Page 700 - Saunders Comprehensive Review For NCLEX-RN

10. Obesity
11. Catheterization
D. Screening is done at the first prenatal visit or at 12 to 16 weeks’
gestation. Rescreening is done based on risk factors.
E. Assessment and Interventions (refer to Chapter 54): It is important
to differentiate between cystitis and the progression to
pyelonephritis. If progressed to pyelonephritis, hospitalization
may be required for antibiotic therapy and possible tocolysis.
XXV. Obesity in Pregnancy
A. Description: Obesity in every population, including adults and
children, is a problem in the United States. Obesity in pregnancy
places the client at risk for several complications during
pregnancy, including gestational diabetes, gestational
hypertension, preeclampsia, venous thromboembolism, and
increased need for cesarean birth.
B. Delivery complications can result from difficulty obtaining IV
access, epidural access, intubation, and decreased oxygen
consumption with associated increased cardiac output, stressing
the heart.
C. Obesity in pregnancy can have negative effects on the newborn,
including stillbirth, premature birth, congenital anomalies, future
obesity, heart disease, and difficulty with breast-feeding.
D. Obese women have lower prolactin response to suckling in the
first week postpartum, contributing to high rates of breast-feeding
failure in this population.
E. Potential postdelivery complications and associated interventions
1. Thromboembolism formation is a concern; as
prescribed, thromboembolism stockings, sequential
compression devices (SCDs), and pharmacological
venous thromboembolism prophylaxis may be
necessary postdelivery.
2. Postpartum hemorrhage is more common, as well as
difficulty locating the fundus, predisposing further to
this problem.
3. Endometritis is common in this population.
4. Early ambulation is encouraged to prevent venous
thromboembolism formation.
5. Frequent monitoring and cleaning of surgical incisions
(episiotomy or cesarean incision) is needed to prevent
infection or dehiscence due to excess abdominal fat
XXVI. Additional complications during pregnancy: See Table 22-3.

Box 22-1

Types of Abortions

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