Common Diseases in OB ward:
Gestational diabetes:
This is a type of diabetes that develops during pregnancy. It usually resolves after childbirth but requires careful
monitoring and management to prevent complications.
Screening
All pregnant women are usually screened for gestational diabetes between 24 and 28 weeks of gestation, although
earlier screening may be recommended for high-risk individuals. The screening involves a glucose challenge test (GCT)
where the patient drinks a sweetened beverage, followed by a blood test to measure blood glucose levels after a specific
time interval.
Diagnostic Testing:
If the screening test indicates elevated blood glucose levels, a diagnostic test called the oral glucose tolerance test
(OGTT) is performed. The patient fasts overnight, and then blood glucose levels are measured before and at specific
intervals after consuming a glucose solution.
Diagnosis:
The diagnosis of gestational diabetes is made based on the results of the OGTT, which indicate impaired glucose
tolerance or elevated blood glucose levels.
Nursing intervention for Patient with Gestational Diabetes ---
Education and Counseling
Nurses play a crucial role in providing information about gestational diabetes, its management, and the importance of
maintaining blood glucose levels within the target range. This includes educating the patient about dietary modifications,
regular exercise, blood glucose monitoring, and the need for medication if prescribed.
Dietary Guidance:
Nurses collaborate with dietitians to develop individualized meal plans that help control blood glucose levels while
meeting the nutritional needs of the mother and the baby. They provide guidance on portion sizes, carbohydrate
counting, and meal timing.
Monitoring and Assessment:
Regular monitoring of blood glucose levels is essential. Nurses educate the patient on how to perform self-monitoring
and interpret the results. They assess the patient's response to the treatment plan, identify any potential complications,
and monitor fetal well-being through regular antenatal assessments.
Medication Administration:
In some cases, insulin or other medications may be prescribed to manage gestational diabetes. Nurses may be
responsible for administering these medications, teaching the patient about proper administration techniques, and
monitoring for any adverse effects.
Pre-eclampsia:
This is a condition characterized by high blood pressure and damage to organs, typically occurring after the 20th week of
pregnancy. It can lead to complications for both the mother and the baby if left untreated.
Blood Pressure Monitoring:
Regular monitoring of blood pressure is crucial. Persistent high blood pressure (systolic blood pressure ≥ 140 mmHg or
diastolic blood pressure ≥ 90 mmHg) on two separate occasions at least four hours apart indicates hypertension in
pregnancy.
Urine Testing:
A urine sample is collected to check for the presence of proteinuria, which is an essential diagnostic criterion for pre-
eclampsia. Proteinuria is determined by measuring the amount of protein in a 24-hour urine collection or through a spot
protein-to-creatinine ratio.
Assessment of Signs and Symptoms:
The healthcare provider assesses the patient for signs and symptoms of pre-eclampsia, including persistent headaches,
visual disturbances, abdominal pain, sudden weight gain, swelling (edema), and changes in reflexes.
Laboratory Tests:
Blood tests are performed to assess organ function and detect potential complications. These tests may include liver
function tests, renal function tests, complete blood count (CBC), and coagulation profile.
Nursing intervention
Blood Pressure Management:
Nurses monitor blood pressure regularly and assist in implementing antihypertensive medications as prescribed by the
healthcare provider. They educate the patient about the importance of blood pressure control and the potential risks
associated with uncontrolled hypertension.
Fetal Monitoring:
Nurses assess the fetal well-being by monitoring fetal heart rate, assessing fetal movements, and conducting non-stress
tests or other fetal surveillance tests as recommended by the healthcare provider.
Bed Rest and Activity Restriction:
Nurses may advise the patient to limit physical activity and follow a prescribed bed rest regimen to help reduce blood
pressure and minimize the risk of complications.
Fluid Balance Monitoring:
Nurses assess the patient's fluid intake and output to maintain optimal fluid balance. They monitor for signs of fluid
overload or dehydration and make appropriate adjustments in collaboration with the healthcare team.
Medication Administration:
Nurses may be responsible for administering medications as prescribed, such as antihypertensives or magnesium sulfate
for seizure prophylaxis in severe cases of pre-eclampsia.
Gestational hypertension:
Similar to pre-eclampsia, gestational hypertension involves high blood pressure during pregnancy. However, it lacks the
presence of organ damage or other signs of pre-eclampsia.
Preterm labor:
Premature labor occurs when contractions begin to open the cervix before the 37th week of pregnancy. This can lead to
premature birth and potential health problems for the baby.
Assessment of Signs and Symptoms:
The healthcare provider assesses the patient for signs and symptoms that may indicate preterm labor, including regular
contractions (more than four contractions in an hour), lower abdominal or back pain, pelvic pressure, changes in vaginal
discharge (increased amount or fluid leakage), or bleeding.
Uterine Activity Monitoring:
The healthcare provider may use a tocometer or electronic fetal monitoring (EFM) to measure uterine activity and assess
the frequency, duration, and intensity of contractions.
