Oral Revalida

than usual
- Elevated blood sugar levels cause
the kidneys to work harder to filter
Gestational Diabetes excess glucose, leading to increased
urine production
Definition:  a dry mouth
- Dehydration resulting from frequent
 high blood sugar (glucose) urination leads to a dry mouth
that develops during  tiredness
pregnancy and usually - Cells aren't getting enough glucose
disappears after giving birth. for energy, leading to fatigue
 It can happen at any stage of  blurred eyesight
- High blood sugar can affect the
pregnancy but is more common
lenses in your eyes, causing blurry
in the second or third vision.
trimester.  genital itching or thrush
 It happens when your body - Yeast infections (thrush) thrive in
cannot produce enough insulin sugary environments, which can
occur with GDM.
– a hormone that helps control
blood sugar levels – to meet Diagnostic Test:
your extra needs in pregnancy.
 Insulin Resistance: Pregnancy  Glucose Challenge Test
hormones like human placental In this test, a health care
lactogen (hPL), estrogen, and professional will draw your
progesterone increase insulin blood 1 hour after you drink a
resistance, making cells less responsive sweet liquid containing glucose.
to insulin You do not need to fast for this
 Gestational diabetes can cause test.
problems for you and your baby Fasting means having nothing to
during pregnancy and after eat or drink except water. If your
birth. But the risks can be blood glucose is too high—140 or
reduced if the condition is more—you may need to return
detected early and well for an oral glucose tolerance test
managed. while fasting. If your blood
Etiology glucose is 200 or more, you may
have type 2 diabetes.
 the pancreatic beta-cell
 Oral Glucose Tolerance
dysfunction or the delayed
Test (OGTT)
response of the beta cells to
The OGTT measures blood
the glycemic levels.
glucose after you fast for at
 the marked insulin resistance
least 8 hours. First, a health
secondary to placental
care professional will draw your
hormonal release.
blood. Then you will drink the
Symptoms: liquid containing glucose. You
 increased thirst will need your blood drawn every
- Excess sugar in the blood pulls hour for 2 to 3 hours for a
water from tissues, making you
thirsty. The kidneys work harder to doctor to diagnose gestational
flush out excess sugar, leading to diabetes.
frequent urination.  High blood glucose levels at
 needing to pee more often
MGDV,SN
 Oral Revalida
any two or more blood test
times— fasting, 1 hour, 2
hours, or 3 hours—mean you
have gestational diabetes. Your
health care team will explain
what your OGTT results mean.
 Your health care professional
may recommend an OGTT
without first having the
glucose challenge test.
Medical Interventions:

 special meal plans

 scheduled physical activity
 daily blood glucose testing
 insulin injection

MGDV,SN
 Oral Revalida
 Insulin lispro, aspart, and
 Educate patients on the
detemir are approved to be
potential risks of GDM to both
used in pregnancy. Insulin
the mother and baby.
glargine is not approved in
 Schedule regular prenatal visits
pregnancy, but the existing
to monitor maternal and fetal
studies did not show any
health.
contraindications. The use of
oral hypoglycemic agents; Health Teachings:
glyburide and metformin
Dietary control
seems to be safe and effective
 1800 to 2400 kcal divided into
in pregnancy.
3 meals and 3 snacks
 20% of protein
 If the medical nutrition therapy
 50% of carbohydrates
and exercise fail to achieve
 30% of fats
glycemic goals for a woman
 reduced saturated fats
with GDM, insulin therapy
and cholesterol
should be initiated.
 increased dietary fiber
Exercise
 should be done even
Nursing Interventions:
before pregnancy
 Monitor and manage blood  eat protein and complex
glucose levels. carbs before exercise
 Provide dietary guidance  maintain a consistent
and develop a personalized exercise program
meal plan to maintain stable  avoid extreme exercise
blood sugar levels. for patients with poor
 Educate patients on self- glucose control
monitoring of blood glucose Insulin therapy
and proper technique for  short acting alone or
glucose testing. with intermediate type
 Collaborate with healthcare  2/3 before breakfast and
professionals to adjust 1/3 before dinner
medication, such as insulin,  injected subq at 90 degree-angle
if necessary.  same site each injection
 Monitor fetal growth and  less in early pregnancy but
development through regular will increase in later
ultrasounds and other tests. pregnancy
 Offer support and counseling  eat immediately after
to address emotional and injecting insulin
psychological concerns related Blood glucose monitoring
to GDM.  four times a day
 Promote physical activity  glucometer
and exercise, as  record sugar level and bring
recommended by healthcare it during OB visit
providers.

MGDV,SN
 Oral Revalida

PPH Secondary to Placental Retained placenta

 is when the placenta
Fragments and Uterine Atony doesn’t completely come
Definition: out of the uterus after the
baby is born.
• Hemorrhage is one of the  Retained tissue hinders uterus
primary causes of mortality from full involusion, thus still
associated with childbearing bleeding
 Sometimes, a piece of the
• 5% to 8% of women experience
placenta is left behind in the
significant postpartum hemorrhage.
uterus (womb). It’s not
• Postpartum Hemorrhage is defined common, but it can be serious.
as blood loss of 1000 mL or more It can cause problems days or
following vaginal or cesarian birth weeks after the birth.
 Retained placenta can lead to
Primary/ Early Hemorrhage
severe infection or life-
- Occurs within the first 24 hours threatening blood loss for the
following the birth mother.

