LESSON PREVIEW/REVIEW (5 Minutes)
LESSON PREVIEW/REVIEW (5 Minutes)
LESSON PREVIEW/REVIEW (5 Minutes)
occurs when fetal red blood cells (RBCs) which possess an antigen that the mother lacks
cross the placenta into the maternal circulation, where they stimulate antibody production.
The antibodies return to the fetal circulation and result in RBC destruction.
ISOIMMUNIZATION
1. ABO Incompatibility 2. RH INCOMPATIBILITY
Occurs when maternal blood type is O and fetus is Rh (D) factor is a protein antigen present on the
a. Type A- most common surface of some people’s RBC (Rh+)
2. Uncommon during pregnancy since antibodies is the Rh Sensitization/Rh Isoimmunization- It is the exposure
large IgM type & cannot cross placental barrier of Rh- blood to Rh+ blood resulting to production anti-Rh
abs
3. During delivery when placenta separates from the
decidua, the barrier is broken allowing maternal blood to It can occur through:
enter the fetal bloodstream. Sensitization from previous pregnancy (Rh- mom
with Rh+ baby)
4. Maternal antibodies will then destroy fetal RBCs after Inadequate response to prophylaxis
birth Incompatible blood transfusion
5. Thus, signs of hemolytic disease will manifest several
hours after delivery -Insignificant amount of antibodies are formed
during pregnancy thus, 1 st baby is not greatly affected.
CLINICAL PRESENTATION -Greatest exposure occurs during placental
generally less severe than with Rh disease. separation which causes massive production of anti Rh
abs during 1st 72 hrs postpartum
LABORATORY FINDINGS -Rh+ fetuses in future pregnancies will be affected
Smear: microspherocytosis -Fetal anemia results & to compensate, fetal bone
Mean Corpuscular Volume (MCV) <95, microcytic marrow produces immature RBCs(erythroblasts) causing
for a newborn (normal for adult) Erythroblastosis Fetalis
Direct Coombs test is often weakly +.
ERYTHROBLASTOSIS FETALIS
MANAGEMENT -Fetal anemia may be so profound that it kills the
A. Preparation prior to delivery should include: fetus
Blood: type O Rh negative packed RBCs, cross- -RBC destruction causes massive production &
matched against the mother. accumulation of bilirubin as the immature liver is unable to
For severe HDN, have blood in the Resuscitation clear them from the body leading to
Room to correct severe anemia immediately after HYPERBILIRUBINEMIA & KERNICTERUS
birth by partial exchange transfusion (ExTx).
Anticipate need for later ExTx for Fetal Complications of Erythroblastosis Fetalis
hyperbilirubinemia and have additional blood for 1. Anemia
these. 2. Splenomegaly & hepatomegaly
Surfactant, if infant is preterm. 3. Hyperbilirubinemia
4. Hydrops fetalis- as organs are not perfused
Catheters (e.g., angiocaths) for immediate
properly, the heart will eventually decompensate; fluid
drainage of hydropic fluid.
builds up resulting to edema
5. Stillbirth
B. Resuscitation
Obtain cord blood for bilirubin (total & direct),
albumin, blood type & Rh, Direct Coombs test,
CBC, platelets, reticulocyte count and nucleated
RBCs.
assisted ventilation with oxygen. If ventilation is
difficult, drain pleural and ascitic fluid; during
paracentesis, take care to avoid puncturing the
enlarged liver and spleen.
Insert umbilical arterial (UAC) and venous
catheters (UVC) and immediately measure blood
pressures, arterial pH and blood gas tensions,
hematocrit (Hct) and blood sugar.
Correct metabolic acidosis with alkali, but only if
giving assisted ventilation
Correct anemia, which is essential for effective
Management
1. Amniocentesis q 2wks beginning at 26 wks to monitor bilirubin
2. Percutaneous umbilical blood sampling at 18-20 wks if bilirubin levels are high
3. Intrauterine Blood fetal transfusions (IUFT) at 10-day to 2-week intervals until 34-36 wks
HIV/AIDS
HIV infection and AIDS can be caused by placental transfer or direct contact with maternal blood during birth.
HIV is a slowly replicating retrovirus and has at least two main divisions, HIV-1 and HIV-2, followed by a variety of
further subtypes.
The virus acts by attacking the lymphoreticular system, in particular CD4-bearing helper T lymphocytes.
The virus enters the cell, substitutes its own RNA and DNA for the cell’s DNA, and begins to replicate, destroying
the lymphocytes in the process as well as their ability to initiate an effective B-lymphocyte response.
