal itching; visible warty causes such a severe conjunctivitis
growths anywhere in perineum, vagina, cervix, or can lead to blindness
rectal area Untreated, the infection spreads easily among sexual
Diagnosis: Clinical exam, viral DNA testing partners and may spread to the testes, scarring the
Management and Treatment: Patient applied: tubules and causing permanent sterility. It often occurs
imiquimod 5% cream or podofilox 0.5%; Provider concurrently with a chlamydial infection.
applied: phodophylin resin, Trichloroacetic acid Although symptoms of gonorrhea in females are not as
(TCA), or bichloracetic acid (BCA); cryotherapy; laser visible, there may be a slight yellowish vaginal discharge.
surgery if severe The Bartholin glands may become inflamed and painful.
If left untreated, the infection can spread to pelvic
Hepatitis B and C organs, most notably the fallopian tubes, can cause PID,
Causative Organism: Hepatitis B virus and, as in males, tubal scarring with permanent sterility.
Signs and Symptoms: Flulike symptoms, rash, In both males and females, if systemic involvement
abdominal pain, dark urine, scleral icterus, jaundice occurs, arthritis or heart disease can develop.
Diagnosis: Hepatitis antibodies and surface Causative Organism: Neisseria gonorrhoeae (thrives on
antigens, liver function tests, liver ultrasound the mucus membrane of vagina/penis)
Management and Treatment: Symptomatic - Signs and Symptoms: Usually asymptomatic, purulent
universal precautions, hepatitis C treated with cervical discharge, menstrual irregularities, pelvic pain
interferon-alpha-2b Diagnosis: Thayer-Martin cultures
Thayer-Martin Agar ← used for the isolation of
Human Immunodeficiency Virus (HIV) pathogenic Neisseria from specimens containing
HIV is carried by semen as well as other body fluids, mixed flora of bacteria and fungi
so, although not officially listed as such, is an STI. Management and Treatment: Cefixime, ceftriaxone,
Causative Organism: Retrovirus ciprofloxacin, ofloxacin, levofloxacin, treat presumptively
Signs and Symptoms: Persistent flulike symptoms for chlamydia
Diagnosis: Complete blood count with differential,
erythrocyte sedimentation rate, CD4 levels, HIV Syphilis
antibodies (must have informed consent) systemic disease transmitted by the spirochete
Management and Treatment: Antiretrovirals Treponema pallidum
a sexually transmitted infection, is of great concern for
the maternal–fetal population.
2nd Semester
After an incubation period of 10 to 90 days, a deep ulcer Signs and Symptoms: Asymptomatic in 50% of women,
(termed a chancre), which is usually painless despite its yellow/green frothy malodorous vaginal discharge,
size, appears usually on the genitalia (penis or labia) or in dysuria, dyspareunia
the vagina, on the mouth, lips, or rectal area from oral– Diagnosis: Wet mount, culture
genital or genital–anal contact. Management and Treatment: Metronidazole single dose;
Early in pregnancy, when the cytotrophoblast layer of treat all partners
the chorionic villi is still intact, its causative spirochete Metronidazole - 2g in single dose; withhold
apparently cannot cross the placenta and damage the breastfeeding during treatment and 12-24 hours after
fetus. When this layer atrophies at about the 16th to 18th dose
week of pregnancy, however, the spirochete can cross Tinidazole - withhold breastfeeding during treatment
and cause extensive fetal damage. and 3 days after dose
If syphilis is detected in the mother and treated with an
antibiotic such as intramuscular benzathine penicillin in
the first trimester, a fetus is rarely affected. If left CLIENT WITH EXPOSURE TO RUBELLA
untreated beyond the 18th week of gestation, hearing
impairment, cognitive challenge, osteochondritis, and Case Scenario/Situation:
fetal death are possible. A.J. has just given birth. She will go home 48 hours after the
Despite the availability of accurate screening tests and delivery. She is breastfeeding her baby. Her antepartum
proven medical treatment, it is growing in incidence; it rubella titer was 1.8.
places a fetus at risk for intrauterine or congenital
syphilis. Rubella ← viral infection transmitted by droplet (sneezing)
Newborn with congenital syphilis - may have congenital also called German measles or 3-day measles
anomalies, extreme rhinitis (sniffles), and a characteristic highly infectious disease caused by a virus, which
syphilitic rash, all of which identify the baby as high risk produces a fever and rash 14-21 days after exposure.
at birth. The virus enters the upper respiratory system and after 7-
Syphilis during pregnancy can cause serious problems 10 days, enter the blood stream.
for your baby, like being born too soon or too small. It The fetus is at risk if the infection occurs during the first
also can cause death for your baby before or after birth. trimester.
If your baby is born with syphilis, it can cause lifelong Congenital rubella infection - frequently results in
problems with: Eyes and ears (like being blind or deaf); congenital anomalies, deafness, and even fetal death.
Teeth, bones and joints Pregnant women should not be vaccinated because of
Causative Organism: Treponema pallidum the risk of acquiring the disease.
Signs and Symptoms: Period of active symptoms and All pregnant women should be screened for rubella.
latency. titer of 1.8 or less = susceptibility to infection
Primary - chancre titer of 1:16 = immunity
Secondary - maculopapular rash on palms and soles The infection can lead to defective fetal development
Tertiary - central nervous system, cardiovascular directly related to organ formation at the time of
changes; gumma lesions maternal exposure. Rubella can result in fetal blindness,
Diagnosis: Venereal Disease Research Laboratory (VDRL) hearing loss, heart disease, mental retardation, or
or rapid plasma reagent (RPR). demise.
To confirm: fluorescent treponemal antibody absorbed Women of childbearing age who are not pregnant
and micro hemagglutination assays for antibody to T. should be immunized against rubella
pallidum Pregnant women should not be vaccinated because
Management and Treatment: Penicillin G: if penicillin of the possibility of developing a rubella infection
allergic, doxycycline or tetracycline while pregnant.
If syphilis is detected in the mother and treated with an Signs and Symptoms: red rash, red eyes, fever, light
antibiotic such as intramuscular benzathine penicillin in cough, swollen lymph nodes, join pain (arthritis)
the first trimester, a fetus is rarely affected. If left
untreated beyond the 18th week of gestation, hearing RISK FACTORS
impairment, cognitive challenge, osteochondritis, and
fetal death are possible. Rubella antibodies (unimmunized)
Children in the home (unimmunized)
Trichomoniasis
Causative Organism: Trichomonas vaginalis
Trichomonas vaginalis ← organism that lives in the DIAGNOSTIC TESTS AND LAB
female genitalia and is a sexually transmitted infection.
Characteristic: green or yellow frothy vaginal discharge, Screening done in early pregnancy for presence of
and most women are unaware they have been infected rubella antibodies (titer of 1:16 or more indicates
until they become symptomatic. immunity – a titer of 1:8 indicates susceptibility to
There is no incubation period for it. Easily treated with a infection).
single dose antibiotic, it is important that both or all Hemagglutination inhibition test (HAI)
partners are treated before having sexual intercourse Radioimmunoassay test (RIA)
again.
2nd Semester
THERAPEUTIC NURSING MANAGEMENT RISK FACTORS

If no previous immunity, rubella vaccine is given to Previous pre-pregnant anemia
the woman post-delivery Poor nutritional status
Instruct the client to avoid pregnancy for at least 3 Close spacing of pregnancies
months if there is exposure to the virus or if post- Twin gestations
rubella immunization is provided. Excessive vaginal bleeding prior to or as result of
pregnancy.
COMPLICATIONS Risks of anemia during pregnancy

However, if anemia is left untreated, it can become
Rubella acquired in the first trimester is associated
severe, causing poor fetal growth, preterm birth or low
with fetal loss and congenital anomalies including
birth weight as well as increasing your risk of needing a
intrauterine growth retardation and deafness.
blood transfusion during delivery or having postpartum
Intrauterine rubella infection is associated with
depression.
deafness, congenital cataracts or glaucoma, heart
disease, liver impairment with jaundice, chronic
pneumonitis, and blood formation disorders,
DIAGNOSTIC TESTS AND LAB
including anemia and thrombocytopenia.
Hemoglobin Level
Hematocrit level
Nutritional History
ANEMIA IN PREGNANCY Serum ferritin
Case Scenario/Situation: defective form of hemoglobin - sickle cell anemia

T.C. is in the 26th week of her pregnancy. Her hemoglobin is adults - sample is drawn from a vein in the arm
9.5 g/dL, and her hematocrit is 30%. She says, “My sister’s children - blood sample from finger or heel
hemoglobin was low, too. They said it was normal, though,
because your blood is thinner during pregnancy, I’m glad I’m
What causes anemia in pregnancy?
not anemic.”
Iron deficiency is the most common cause of anemia in
pregnancy.
Key Points
Folate-deficiency anemia
Iron requirements double during pregnancy to 30
Folate ← vitamin found naturally in certain foods like
mg/day.
green leafy vegetables
Iron is needed for maternal hemoglobin formation and
a type of B vitamin, the body needs folate to produce
for fetal stores.
new cells, including healthy red blood cells.
It is nearly impossible to ingest enough dietary iron to
During pregnancy, women need extra folate.
meet the iron requirements of pregnancy.
Medical guidelines recommend that all pregnant women
How does iron deficiency anemia during pregnancy affect
receive a supplement of 30 mg of ferrous iron daily,
the baby?
beginning at 12 weeks of gestation
Severe anemia during pregnancy increases your risk of
pregnant women with iron deficiency anemia receive
premature birth, having a low-birth-weight baby and
60-120 mg daily
postpartum depression. Some studies also show an
Complications:
increased risk of infant death immediately before or
preterm birth
after birth.
poor wound healing
infection
How common is anemia in pregnancy?
cardiac failure during labor
2 billion of the world's population is anemic
more common in women then men
Iron deficiency anemia ← most common hematological
Prevalence
disorder in pregnancy
29% of non-pregnant
nutritional disorder in which the blood lacks adequate
38% of pregnant women
healthy RBC with hemoglobin less than 12 g/dL
Maternal blood volume increases by 1,500 mL during
Signs and Symptoms:
pregnancy, so iron is needed to expand the maternal red
Hemoglobin level below 10 mg/dL
blood cell mass.
Hematocrit level below 35%
Maternal iron requirement raises significantly the last
Fatigue/ pallor
half of the pregnancy as the fetus’s requirement
Susceptibility to infection
increase.
Intolerance to blood loss after delivery
This leads to the depletion of maternal iron stores. Diet
alone cannot replace gestational iron losses. Even
women with good nutrition will most likely end pregnancy
with an iron deficit if they do not take an iron supplement
during pregnancy.
2nd Semester
How is anemia treated during pregnancy? Substance abuse ← addiction to or continued use of an
Anemia during pregnancy can easily be treated by illegal or prescribed substance/drug even though it is
adding iron or vitamin supplements to your daily routine. causing physical, social, or interpersonal problems.
Typically, this is all that is needed to reverse the effects Any use of alcohol or illicit drugs during pregnancy is
of anemia. However, in very rare cases, women with considered substance abuse.
severe anemia may need a blood transfusion. inability to meet major role obligations, an increase in
legal problems or risk-taking behavior, or exposure to
THERAPEUTIC MANAGEMENT hazardous situations because of an addicting substance
Tobacco and alcohol ← the most frequently abused
Provide education about food sources rich in iron, substances in pregnancy.
fortified cereals, enriched breads, liver, meat, dried Risk factors: psychiatric illness, physical or sexual, low-
fruits (e.g., raisins) leafy green vegetables, and self-esteem
legumes. Some women do not tolerate iron Any use of alcohol or illicit drugs during pregnancy is
supplements well, so food sources are important considered “abuse” because of the serious effects of the
Instruct about the need for high fluid intake and a fetus and neonate.
high-fiber diet to prevent constipation. nicotine, alcohol, cocaine, marijuana, narcotics,
Instruct about the need for supplemental iron. hallucinogens, stimulants, sleeping pills, tranquilizers,
Instruct that Vit. C will increase absorption. and pain relievers
Teach mother that iron will produce a black stool Maternal substance use during the first trimester places
and may cause other gastrointestinal symptoms the fetus at the greatest risk.
such as gas and nausea Risk increases with the strength, amount, frequency,
If it can be tolerated, iron is best absorbed if taken and route of administration.
when stomach is empty. can disturb relationships, create dependency, and
Milk inhibits absorption. cause serious health problems
Prenatal alcohol exposure ← most common preventable
cause of mental retardation.
PHARMACOLOGIC MANAGEMENT Every pregnant woman should be screened for
substance abuse (at least verbally) at the first
Oral - ferrous sulfate or ferrous gluconate
prenatal visit, so that intervention can begin early.
Parenteral (if oral not tolerated) - iron-dextran
However, women who abuse drugs often do not
complex (Imferon)
receive prenatal care.
Substance dependent ← person has withdrawal
symptoms following discontinuation of the substance,
COMPLICATIONS
combined with abandonment of important activities,
Congestive Heart Failure during labor spending increased time in activities related to the
Poor wound healing substance use, using substances for a longer time than
Increased risk for postpartum hemorrhage and planned, or continued use despite worsening problems
infection because of substance use.
Preterm birth
Risk for small for gestational age (SGA) babies RISK FACTORS
Maternal: Age (e.g., women ages 21-34 have the highest rates
Repeated infections due to decreased body of specific alcohol-related problems during
resistance to infections pregnancy)
preterm labor Previous alcohol and tobacco use
late abortions Sexual promiscuity
cardiac failure Depression and anxiety disorders
circulatory shock Low self esteem
lack of normal extra volume reserve Insomnia
puerperal sepsis Physical or sexual abuse
impaired involution of uterus
lactation difficulties
Urine toxicology screen for specific drugs
Serum toxicology screen for specific drugs and
A WOMAN WITH SUBSTANCE ABUSE alcohol