Cervical Examination:
A pelvic examination is performed to evaluate the cervix for changes such as cervical effacement (thinning) and dilation
(opening). A short or dilated cervix may indicate a risk of preterm labor.
Nursing intervention
Monitoring and Assessment:
Nurses continuously monitor the patient's contractions, fetal heart rate, and vital signs to identify any changes or signs of
distress. They also assess the patient's pain levels and evaluate the progress of labor.
Bed Rest and Activity Restriction:
Nurses may recommend bed rest or activity restriction to reduce uterine activity and minimize the risk of further
progression of preterm labor. They educate the patient about the importance of compliance with bed rest guidelines and
provide support and comfort measures.
Fluid and Nutrition Management:
Nurses ensure that the patient is adequately hydrated and receiving proper nutrition to support both the mother and the
baby. They may collaborate with a dietitian to develop a suitable meal plan.
Emotional Support and Education:
Preterm labor can be emotionally challenging for the patient. Nurses provide emotional support, address concerns, and
educate the patient about preterm labor, potential complications, and the importance of seeking medical attention
promptly if there are any changes or worsening symptoms.
Postpartum hemorrhage:
Excessive bleeding after childbirth, defined as a loss of more than 500ml of blood, can occur due to various factors such
as retained placenta, uterine atony (lack of uterine muscle tone), or trauma.
Visual Assessment:
The healthcare provider visually examines the patient for signs of excessive bleeding, such as saturating pads or bed
linens with blood, pooling of blood in the vaginal area, or the presence of large blood clots.
Measurement of Blood Loss:
The healthcare provider estimates blood loss by weighing blood-soaked pads or using a graduated collection container
for blood clots. Quantifying blood loss helps determine if it exceeds normal limits.
Vital Sign Monitoring:
The patient's vital signs, including blood pressure, heart rate, and oxygen saturation, are continuously monitored to
detect signs of shock or instability.
Nursing intervention:
Immediate Response:
Nurses promptly respond to the situation by alerting the healthcare team, activating emergency protocols, and providing
immediate care to stabilize the patient.
Fundal Massage:
If uterine atony (lack of uterine muscle tone) is the cause of bleeding, nurses perform gentle but firm fundal massage to
stimulate uterine contractions and help control bleeding.
Administration of Medications:
Nurses may assist in administering medications as prescribed, such as uterotonic medications (e.g., oxytocin,
misoprostol) to promote uterine contractions and reduce bleeding.
Intravenous Fluids and Blood Products:
Nurses ensure the patient receives intravenous fluids and blood products, if necessary, to restore fluid volume and
address potential blood loss.
Oxygen Therapy:
If the patient shows signs of shock or decreased oxygen saturation, nurses administer oxygen therapy to improve
oxygenation.
Continuous Monitoring:
Nurses closely monitor vital signs, including blood pressure, heart rate, respiratory rate, oxygen saturation, and urine
output, to assess the patient's response to interventions and detect any changes or signs of worsening condition.
Infections:
Infections such as urinary tract infections, postpartum endometritis (infection of the uterine lining), or wound infections
can occur during the postpartum period.
Clinical Assessment:
The healthcare provider assesses the patient's symptoms and conducts a physical examination. Signs of infection may
include fever, increased heart rate, redness or swelling at the site of infection, pain or tenderness, abnormal vaginal
discharge, or other localized or systemic signs of inflammation.
Evaluation of Laboratory Tests:
The healthcare provider may order specific laboratory tests to aid in the diagnosis of an infection. These can include
blood tests, such as a complete blood count (CBC) to assess for an elevated white blood cell count (indicating infection)
or an elevated C-reactive protein (CRP) level (indicating inflammation). Other tests may include cultures of blood, urine,
or other bodily fluids to identify the presence of specific pathogens.
Nursing Intervention:
Infection Control Measures:
Nurses follow appropriate infection control protocols, such as hand hygiene, wearing personal protective equipment
(PPE), and adhering to isolation precautions as necessary, to prevent the spread of infection to other patients and
healthcare workers.
Symptom Management:
Nurses provide comfort measures to alleviate symptoms associated with the infection, such as pain management,
application of warm or cold compresses, or positioning for optimal comfort.
Wound Care and Dressing Changes:
If the infection involves a wound or incision, nurses follow appropriate wound care protocols, including cleaning, dressing
changes, and monitoring for signs of wound healing or worsening infection.
Education and Prevention:
Nurses educate the patient about the infection, its transmission, and prevention measures. They provide guidance on
proper hygiene practices, wound care at home if applicable, and the importance of follow-up appointments or
monitoring for resolution of the infection.
Anemia:
Pregnancy can sometimes lead to anemia, a condition characterized by a decrease in red blood cells or hemoglobin
levels. Iron deficiency is a common cause of anemia during pregnancy.
Clinical Assessment:
The healthcare provider assesses the patient's medical history, current symptoms, and risk factors for anemia.
