Nursing Care & Complications of Pregnancy

Nursing Care & Complications of Pregnancy

• The presentation covers nursing care and complications during pregnancy, specifically focusing on management strategies.

Class Objectives

• Describe health promotion activities and prenatal monitoring in routine pregnancies.
• Discuss the antenatal record and documentation of pertinent information.
• Discuss domestic abuse and approaches to care.
• Review common warning signs and complications during pregnancy, including treatments.

Preconception Care

• Preconception assessment includes an in-depth health history of the individual and family.
• Early interventions, such as nutritional adjustments and smoking/drinking cessation, are crucial.

Preconception Care (Continued)

• Healthy babies result from healthy mothers.
• The most vulnerable time for pregnancy is between days 17 to 56 after fertilization (approximately 4 to 10 weeks).
• Folic acid is important for preventing neural tube defects.

Goals of Prenatal Care

• Ensure a safe birth for the pregnant person and child by promoting good health habits and reducing risks.
• Teach health habits that can continue after pregnancy.
• Educate the pregnant person about self-care during pregnancy.
• Provide physical care and promote health for the pregnant person, fetus, newborn, and family.
• Prepare clients for the responsibilities of parenthood.

The Initial Prenatal Visit

• The initial visit is the longest, and involves obtaining baseline data.
• This visit aims to confirm or rule out a pregnancy diagnosis and ascertain risk factors.
• Determining the due date and providing education for maintaining a healthy pregnancy are also key objectives.

Presumptive Signs of Pregnancy (Subjective)

• Amenorrhea (no menstruation)
• Nausea
• Breast changes (tenderness/increased pigmentation)
• Urinary frequency
• Fatigue and drowsiness
• Quickening (feeling the baby move)

Probable Signs of Pregnancy (Objective)

• Goodell's sign (softening of the cervix)
• Chadwick's sign (bluish/purplish vaginal color)
• Uterine enlargement
• Braxton Hicks contractions (mild tightening)
• Pregnancy tests (relatively accurate, but can have false negatives)

Positive Signs of Pregnancy (Not explained by anything else)

• Fetal heart sounds
• Fetal movement noted by the examiner
• Visualization of fetus by ultrasound

Reproductive History Terminology

• Gravida: The total number of pregnancies.
• Primigravida: First pregnancy.
• Multigravida: More than one pregnancy.
• Parity: Communicates the outcomes of previous pregnancies.

Recording Obstetric History (GT/PALS)

• Gravida (# pregnancies), Para (deliveries after 20 weeks).
• Term: Pregnancies that ended at term (37+ weeks).
• Preterm: Pregnancies that ended before 36 weeks.
• Abortions: Pregnancies that ended before 20 weeks.
• Living: Number of currently living children.
• Stillbirths: Number of babies born dead after 20 weeks.

First Prenatal Visit (Continued)

• Physical examination, including a head-to-toe assessment and pelvic exam for size.
• Laboratory work, such as a complete blood count, blood type and antibody screen, tests for infections, and pap smears.

Risk Assessment

• Factors considered include:
• Prenatal care sought late.
• Patient's attitude towards the pregnancy.
• Unwanted pregnancy.
• Risks during pregnancy (substance use, history of complications with previous pregnancies, preexisting diseases, socioeconomic factors, living conditions, and domestic violence).

Intimate Partner Violence

• Recognize the signs and behaviors of violence.
• Conduct private assessments, maintaining confidentiality to avoid escalation.
• Build rapport with the person to help them determine the best approach.
• Refer to appropriate shelters or support services.
• Report abuse of children to the proper authorities.
• Violence within an intimate relationship results in physical, emotional, or psychological harm.

Subsequent Prenatal Visits

• Usually seen monthly (weeks 1–28), biweekly between (weeks 29–36) and weekly until delivery.
• Visits include specific assessments like weight, blood pressure, urine protein/glucose, fetal heart rate, and edema.

Subsequent Prenatal Visits (Continued)

• Fundal height should match the number of weeks progressed.
• Practitioner measures fundal height in centimeters.

Subsequent Prenatal Visits (Continued)

• Screening for pregnancy, such as prenatal screening, is done throughout pregnancy.
• At 28 weeks, women who are Rh(D)-negative are screened for antibodies and administered anti-D immune globulin (RhoGam).
• Group B Streptococcus (GBS) is screened after 35 weeks.

Subsequent Prenatal Visits (Continued)

• MSAFP (Maternal Serum Alpha Fetoprotein) screens for neural tube defects and other chromosomal or genetic defects.
• Amniocentesis may be performed between 15–20 weeks to determine genetic makeup.
• Chorionic villus sampling for pregnancy elective abortions can be performed previously in a pregnancy, with the sampling of the placenta tissue taken through the vagina.

The Physical Examination

• Includes laboratory tests (Page 61/67).
• Ultrasonography
• Pelvic examinations.
• Assessment of the bony pelvis relative to existing conditions (e.g. size and position of fetus at term and quality of contractions in labor.)

Lab Tests

• Blood work: CBC, RH status, sickle cell, STD, rubella titre, HIV, Hep.
• Urinalysis: Glucose, protein, erythrocytes leukocytes, and bacteria.
• Pelvic lab tests: Pap, gonorrhea, chlamydia, and strep.
• Ultrasonography: Gestational sac detection, fetal heart beat (FHB).

Monitoring and Evaluating the Pregnant Woman in Subsequent Visits

• Blood pressure.
• Weight
• Fundal height.
• Fetal heart tones
• Urine
• Edema
• Sharing questions and concerns.

Pregnant Abdominal Assessment

• YouTube video link: https://www.youtube.com/watch?v=bwHx-RC-Pj4