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Respiratory and Endocrine Disorders in Pregnancy

Pregnancy is both a wonderful and dangerous thing to undergo. Our body sometimes acts in whimsical ways, so as nurses, we should be there to guide and educate our clients accordingly during their journey throughout pregnancy.

Respiratory Disorders in a Pregnant Woman

The respiratory system is one of the most important systems that should be assessed during pregnancy and also in the newborn. Acquiring a respiratory disorder in pregnant women could be fatal and detrimental to the health of both the fetus and the woman.

Acute Nasopharyngitis

  • Estrogen stimulation causes nasal congestion, which makes nasopharyngitis more severe during pregnancy.
  • Aspirin must be avoided because it can cause clotting interference in both the mother and the fetus and also prolonged pregnancy.
  • Before taking any over-the-counter cough syrup, the woman must consult her healthcare provider.
  • Antibiotic therapy is unnecessary unless it is to prevent a secondary infection.

Influenza

  • Influenza spreads in epidemic form and is caused by viruses A, B, or C.
  • Its symptoms are high fever, pains in the back and extremities, and a sore throat.
  • Influenza can cause preterm labor but it is not linked to any congenital anomalies in the fetus.
  • Antipyretics like Tylenol can be administered to control fever.
  • Women can be safely immunized against influenza during pregnancy because the vaccine only contains killed virus.

Pneumonia

  • Bacterial and viral pathogens such as S. pneumonia, H. influenza, and Mycoplasma pneumonia are responsible for the invasion of the lung tissue during pneumonia.
  • An acute inflammatory response happens after the invasion in the lung alveoli.
  • Bacteria or virus is trapped within the lung segments and lobes, filling the lung with fluid and blocking off the breathing space.
  • Antibiotic therapy and oxygen administration are the treatment to be used.
  • Ventilation support is only necessary in severe cases.
  • Preterm labor may occur late in pregnancy because of oxygen deficit, so oxygen must be administered for the fetus.

Severe Acute Respiratory Syndrome

  • SARS is characterized by persistent fever, muscle aches, chills, dry cough, malaise, headache, and dyspnea.
  • Decreased lymphocyte and platelet counts are common laboratory findings.
  • The pathogen for this illness is the coronavirus which has originated from southern China.
  • The mode of transmission of SARS is close person to person contact via droplet transmission.
  • Therapy includes intravenous antibiotic and respiratory support.
  • SARS during pregnancy is associated with spontaneous miscarriage, intrauterine growth restriction, and preterm labor.

Asthma

  • Asthma is marked by reversible airflow obstruction, airway hyperreactivity, and airway inflammation.
  • Asthma is associated with perinatal complications.
  • Symptoms would only be triggered by inhaled allergens, which release histamines and leukotrienes from an IgE/immunoglobulin interaction.
  • Bronchial constriction occurs and thick bronchial secretions are produced, leading to decrease in the size of the lumen of air passages.
  • Asthma causes a decrease in the oxygen supply going to the fetus which could begin preterm labor or restrict fetal growth.
  • Inhaled corticosteroids such as beclomethasone and budesonide are safe for pregnant women.
  • Cromolyn sodium and leukotriene receptor antagonists can also be continued during pregnancy.

Endocrine Disorders in a Pregnant Woman


Disorders of the endocrine system greatly affect the hormones in a pregnant woman’s body. Hormones have a major role in pregnancy and should, therefore, be monitored accordingly.

Diabetes Mellitus

  • In diabetes mellitus, the pancreas cannot produce adequate insulin to regulate glucose levels in the body.
  • The problem in diabetes mellitus is controlling the balance between glucose and insulin levels to prevent hypoglycemia and hyperglycemia.
  • Infants born to women with diabetes mellitus are five times more likely to have heart anomalies.
  • Type 1 diabetes occurs during childhood and the pancreas could not produce adequate insulin for body requirements.
  • Type 2 diabetes occurs in older adults with gradual failure of insulin production that occurs with aging.
  • As pregnancy progresses, women normally experience several changes in the glucose-insulin regulatory system.
  • At about week 24, the pregnant woman with diabetes must increase her insulin dosage as advised to prevent hyperglycemia.
  • Continued use of glucose by the fetus could lead to hypoglycemia for the mother between meals.
  • An increase in the production of amniotic fluid occurs because of hypoglycemia in the fetus that causes increased urine production.
  • A pregnant woman may develop hydramnios, and could be at risk for hemorrhage because of poor uterine contractions.
  • Pregnancy-induced hypertension and infection could occur to a woman with poor glucose regulation.
  • Infants of mothers who have poorly controlled diabetes are large for gestational age.
  • There are high incidences of congenital anomalies such as caudal regression syndrome, spontaneous miscarriage, and stillbirth in infants of women with uncontrolled diabetes.
  • Neonates at birth are at risk for hypoglycemia, respiratory distress syndrome, hypocalcemia, and hyperbilirubinemia.
  • More frequent prenatal visits should be done for women with diabetes for close monitoring of their condition and of the fetus.
  • Management includes insulin pump therapy, blood glucose monitoring, tests for placental function and fetal well-being, and good timing for birth.
  • Educate the woman that her diet should include a reduced amount of fat.
  • The woman may also consume a snack of protein and complex carbohydrates at night for slower digestion.
  • If she is unable to eat because of nausea and vomiting, she should notify her healthcare provider so she could be given intravenous fluid supplementation.
  • A fasting blood glucose level of below 95 mg/dL to 100 mg/dL and a 2-hour postprandial level of below 120 mg/dL show good blood glucose control.

