Recommended Nutrients to Increase During Pregnancy 2

● Recommended Nutrients to Increase During Pregnancy Dietary Complications During Pregnancy Nausea and constipation Nausea and constipation are common during pregnancy. Client Education ● For nausea, eat small amounts frequently (every 2 to 3 hr) to avoid large meals that distend the stomach, and avoid alcohol, caffeine, and fried, fatty, and spicy foods. Also avoid consuming excessive amounts of fluid, and DO NOT take a medication to control nausea without first checking with the provider. Ginger (ginger ale soda, ginger tea, ginger candies) and herbal tea (peppermint, raspberry) might also be helpful.< ● For constipation, increase fluid consumption, perform physical activity, and include extra fiber in the diet. Fruits, vegetables, and whole grains all contain fiber. Client Teaching About Stress Incontinence Patient-Centered Care Nursing Care ● Establish a toileting schedule. ● Monitor and increase fluid intake during the daytime and decrease fluid intake prior to bedtime. ● Remove or control barriers to toileting. ● Provide incontinence garments. ● Apply an external catheter for females or condom catheter for males. ● Avoid the use of indwelling urinary catheters. ● Provide incontinence care. Client Education ● Maintain regular bowel movements. ● Try to empty bladder completely with each void. ● Keep an incontinence diary. ● Perform Kegel exercises 3 to 4 times per day: Tighten pelvic muscles for a count of 10, relax slowly for a count of 10, and repeat in sequences of 15 in the lying-down, sitting, and standing positions. ● Perform bladder compression techniques (Credé, Valsalva, double voiding, splinting) to help manage reflex incontinence. ● Avoid caffeine and alcohol consumption because these can irritate the bladder and increase diuresis and the urge to urinate. ● Adverse effects of medications can affect urination. ● Conduct vaginal cone therapy to strengthen pelvic muscles (for stress incontinence). Client Education ● Maintain regular bowel movements. ● Try to empty bladder completely with each void. ● Keep an incontinence diary. ● Perform Kegel exercises 3 to 4 times per day: Tighten pelvic muscles for a count of 10, relax slowly for a count of 10, and repeat in sequences of 15 in the lying-down, sitting, and standing positions. ● Perform bladder compression techniques (Credé, Valsalva, double voiding, splinting) to help manage reflex incontinence. ● Avoid caffeine and alcohol consumption because these can irritate the bladder and increase diuresis and the urge to urinate. ● Adverse effects of medications can affect urination. ● Conduct vaginal cone therapy to strengthen pelvic muscles (for stress incontinence). Identifying Potential Newborn Complications Gonorrhea Neisseria gonorrhoeae is the causative agent of gonorrhea. Gonorrhea is a bacterialinfection that is primarily spread by genital-to-genital contact. However, it also can be spread by anal-to-genital or oral-to-genital contact. It can also be transmitted to a newborn during birth. The CDC recommends all clients who are pregnant, receive screening/testing for gonorrhea at the first prenatal visit and rescreened in the third trimester (if less than 25 years of age and/or at high risk). Complications: If not treated during pregnancy, can cause the following. ● PID ● Salpingitis ● Prelabor rupture of membranes (PROM) ● Preterm birth ● Intrauterine infection ● Postpartum sepsis, endometritis ● If transmitted to the neonate, it can cause neonatal sepsis, intrauterine growth restriction (IUGR), ophthalmia neonatorum (which can cause blindness). Analyzing Findings of Infections to Determine Actions to Take Antibiotics ● Dual therapy is the recommended first-line treatment: Azithromycin PO single dose and ceftriaxone IM administered concurrently on the same Teaching a Client About a Nonstress Test Client Preparation ● Seat the client in a reclining chair, or place in a semi-Fowler’s or left-lateral position. ● Apply conduction gel to the client’s abdomen. ● Apply two belts to the client’s abdomen, and attach the ultrasound transducer and tocotransducer. Ongoing Care ● Instruct the client to press the button on the handheld event marker each time they feel the fetus move. ● If there are no fetal movements (fetus sleeping), vibroacoustic stimulation (sound source, usually laryngeal stimulator) can be activated for 3 seconds on the maternal abdomen over the fetal head to awaken the sleeping fetus. ● ● Identifying Swelling on a Newborn's Scalp ● ● ● ● ● Risk Factors for Ovarian Cancer Dual therapy is the recommended first-line treatment: Azithromycin PO single dose and ceftriaxone IM administered concurrently on the same day. Head Head should be 2 to 3 cm larger than chest circumference. If the head circumference is greater than or equal to 4 cm larger than the chest circumference, this can be an indication of hydrocephalus (excessive cerebral fluid within the brain cavity surrounding the brain). If the head circumference is less than or equal to 32 cm, this can be an indication of microcephaly (abnormally small head). Anterior fontanel should be palpable and approximately 5 cm on average and diamond shaped. Posterior fontanel is smaller and triangle-shaped. Fontanels should be soft and flat. Fontanels can bulge when the newborn cries, coughs, or vomits, but should be flat when the newborn is quiet. Bulging fontanels at rest can indicate increased intracranial pressure, infection, or hemorrhage. Depressed fontanels can indicate dehydration. Sutures should be palpable, separated, and can be overlapping (molding), a normal occurrence resulting from head compression during labor. Caput succedaneum (localized swelling of the soft tissues of the scalp caused by pressure on the head during labor) is an expected finding that can be palpated as a soft edematous mass and can cross over the suture line. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment. Complications Endometrial and ovarian cancers When estrogen is used alone for postmenopausal therapy Nursing actions: Administer progestins along with estrogen. Assessment Risk Factors ● Middle aged or older adult clients (age greater than 40 years; risk increases with age) ● Nulliparity or first pregnancy after 30 years of age ● Family history of ovarian, breast, or genetic mutation for hereditary nonpolyposis colon cancer (HNPCC) ● BRCA1 or BRCA2 gene mutations ● Diabetes mellitus ● Early menarche/late menopause ● Endometriosis ● Infertility Assessment Risk Factors ● Middle aged or older adult clients (age greater than 40 years; risk increases with age) ● Nulliparity or first pregnancy after 30 years of age Identifying Potential Complications in Newborns Kernicterus is an irreversible, chronic result of bilirubin toxicity. The newborn demonstrates many of the same manifestations of bilirubin encephalopathy with hypotonia, severe cognitive impairments, and spastic quadriplegia. Acute bilirubin encephalopathy is when the bilirubin is deposited in the brain. This occurs once all of the binding sites for the bilirubin are used within the body, resulting in necrosis of neurons. Bilirubin levels higher than 25 mg/dL place the newborn at risk. This can result in permanent damage including dystonia and athetosis, upward gaze, hearing loss, and cognitive impairments. Analyzing Findings of Infections to Determine Actions to Take Antibiotics Recognizing Cues of Complications of Breastfeeding Mastitis ● Painful or tender localized hard mass and reddened area, usually on one breast ● Influenza-like manifestations (chills, fever, headache, body ache) ● Fatigue Caring for a Client Who Is Postpartum and Receiving Heparin Heparin QEBP ● Obtain baseline vital signs. ● Obtain baseline and monitor aPTT, platelet count, and hematocrit levels. ● Read label carefully. Heparin is dispensed in units and in a variety of concentrations. ● Check dosages with another nurse before administration. ● Use an infusion pump for continuous IV administration. ○ Monitor rate of infusion every 30 to 60 min. QS ○ Monitor aPTT every 4 to 6 hr until appropriate dose is determined, then monitor daily. ● Administer deep subcutaneous injections in the abdomen, ensuring a distance of 2 inches from the umbilicus. Do not aspirate. ○ Use a 20- to 22-gauge needle to withdraw medication from the vial. Then, change the needle to a smaller needle (25- to 31-gauge, 3/8 to 5/8 inches long). ○ Apply gentle pressure for 1 to 2 min after the injection. Rotate and record injection sites. ● Advise clients to use an electric razor for shaving and to brush with a soft toothbrush. Priority Action for a Client Who Is Postpartum and Experiencing Excessive Bleeding Nursing Care ● Determine QBL immediately following birth. ● Weigh all blood saturated items and clots, measure fluids in suction cannisters, and subtract any irrigation fluids. ● Firmly massage the uterine fundus. ● Monitor vital signs. ● Assess for source of bleeding. ○ Assess fundus for height, firmness, and position. If uterus is boggy, massage fundus to increase muscle contraction. ○ Assess lochia for color, quantity, and clots. ○ Assess for clinical findings of bleeding from lacerations, episiotomy site, or hematomas. ● Assess bladder for distention. Insert an indwelling urinary catheter to assess kidney function and obtain an accurate measurement of urinary output. ● Maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions, such as lactated Ringer’s or 0.9% sodium chloride; colloid volume expanders, such as albumin; and blood products (packed RBCs and fresh frozen plasma). ● Provide oxygen at 10 to 12 L/min via nonrebreather facemask, and monitor oxygen saturation. ● Elevate the client’s legs to a 20° to 30° angle to increase circulation to essential organs. Safety/Risk Reduction QS ● Look first for a safety risk. For example, is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection, or injury? ● Next ask, “What’s the risk to the client?” and “How significant is the risk compared to other posed risks?” ● Give priority to responding to whatever finding poses the greatest (or most imminent) risk to the client’s physical well-being.