Chapter 22: High-Risk Pregnancy & Special Needs Families

High-Risk Pregnancy & Special Needs Families emphasizes the systematic application of the nursing process (assessment, diagnosis, planning, implementation, and evaluation) integrated with the six Quality and Safety Education for Nurses (QSEN) competencies to ensure patient-centered, safe, and quality care across various healthcare settings. For pregnant adolescents, care must address their unique developmental tasks, such as establishing independence, adjusting body image, and selecting a vocation, which are superimposed on the demands of pregnancy. This population is at higher risk for complications like iron-deficiency anemia, preterm labor, intimate partner violence, and is often reluctant to seek early prenatal care due to denial or discomfort in adult settings. Nurses must adopt a nonjudgmental approach and recognize that pregnant adolescents are often considered an emancipated minor capable of making their own healthcare decisions. For patients over 40 years of age, designated as advanced maternal age, counseling focuses on managing higher risks for gestational hypertension, varicosities, and complications of labor, alongside the psychological task of generativity. This age group is also offered specific screening tests, such as circulating free DNA (cfDNA) and amniocentesis, due to the increased risk of fetal chromosomal abnormalities. Specialized care is detailed for those with physical or cognitive disabilities, requiring modifications to assessment and mobility support, such as positioning adjustments during exams and helping patients transition to using devices like wheelchairs to ensure safety and prevent injury. In patients with high spinal cord injuries, continuous observation for autonomic dysreflexia, an exaggerated response to stimuli like a distended bladder, is critical. Substance use disorder presents major risks, as illicit substances readily cross the placenta, leading to potential fetal effects and conditions such as neonatal abstinence syndrome. Cocaine use is particularly dangerous due to severe vasoconstriction, which can compromise placental circulation and result in premature separation of the placenta (abruptio placentae). Nursing interventions emphasize encouraging participation in treatment programs and providing necessary support to reduce substance intake. Finally, the chapter addresses trauma management, noting that physiologic changes of pregnancy, such as increased plasma volume, can mask the signs of hypovolemic shock, requiring quick and careful assessment. Resuscitation efforts must include manually displacing the uterus to prevent supine hypotension syndrome, and assessment must rule out direct fetal injury, such as placental dislocation.