Hypothyroidism

  • Hypothyroidism is rare among pregnant women because this disease causes anovulation and inability to conceive.
  • A pregnant woman with hypothyroidism would have a hard time increasing thyroid functioning necessary for a pregnant level which could lead to spontaneous miscarriage.
  • Manifestations include fatigue, dry skin, and little tolerance for cold with an increased incidence in nausea and vomiting or hyperemesis gravidarum.
  • Levothyroxine dosage would need to be increased by as much as 20% to 30% for the duration of pregnancy.
  • Advise the woman to separate thyroxine ingestion from calcium, iron, or soy products by about 4 hours to avoid problems with the absorption of thyroxine.

Practice Quiz: Respiratory and Endocrine Disorders in Pregnancy

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1. A pregnant woman diagnosed with diabetes should be instructed to do which of the following to control her glucose level? A. Discontinue insulin injections until pregnancy is completed. B. Ingest a smaller amount of food prior to sleep. C. Notify the physician if she is unable to eat because of nausea and vomiting. D. Prepare foods with increased fat content. 2. After delivery, a diabetic woman might need to do which of the following? A. Change to oral hypoglycemic agents. B. Bottle Feed her infant. C. Receive no insulin during the postpartal period. D. Take medications to decrease uterine hypertonicity if hydramnios was present. 3. The nurse is reviewing the blood glucose levels of several pregnant women with diabetes. Which of the following results would demonstrate good control? A. Fasting level of 78 mg/dL B. Fasting level of 135 mg/dL C. 2-hour postprandial level of128 mg/dL D. 2-hour postprandial level of 132 mg/dL 4. What is the recommended therapy for pregnant women with acute nasopharyngitis? A. Aspirin therapy B. Corticosteroid therapy C. The use of over-the-counter cough syrups D. Antibiotic therapy 5. The nurse is reviewing the laboratory results of a pregnant woman suspected with SARS. Which of the following indicates that she might be carrying the disease? A. Increased erythrocytes B. Increased platelet count C. Decreased platelet count D. Increased lymphocyte levels Answers and Rationale 1. Answer: C. Notify the physician if she is unable to eat because of nausea and vomiting. C: The woman may need intravenous fluid supplementation if she cannot eat because of nausea and vomiting. A: Insulin injections are needed even during pregnancy to help regulate the blood glucose levels. B: The woman may make her final snack of the day one of protein and complex carbohydrates for slow digestion during the night. D: The woman’s diet must include a reduced amount of saturated fats only. 2. Answer: D. Take medications to decrease uterine hypertonicity if hydramnios was present. D: The woman is at risk for hemorrhage from poor uterine contractions. A: No change is needed for hypoglycemic agents. B: The woman is still allowed to breastfeed because insulin could not pass into the breast milk. C: The woman must return to her prepregnant insulin diabetic requirements after birth. 3. Answer: A. Fasting level of 78 mg/dL A: Fasting blood glucose levels for pregnant women must not exceed 95 to 100 mg/dL. B: Fasting blood glucose levels for pregnant women must not exceed 95 to 100 mg/dL. C and D: 2-hour postprandial levels must not exceed 120 mg/dL 4. Answer: C. The use of over-the-counter cough syrups C: The woman can take over-the-counter cough syrups after consulting her primary care provider or obstetrician. A: Aspirin could cause clotting interferences in both the mother and the fetus. B: Corticosteroids are not necessary for acute nasopharyngitis D: Antibiotic therapy is only necessary if there is a secondary infection to treat. 5. Answer: C. Decreased platelet count C: A pregnant woman with SARS has a decreased platelet count as a common laboratory finding. A: Erythrocytes are not affected in a pregnant woman with SARS B: Decreased platelet count occurs with SARS D: Decreased lymphocyte levels occur with SARS
As nurses, we are tasked to be with the client almost every time. Our roles could greatly influence the way they think, act, and decide while inside the hospital walls so the information that we give them must be accurate and factual. Client education especially when it comes to diseases is vital so they can also be aware of what is happening inside their bodies.

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