Nursing Management During Pregnancy PDF

Nursing Management During Pregnancy Courtney Russell MSN, RN  Learning Objectives 1. Summarize goals of prenatal care and scheduling of prenatal visits 2. Analyze key components of health history in pregnancy including calculation of obstetric history (GP TPAL) 3. Ca...

Nursing Management During Pregnancy Courtney Russell MSN, RN  Learning Objectives 1. Summarize goals of prenatal care and scheduling of prenatal visits 2. Analyze key components of health history in pregnancy including calculation of obstetric history (GP TPAL) 3. Calculate the estimated date of birth using common methods 4. Characterize results of screening tests, assessments, and lab findings of prenatal patients at initial and subsequent visits 5. Describe and analyze tests used to monitor fetal well-being during pregnancy 6. Outline appropriate nursing management to promote maternal self-care and to minimize the common discomforts of pregnancy 7. Identify danger signals in pregnancy and possible causes  Preconception Care – Promote health and well-being of woman and her partner before pregnancy – Identification of genetic risks – Healthy weight prior to pregnancy – Elimination of use of harmful substances Pregnancy Length & Trimesters Pregnancy/Gestation lasts about 40 weeks Measure from last menstrual period 3 trimesters – 1st trimester- through the end of 12 completed weeks – 2nd trimester- 13 weeks through 27 completed weeks – 3rd trimester- 28 weeks-through 40+ weeks  Prenatal Care – First prenatal visit typically in first trimester – Improves pregnancy outcomes for mother and fetus – Purpose: – Monitor physical and psychological changes – Provide anticipatory guidance and health teaching – Preparing for labor and post pregnancy events (breast feed, bottle feed, how long are you off work, support system) Periodic Prenatal Visits – Every 4 weeks (monthly) until 28 weeks – Every 2 weeks until 36 weeks – Every week until delivery  Initial Prenatal Visit – Thorough Health History: PMH/Family History/Nutrition/Current Meds/ Reproductive/obstetrical history – Psychosocial history – Mental health screening, Hx/Risk for intimate partner violence – Risk Assessment- low/high risk pregnancy – Teaching – Labs/Diagnostics – Determination of due date – Physical Exam: baseline weight, VS, and pelvic exam Determination of Due Date – Estimating date of birth (EDB) – Naegele Rule- first day of the last menstrual period (LMP) – Subtract 3 months, add 7 days, add a year – Let’s practice: LMP: July 2 nd, October 14th, April 30th February 20 th – Ultrasound for gestational age (most accurate)  Risk Assessment – Ages < 16 or > 35 ( advanced maternal age/ geriatric age) – Underweight ( 200 lbs) – Recurrent abortions/miscarriages – 5th or subsequent pregnancy/delivery – Previous stillborn or fetal demise – Substance use/abuse – Physical abuse- intimate partner violence – Hx of preterm births or anomalies – Low socioeconomic level – Medical Conditions: Cardiac, Diabetes, Thyroid, Renal, Epilepsy  Initial Prenatal Visit Physical Assessment – Vital Signs, Baseline Weight – Pelvic Exam (once you do the first one you don’t need another one until the last month of pregnancy) – Fetal Assessment – FHT (Doppler, US) – Can’t hear HR until 8 weeks  Physical Examination – Pelvic Exam: – Exam of external and internal structures – Bimanual examination – Is the pelvis good for vag birth? – Pelvic shape: gynecoid, android, anthropoid, platypelloid  Initial Lab Work – Blood Type: Rh Factor – Antibody Screen – CBC: WBC, RBC, H/H, Plt **Good to know where she starts and trend her through the pregnancy** – BMP/CMP **Good to know where she starts and trend her through the pregnancy** – Rubella titers: