Chapter 20: Pregnancy Complications & Nursing Care

Pregnancy Complications & Nursing Care explores the hemodynamic burden of pregnancy on the cardiovascular system, detailing the management of heart disease classifications, peripartum cardiomyopathy, and the risks associated with valve prostheses and venous thromboembolism, which often require careful anticoagulation therapy using low-molecular-weight heparin to prevent deep vein thrombosis and pulmonary emboli. The text examines hematologic disorders, differentiating between physiologic anemia, iron-deficiency anemia, and folic acid-deficiency anemia, while outlining the vaso-occlusive crises associated with sickle cell disease and the implications of coagulation disorders like von Willebrand disease and idiopathic thrombocytopenic purpura. Respiratory and renal health are addressed through the management of asthma, tuberculosis, cystic fibrosis, and the prevention of pyelonephritis arising from asymptomatic bacteriuria or urinary tract infections. Significant attention is given to endocrine dysfunction, specifically the pathophysiology of diabetes mellitus during gestation; this includes the distinction between type 1, type 2, and gestational diabetes, the mechanisms of insulin resistance caused by placental hormones, and the protocols for glucose tolerance screening, HbA1c monitoring, and insulin administration to prevent fetal macrosomia and congenital anomalies. The chapter also covers thyroid dysfunction, distinguishing between the risks of hypothyroidism and hyperthyroidism, such as thyroid storm. Furthermore, it delves into rheumatic disorders such as systemic lupus erythematosus and rheumatoid arthritis, gastrointestinal emergencies like appendicitis and cholecystitis, and neurologic conditions including epilepsy and multiple sclerosis, evaluating the teratogenic potential of necessary pharmacologic interventions like anticonvulsants. Finally, the discussion extends to the management of malignancies, mental illness, and the psychosocial impact of high-risk status on the family unit, framing care within the Quality and Safety Education for Nurses (QSEN) competencies to ensure optimal maternal and fetal outcomes.