- Highest risk Etiology:

- Very unestimated  uterine muscles don’t contract

enough to clamp the placental
Secondary/ Late Hemorrhage blood vessels shut.
- 24 to 6 weeks after birth

• Within the current healthcare Risk Factors:

environment and the trending for  Tachyphylaxis
shortened days after delivery, there is - rapid administration of oxytocin
a potential for more incidents of 10ugtts IM or IVF after expulsion of
primary PPH occurring outside of baby but before placental
primary care settings (hospitals or delivery. 20ugtts/min Plain NSS or
birthing centers) Lactated Ringer
Uterine Atony  Trauma and Laceration
• Relaxation of uterus - can disrupt the normal
- Contracting uterus stops bleeding contractile function of
uterus
• Pertains to the muscle of uterus  Surgical interventions
• Most frequent cause of postpartum - instruments assisted deliveries
hemorrhage like forces and suction
 prolonged oxytocin use
• Uterus must remain contracted to  high parity
prevent bleeding at the placental  preterm delivery
site.  history of uterine surgery
-Should be firm not boggy or relaxed  IVF conceptions.

MGDV,SN
 Oral Revalida
Symptoms:

 prolonged or excessive bleeding

MGDV,SN
 Oral Revalida
 Low blood pressure.
appropriate ongoing treatment,
 Fast heart rate.
manual exploration and removal
 Feeling dizzy or faint.
should be undertaken. This is
 Pale appearance. simultaneously therapeutic by
 Losing consciousness. emptying the uterus and
 Being unable to pee.
permitting contraction while also
 Pain, especially in your back.
 fever
 aiding in the diagnosis of
 a bad smelling discharge
placenta accreta and uterine
from the vagina
rupture. Cervical and vaginal
 heavy bleeding
lacerations may also be
 large pieces of tissue coming
palpated at this time.
out of the vagina
 Ultrasound
Diagnostic Test:  Blood serum sample if there is
a presence of HCG
 Assessment of uterine tone and
size is accomplished using a
hand resting on the fundus and Medical Interventions:
palpating the anterior wall of
• Intravenous oxytocin, carboprost, or
the uterus. The presence of a
methylergonovine.
boggy uterus with either heavy
vaginal bleeding or increasing  Oxytocin 1 hour Iv –
uterine size establishes the
 Carboprost (hemabate) 15-
diagnosis of uterine atony. The
90 minutes up to 8 doses IM
presence of uterine atony and
–
resulting hemorrhage usually
prevents the diagnosis of PPH  Methylergonovine or methergine
from other causes because of 2 - 4 hours up to 5 doses
an inability to visualize other
• Rectal misoprostol administration
sites. For this reason, and
- Decreased postpartum hemorrhage
because of the rapidity of blood
loss secondary to atony,
management and control of Tranexamic acid (TXA)
atony is paramount.
- reduces bleeding within 3 hours of
 If the placenta has been birth no use after 3 hours , women
delivered, inspection findings with postpartum hemorrhage should
suggest whether portions of it received 1g IV asap
have been retained. If it is •Caution with prostaglandins due to
undelivered or if retained clots potential side effects.
or placental fragments are Always make sure of availability and
distending the uterus and stock!
bleeding is persisting despite
•Prostaglandins

MGDV,SN
 Oral Revalida
 can cause diarrhea, • Dilatation and curettage (D&C)
nausea and vomiting,
should always have anti
emetic

 Misoprostol (Cytotec)

 Carboprost
Tromethamine
(Hemabate)

•Methergine - increased blood

pressure

• Blood transfusion for significant blood

loss.

• Ensure blood typing and

cross- matching.

• Autotransfusion for those who

donated blood during pregnancy.

• Suturing, balloon compression, or

embolization.

 Balloon Compression 100ml

and gradually increasing
300ml
 If no changes within 15
minutes transfer
 If controlled give oxytocin 20 IU
in 1L IV fluids 60drops per
minute and Ampicillin 2gm IV
 Uterine embolization –
blocking the blood supply in
the uterus

• Ligation of uterine arteries or

hysterectomy in extreme cases

Hysterectomy

 Indicated for unmanageable

extreme bleeding

Last resort > ligation of uterine arteries

Embolization of pelvic and uterine
vessels by angiographic techniques

• Embolization of pelvic and uterine

vessels by angiographic techniques

MGDV,SN
 Oral Revalida
• Hemorrhage may be delayed • Retained placental fragments
until patient gets home, ensure
patient knows how to assess

-Lochia Health Teaching

• Accreta may be deeply attached

 D & C may not be sufficient

 Balloon occlusion
 Embolization of internal
iliac arteries

• A catheter (a thin, flexible tube)

is inserted into the femoral artery
through a small incision, usually in the
groin area.

• The catheter is then guided

through the blood vessels to reach
the internal iliac arteries, which
supply blood to the pelvic organs,
including the uterus

Hysterectomy

• • Hysterectomy is the
surgical removal of the uterus
and cervix.

• Supracervical hysterectomy
refers to removal of the uterus while
the cervix is spared.

TAHBSO

• Total Abdominal
Hysterectomy and Bilateral Salpingo-
Oophorectomy – No reproductive
system

• The removal of the entire

uterus, the ovaries, fallopian tubes,
and the cervix.

• TAHBSO is usually performed

in the case of uterine and cervical
cancer.

• This is the most common

kind of hysterectomy.

• Premature separation of the placenta

MGDV,SN
 Oral Revalida
 Take medicines as prescribed.