An adolescent comes to the clinic for the first time when she
is in the third trimester of pregnancy. She has gained only
five pounds over her stated pre-pregnant weight. Her
partner confides to the nurse that the client “drinks a lot of
alcohol.”
2nd Semester
Fetal Alcohol Syndrome (FAS) ← Prenatal and postnatal

SIGNS AND SYMPTOMS
growth restriction
Specific signs and symptoms depend on the substance central nervous system malfunctions (including mental
being used/abused. retardation)
facial features such as microcephaly, small eyes,
Signs of maternal addiction to some kind of drug flattened nasal bridge, and a thin upper lip
include: FAS may also include other craniofacial anomalies
Constricted pupils no philtrum
Dental caries The incidence of learning delays and behavioral
Mood swings abnormalities, such as attention deficit hyperactivity
Rhinitis disorder (ADHD) or oppositional behavioral disorder, are
Frequent falls/accident greater in children exposed to alcohol prenatally.
Anorexia Tobacco effects
Weight loss Prematurity
Poor hygiene low birth weight
No prenatal care increased risk for respiratory disorders
Irregular, fast heart rate developmental delays
Recurrence of sexually transmitted diseases sudden infant death syndrome (SIDS)
Signs of withdrawal in newborn hours after birth:

Listlessness HEMOLYTIC DISEASE OF THE FETUS & NEWBORN
Poor muscle reflexes
Poor feeding, uncoordinated suck, swallow Hemolytic - Latin for “destruction” (lysis) of red blood cells
High pitched cry A certain degree of lysis of red blood cells in the new-
Restless sleeping born results from the destruction of red blood cells by a
Inability to be consoled when crying normal
Hematologic disorders during pregnancy involve either
blood formation or coagulation disorders.
THERAPEUTIC NURSING MANAGEMENT
Hemolytic disease of the fetus and newborn
Identify drug abuse early; incorporate questions or an immune reaction of the mother’s blood against the
self-report questionnaires into routine prenatal blood group factor on the fetus’ RBCs.
interviews. When RhoGAM (Rh immune globulin) became available
Intervene and teach client to stop drug abuse and in the 1960s to treat isoimmunization in Rh-negative
improve general health. women, the incidence of hemolytic disease in the fetus
Refer for rehabilitation. and newborn dropped significantly.
Be aware of laws regarding prenatal drug use in
some states, the child must be referred to child ETIOLOGY
protective services
Hemolytic disease ← occurs most frequently when the
mother does not have the Rh factor present in her
MATERNAL COMPLICATIONS blood but the fetus has this factor.
Another common cause of hemolytic disease is ABO
High blood pressure incompatibility.
Anemia most cases - the mother has blood type O and
Nutritional deficiencies the fetus has blood type A.
Pancreatitis It may also occur when the fetus has blood type
Alcohol hepatitis and cirrhosis B or AB.
Hemolysis - caused by maternal anemias
thalassemia or from other blood group antigens
COMPLICATIONS IN FETUS AND NEWBORN (anti-D)
Rh incompatibility → hydramnios - increase in
Newborn addiction and withdrawal
amount of amniotic fluid (normal-1000 mL)
Abruptio placenta
Fetus: Intrauterine Growth Retardation (IUGR)-
cocaine, heroin, amphetamines
Long-term learning disabilities and delayed
language development
2nd Semester
PATHOPHYSIOLOGY NURSING MANAGEMENT

