Rh negative mother

[GingerSue]

When the mother is Rh negative and has given birth

{I am trying to prepare a nursing diagnosis}

Would it be: risk for subsequent infant hemolytic disease, anemia related to

risk for maternal sensitization

determination of her status re: sensitization and Rh factor of the infant are both necessary

there is the need for protective measures to prevent her from developing sensitization

any comments about the nursing diagnosis?

thanks

[Daytonite, BSN, RN]

I think if you think on this a little more you will probably nail this on your own. :roll

The question is one of preventing injury to the mother. Strictly speaking, the nursing diagnosis you want to use is Risk for Injury. However, you can tweak the actual verbal language of it a little if your nursing instructors allow you to do that. So, perhaps, Risk for Maternal Injury R/T Rh sensitization following delivery?

[GingerSue]

the woman, if her infant is Rh positive, is at risk for Rh sensitization

if she becomes sensitized, then her antibodies will destroy the RBCs of subsequent pregnancies - so they are at risk for hemolytic disease

the globulin destroys fetal cells in her bloodstream, before sensitization occurs, blocking antibody production, and this provides passive immunity for the mother, which prevents the development of permanent active immunity

but without the RhoGAM, and she does go on to develop the antibodies, what happens to the mother?

{she'll have unsafe pregnancies, but is that considered "maternal injury" or is the fetus a separate individual?}

{if a subsequent fetus' blood cells are being destroyed by maternal antibodies, then this fetus might need intrauterine transfusions to correct the anemia produced by the hemolysis and improve fetal oxygenation - the procedure is hazardous to the fetus, and complications could include fetal distress, fetal hematoma, fetal-maternal hemorrhage, fetal death, or chorioamnionitis}

[Jolie, BSN]

[quote=GingerSue;2130494

{she'll have unsafe pregnancies, but is that considered "maternal injury" or is the fetus a separate individual?}

I'm not an expert on nursing diagnoses, but this one is particularly dificult, since it is future fetuses who risk injury, not the mother.

I'll watch and see what suggestions others make.

[GingerSue]

so far, from my reading, it is the fetus who is at risk of hemolytic disease, anemia, needs transfusion

the mother might be at risk during the transfusion (as mentioned the fetal-maternal hemorrhage possible complication)

and as my textbook suggests only 2 nursing diagnoses:

Health-Seeking Behavior: information about the purpose of RhIgG related to an expressed desire to understand the treatment of Rh incompatibility

and

Ineffective Individual Coping related to depression secondary to the development of indications of the need for fetal exchange transfusion

- I'm just trying to get a better understanding of other possibilities

thanks