Nursing Interventions:
 Talk to your doctor or midwife
about whether you need to
take iron pills or a
 Visual Assessment- assess the multivitamin.
color and amount of blood
either when in perineal pads  Wear compression stockings
or toilet. Also ask for the if your doctor or midwife
clots recommends them.
 Quantitative Assessment-
measure the blood loss by  Eat foods that are high in iron
weighing the perineal pads and vitamin C. Good sources
before and after use - 1gm = of iron include red meat,
1ml beans, leafy green vegetables,
and iron-fortified breakfast
 Vital Signs Monitoring - cereals. For vitamin C, try
increased heart rate , citrus fruits.
decreased bp and increased RR

- Fundal assessment- palpating  Watch your bleeding closely.

the fundus regularly to assess You should see less of it over
when its firm and contracted the next 6 weeks.
should feel like a harf mask
below the level of umbilicus and  Use pads for bleeding. Don't
palpable use tampons or cups until your
doctor or midwife says it's
okay.
 Assess for Shock - pallor , cool
and clammy skin , rapid  Call your doctor, midwife, or
breathing, altered mental status nurse advice line now or seek
. Drop of hemoglobin’s and immediate medical care if
hematocrit over short period of you:
time there is an increased
bleeding  Have heavy vaginal bleeding
 Turning woman on her (soaking through one or more
side during inspection to pads in an hour, or passing
prevent pooling. blood clots bigger than an egg).
 Frequent palpation of
uterine fundus to ensure
contraction.
 Frequent assessments of
lochia for flow and clot size.
 Monitoring vital signs: Pulse
and blood pressure.
Health Teachings: Pre-eclampsia
Definition:
 Get plenty of rest.
MGDV,SN
 Oral Revalida
 a serious medical condition
that can occur about midway

MGDV,SN
 Oral Revalida
through pregnancy (after 20
Symptoms:
weeks).
 People with preeclampsia Not Severe:
experience high blood
 1+ protein in urine (proteinuria) or
pressure, protein in their urine,
other signs of kidney problems
swelling, headaches and
 300 mg in a 24 hour urine
blurred vision.
protein collection
 This condition needs to be
 0.3 or higher urine protein
treated by a healthcare
creatinine
provider. It typically goes away
 BP- 140/90
after your baby is delivered.
Severe:
Etiology:
 160/110
 Problems with how well blood
 Less than 100,000 platelet counts
circulates in the placenta may
(thrombocytopenia)
lead to the irregular regulation
 Elevated liver enzymes
of blood pressure in the
that indicate liver
mother.
problems
Risk Factors:  Serum creatinine above
1.1mg/dL
 Chronic high blood pressure or
 Severe headaches
kidney disease before
 Changes in vision, including
pregnancy
temporary loss of vision, blurred
 High blood pressure or
vision or light sensitivity
preeclampsia in an
 Shortness of breath, caused
earlier pregnancy
by fluid in the lungs
 Obesity. Women with
 Pain in the upper belly,
overweight or obesity are also
usually under the ribs on the
more likely to have
right side
preeclampsia in more than one
 Severe epigastric pain &
pregnancy.
nausea or vomiting
 Age. Women older than 40 are
 Pulmonary edema
at higher risk.
 Abdominal edema (ischemia
 Multiple gestation (being
to the pancreas or liver)
pregnant with more than
 Cerebral edema (seeing spots,
one fetus)
blurred vision, severe
 African American ethnicity.
headache,marked hyperflexia
Also, among women who have
& ankle clonus)
had preeclampsia before, non-
white women are more likely Diagnostic Test:
than white women to develop
preeclampsia again in a later Blood tests
pregnancy. -These tests can determine how well
 Family history of preeclampsia. your liver and kidneys are functioning
and whether your blood has a normal
number of platelets — the cells that help

MGDV,SN
 Oral Revalida
blood clot.

MGDV,SN
 Oral Revalida
 Obtain CBC, platelet count, - Urinary output should be 30ml/hr
liver function, blood urea - maintain bed rest in LLR(Left
nitrogen, creatinine & fibrin lateral recumbent)
degradation products. - provide high protein diet
with moderate sodium
Urinalysis - IV Fluid line for drug
administration & to reduce
-Your health care provider might test hemoconcentration &
a sample of your urine to see if it hypovolemia
contains protein, or he or she might - monitor frequently
have you collect your urine for 24  maternal and fetal heart VS
hours so it can be tested for the total  I&O
amount of protein.  daily weight or presence
of edema
Medical Interventions:  reflexes – deep tendon
reflexes (if taking magsul)
 Antihypertensive drugs to
 onset or progress of
lower blood pressure labor; signs of abruptio
 Anticonvulsant medication, such placenta
as magnesium sulfate, to  Biophysical profile done
prevent seizures to asses uteroplacental
 Corticosteroids to promote sufficiency
development of your  tonic-clonic seizure
baby's lungs before (with involuntary
delivery movements)
 priority care for a patient is
Nursing Interventions w/o severe
to maintain a patent airway
features:

 Monitor antiplatelet therapy - administer drugs as ordered
 Low dose antiplatelet agent  magnesium sulfate
such as aspirin may prevent or  hydralazine
 other anti-hpn drugs
delay the development of
o nifedipine
preeclampsia o labetalol oral
 provide emotional support o labetalol IV
 diazepam (valium)
 Nursing Interventions with severe - prevent convulsion
features:
 treatment and nursing care: WHEN CONVULSION OCCUR:
- Monitor BP q4 hours  reduce environmental stimuli
- Assess renal & liver function &  Raise side rails to prevent injury
development of DIC as wells  place patient in a semi-
as plasma estriol levels darkened and quiet room
(placenta function) &
 room should be near the nurses’
electrolyte levels
station
- Blood sample for type & cross
match because the pt is high  monitor for signs of
risk for abruptio placentae impending convulsions
resulting to hemorrhage  -provide care during convulsions
- Indwelling Catheter  never leave a convulsing
MGDV,SN
 Oral Revalida
patient alone

