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Information about CPD & PIH

Published on January 26, 2009

Author: karamonina

Source: authorstream.com

CEPHALOPELVIC DISPROPORTION : CEPHALOPELVIC DISPROPORTION Slide 2: Implies disproportion between the head of the baby (cephalus) and the mother’s pelvis Complications can occur if the fetal head is too large to pass through the mother’s pelvis or birth canal One of the commonest cause of different complications in labor Very frequently diagnosed and is a very common indication of cesarian sections CAUSES : CAUSES increased fetal weight fetal position problems with the pelvis problems with the genital tract SIGNS AND SYMPTOMS : SIGNS AND SYMPTOMS the delivery of the baby is obstructed The labor is prolonged Slide 5: pathophysiology Slide 6: Disproportion between head of the baby and the mother’s pelvis Fetus does not engage but remains floating malposition Premature rupture of membranes Uterine cord prolapse Fetal distress!! Trial labor Prolonged labor Delayed second stage DIAGNOSIS : DIAGNOSIS Estimation of the size of the pelvis: Clinical pelvimetry – assessment of the size of the pelvis is made manually by examining the pelvis and palpating the pelvic bones by vaginal examination Radiologic pelvimetry – xrays or CT scans are taken of the pelvis in different angles and views and the pelvic diameter measured. DIAGNOSIS : DIAGNOSIS Ultrasound – estimation of the baby’s size can be made by ultrasonogram MANAGEMENT : MANAGEMENT Cesarian section NURSING DIAGNOSIS : NURSING DIAGNOSIS Anxiety Fatigue Risk for fetal injury Risk for impaired skin integrity Situational low self- esteem interventions : interventions Monitor heart sounds and uterine contractions continuously, if possible, during trial labor. Urge the woman to void every 2 hours s Assess FHR carefully Establish a therapeutic relationship, conveying empathy and unconditional positive regard Instruct in methods to conserve energy Massage bony prominences gently and change position on bed in a regular schedule Convey confidence in client’s ability to cope with current situation PREGNANCY – INDUCED HYPERTENSION : PREGNANCY – INDUCED HYPERTENSION Pregnancy- induced hypertension : Pregnancy- induced hypertension A condition in which vasospasm occurs during pregnancy in both small and large arteries Originally was called toxemia Cause: unknown Risk Factors : Risk Factors Women of color, or with a multiple p regnancy, primiparas <20 years of age or >40 years Women from low socioeconomic backgrounds, whose who have had 5 or more pregnancies, those who have hydramnios, or those who have underlying disease (e.g. heart disease, DM with vessel or renal involvement, essential HPN) Signs and symptoms : Signs and symptoms HPN Proteinuria Extensive edema Vision changes Classifications of PIH : Classifications of PIH Gestational HPN ? BP but has no proteinuria or edema no drug therapies necessary Mild Preeclampsia BP rises to 140/90 mmHhg, taken on 2 ocassions at least 6H apart systolic BP >30 mmHg and diastolic pressure >15 mmHg above pre pregnancy values proteinuria (1+ or 2+ on a reagent test strip on a random sample) edema Slide 17: Severe preeclampsia BP of 160 mmHg (systolic) and 110 mmHg (diastolic) proteinuria (3+ or 4+ on a random urine sample or more than 5 g on a 24H sample) extensive edema Eclampsia seizure or coma accompanied by s/sx of preeclampsia Slide 18: pathophysiology Slide 19: Increased cardiac output Injury of endothelial cells of the arteries leading to vasospasm Change in the action of prostaglandins resulting to Vasoconstriction Dec blood supply and O2 perfusion To vital organs hypertension Kidneys Liver/ pancreas placenta Slide 20: kidneys Glomerular degeneration Dec glomerular filtration Inc glomerular permeabilty Inc tubular reabsorption of sodium Escape of serum proteins, albumin And globulin, into the urine (proteinuria) water retention Fluid diffuses from circ system to extracellular spaces edema oliguria Gen H2O retention Slide 21: LIVER Tissue ischemia Vascular stasis Epigastric pain Convulsion!! Slide 22: PLACENTA Tissue ischemia Release thromboplastin-like substances Premature placental deterioration Dec fetal nutrient Abruptio placenta Fetal distress Premature labor and delivery Nursing diagnoses : Nursing diagnoses Decreased cardiac output Ineffective tissue perfusion Fluid volume excess Urinary retention Risk for fetal injury Social isolation Nursing interventions : Nursing interventions Mild PIH Promote bed rest – lateral recumbent position Promote good nutrition – usual pregnancy diet Provide emotional support – instruct woman to report if symptoms worsen, bring concerns out into the open Slide 25: Severe PIH Support bed rest – visitors restricted to support people, darken room, if possible, provide clear explanations of what is happening and what is planned, allow opportunity to express feelings Monitor maternal well-being – monitor BP q4H, obtain blood studies, daily hematocrit levels as ordered, anticipate need for freq plasma estriol levels and electrolyte levels, obtain daily wts and MIO Slide 26: Monitor fetal well being – single doppler auscultation approx 4H interval, FHR maybe assessed with an external fetal monitor, NST or BPP daily, O2 admin to mother Support a nutritious diet – moderate to high in protein and moderate in sodium, IVF line Slide 27: Administration medications to prevent eclampsia hydralazine/ Apresoline labetalol/ Normodyme DOC: magnesium sulfate antidote: calcium gluconate Eclampsia - seizure precautions Slide 29: Prepared by miko camay ricah

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