(Chapter 42: Nursing Care of A Family with an Immune Disorder, p.1174)
ETIOLOGIC AGENT:
1. retrovirus that targets helper T lymphocytes (T4 cells) that contain the CD4 antigen (which regulates normal immune
response) making the patient susceptible to opportunistic infections
2. Present in infected person’s blood, semen, and other body fluids
Risk factors: Assessment
1. Multiple sexual partners of the individual or Early Symptoms:
sexual partner 1. Fatigue
2. Bisexual partner, MSM 2. Anemia
3. IV drug use by the individual or partner 3. Diarrhea
4. Others: BT, tattoo, etc 4. Weight loss
5. Lymphadenopathy
6. Night sweats
Assessment Management
1. A 26-week pregnant client was diagnosed with ABO incompatibility. She asked you what her diagnosis means.
Which of the following is incorrect regarding ABO incompatibility?
A. The mother has inborn antibodies vs blood type A and B in her bloodstream.
B. Uncommon during pregnancy since antibodies is the large IgM type & cannot cross placental barrier
C. During delivery when placenta separates from the decidua, the barrier is broken allowing maternal blood to enter the
fetal bloodstream.
D. Antibodies vs Rh antigen are not naturally-occurring but are produced when Rh+ blood enters the bloodstream of an
Rh- person.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. An 18-week pregnant client ask you what is Rh incompatibility. Which of the following is correct regarding Rh
Incompatibility? EXCEPT:
A. Rh (D) factor is a protein antigen present on the surface of some people’s RBC (Rh+)
B. Antibodies vs Rh antigen are not naturally-occurring but are produced when Rh+ blood enters the bloodstream of an
Rh- person.
C. The mother has inborn antibodies vs blood type A and B in her bloodstream.
D. The Rh + gene is a dominant and therefore if either the mother or the father or both parents are Rh+, the baby will be
Rh+
ANSWER: ________
RATIO:___________________________________________________________________________________________
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_________________________________________________________________________________________________
3. Kyra a client who gave birth to a female newborn and was diagnosed as having ABO incompatibility. Which of
the following is incorrect for the laboratory findings of a newborn with ABO incompatibility?
A. Blood Smear result is microspherocytosis
B. <95, microcytic for a newborn
C. Direct Coombs test is often weakly +
D. Direct Coombs test is often weakly –
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Kyra’s child was ordered to have Exchange Transfusion. She asked you what are the possible complications of
the procedure. The following are complications of Exchange Transfusion, EXCEPT:
A. Hypothermia
B. Hypocalcemia
C. Hyperkalemia
D. Hypoglycemia
E. Hypernatremia
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________ _________________
_________________________________________________________________________________________________
5. A patient was diagnosed with Habitual Abortion due to Rh incompatibility and had a fetal complication of
Erythroblastosis Fetalis. She asked you what will be the complication if she will get pregnant again. The
following are complications of Rh Incompatibility, EXCEPT:
A. Anemia
B. Splenomegaly & hepatomegaly
C. Hyperbilirubinemia
D. Wilms Tumor
E. Hydrops fetalis
7. Reme a pregnant client asked you what are the risk factors for having HIV/AIDS. The following are risk factors
of HIV/AIDS, EXCEPT:
A. Multiple sexual partners of the individual or sexual partner
B. Bisexual partner
C. IV drug use by the individual or partner
D. Deep, open-mouth kissing without mouth sores
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. A patient asked you regarding HIV/AIDS on what is Seroconversion. You know that Seroconversion is:
A. Seroconversion is the production of antibodies versus HIV that happens in 5 weeks to a year.
B. Seroconversion is the production of antibodies versus HIV that happens in 6 weeks to a year.
C. Seroconversion is the production of antibodies versus HIV that happens in 7 weeks to a year.
D. Seroconversion is the production of antibodies versus HIV that happens in 4 weeks to a year.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. A pregnant client was admitted with a lung infection that can affect people with weakened immune systems,
such as those infected with HIV, the virus that causes AIDS. Which of the following condition pertains to the
client’s condition?
A. Hospital Acquired Pneumonia
B. Community Acquired Pneumonia
C. Pneumocystis Carinii Pneumonia
D. Fungal Pneumonia
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
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10. You were conducting a physical examination to a pregnant client. Upon examining the skin of the patient you
saw red to purplish skin patches and was told that she is taking Zidovudine. You know that the patient is having:
A. Angiosarcoma
B. Fibroblastic Sarcoma
C. Kaposi’s Sarcoma
D. Leiomyosarcoma
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________
RATIO:_______________________________________________________________________________________
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You are done with the session! Let’s track your progress.
PERIOD 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PERIOD 2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PERIOD 3
32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
1. You will use index cards or half-sheets of paper to provide written feedback to the following questions:
a. What was the most useful or the most meaningful thing you have learned this session?
b. What question(s) do you have as we end this session?
2. Pass the responses to your instructor before you leave.
(For next session, review Chapter 20: Nursing Care of a Family Experiencing Complication From a Preexisting or
Newly Acquired Illness: Hematologic Disorder page 498)