This disorder occurs when the fetus has a blood Administer RhoGAM to the unsensitized Rh-negative
group antigen that the mother does not possess. client as appropriate.
The mother’s body forms an antibody against that Administer RhoGAM at 28 weeks’ gestation, even
particular blood group antigen, and hemolysis when titers are negative, or after any invasive
begins. procedure, such as amniocentesis
maternal sensitization ← process of antibody RhoGAM ← protects against the effects of early
formation transplacental hemorrhage
The fetus has resulting anemia from the hemolysis When the Rh-negative mother is in labor,
of blood cells. The fetus compensates by producing crossmatch for RhoGAM, which must be given within
large numbers of immature erythrocytes, a 72 hours of delivery of the newborn.
condition known as erythroblastosis fetalis,
hemolytic disease of the newborn, or hydrops Provide management for the sensitized Rh-negative
fetalis. mother and Rh-positive fetus.
Erythroblastosis fetalis ← fetus compensates by Focus management of the sensitized Rh-negative
producing large numbers of immature mother on close monitoring of fetal well-being as
erythrocytes, hemolytic disease of the newborn. reflected by Rh titers, amniocentesis results, and
Hydrops ← edema; fetalis ← lethal state of the sonography.
infant If there is evidence of erythroblastosis, notify the
In Rh incompatibility, the hemolysis usually begins in prenatal team of the possibility for delivery of a
utero. It may not affect the first pregnancy, but all compromised newborn.
pregnancies that follow will experience this
problem. Provide management for ABO incompatibility.
In ABO incompatibility, the hemolysis does not Phototherapy usually can resolve the newborn
usually begin until the birth of the newborn. jaundice associated with ABO incompatibility
cover the eyes and genitals of the newborn
Phototherapy ← use of visible light for the
ASSESSMENT FINDINGS treatment of hyperbilirubinemia in the newborn.
This relatively common therapy lowers the
Clinical manifestations serum bilirubin level by transforming bilirubin
The hemolytic response in ABO incompatibility into water-soluble isomers that can be
usually begins at birth with a resulting newborn eliminated without conjugation in the liver.
jaundice. The dose of phototherapy largely determines
Rh incompatibility may lead to: how quickly it works; the dose, in turn, is
Hydramnios in the mother determined by the wavelength of the light,
Excess bilirubin levels in the amniotic fluid the intensity of the light (irradiance), the
Varying degrees of hemolytic anemia distance between the light and the infant,
(erythroblastosis) in the fetus. and the body surface area exposed to the
If the condition is left unmanaged, 25% of light.
affected infants may die or suffer permanent Initiation of early feeding and exchange blood
brain damage. transfusions may be immediate measures required
to reduce indirect bilirubin levels.
Laboratory and diagnostic study findings
Indirect Coombs test ← can aid in the search for
agglutination of Rh-positive RBCs to determine if
antibodies are present.
SIGNIFICANT ANTEPARTUM COMPLICATIONS
Amniocentesis ← used to determine optical density
and estimate fetal hemolysis
Spectrophotometer readings ← made of the 1ST TRIMESTER BLEEDING
amniotic fluid collected. The readings are obtained
The time during pregnancy at which bleeding occurs
to determine fluid density. They are plotted on a
helps to identify its cause.
graph and correlated with gestational age. The
2 most common causes of bleeding during the first
amount of bilirubin resulting from the hemolysis of
trimester
red blood cells can then be estimated.
spontaneous miscarriage (abortion)
Antibody titer ← should be drawn at the first
ectopic pregnancy
prenatal visit on all Rh-negative women.
should be drawn at 28 and 36 weeks of
pregnancy and again at delivery or abortion.
normal value = 0; The result is usually reported as
a ratio; normal is 1:8. If the titer is absent or
minimal (1:8), no therapy is needed.
A rising titer indicates the need for RhoGAM and
vigilant monitoring of fetal well-being.
2nd Semester
SPONTANEOUIS MISCARRIAGE (ABORTION)

COMPLICATIONS
Abortion (Miscarriage) ← Pregnancy that ends before the
fetus can survive outside the uterus is called an abortion. Incomplete abortion ← part of the products of
Abortions occur in the first or second trimester before 20 conception are not expelled
weeks gestation, and are either spontaneous or induced. Missed abortion ← the fetus dies but is not expelled
Miscarriage ← is the lay term, but is becoming more for 4-6 weeks after fetal loss
widely used among healthcare workers because the Disseminated intravascular coagulation (DIC)
term abortion has negative connotations for some following long duration of missed abortion in first
women. trimester
Spontaneous abortion ← occurs naturally, without Hemorrhage
outside intervention Infection
Induced abortion ← intentionally-produced loss of
pregnancy by a woman or others. This is also known as
elective abortion TYPES OF ABORTION
RISK FACTORS Threatened miscarriage

early-under 18 weeks; late-16 to 24 weeks
Defects in ovum or sperm Cause: Unknown; possibly chromosomal; uterine
Inadequate intrauterine environment, defective abnormalities
implantation Assessment: Vaginal spotting, perhaps slight
Maternal diseases that predispose to abortion: cramping
infection, diabetes, hormonal deficiencies,
incompetent cervix Missed miscarriage
Fetal or placental developmental defects, genetics Assessment: Vaginal spotting, perhaps slight
cramping; no apparent loss of pregnancy
Caution: Disseminated intravascular coagulation,
SIGNS AND SYMPTOMS associated with missed miscarriage
Vaginal bleeding Imminent (Inevitable) miscarriage

Abdominal uterine cramping Assessment: vaginal spotting, cramping, cervical
Low backache dilatation
Eventual rupture of membranes and dilation of
cervix Incomplete miscarriage
Assessment: Vaginal spotting, cramping, cervical
dilatation, but incomplete expulsion of uterine
THERAPEUTIC NURSING MANAGEMENT contents
Take a health history Complete miscarriage

Document onset, duration, amount and character of Assessment: Vaginal spotting, cramping, cervical
bleeding. dilatation, and complete expulsion of the uterine
Monitor vital signs. contents.
Prepare for a dilation and curettage (D&C) if
spontaneous abortion in first trimester.
Recurrent Pregnancy Loss
Provide emotional support.
Habitual aborters ← women who had 3 spontaneous
Provide bed rest.
miscarriages that occurred at the same gestational age
Instruct to avoid intercourse until the bleeding
they were advised they were apparently too
stops.
“nervous” or that something was so wrong with their
hormones that childbearing was not for them
Recurrent pregnancy loss ← used to describe the
THERAPEUTIC NURSING MANAGEMENT miscarriage pattern, and a thorough investigation is
done to discover the cause of the loss and help ensure
Take a health history
the outcome of a future pregnancy.
Document onset, duration, amount and character of
occurs in about 1% of women who want to be
bleeding.
pregnant; many occur for unknown reasons
Monitor vital signs.
Possible causes:
Prepare for a dilation and curettage (D&C) if
Defective spermatozoa or ova
spontaneous abortion in first trimester.
Endocrine factors - lowered levels of protein bound
Provide emotional support.
iodine (PBI), butanol-extractable iodine (BEI), and
Provide bed rest.
globulin-bound iodine (GBI), poor thyroid function, or
Instruct to avoid intercourse until the bleeding
luteal phase defect.
stops.
Deviations of the uterus - septate or bicornuate
uterus
Infection
Autoimmune disorders - lupus anticoagulant and
antiphospholipid antibodies.
2nd Semester
ECTOPIC (TUBAL) PREGNANCY