MGDV,SN
 Oral Revalida
 maintain patent airway magsul toxicity occur
 promote safety/prevent injury
 reduce environmental stimuli
 monitor, record and report
the type of convulsion
 continue strict monitoring for
48 hours after delivery
 monitor antiplatelet therapy
 support bed rest
 Left recumbent position
- help prevent supine hypotension
 sudden noises can cause seizures
 darken the room if possible
- bright light can also
trigger seizures
- room should not be so dark
 stress is another stimulus as it is
capable of increasing BP and
evoking seizures in patient
 monitor fetal and maternal VS
 support a nutritious intake
- high in protein and
moderate sodium (to avoid
edema)
- 1,800 kcal: 1st trimester
- 2,200 kcal: 2nd trimester
- 2,400 kcal: 3rd trimester

Administering Medications to
Prevent Eclampsia

 hypotensive drugs
 hydralazine
 labetolol
 these drugs act to lower blood
pressure by peripheral
dilatation and thus do not
interfere with placental
circulation
 Magnesium Sulfate
- Blood serum must be
maintained 5-8 mg/dL. If it rises,
respiratory depression, cardiac
arrhythmias & cardiac arrest can
occur
- Calcium gluconate (1g) antidote
for magsul, should be given if

MGDV,SN
 Oral Revalida
Signs of MagSul Toxicity
- Decreased UO
- Depressed respi
- Reduced consciousness
- Decreased tendon reflexes

Health Teachings:

 Monitor yourself for symptoms

of preeclampsia. Call your
healthcare provider or midwife
if you have symptoms such
as a severe headache, vision
changes, or sudden swelling
in your face and hands.
 Keep track of your blood
pressure at home if your
doctor or midwife asks you to.
Ask your healthcare provider
or midwife to make sure that
the monitor is working and
that you're using it right.
Follow instructions about when
to take your blood pressure
and what to avoid before
taking your blood pressure.
 Take medicines exactly as
prescribed. You may need
to take medicine to control
your blood pressure.
 Do not use tobacco or
tobacco- like products,
including cannabis, and other
substances. They can harm
your health. They can also
affect your baby’s growth,
health, and the development
of their brain and lungs
 Gain a healthy amount of
weight. Talk with your
healthcare provider or midwife
about how much weight gain
is healthy for you. Gaining too
much weight while you're
pregnant may be harmful.

MGDV,SN
 Oral Revalida
 Check your baby's movements. from the site of implantation.
Once each day, time how long  Pelvic pain
it takes to count 6 movements. - Results from the stretching and possible
rupture of the fallopian tube as the
If you don't feel at least 6 ectopic pregnancy grows.
movements in 2 hours, call  Sharp abdominal pain
your healthcare provider or - Often accompanies the rupture of the
midwife. fallopian tube, which can lead to internal
bleeding and acute abdominal pain.
 Sharp stabbing pain at the
Ectopic Pregnancy lower quadrant
- Typically associated with the site of the
Definition: ectopic pregnancy, often felt on one side
of the lower abdomen due to the location
 implantation occurred of the fallopian tube.
outside the uterine cavity
Diagnostic Test:
 second most common cause
of bleeding in early pregnancy • Transvaginal ultrasound
 An ultrasound exam: An
most common site is fallopian tube: ultrasound uses sound waves
to create a picture of your
 ampullar portion – 80%
body’s internal structures. Your
 isthmus – 12%
provider will use this test to see
 interstitial or fimbrial – 8%
where the fertilized egg has
obstruction is present implanted.
 Blood test
obstruction may be due to:
 You provider may test your
 previous infection blood to see how much of the
 congenital malformations hormone human chorionic
 scar from tubal surgery gonadotropin (HCG) you have
 uterine tumor in your body. Your body only
makes HCG during
Etiology:
pregnancy. A low amount
 smoking
may indicate an ectopic
- Damages fallopian tubes, increasing risk
of blockage pregnancy because HCG
 Alcohol levels increase dramatically
- heavy alcohol consumption may disrupt when a fertilized egg
ovulation and implantation implants in your uterus.
 early use of contraceptive pills
and IUD Medical Intervention:
- potential disruption of normal hormonal
and uterine function  IM administration of methotrexate
 history of infertility followed by in
vitro  chemotherapeutic agent that
- due to scarring or abnormalities in is a folic acid antagonist. It
the fallopian tubes resulting from destroys rapidly growing cells
prior interventions
such as the trophoblast and
Symptoms:
the zygote. This would be
 Vaginal bleeding
- due to implantation of the embryo administered until a negative
outside the uterus, leading to bleeding hCg titer results have been

MGDV,SN
 Oral Revalida
produced.
- the advantage of this therapy is
that the tube is left intact, with no
surgical scarring that could cause a
second ectopic implantation
 hCG will be monitored until
(-) hCG titer is achieved

 hysterosalpingogram or ultrasound
- X-ray procedure that is used to view the
inside of the uterus and fallopian tubes

 laparoscopy (ruptured
fallopian tube)
- to stop and repair the
bleeding vessel and fallopian
tube

MGDV,SN
 Oral Revalida
 iv fluids and blood transfusion sexual intercourse, sun exposure
due to risk of Methotrexate
Nursing Intervention:
dermatitis, and ultrasound and
 Monitor VS - To detect signs of shock pelvic examinations during
or other complications, Methotrexate therapy
 Monitor presence and amount surveillance
of bleeding - Assessing for signs of
hemorrhage and determining the need
for immediate intervention
 Monitor for increase and pain
and abdominal distention
and rigidity - Indicates possible
rupture of the fallopian tube
 Monitor complete blood
count(CBC) - for signs of anemia or
changes in white blood cell count, which
may indicate internal bleeding or
infection.
 Provide comfort measure
like back rubs, deep
breathing - alleviate discomfort
and promote relaxation
 Administer analgesics
as indicated - To manage
pain

Health Teachings:

