Complications in pregnancy - Infections ATI CH 8

Complications in pregnancy - Infections ATI CH 8 Maternal infections during pregnancy - Maternal infections during pregnancy require prompt identification and treatment by a provider. HIV, TORCH infections, Group B streptococcus ß-hemolytic, chlamydia, gonorrhea, and Candida albicans. HIV/AIDS - HIV is a retrovirus that attacks and causes destruction of T lymphocytes. It causes immunosuppression in a client. How is HIV/AIDS transmitted from mother to fetus or neonate? - HIV is transmitted from the mother to a neonate perinatally through the placenta and postnatally through the breast milk. Does prenatal testing include testing for HIV? - Yes. Routine laboratory testing in the early prenatal period includes testing for HIV. Early identification and treatment significantly decreases the incidence of perinatal transmission. What are the other times during pregnancy that HIV testing is recommended? - Testing is recommended in the third trimester for clients who are at an increased risk, and rapid HIV testing should be done if a client is in labor and her HIV status is unknown. The patient is HIV positive; which procedures should be avoided during pregnancy, labor & delivery? - Procedures, such as amniocentesis and an episiotomy, should be avoided due to the risk of maternal blood exposure to the fetus Use of internal fetal monitors, vacuum extraction, and forceps during labor should be avoided because of the risk of fetal bleeding. Administration of injections and blood testing should not take place until the first bath is given to the newborn. What are the maternal risk factors for HIV? - ● IV drug use ● Multiple sexual partners ● Bisexuality ● Maternal history of multiple STIs ● Blood transfusion (rare occurrence) What assessment data findings should the nurse anticipate seeing in a patient positive for HIV/AIDS? - ■ Fatigue and influenzalike symptoms ■ Diarrhea and weight loss ■ Lymphadenopathy and rash ■ Anemia What are the expected labs concerning HIV/AIDS in pregnancy? - ■ Obtain informed maternal consent prior to testing. Testing begins with an antibody screening test, such as enzyme immunoassay. Confirmation of positive results is confirmed by Western blot test or immunofluorescence assay. ■ Use rapid HIV antibody test (blood or urine sample) for a client in labor. ■ Screen the client for STIs such as gonorrhea, chlamydia, syphilis, and hepatitis B. ■ Obtain frequent viral load levels and CD4 cell counts throughout the pregnancy. What should be included in the nursing care for a maternal client positive for HIV/AIDS? - ◯ Provide counseling prior to and after testing. ◯ Refer the client for a mental health consultation, legal assistance, and financial resources. ◯ Use standard precautions. ◯ Administer antiviral prophylaxis, triple-drug antiviral, or highly active antiretroviral therapy (HAART) as prescribed. ◯ Obtain prescribed laboratory testing. ◯ Encourage vaccination against hepatitis B, pneumococcal infection, Haemophilus influenzae type B and viral influenza. ◯ Encourage use of condoms to minimize exposure if partner is the source of infection. ◯ Review plan for scheduled cesarean birth at 38 weeks for maternal viral load of more than 1,000 copies/mL. ◯ Infant should be bathed after birth before remaining with the mother. What medications are used for a maternal client positive for HIV/AIDS? - Retrovir (Zidovudine): ■ Antiretroviral agent ■ Nucleoside reverse transcriptase inhibitor What are some nursing considerations regarding Retrovir (Zidovudine) for a maternal client positive for HIV/AIDS? - ■ Administer retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor or cesarean birth. ■ Administer retrovir to the infant at delivery and for 6 weeks following birth. What should be included in the discharge instructions for a maternal client positive for HIV/AIDS? - ■ Instruct the client not to breastfeed. ■ Discuss HIV and safe sexual relations with the client. ■ Refer client and infant to providers specializing in the care of clients who have HIV. TORCH - TORCH is an acronym for a group of infections that can negatively affect a woman who is pregnant. These infections can cross the placenta and have teratogenic affects on the fetus. T - Toxoplasmosis O - Other: Hep, Syph; Gon/Chlam, Varicella R - Rubella C - Cytomegalovirus H - Herpes Simplex Toxoplasmosis - Toxoplasmosis is caused by consumption of raw or undercooked meat or handling cat feces. The symptoms are similar to influenza or lymphadenopathy. Other infections - Other infections can include hepatitis A and B, syphilis, mumps, parvovirus B19, and varicella-zoster. These are some of the most common and can be associated with congenital anomalies. ................