Palpable adnexal mass or unilateral tenderness on
Case Scenario/ Situation: bimanual examination
A 31-year-old female presents to the emergency room with (+) pregnancy test
sudden pain radiating from her mid abdomen to her right Missed menses
shoulder. The patient reports that she is also experiencing Dark red or brown vaginal bleeding
light vaginal bleeding. Upon questioning the nurse finds out once ruptured
the patient has an IUD and that she missed her last period. Complains of referred shoulder pain (due to
The patient is currently sexually active with multiple partners diaphragmatic irritation from bleeding into the
as well. peritoneal cavity)
the patient may also exhibit syncopal symptoms
Ectopic pregnancies ← implantation of a fertilized ovum due to hypovolemia.
outside of the endometrial cavity
can occur within the fallopian tube or anywhere outside
of the uterus because the fertilized embryo is implanted DIAGNOSIS AND TREATMENT
into an inhospitable environment, it can cause rupture of
the structure it is in, causing hemorrhage and death. Β-Human chorionic gonadotropin tests will be
Approximately 95% of ectopic pregnancies occur elevated if there is a pregnancy. Those levels double
within the fallopian tube, but implantation can also every few days in a normal intrauterine pregnancy.
occur on the ovary, and within the cervix or Low Β-human chorionic gonadotropin levels are
abdominal cavity. indicative of impending pregnancy loss.
Women who have had pelvic surgeries, IUDs or pelvic Hemoglobin and hematocrit levels determine
infections are at the greatest risk for developing an blood loss. Pelvic ultrasound tests confirm the
ectopic pregnancy. presence of a tubal pregnancy.
Signs and symptoms: often subtle, such as mild to Culdocentesis ← may be performed to determine
moderate menstrual cramping of progressing to intraperitoneal bleeding; determines if there is
localized and extreme pain. Women do not know they blood in the space behind the uterus
have an ectopic pregnancy until the pain is so severe done by insertion of a needle through the
that they seek treatment. vaginal wall into the cul-de-sac.
As the embryo grows, rupture of the structure is Nonclotted blood is indicative of hemorrhage.
inevitable. If it is confirmed that the patient has an ectopic
It is the leading cause of pregnancy-related deaths in pregnancy, surgical intervention, such as
the first trimester secondary to hemorrhage. laparoscopy or laparotomy, is indicated if the
patient has life-threatening symptoms.
CONTRIBUTING FACTORS Results of a culdocentesis:
negative - by the presence of clear fluid.
Any woman with history of pelvic inflammatory positive - free flow of nonclotting blood-
disease, a history of abdominal or pelvic surgery, or intraperitoneal hemorrhage is diagnosed. But
who uses an intrauterine device (IUD) has an if not, ectopic pregnancy cannot be excluded
increased risk of an ectopic pregnancy. Nondiagnostic - No fluid
Tubal scarring ← decreases the ability of the Hematocrit of the aspirate is helpful.
fertilized ovum to move through the fallopian tube, Nonsurgical management - use of methotrexate
causing it to become implanted into the wall of the intramuscularly, prostaglandins, or misoprostol in
tube itself. stable patients who prefer not to undergo surgery
As the pregnancy progresses, serum human and whose mass is less than 4 cm and is unruptured
chorionic gonadotropin levels continue to rise
while the fetus continues to grow
Infectious Disease in Pelvic or Female Organs
Defect in The Structure of Fallopian Tube 2ND TRIMESTER BLEEDING
Different Contraceptive Method to Help Childbirth
Infertility Or Method to tackle Infertility
GESTATIONAL TROPHOBLASTIC DISEASE
Habit of Smoking (HYDATIDIFORM MOLE-H MOLE)
SIGNS AND SYMPTOMS Ms. Soz. A. 34-year-old woman, she is vegetarian, married for
7 years,Gravida 3, Para 0 @ 14 weeks GA. The previous
It is difficult to diagnose an ectopic pregnancy until the
abortions were at 7&8 weeks. She complains of: mild vaginal
patient experiences consequences of an impending
bleeding for 4 days, nausea and moderate vomiting.
rupture.
Bright red spots commenced & days before which she

Unilateral lower quadrant pain is generally the first
thought was normal in pregnancy. However since then the
symptom of an ectopic pregnancy. The pain may be
bleeding is almost as heavy as period, there are no clots,
dull to constant or colicky in nature and progressively
mild abdominal pain, systemically she has nausea for 3
worsens. Symptoms are not apparent until the tube
weeks and vomit periodically. There is no other significant
ruptures when the embryo becomes too large.
gynecologically history.
2nd Semester
Examination:
The patient had a blood pressure of 100/70 and a pulse of Tissue is sent to pathology for further examination
100 bpm. and confirmation of diagnosis.
She was well orientated, afebrile and had a slight pallor. Serum β-human chorionic gonadotropin levels are
She had some lower abdominal discomfort with more monitored until they return to nonpregnant levels.
tenderness at the right iliac fossa, but there was no
rebound or guarding.
On speculum examination: reveals closed cervix with
some blood coming from cervical canal. PREMATURE CERVICAL DILATATION
Bimanual examination: uterus feels bulky and soft, (INCOMPETENT CERVIX)
approximately 10 week in gestation.
There is no adnexal tenderness or cervical excitation In a normal pregnancy, the cervix remains open until the
Serology ↑ β-hCG: B-HCG was 7981 U/l. moment of delivery when it starts to dilate and thin to allow
Cross match and grouping: A+ , Hb was 8.0 g/l. the passage of the baby.
Ultrasound: increase uterine echogenicity classically
have "snowstorm" appearance with no fetus. Cervical incompetence ← medical condition where the
Gross pathology: "honeycombed uterus" or "cluster of cervical dilation triggers prematurely, without being caused
grapes" gross appearance by birth, but rather by the weakness of the cervix itself
can have various causes, the most important one being
Molar pregnancies ← rare but occur as a result of an a wound on the cervix.
overproduction of placental cells which produce a mass but pathology associated with pregnancy in which the cervix
not a pregnancy. opens before the pregnancy reaches the term or in the
Patients will have positive pregnancy signs such as a absence of labor.
missed menses, a positive pregnancy test, breast The effects of a cervical insufficiency are noticed during
tenderness and nausea. The patient will also have a the second and third trimester of pregnancy, when the
larger than gestational age-sized uterus. internal cervix opens, followed the premature rupture of
membranes and abortion or preterm birth, depending on
Hydatidiform moles ← form of gestational trophoblastic the moment of pregnancy development.
disease and is a result of a higher than normal production of
the cells that originate in the placenta. This overproduction Normal Length of a Cervix
of cells produces a mass instead of a viable pregnancy. 4-5 cm when not expecting
are also known as a molar pregnancy A study discovered that at 24 weeks of pregnancy, the
Incidence: 1 in every 1,000 pregnancies and increases average length of the cervix is of 3.5 cm.
with advanced maternal age When the length of the cervix is under 2.2 cm, a woman
Etiology: unknown might face a 20% probability of premature birth
2 types of hydatidiform moles
complete (or classic) Causes of cervical incompetence:
partial Cervical trauma due to some obstetric or gynecological
Approximately 10-15% of hydatidiform moles may develop procedures (conization, dilation for aspiration or
into invasive moles or, more rarely, choriocarcinoma, a curettage, cracks during a previous birth, etc.).
malignant form of cancer. Congenital causes – weaken the cervix
An incompetent cervix cannot support the fetus’s weight