 Advise the patient on the

advantages and disadvantages
of each treatment option
 Women may grieve at the loss
of pregnancy and may need
appropriate support
 Explain that fertility rates after
either medical or surgical
management are similar in
patients with no history of
subfertility or tubal pathology
 In patients with a history of
subfertility, improved
reproductive outcomes are
observed with medical or
expectant management than
with surgery
 Women undergoing medical
management should avoid
alcoholic beverages, NSAIDs,
vitamins containing folic acid,

MGDV,SN
 Oral Revalida
 Patient with confirmed system attack against
ectopic pregnancy should the fetus’s red blood
cells, which your body
avoid using intrauterine
thinks are foreign
device as contraception
objects.
since this can increase the
chance of ectopic pregnancy
 Describe the side effects of
medical therapy and
symptoms to monitor (eg
severe abdominal pain,
lightheadedness)
 Patients should be
advised regarding their
risk of future ectopic
pregnancy
 In patients with no history of
subfertility or tubal pathology,
no difference in the risk of
future tubal ectopic pregnancy
or tubal patency rates is seen
between the different
management approaches.

RH Incompatibility
Definition:
 Rh-negative pregnant
carries a fetus with
Rh- positive blood
type. With

Rh
incompatibility, your
immune system
reacts to this
difference (known

as
incompatibility) and
creates antibodies.
These antibodies
drive an immune

MGDV,SN
 Oral Revalida
(tachycardia)
Etiology:  Fast breathing
 Being an Rh-negative (tachypnea)
woman, and  Lack of energy
conceiving a baby  Swelling under the skin
with a man who is  Large abdomen
Rh- positive (that
baby would have a Diagnostic Test:
50% or greater
chance of inheriting  Anti D titer test
Rh-positive blood) (1) - is done on a blood
sample to check the
Symptoms: level of Anti D Titer
level in the blood. It is
A yellow coloring of performed specifically
amniotic fluid. This on pregnant women
color may be because to assess their Rh
of bilirubin. This is a incompatibility and
substance that is also to check results
released when blood of the medications.
cells break down.
 Your baby may have a - An ultrasound to view
big liver, spleen, or the baby for fluid build-
heart. There may also up.
be extra fluid in your
baby's stomach, lungs, - Amniocentesis.
or scalp. These are
signs of hydrops - Percutaneous umbilical
fetalis. This condition cord sampling of the
causes severe swelling fetal blood (During this
(edema). test, a blood sample gets
taken from the baby’s
 Rh disease can cause umbilical cord. This
problems in your sample gets tested for
newborn. anemia, bilirubin, and
other antibodies.)
The condition caused
by Rh disease in Medical/Nursing
babies is called Interventions:
hemolytic
disease of the - RhIG (RhoGAM) is given
newborn (HDN). Your at 28 weeks of
baby may have the pregnancy
following symptoms: - it will be given again 72
hours after birth via IM
 Yellow coloring of the  RhIG will be given in
skin and whites of the the same manner
eyes (jaundice) every pregnancy
 Pale-coloring because of  after birth, the infant’s
anemia blood type will be
 Fast heart rate assessed
MGDV,SN
 Oral Revalida
 intrauterine infusion loss and volume
- to restore fetal RBCs
depletion,
- usually done between 32
resulting in
to 35 weeks of gestation
ketonuria and/or
- done via amniocentesis
Etiology: ketonemia.
- fetus own blood type or
type O negative  Unknown
- birthing parent is urged
to rest for 30 minutes Risk Factors:
 RhIG should be
given after the  Having HG in a
IU transfusion prior pregnancy.
- in severe cases, the  Having a multiple
fetus should be delivered pregnancy (twins,
between 32 to 34 weeks triplets or more).
but in mild cases it can  Being pregnant for
be extended until 37 to the first time.
38 weeks  A biological family
- after birth, the infant history of severe
may require the ff: morning sickness
 phototherapy or HG.
 exchange  History of motion
transfusion sickness or migraine
headaches.
Health teaching:  Having gestational
trophoblastic
- If not sure what your Rh disease (GTD),
factor is and think you're which involves
pregnant, it's important abnormal cell
to start regular prenatal growth in your
care as soon as possible uterus.
- Including blood-type
testing. Symptoms:
- With early detection and
treatment of Rh  Severe nausea.
incompatibility, you can  Vomiting more than
focus on more important three times per day.
things — like welcoming  Losing more than 5%
a new, healthy baby. of your pre-
pregnancy weight.
 Not being able to keep
Hyperemesis gravidarum food or liquids down.
 Dehydration.
Definition:  Feeling dizzy or
lightheaded.
 intractable  Peeing less than normal.
vomiting during  Extreme tiredness.
pregnancy,  Fainting.
leading to weight  Headaches.

MGDV,SN
 Oral Revalida
cases of hyperemesis
Other less common gravidarum might
symptoms include: require that nutrients
be given through an IV
 Low blood pressure. that bypasses your
 Rapid heart rate. digestive system
 Dry skin. completely. This allows
 Confusion. your digestive system
 Jaundice due to liver to heal and not have to
damage. work at all.
 Wernicke-Korsakoff
syndrome. Health Teachings:

Diagnostic Test:  Lifestyle changes:

These changes might
 Blood Test include wearing a
 Urinalysis pressure- point
 Ultrasound wristband
(acupressure bands)
- high level of BUN may or eating ginger chews
indicate DEHYDRATION and drinking ginger
tea for nausea.
Medical/Nursing
Intervenions:  Dietary changes: Small,
frequent meals (every
Mild cases: two hours) of bland,
 lifestyle changes dry food can help with
 dietary changes (blunt nausea and vomiting.
diet) Crackers, toast, white
 avoid triggers potatoes or rice are
 anti-nausea meds good examples.
(pyridoxine (vitamin Studies show foods
B6), doxylamine) high in fat can
contribute to nausea
Severe cases: during
 anti-nausea meds pregnancy. Your
(promethazine, provider may
metoclopramide, recommend avoiding
ondansetron) greasy or spicy foods.
 iv fluids  Don’t take any
 Tube feeding: You’ll get medications for
nutrients from a flexible nausea or vomiting
tube that your provider without talking to your
places in your nose or provider first.
stomach. In most Prescription
cases, you’ll be medication is also an
hospitalized for option.
treatment.  Avoiding triggers: You
may notice certain
 (TPN): The most severe things make you more
nauseated, like

MGDV,SN
 Oral Revalida
specific
smells or
riding in a
car. Try to
avoid
activities

MGDV,SN
 Oral Revalida
that make you feel intestine has been
this way. torn (perforated).