Symptoms of anemia may include fatigue, weakness, pale skin, shortness of breath, dizziness, rapid heart rate, and
headache.
Physical Examination:
The healthcare provider performs a physical examination to check for signs of anemia, such as pale conjunctiva, pale
mucous membranes, and an enlarged spleen or liver.
Nursing diagnosis:
Education and Patient Support:
Nurses educate the patient about their diagnosis, the underlying causes of anemia, and the importance of adherence to
prescribed treatment plans. They provide support and address any concerns or questions the patient may have.
Medication Administration:
Nurses assist in administering medications as prescribed by the healthcare provider. This may include iron supplements,
vitamin B12 injections, or other specific treatments depending on the type and cause of anemia.
Nutritional Support:
Nurses collaborate with a dietitian to develop a suitable meal plan that includes foods rich in iron, vitamin B12, and
folate. They educate the patient on dietary modifications and the importance of a well-balanced diet to support the
management of anemia.
Blood Transfusion Management:
In severe cases of anemia or acute blood loss, nurses may assist in the administration of blood transfusions as prescribed
by the healthcare provider. They monitor the patient's vital signs and potential adverse reactions during and after the
transfusion.
Symptom Management:
Nurses provide comfort measures to alleviate symptoms associated with anemia, such as fatigue and shortness of
breath. They promote rest, encourage pacing activities, and assist the patient in conserving energy.
Gestational Diabetes:
Medications: Insulin is commonly prescribed for the management of gestational diabetes. Depending on the patient's
specific needs, different types of insulin may be used, such as short-acting (regular insulin) or long-acting (basal insulin)
formulations. The specific dosage and regimen will be determined by the healthcare provider based on individual patient
factors.
Formulation: Insulin is available in various formulations, including vials for injection, pre-filled syringes, and insulin pens
that allow for convenient and accurate dosing.
Pre-eclampsia:
Medications: The main treatment for pre-eclampsia is magnesium sulfate, which is administered intravenously (IV). It
helps prevent seizures (eclampsia) and can also have a relaxing effect on uterine smooth muscle.
Formulation: Magnesium sulfate is typically provided in a solution for IV administration under healthcare professional
supervision. The dosage and duration of administration will be determined by the healthcare provider based on the
severity of pre-eclampsia.
Preterm Labor:
Medications: Tocolytic medications are commonly used to suppress uterine contractions and delay preterm labor. Some
examples include:
Terbutaline: It is a beta-2 adrenergic agonist and is available in oral, subcutaneous, or intravenous formulations.
Nifedipine: It is a calcium channel blocker and is available in oral formulations.
Formulation: The specific formulation of tocolytic medications will depend on the medication chosen and the route of
administration. Terbutaline is available in tablet or injectable forms, while nifedipine is typically available in tablet form.
Postpartum Hemorrhage:
Medications: Medications commonly used to manage postpartum hemorrhage include:
Oxytocin: It is a hormone that helps contract the uterus and control bleeding. It is typically administered intravenously.
Misoprostol: It is a prostaglandin medication that can be administered orally, rectally, or sublingually.
Tranexamic acid: It is an antifibrinolytic agent that can be given intravenously to help control bleeding.
Formulation: Oxytocin is usually provided in a solution for intravenous administration. Misoprostol can be available as
tablets or suppositories, and tranexamic acid is available as an intravenous solution.
Common Diseases in pedia ward
Respiratory Infections:
Pneumonia
Bronchiolitis
Asthma
Croup Influenza (flu)
Respiratory syncytial virus (RSV) infection
Gastrointestinal Disorders:
Gastroenteritis (stomach flu)
Diarrhea
Gastroesophageal reflux disease (GERD)
Appendicitis
Febrile Illnesses and Infections:
Upper respiratory tract infections (common cold, sinusitis, tonsillitis)
Streptococcal infections (strep throat)
Viral infections (measles, mumps, chickenpox)
Urinary tract infections (UTIs)
Ear infections (otitis media)
Pediatric Skin Conditions:
Eczema (atopic dermatitis)
Impetigo
Diaper rash
Contact dermatitis
Fungal infections (ringworm, candidiasis)
Childhood Chronic Conditions:
Asthma
Allergies
Diabetes (Type 1 or Type 2)
Cystic fibrosis
Epilepsy
Juvenile idiopathic arthritis
Pediatric Surgical Conditions:
Appendicitis
Inguinal hernia
Intussusception
Congenital abnormalities (heart defects, cleft lip/palate, etc.)
Surgical emergencies (trauma, foreign body ingestion)
Hematologic Disorders:
Anemia (iron-deficiency anemia, sickle cell anemia)
Bleeding disorders (hemophilia, von Willebrand disease)
Thalassemia
Leukemia
Immune thrombocytopenia (ITP)
Neurological Disorders:
Seizure disorders (epilepsy)
Cerebral palsy
Developmental delays
Neurodevelopmental disorders (autism spectrum disorders, ADHD)