SIGNS AND SYMPTOMS and dilates without any contractions or pain, sometimes
Similar to an early pregnancy: Amenorrhea, Breast opening completely.
tenderness, Nausea
(+) pregnancy test Due to dilation, the amniotic membranes “drop” through the
Vaginal bleeding may occur at about the 12th week opening and break, which irritate the uterus and lead to
in 95% of all cases. The client may believe she is labor, often even before the fetus is able to survive outside
experiencing a spontaneous abortion. the uterus. In a lot of cases, labor is too advanced to be
Examination may reveal an abnormal growth in the stopped.
size of the uterus for gestational age.
Symptoms similar to preeclampsia; hypertension, Causes of a short cervix:
edema, and proteinuria. Surgical cervical dilatations
Studies have shown that if the woman has suffered
surgical cervical dilatations, the risk of cervical
insufficiency depends on the number of dilatations
DIAGNOSIS AND TREATMENT
suffered and their severity.
pelvic ultrasound - confirms the absence of fetal If the surgical dilation has been made following a
heart tones or gestational sac. β-Human chorionic miscarriage, there small chances of a cervical
gonadotropin levels will be high due to the incompetence. Regarding induced abortions, it was
placental cells that comprise the tumor. Upon noticed that only after 3 such interventions, the risk
confirmation that there is no fetus, a dilation and for the woman to have an incompetent cervix
curettage (D&C) is performed. increases by 12%
2nd Semester
Signs of an Incompetent Cervix: If you have a history of premature birth whose cause is
If you have an incompetent cervix, you may not have a sign cervical insufficiency, a prophylactic circularization will
or symptom while the cervix starts to open during your early be performed before the cervix starts to open
pregnancy. It’s possible for you to experience a slight This medical procedure is performed before the week 14
discomfort over a few days or weeks, but starting with the of pregnancy.
week 15 or 20 of pregnancy. Some symptoms may be: it will be recommended to you to restrict your physical
Sensation of pelvic pressure activities and sexual contacts
Back pain Although it wasn’t proven to be a remedy for
Small abdominal cramps premature birth, in some situations your obstetrician
Change in the vaginal discharge. will recommend you bedtime rest.
Small vaginal bleeding.
How to Prepare
COMPLICATIONS If you are expecting a baby and you have a risk factor
for cervical insufficiency or have experienced a symptom
An incompetent cervix poses a risk of pregnancy, during the second trimester of pregnancy, which indicate
especially during the second trimester of pregnancy, the possibility of an incompetent cervix, visit your doctor
including: immediately.
Premature birth. Depending on the circumstances, you may immediately
Loss of pregnancy. need medical attention.
If a baby is born prematurely, he may risk having
some medical issues, including poorly developed What Can You Do?
organs, low birth weight and shortness of breath. Ask about the pre-visit restrictions. In most situations,
Children who are born before term also have a you’ll be immediately allowed for a pre-visit. If this isn’t
higher risk of behavioral issues and learning the case, you should still ask your doctor if you should
disabilities. These risks are somehow greater for restrict your activities, while you are waiting for the visit
children who are born before the week 32 of to take place.
pregnancy. Find a close person or friend who can stay with you
during these medical visits. Fear and anxiety might
distract you from what the doctor has to say. Bring
INVESTIGATIONS AND DIAGNOSIS someone with you who isn’t able to remember all the info
the doctor has to tell you.
Cervical insufficiency can be diagnosed during
pregnancy, and even when the diagnosis is difficult,
especially if it’s the first pregnancy. There’s no test 3RD TRIMESTER BLEEDING
that can be done before remaining pregnant and
which to predict adequately if the cervix is Placenta Previa
incompetent. Premature Separation of the Placenta (Abruptio
The diagnosis of cervical incompetence can be Placentae)
attributed to a history of pregnancy loss in the Disseminated Intravascular Coagulation (DIC)
second and third trimester of pregnancy, without
any other pathologies being identified, or it can be
diagnosed by ultrasound if the cervical shortening
PLACENTA PREVIA
and dilation is noticed before pregnancy loss or
premature birth. Case Scenario/ Situation:
A woman at 33 weeks of gestation is admitted to the
hospital for the diagnosis of placenta previa. She is not in
TREATMENT labor and is having only mild vaginal bleeding and spotting.
Her fetal heart rate is within normal limits for rate and
If you have less than 24 weeks of pregnancy, a history
pattern. She is receiving “expectant management” (that is,
of premature birth or the ultrasound has showed that
observation and bed rest) rather than being immediately
the cervix is open, the obstetrician will recommend a
scheduled for a cesarean birth.
surgical procedure that is known as cerclage, which
should prevent premature birth. During this surgical
Medical orders include the following:
procedure, the cervix is sewn to remain closed until the
Transabdominal ultrasonographic examination every
term, and the sutures are removed in the last month or
two weeks
during labor.
Monitor fetal heart rate for 30 minutes daily
Weekly non-stress test
Cerclages ← help prevent premature birth by reinforcing the Hemoglobin and hematocrit, weekly
cervical muscle during the procedure Insert a venous access device (saline lock)
the cervix is stitched closed to help support the weight of Give betamethasone (glucocorticoid) 12 mg IM q12 hours x
the baby and prevent preterm birth; are recommended in 2 doses. Repeat in seven days if birth has not occurred.
these cases and for mothers with histories of preterm
delivery.
2nd Semester
Placenta previa ← a condition of pregnancy in which the