INTUSSUSCEPTION Medical/Nursing
Interventions:
Definition:
 most frequent causes  hydrostatic reduction
of intestinal with barium enema
obstruction in children  anastomosis and pull-
 most common in through
children between 3 to  promote adequate
9 month of age hydration
 monitor bowel
Etiology: elimination status
 unknown cause  monitor for infection
 associated with:
- viral infections Health teachings:
- intestinal polyps
- Meckel diverticulum  Let your child get back
- lymphoma to normal activity as
soon as they feel up
Symptoms: to it.
 currant-jelly stools
 palpable Sausage  This health problem can
shaped mass alt RUQ sometimes come
 abdominal distention & back. Watch your
pain child for signs. Look
 bile-stained fecal for belly (abdominal)
vomitus pain that gets worse,
 lower GI series staircase or vomiting. Also look
or coiled spring sign for crying spells
without a cause and
Diagnostic Tests: drawing the legs up
toward the belly.
 Ultrasound or other
abdominal imaging.  Feed your child a
An ultrasound, X-ray normal diet.
or computerized
tomography (CT) scan  Follow-up care
may reveal intestinal  Follow up with your
obstruction caused by child’s healthcare
intussusception. provider, or as told.
Imaging will typically
show a "bull's-eye," - Call your child's
representing the healthcare provider right
intestine coiled within away if your child has:
the
intestine. Abdominal  Fever
imaging  Belly pain that comes
also can show if the

MGDV,SN
 Oral Revalida
and goes
 Constant belly pain that
Symptoms:
doesn't get better or
seems to be getting
 Vomiting
worse
 Weight loss
 Vomiting
 Ravenously hungry
 Extreme sluggishness,
despite vomiting
tiredness, or fatigue
 Lack of energy
 Dark, mucus-like, bloody
 Fewer bowel movements
stools
 Constipation
 Pale skin color
 Frequent, mucous stools

Diagnostic Test:

 Blood tests
 Abdominal X-rays
 Abdominal ultrasound.
 Barium swallow/upper
GI, series.
Pyloric stenosis
Medical Interventions:
Definition:
 Prehospital care. As
 also known as infantile with all pediatric
hypertrophic pyloric resuscitations,
stenosis (IHPS), is an prehospital care in
uncommon condition patients with pyloric
in infants stenosis should be
characterized by consistent with pediatric
abnormal thickening advanced life support
of the pylorus (PALS)
muscles in the recommendations for
stomach leading to infants who are
gastric outlet dehydrated or in shock.
obstruction. Clinically
infants are well at birth.  Correction of
Then, at 3 to 6 weeks of dehydration. If significant
age, the infants dehydration has
present with occurred, immediate
"projectile" vomiting, treatment requires
potentially leading to correction of fluid loss,
dehydration and electrolytes, and acid-
weight loss. base imbalance,
starting with an initial
Etiology fluid bolus (20ml/kg) of
isotonic crystalloid.
 Unknown,although
genetic factors may  Diet. Feeding can be
play a role. initiated 4-8 hours after

MGDV,SN
 Oral Revalida
recovery from  Maintain adequate
anesthesia, although
earlier feeding has
been studied; infants
who are fed earlier than
4 hours do not have a
worse total clinical
outcome; however,
they do vomit more
frequently and more
severely, leading to
significant discomfort for
the patient and anxiety
for the parents.

 Pyloromyotomy is often
done using minimally
invasive surgery. A
slender viewing
instrument, called a
laparoscope, is inserted
through a small incision
near the baby's navel.
Recovery from a
laparoscopic procedure
is usually quicker than
recovery from
traditional surgery. This
method also leaves a
smaller scar.

 IV atropine. The
intravenous dose of
atropine for the
treatment of pyloric
stenosis ranges in
studies from 0.04
to
0.225mg/kg/day and is
given for 1 – 10 days.
 Oral atropine. Oral
atropine (0.08 –
0.45mg/kg/day) is
continued, after IV
therapy has been
deemed successful, for
3 weeks to 4 months.

Nursing Intervention:

MGDV,SN
 Oral Revalida
nutrition and the interruption in
fluid intake. normal feeding and
If the infant sucking habits.
is severely  Promote skin integrity.
dehydrated The infant is
and repositioned, the
malnourished diaper is changed,
, rehydration and lanolin or A and
with D ointment is applied
intravenous to dry skin areas.
fluid and  Promote family coping.
electrolytesare Include the
necessary; caregivers in the
feedings of preparation for
formula surgery and explain
thickened the importance of
with infant added IV fluids, the
cereal and reason for
fed through a ultrasonographic or
large-holed barium swallow
nipple may be examination, and the
given to
improve
nutrition; feed
the infant
slowly while
he or she is
sitting in an
infant seat or
being held
upright.
 Provide mouth care. The
infant needs
good mouth
care as the
mucous
membranes
of the mouth
may be dry
because of
dehydration
and the
omission of
oral fluids
before
surgery; a
pacifier can
satisfy the
baby’s need
for sucking
because of

