20
Nursing Care of a Family Experiencing a
Pregnancy Complication From a Preexisting
or Newly Acquired Illness
Angelina Gomez, 22 years old, is a gravida 1, para 0 woman, 34 weeks pregnant,
whom you meet in the emergency room. Her electronic record shows you she had
rheumatic fever with mitral valve stenosis as a child. During this pregnancy, she
developed gestational diabetes. At 34 weeks, she has already been hospitalized twice
for hyperglycemia. This afternoon, she fainted while participating in her weekly
hour-long aerobics class. Her serum glucose at the moment is 207 mg/dl. Blood
pressure is 90/40 mmHg; pulse rate is 130 beats/min; the fetal heart rate is 180
beats/min. A uterine monitor shows she is having moderate-strength contractions 7
minutes apart. Angelina asks you, “If exercise is supposed to be good for you, why
did this happen?”
Previous chapters discussed normal pregnancy and the minor discomforts that
may occur. This chapter adds information about illnesses and other events that can
complicate pregnancy when they occur prior to or during pregnancy. As more
women wait until they are older than age 30 years to have their first child, more and
more women enter pregnancy with a preexisting disorder, such as cardiac or
respiratory illness, that can complicate pregnancy.
How would you answer Angelina? Do you think she realizes pregnancy often
becomes high risk not because of any one factor but an accumulation of them?
KEY TER MS
deep vein thrombosis (DVT)
glucose challenge test
glycosuria
glycosylated hemoglobin (HbA1c)
high-risk pregnancy
hyperglycemia
hypoglycemia
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,megaloblastic anemia
orthopnea
paroxysmal nocturnal dyspnea
peripartal cardiomyopathy
OBJ EC TIV ES
After mastering the contents of this chapter, you should be able to:
1. Define high-risk pregnancy, including preexisting factors that contribute to its
development such as diabetes mellitus or cardiovascular disease.
2. Identify 2020 National Health Goals related to complications of pregnancy that
nurses can help the nation achieve.
3. Assess a woman with an illness during pregnancy for changes occurring in the
illness because of the pregnancy or in the pregnancy because of the illness.
4. Formulate nursing diagnoses related to the effect of a preexisting or newly acquired
illness on pregnancy.
5. Identify expected outcomes that will contribute to a safe pregnancy outcome when
illness occurs with pregnancy as well as help families manage seamless transitions
across differing healthcare settings.
6. Using the nursing process, plan nursing care that includes the six competencies of
Quality & Safety Education for Nurses (QSEN): Patient-Centered Care, Teamwork
& Collaboration, Evidence-Based Practice (EBP), Quality Improvement (QI),
Safety, and Informatics.
7. Implement nursing care for a woman when illness complicates pregnancy, such as
teaching her how to measure blood glucose.
8. Evaluate expected outcomes for achievement and effectiveness of care.
9. Integrate knowledge of high-risk pregnancy and the interplay of nursing process,
the six competencies of QSEN, and Family Nursing to promote quality maternal
and child health nursing care.
Although pregnancy can be a stressful time, generally, women experience overall good
health during pregnancy, perhaps in part because of their extra care and concern in
keeping healthy for two. This extra motivation also encourages a woman with a high-
risk pregnancy to carefully follow a therapeutic regimen established for her to keep
herself and her fetus safe.
Unit 4 addresses the nursing role and care you might provide to families with
pregnancy complications, which are common. This chapter focuses on women who
enter pregnancy with a chronic condition, such as cardiovascular or kidney disease, and
those who experience unintentional injury or develop a chronic illness during
pregnancy. Both the woman and the fetus can be at risk for complications. Either the
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,pregnancy can complicate the disease or the disease can complicate the pregnancy,
affecting the fetus or leaving the woman less equipped to function in the future or
undergo a future pregnancy. Nursing care needs to include close observation of both
maternal health and fetal well-being, education for the woman and her family about
special danger signs to watch for during pregnancy, and actions to minimize
complications whenever possible, including:
• Preventing disorders from affecting the health of the fetus
• Helping a woman regain her health as quickly as possible so she can continue a
healthy pregnancy and prepare herself psychologically and physically for labor,
birth, and the arrival of her newborn
• Helping a woman learn more about her illness so she can continue to safeguard
her health during her childrearing years
Conditions that cause severe symptoms such as a marked change in fluid and
electrolyte balance, altered cardiovascular or respiratory function, or severe blood loss
are especially dangerous to a fetus (Gregory, Korst, Lu, et al., 2013). Because of this
danger, 2020 National Health Goals related to complications of pregnancy have been
established (Box 20.1).
BOX 20.1
Nursing Care Planning Based on 2020 National Health Goals
Several National Health Goals are aimed at reducing complications of pregnancy that
arise from existing or newly acquired disorders.
• Reduce the rate of fetal deaths to 5.6 per 1,000 live births from a baseline of 6.2
per 1,000 live births.
• Reduce the rate of maternal deaths to 11.4 per 100,000 live births from a baseline
of 12.7 per 100,000 live births.
• Reduce the rate of maternal illness and complications during pregnancy to 28 per
100 births from a baseline of 31.1 per 100 births (U.S. Department of Health and
Human Services, 2010; see www.healthypeople.gov).
Nurses can help the nation reach these goals by educating women about the
importance of entering pregnancy in the best state of health possible. Helping women
who have diabetes mellitus understand the importance of pre-pregnancy care so they
enter pregnancy without hyperglycemia is an important step toward reducing
congenital anomalies in newborns. Supporting women with kidney, heart, or
respiratory disease during pregnancy to continue to follow their medical regimen is
yet another way.
Nursing Process Overview
FOR CARE OF A WOMAN WITH A PREEXISTING OR NEWLY
ACQUIRED ILLNESS
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, ASSESSMENT
An accurate prenatal assessment of a woman with a preexisting or newly acquired
illness requires a thorough understanding of the signs and symptoms of the illness in
addition to an understanding of the course of a normal pregnancy (Fig. 20.1).
Assessment techniques include objective measures such as establishing baseline vital
signs as well as subjective factors such as the extent of edema or level of exhaustion a
woman is experiencing. Such assessment is best made by healthcare personnel who
care for a woman consistently throughout the pregnancy so that subtle changes can be
recognized. It’s also important to teach a woman how to assess her own health in
relation to objective parameters. She could report exhaustion, for example, in relation
to daily activity such as “Two weeks ago I could walk a block without being short of
breath. Today I could walk only half a block” or “The last time I was in for a
checkup, edema didn’t occur until bedtime. Now I notice it every afternoon by the
time my son comes home from school.”
Figure 20.1 It is important to establish baseline vital signs to later
identify a complication related to a preexisting condition. (Monkey
Business Images/Shutterstock.com)
NURSING DIAGNOSIS
Nursing diagnoses developed for a woman with a high-risk pregnancy address her
specific, disease-related condition as well as any therapeutic restrictions her condition
might require. Examples of possible nursing diagnoses include:
Ineffective tissue perfusion (cardiopulmonary) related to poor heart function
secondary to mitral valve prolapse during pregnancy
Pain related to pyelonephritis secondary to uterine pressure on ureters
Social isolation related to prescribed bed rest during pregnancy secondary to
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