placenta is implanted abnormally in the lower part of the Preterm birth
uterus Premature rupture of membranes
most common cause of painless bleeding in the third Blood transfusion reactions
trimester of pregnancy
occurs when the placenta implants near or over the
cervical os rather than in the uterine fundus. THERAPEUTIC NURSING MANAGEMENT
described as marginal when only an edge of the
placenta extends to the internal os, Assess amount and character of bleeding
it may extend into the os during cervical dilation in Monitor vital signs
labor. Monitor urinary output
Classic symptom: Painless vaginal bleeding Monitor fetal heart rate and fetal activity
Vaginal exams are prohibited in the presence of continuously
vaginal bleeding because of the risk or perforating Avoid digital vaginal exams
the placenta and causing hemorrhage. Instruct client to avoid enemas, douching, or sexual
Nursing care: Monitor for bleeding and onset of labor. intercourse
Medical treatments: bed rest and intravenous fluids. Provide bed rest if previa occurs prior to 36 weeks
Cesarean birth is usually indicated. gestation
Key terms: Marginal placenta previa, partial placenta Monitor for continued bleeding and onset of labor
previa, total placenta previa, cervical os Administer intravenous fluid replacement
occurs in 1:200 pregnancies
It occurs in 4 degrees: DIAGNOSTIC TESTS AND LAB

low-lying placenta ← implantation in the lower rather
Abdominal ultrasound is done to confirm placental
than in the upper portion of the uterus
placement and position
placenta edge approaches that of the cervical os ←
If hospitalized, perform a non-stress daily to monitor
marginal implantation
fetus
partial placenta previa ← occurs when the placenta only
partially covers the internal os; implantation that
occludes a portion of the cervical os PHARMACOLOGIC MANAGEMENT
total placenta previa ← the internal os is completely
covered by the placenta when the cervix is fully dilated; For preterm labor prior to 34 weeks gestation,
implantation that totally obstructs the cervical os The administer betamethasone, as prescribed, to
degree to which the placenta covers the internal cervical promote fetal lung maturity if delivery seems
os is generally estimated in percentages: 100%, 75%, 30%, unavoidable.
and so forth. Blood transfusion may be needed for severe
anemia, chronic abruptio placenta or placenta
RISK FACTORS previa.
Uterine scarring
Multiple gestation
History of placenta previa ABRUPTIO PLACENTA
Closely-spaced pregnancies
Uterine tumors Case Scenario/Situation:
Increased maternal age A woman at 35 weeks of gestation is admitted to the
Endometritis hospital for the diagnosis of abruptio placenta. She is
gravida 1, para 0. She is having a small amount of vaginal
bleeding along with moderately severe abdominal pain. The
SIGNS AND SYMPTOMS fetal heart rate is within normal limits for rate and pattern.
Painless vaginal bleeding (intermittent or in gushes), Her blood pressure has been elevated for the past month,
most commonly occurring in the third trimester and is 160/90 today. Her pulse is 80, temperature is 98.6
Progressively more severe more severe bleeding as degrees F, and respirations are 14.
delivery nears
Decreasing urinary output The nursing history reveals that she is underweight and does
Anxiety and fear not maintain a healthy diet. She says, “I don’t know how I
can stand to stay here if you don’t let me smoke.”
COMPLICATIONS Medical orders include the following:

Continuous electronic fetal monitoring
Hemorrhage
Indwelling urinary catheter
Fetal distress/ demise related to hypoxia in utero
Intravenous fluids
Intrauterine growth retardation
Give betamethasone (a glucocorticoid) 12 mg
Cesarean delivery
intramuscular q 12 hours x 2 doses
2nd Semester
Abruptio Placenta ← premature separation of only part or of

the entire placenta from the uterine wall; the placenta
appears to have been implanted correctly, suddenly, Hemoglobin
however, it begins to separate and bleeding results; occurs Hematocrit
in 1% of all deliveries. Ultrasound of abdomen
Abruption - medical emergency because the risk of Blood type and crossmatch
maternal hemorrhage and fetal death are significant-10- Coagulation profile
30% of clients develop clotting defects (e.g. disseminated Sonogram (to rule out placenta previa)
intravascular coagulation [DIC]). Abruptio placenta
should be suspected when there is sudden onset of
intense, localized uterine pain, with or without vaginal SIGNS AND SYMPTOMS
bleeding.
Hospitalization - nearly always necessary because the Dark red vaginal bleeding
placenta can separate further at any time. Uterine rigidity
Vaginal birth maybe feasible, but an emergency Sudden onset of intense abdominal pain
cesarean delivery may be indicated in case of fetal Uterine contractions
distress. Fetal distress
It is a medical emergency, as approximately 10% of cases
of abruption are severe enough to threaten fetal viability.
Mild-to-severe abdominal pain and uterine rigidity are THERAPEUTIC NURSING MANAGEMENT
usually present and differentiate this condition from
placenta previa. Assess amount and character of bleeding.
Vaginal bleeding is present in 70-80% of cases, although Assess degree of abdominal rigidity.
bleeding may remain concealed (retroplacental Assess degree of abdominal pain.
hemorrhage). Assess fetal activity and heart tones.
Measure fundal height if concealed bleeding is
suspected.
CLINICAL SYMPTOMS
Monitor for shock (vital signs, urine output, physical
Grade 1 (mild) ← Mild vaginal bleeding, mild uterine assessment).
tenderness; mild uterine tetany; 10-20% of placental Provide emotional support because the family may
surface is detached; neither mother nor fetus is in be experiencing fetal loss in
distress. addition to a critical illness.
Prepare woman for possible emergency cesarean
Grade 2 (moderate) ← Uterine tenderness and tetany, delivery.
with or without external bleeding; mother not in shock, Administer blood transfusion if ordered
but fetal distress present; about 20-50% of placental
surface is detached.
COMPLICATIONS
Grade 3 (severe) ← Severe uterine atony; woman in Severely compromised fetal well-being.
shock (although bleeding may not be obvious); fetus is Fetal demise (frequent if separation is 50% or
dead; woman often has coagulopathy; more than 50% greater)
of placental surface is detached. Maternal disseminated intravascular coagulopathy
(DIC)
Concealed central placental bleed
RISK FACTORS
Shock
External uterine trauma (blunt trauma)
Drug abuse during pregnancy especially cocaine
Pregnancy-induced hypertension
Previous abruption DISSEMINATED INTRAVASCULAR COAGULATION
Folic acid deficiency
Smoking Disseminated Intravascular Coagulation (DIC) ← acquired
Cocaine use disorder of blood clotting in which the fibrinogen level falls
Premature rupture of membranes to below effective limits.
Maternal hypertension-this is the most consistently occurs when there is such extreme bleeding and so many
identified risk factor platelets and fibrin from the general circulation rush to
Multifetal pregnancies the site that there is not enough left in the rest of the
Short umbilical cord body.
Early symptoms: easy bruising or bleeding from an
intravenous site
Conditions associated with its development: Premature
separation of the placenta, pregnancy-induced
hypertension, amniotic fluid embolism, placental
retention, septic abortion, and retention of a dead fetus
2nd Semester
results in a paradox: at one point in the circulatory

