Untitled

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