MGDV,SN
 Oral Revalida
function of the NG
 If you use formula,
tube and saline
don’t give your baby
lavage; describe the
more than 3 ounces
surgical procedure to
every 3 hours for the
be performed; and
first 3 days. After 3
explain what to
days, you can slowly
expect and how long
increase the amount
the operation will
as directed by your
last.
healthcare
provider.
Health teachings:
 Don’t worry about
Incision care limiting your baby’s
activity. Most babies
 Keep your baby’s can go back to normal
incision clean and dry. activity soon after
Don’t use lotion, surgery.
powder, oil, or cream
on it.
To treat pain:
 You can give your baby  Talk with your child's
sponge baths for 2 healthcare provider
days after the about what signs to
surgery. After that, watch for to know if
you can give your your baby is in pain.
baby baths. Make sure
to keep the incision out
 Talk with the provider
of the water.
before giving
acetaminophen for
 Don’t remove the white pain if needed. Ask
sticky strips on your how much medicine to
baby’s incision. Let give your child and
them fall off on their how often.
own. If surgical glue
was used, it will peel
 Don’t give more than
off on its own in 5 to
the maximum daily
10 days.
dose in any 24-hour
period.
 Don’t lift your baby
under the arms. This will Follow-up care
stretch the stitches
 Make a follow-up
and may cause pain.
appointment as
Instead, lift your baby
directed by your
by supporting his or
provider.
her buttocks and
head.
Call your baby's healthcare
provider right away if any of
 Other home care
the following occur:
 If you breastfeed, you
can breastfeed your
 Fever of 100.4°F (
baby as normal.
38°C) or higher, or as
MGDV,SN
 Oral Revalida
directed

MGDV,SN
 Oral Revalida
by your healthcare
meningitis outbreak
provider
Etiology
 Redness, swelling, or
smelly fluid at the
 causative agent is
incision site
group b
streptococcus and
 Pain that is not helped
Streptococcus
by medicine pneumoniae
 e. coli prevalent in
 Signs of fluid loss infants under 2 mos
(dehydration), such as old
fewer wet diapers, no  Haemophilus influenzae
tears when crying, or but because of the
sunken soft spot routine immunization
(fontanel) on your bumaba na yung
baby’s head cases caused by H.
influenzae
 Vomiting more than 3
times in a row, or
vomiting that lasts Symptoms:
more than 48 hours
after discharge  early symptoms include irritability
and headache
 Your baby's belly  children usually have had 2-
appears to be 3 days of URTI prior to the
swelling. development of meningitis
 positive Brudzinzki and Kernig
signs
Bacterial Meningitis  opisthotonos
 altered consciousness
Definition:  increased WBC
 elevated protein levels
 bacterial infection that  decreased glucose levels
causes inflammation  lumbar puncture confirms
of the membranes of the diagnosis
the brain, is called
bacterial meningitis Diagnostic Test:
 effective vaccination
helps prevent the  physical examination to look
condition for symptoms of meningitis.
 according to WHO: 1 in  blood test to check for bacteria
6 people died from or viruses.
bacterial meningitis
- 1 in 5 develops serious  lumbar puncture – where a
complications sample of fluid is taken from the
 32%-100% fatality rate in spine and checked for bacteria or
the PH viruses.
 2019,tawi-tawi, bacterial  CT scan to check for any
problems with the brain, such as
MGDV,SN
 Oral Revalida
swelling.

MGDV,SN
 Oral Revalida
Medical Intervention: puncture if the clinical
 antibiotic therapy suspicion of meningitis is
 corticosteroids high.
 osmotic diuretics  Current evidence suggests
- reduce ICP and prevent that steroids may reduce
complications like hearing the risk of
loss
 respiratory precautions and
antibiotic prophylaxis for
close contacts
 close monitoring for
neurological sequel
- learning problems, seizures,
hearing and cognitive challenges

Nursing Intervention:

 Treat seizures in the setting of

meningitis immediately.
 Fluid resuscitation may
be required.
 Administer antibiotics.
- Antibiotics must not be delayed
for more than 30 minutes once
the decision to treat has been
made.
- A delay to antibiotics is
associated with poorer
outcomes.
 Lumbar Puncture.
- Delay to LP should not
delay antibiotic
administration.
- LP may be delayed due to the
severity of the child’s condition.
 Monitor site for swelling and
signs of infection ½ hourly for 4
hours.
 If steroids are ordered,
administer 15 minutes prior to
parenteral antibiotics or, if this is
not possible, within one hour of
receiving their first dose of IV
antibiotics.
 Steroids may be ordered and
given at the time of lumbar

MGDV,SN
 Oral Revalida
hearing loss in bacterial
meningitis.
 Steroids are not recommended in
neonates due to concern
regarding effects on
neurodevelopment.
 Measure head circumference of
infants – place order in Epic.
 If encephalitis is suspected, IV
acyclovir will be ordered.
 Bacterial Meningitis (excluding
meningococcal meningitis) does
not require isolation. Staff should
don appropriate PPE when
performing procedures such as
blood sampling.
 Vital signs and neurological
observations including blood
pressure must be done at 15
minute intervals for the first two
hours, then at intervals
determined by the child’s
conscious state, or at a minimum
of 4hrly when the child is stable.
 In infants, fontanel assessment to
be documented at least once per
shift.
 Strict fluid balance monitoring to
be maintained.
 Skin assessment to be done at
least once per shift, with any new
or increasing rash identified.
 Monitor LP site for signs of
infection or swelling at least once
per shift (See Lumbar Puncture).
 In infants, head circumference
should be measured daily.
 Increased head circumference
indicates increased intra-cranial
pressure.
 Blood sampling should continue
6-12hrly, until serum Na+ level is
within normal ranges and stable
(and/or the child is no longer on
IV therapy).

MGDV,SN
 Oral Revalida
 Fluid management. 38.3˚ C or above
 Intravenous fluid as ordered.
 Enteral feeds should be
started when the child is
stable.
 Enteral feeds should be
withheld in children with a
reduced level of
consciousness, vomiting or
having frequent convulsions.
 Children who are drinking well
should have intravenous fluids
run slowly to keep cannula
patent.
 Ensure adequate analgesia.
 Pain can be related
to meningeal
irritation.
 Low stimulus environment
 Reduce tactile handling of
the child
 A quiet, dimly lit room can
reduce agitation, especially
in children and young people
experiencing photophobia
and/or phonophobia.
 Positioning
 Where possible, raise the head
of the bed greater than 30
degrees and maintain a neutral
alignment.
 Intravenous access
 Maintain peripheral intravenous
(IV) access and escalate loss of
IV access to medical staff
immediately.
 Some infants, children and
young people may have a
central venous access device
(CVAD) inserted.

Health Teachings:

Call your child’s health care

provider if they have:

 Chills or a fever of 101˚ F or

MGDV,SN
 Oral Revalida
 A stiff neck again – hold
their neck still or cry when
their head moves
 Vomiting
 Change in behavior –
crying more than usual,
irritable, more sleepy,
confused
 Hearing loss
 Severe headaches
 Bulging soft spot on their head
– babies only

Definition: Tetralogy of Fallot

- cyanotic defect and is defined
by four components:
 right ventricular outflow
tract obstruction due to
pulmonary valve
hypoplasia and/or
pulmonary stenosis
 VSD
 overriding aorta (means aorta
is closer to the right side of the
VSD)
 right ventricular
hypertrophy (isolated
problem but occurs
secondary due to
pulmonary stenosis)

Risk factors:

 Family history.
 Having a virus during
pregnancy. This includes
rubella, also known as German
measles.
 Drinking alcohol
during pregnancy.
 Eating poorly during pregnancy.
 Smoking during pregnancy.
 Mother's age older than 35.
 Down syndrome or
DiGeorge syndrome in the
baby.

Symptoms:
MGDV,SN
 Oral Revalida
 hypercyanotic spell administered

- irritability

- deeply cyanotic (hallmark’s)

- respiratory distress

 slow weight gain

- poor feeding

- clubbing; dyspnea, fainting

 systolic murmur

Diagnostic Test:

 echocardiography to confirm
 cardiac catheterization may be
necessary if the coronary
artery anatomy is not well
visualized
 ECG
 ABG (Arterial blood gas)

Medical Intervention:

 oxygen administration
 phenylephrine
 propranolol
 modified Blalock-taussig shunt
(creates a pathway for blood
to reach the lungs.)
 open-heart surgery

Nursing Interventions:

 Monitor blood pressure and

heart rate.
 Place the patient on their left
side, knees to chest.
 Cautiously administer
oxygen therapy as
prescribed.
 Manage Tet spells.
- Morphine, propranolol (or
metoprolol), or, in difficult
situations, phenylephrine may be
MGDV,SN
 Oral Revalida
to the child. These pounds (2 kg).
medications lessen tet
spells’ incidence and  Keep a close eye on your child's diet
severity. to make sure they get enough
 Prepare for surgical calories to heal and grow.
management.

Health Teaching:

 Your child will need at least 3 or 4

more weeks at home to recover.

 Pain after surgery is normal. The

pain will likely decrease after the
second day and can sometimes
be managed with acetaminophen
(Tylenol).

 The provider will tell you when it is

OK for your child to return to
school or daycare.

 Most often, the first few weeks

after surgery should be a time
to rest.

 For the first 4 weeks after surgery,

your child should not do any
activity that could result in a fall
or a blow to the chest. Your
child should also avoid bicycle
or skateboard riding, roller
skating, swimming, and all
contact sports until the provider
says it is OK.

 Do not pull or lift the child by the

arms or from their armpit area.
Scoop the child up instead.

 Prevent your child from doing

any activities that involve pulling
or pushing with the arms.

 Try to keep your child from

lifting the arms above the
head.

 Your child should not lift

anything heavier than 5
MGDV,SN
 Oral Revalida
When to Call the Doctor
 After heart surgery, most babies and
infants (younger than 12 to 15
months) can take as much formula
or breast milk as they want. In some
cases, the provider may want your
baby to avoid drinking too much
formula or breast milk. Limit feeding
time to around 30 minutes. Your
child's provider will tell you how to
add extra calories to formula if it is
necessary.

 Look at the wound for signs of

infection, such as redness,
swelling, tenderness, warmth, or
drainage.

 Your child should take only a shower

or a sponge bath until your provider
says otherwise. Steri-Strips should
not be soaked in water. They will
begin to peel off after the first week.
It is OK to remove them when they
start to peel off.

 For as long as the scar looks pink,

make sure it is covered with clothing
or a bandage

 Ask your child's provider before

getting any immunizations for 2 to 3
months after surgery.

 Afterward, your child should have a

flu shot every year.

 Make sure you have clear

instructions from your child's heart
provider about when your child
needs antibiotics. It is still very
important to have your child's teeth
cleaned regularly.

 Be sure to give your child the correct

dosage. Follow-up with your provider
1 to 2 weeks after the child leaves
the hospital or as instructed.

MGDV,SN
 Oral Revalida
Call the provider if your child has:

 Fever, nausea, or vomiting

 Chest pain, or other pain
 Redness, swelling, or drainage from
the wound
 Difficulty breathing or shortness of
breath
 Puffy eyes or face
 Tiredness all the time
 Bluish or grayish skin
 Dizziness, fainting, or heart
palpitations
 Feeding problems or reduced
appetite

MGDV,SN