02.05 Maternal Risk Factors

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Overview

  1. Pre existing conditions put the mother at greater risk for complications

Nursing Points

General

  1. Genetic issues
    1. Risk of heredity
  2. Abuse and violence
  3. Nicotine or substance abuse
    1. Cross the placenta
    2. NO safe amount of alcohol
      1. Risk of fetal alcohol Syndrome (refer to FAS lessson)
  4. Sexually transmitted infection
    1. Can be passed to infant
    2. Herpes, Syphilis, HIV, AIDS, Hepatitis B
  5. Mental illness
    1. Postpartum Depression
    2. Postpartum Psychosis
  6. Cardiac conditions
    1. The heart is a pump
    2. Increased blood volume to be pumped during pregnancy
    3. Increased weight during pregnancy is more work on the heart
  7. Diabetes
    1. High blood sugars = increased insulin→ growth hormone = bigger baby
    2. Hormones in pregnancy raise blood sugar
  8. Underweight
    1. Poor nutrition to grow fetus
  9. Obesity
    1. At increased risk for diabetes and other concerns
    2. Gain more weight in pregnancy
    3. Poor nutrition → not good for fetal development
    4. Grow a larger fetus
  10. Hypertension
    1. High blood pressure→ grows a smaller fetus → doesn’t get proper nutrients
  11. Thyroid
    1. Increased risk of miscarriage and stillbirth
  12. Young (under 20)
    1. Lack of maturity for situation and understanding
    2. Poor nutrition
    3. More at risk for preeclampsia
  13. Advanced maternal age
    1. Older eggs
    2. Body doesn’t provide for the fetus as well as younger age
  14. Poverty
    1. Lack resources such as transportation to get to prenatal appointments
      1. Scant prenatal care
      2. No insurance
    2. Healthy food is more expensive

Assessment

  1. Assess their history
    1. HTN, Diabetes
  2. Assess weight
  3. Assess blood pressure
  4. Assess level of knowledge and importance of getting to appointments as well as ability.

Therapeutic Management

  1. Management of current risk factors/diseases
  2. Might need referral to specialist
    1. Diabetes educator and physician
    2. cardiologist
  3. Might need referral to high risk maternal/fetal doctor
  4. Make sure patient is taking prenatal vitamin

Nursing Concepts

  1. Reproduction
  2. Human Development
  3. Health Promotion

Patient Education

  1. Education on how to manage disease during pregnancy
    1. ie: more insulin requirements, cardiac medications, frequent blood pressure checks
  2. Education on the important of prenatal appointments
  3. Educate on prenatal vitamins
  4. Educate on the importance of avoiding  substances and alcohol
  5. Smoking cessation

Reference Links

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Video Transcript

In this lesson I will better explain risk factors that could put a patient at greater risk for other comorbidities or her baby at risk during pregnancy.

Good health prior to pregnancy is essential. Promoting good health prior to pregnancy can better the outcomes for the mom and baby. Almost any health concern or disease process can put the mother and fetus at a greater risk such as; diabetes, hypertension, obesity, advanced maternal age, and cardiac conditions

Let’s look as specific risk factors and the why behind them. Genetics is a risk factor because if the mother has a genetic disorder it could make the pregnancy more difficult or theres a chance of her passing on the gene. Abuse and violence could worsen with a pregnancy, especially if it is an unwanted pregnancy. This puts the mother at a greater risk and of course the unborn child at risk. Nicotine and substance abuse means that the mother is already not in the healthiest state and the pregnancy could be difficult for her. The baby is also put at risk because they are at risk for deformities and being born addicted. Substances pass the placenta. With alcohol there is no safe amount during pregnancy and the fetus is at risk for fetal alcohol syndrome. (refer to fetal alcohol syndrome lesson for more information). Sexually transmitted infections can be passed to the infant. Mental illness can worsen during and after pregnancy because of hormone fluctuations.