LABORATORY FINDING
system, the person has increased coagulation, but
throughout the rest of the system, a bleeding defect
Thrombocytopenia
exists.
Prolonged PR, APTT, thrombin time
DIC is an emergency because it can result in extreme
Decreased fibrinogen
blood loss. Goals for care should reflect the presence of
Elevated D-dimers
the emergency.
Schistocytes on the peripheral blood smear
Precipitating factors:
Abruptio placenta
TREATMENT
PIH
Sepsis Treatment of the underlying disorder
Retained fetus (fetal demise) Transfusion support of RBCs or Fresh Frozen Plasma
Fetal placenta fragments (FFP) to replace coagulation factors
Amniotic embolism
maternal liver disease
Septic abortion NURSING INTERVENTIONS
HELLP & preeclampisa
Bleeding precautions
Avoid unnecessary needle sticks or procedures that
TYPE CAUSE
could cause bruising &
Maliognanciders Solid tumors bleeding (don't take BP more than necessary)
Leukemia Personal care (toothette/soft bristled toothbrush, no
shaving/electric razor)
Obstetric Retained dead fetus Fall precautions
syndrome
Retained products of Psychosocial
conception Pt teaching
Emotional support (talking, being with, validating
Hematologic Myeloproliferative feelings)
syndromes
Monitor/Asses VS
Vascular Rheumatoid arthritis skin hematomas, ischemic changes, petechiae,
Raynaud disease purpura
ecchymosis
Cardiovascular Myocardial infection Mental Status
Renal function las, urine output
Inflammatory Ulcerative colitis Cardiopulmonary function (assess for s/s impaired
Crohn disease organ/tissue perfusion - skin
Sacrodosis temp, cyanosis)
Localized DIC Aortic aneurysms

Giant hemangioma
(Kasabach-Merritt
syndrome)
Acute renal allograft
rejection
PATHOPHYSIOLOGY
Hyper-activated coagulation system
Hyper-activated fibrin-lytic system or both
simultaneously
Coagulation factors consumed as soon as they are
made
Secondary to an underlying disease or condition
CLINICAL FINDING
Risk of bleeding
Risk of thrombosis

NCM 2208 - Care of Mother and Child at Risk or With Problems (Acute and Chronic) (PRELIMS

Uploaded by

Copyright:

Available Formats

You might also like

NCM 2208 - Care of Mother and Child at Risk or With Problems (Acute and Chronic) (PRELIMS

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCM 2208 - Care of Mother and Child at Risk or With Problems (Acute and Chronic) (PRELIMS

Uploaded by

Copyright:

Available Formats

CARE OF MOTHER AND CHILD AT RISK OR NCM 2208

WITH PROBLEMS (ACUTE AND CHRONIC) A.Y. 2022-2023

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

A. NATIONAL HEALTH SITUATION ON MCN

COOPERATION FOR HEALTH Labor (October 2022)

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

2020 CENSUS OF POPULATION AND HOUSING HEALTH

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

GENDER: WORKING CHILDREN LATEST RELEASES

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

MEASURING MATERNAL AND CHILD HEALTH

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

TRENDS IN THE MATERNAL C. GENETICS AND GENETIC COUNSELING

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Imprinting Other genetic disorders do not affect life in utero, so the

B. Nature of Inheritance/Inheritance Patterns

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

X-LINKED DOMINANT INHERITANCE/DISORDER X-LINKED RECESSIVE INHERITANCE/DISORDER

Alport’s Syndrome Color Blindness

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Duchenne Muscular Dystrophy (DMD) Clubfoot

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

IMPRINTING OTHER CHROMOSOMAL ABNORMALITIES

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

neck is short Assessment of the general medical history of the

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Principle of Controlled Emotional Involvement GENETIC COUNSELING

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

Percutaneous umbilical blood sampling ← is removal of

Fetoscopy ← involves the insertion into the mother’s uterus of

SPECIFIC TESTS INCLUDE:

Heterozygote screening ← directed at detecting clinically

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

Blood glucose ← indicates the concentration of glucose D. IMPLEMENTATION

C. PLANNING AND OUTCOME IDENTIFICATION RISK FACTORS FOR PREGNANT WOMEN

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

PSYCHOLOGICAL SOCIAL PHYSICAL

Marginalized because of: Pregnancy-induced

Severely frightened by Lack of support person Hemorrhage

Inability to participate Unplanned caesarean birth Fluid and electrolyte

PRE-GESTATIONAL MEDICAL CONDITION

History of mental illness High altitude hemopoietic or blood

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

Studying COVID-19 in Children Symptoms of monkeypox in pregnancy:

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD

Lecture | Level 2 | CPU BSN Class 2025 Neri, H.A.G. | BSN 2E

CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD