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graph LR A[Excessive Vitamin A Intake (Hypervitaminosis A)] --> B(Increased Retinoic Acid Levels); B --> C{Direct Teratogenic Effects on Developing Embryo/Fetus}; C -- Cellular Dysfunction (e.g., altered cell growth, differentiation, apoptosis) --> D[Embryonic/Fetal Malformations]; C -- Oxidative Stress & DNA Damage --> E[Fetal Growth Restriction/Death]; B --> F(Uterine Irritability & Contractions); F --> G[Cervical Dilation]; D --> H[Spontaneous Abortion]; E --> H; G --> H; subgraph "Clinical Manifestations" D -- Microcephaly, facial dysmorphia, heart defects, CNS abnormalities --> I[Fetal Ultrasound Anomalies]; E -- Intrauterine growth retardation (IUGR), fetal demise --> J[Decreased Fetal Movement/Heart Rate]; F -- Abdominal cramping, vaginal bleeding --> K[Threatened Abortion]; G -- Increased vaginal bleeding, passage of fetal tissue --> L[Inevitable/Complete Abortion]; end subgraph "Nursing Interventions" A -- Dietary Assessment & Education --> M[Educate patient on recommended Vitamin A intake, food sources, and supplement use. Emphasize risks of excessive intake during pregnancy.]; B -- Monitoring for Hypervitaminosis A Symptoms (e.g., nausea, vomiting, headache, skin changes) --> N[Assess for signs and symptoms of Vitamin A toxicity. Monitor serum Vitamin A levels if indicated.]; C/D/E -- Prenatal Monitoring (e.g., fetal ultrasound, NST) --> O[Monitor fetal well-being through regular prenatal checkups, ultrasounds, and other appropriate assessments.]; F/G -- Management of Threatened/Inevitable Abortion --> P[Provide supportive care, monitor vital signs, assess bleeding, and prepare for potential interventions (e.g., D&C). Offer emotional support and counseling.]; H -- Post-Abortion Care --> Q[Provide emotional support, pain management, and monitor for complications (e.g., infection, hemorrhage). Offer referral for counseling and support groups.]; end
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