Cardiac is a huge risk factor because during pregnancy the women have extra blood volume and the heart has to work harder. The heart is a pump so if the pump already has trouble then pregnancy is going to be hard on the pump. In pregnancy the hormones cause blood sugars to really increase so this can make diabetes hard to control. This puts the mom and fetus at risk. If a patient is too underweight or obese pregnancy will be difficult on them because they do not have good nutrition to be healthy and grow a healthy baby. Thyroid disorders cause a lot of miscarriage and stillbirth if not in control so this is a risk factor. Patients that are young (under 20) or advanced maternal age (over 35) are at a greater risk. The young are at risk for blood pressure concerns in pregnancy, specifically preeclampsia. The older population have older eggs and puts them more at risk for having babies with genetic disorders. An older patient but not be in as good of health either which increases the risk. Poverty is a risk factor because these patients lack resources. The patient might not be able to afford prenatal vitamins, healthy foods, and lack resources to get to prenatal appointments.

The assessment pieces that we need to gather are her history. Does she have a cardiac history? Diabetes? Genetic concerns? We need to know her weight so we can help her identify how much weight will be a healthy weight for her to gain. A current blood pressure to ensure she is in a current healthy range, which will be monitored throughout pregnancy. We also need to assess her level of knowledge. Does she realize the importance of coming to prenatal appointments and the need to take prenatal vitamins? Does she know how often she should be planning to go to appointments?

Our management of this patient is going to number one manage the problem! We have to treat the risk factor. Patients that are diabetic or become diabetic or are instructed by a physician for other reasons need to manage blood sugars.We can set the patient up with referrals such as specialist. Maybe she needs a dietician, endocrinologist, or high risk OB. We need to ensure she is taking her prenatal vitamins, We need to discuss follow up appointments to ensure she comes back for appointments.

Education for this patient is going to revolve around how she can manage the problem. Educate on the importance of prenatal vitamins and follow up appointments. She needs to understand the importance of avoiding substance and alcohol abuse as well as smoking cessation.

Good health prior to pregnancy is essential. The patient must be healthy to have a healthy pregnancy. Whatever we can do to make sure she isin the best health before and during the pregnancy will mean better outcomes. .T We will either have a baby that is small or large because of these risk factors. Prenatal care is imperative to help the patient manage her risk factor as well as ensure the baby is growing adequately.
Reproduction, human development, and health promotion are our nursing concepts.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 10

A pregnant client is struggling with alcohol abuse and recognizes that she has a problem with addiction. In addition to counseling, the nurse recommends that the client attend an Alcoholics Anonymous meeting. The client tells the nurse, “I do not want to go there! Those people will all judge me because I am pregnant!” Which response from the nurse is correct?

  • Question 2 of 10

A nurse is educating a client who has very high blood pressure during pregnancy. Which statement by the client indicates the most understanding?

  • Question 3 of 10

A nurse is assessing clients for the need for genetic testing during pregnancy. Which client is the most appropriate to recommend for immediate genetic testing?

  • Question 4 of 10

A nurse is educating a pregnant client who is HIV positive on maternal-fetal transmission. Which information would be appropriate to include in the teaching?

  • Question 5 of 10

A nurse is educating a pregnant client on the risks of smoking during pregnancy. Which of the following should be included in the teaching? Select all that apply.

  • Question 6 of 10

The nurse is working with a client who requires hemodialysis and has become pregnant. The client asks the nurse, “Will I be able to continue with dialysis even though I am pregnant?” Which response from the nurse is accurate?

  • Question 7 of 10

A pregnant client is being seen for routine prenatal care. The client is 28 weeks’ gestation with her first pregnancy and has a history of systemic lupus erythematosus. Choose which outcome is most commonly associated with chronic medical illness in a pregnant mother.

  • Question 8 of 10

A 31-year-old pregnant client and her husband arrive at the healthcare clinic for a prenatal visit. The nurse notes several areas of bruising on the client’s legs and buttocks during the exam. Which response from the nurse is most appropriate in this situation?

  • Question 9 of 10

A 35-year-old pregnant client tells the nurse that she has been feeling significant stress in her life since she became pregnant. Select all of the appropriate measures the nurse can suggest as part of stress reduction in a pregnant client.

  • Question 10 of 10

A nurse is educating a client with Type 1 Diabetes about how to know if she can have a healthy pregnancy. Which statement indicates the client understood the teaching?

Module 0 – OB Course Introduction

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