Nursing Management During Pregnancy PDF

Chapter 12 Nursing Management During Pregnancy Preconception Care and Diagnostic Testing Amniocentesis Biophysical profile Chorionic villus sampling (CVS) Natural childbirth Perinatal education Preconception care  Goal...

Chapter 12 Nursing Management During Pregnancy Preconception Care and Diagnostic Testing Amniocentesis Biophysical profile Chorionic villus sampling (CVS) Natural childbirth Perinatal education Preconception care  Goals of Preconception Care Identify and modify biomedical, behavioral, Promote the health and and social risks to a well-being of a birthing person's health or person and their partner pregnancy outcome before pregnancy. through prevention and management intervention. Risk Factors for Adverse Alcohol Pregnancy Isotretinoins misuse Outcomes #1 Diabetes Antiepileptic (preconcepti drugs on) HIV/AIDS Folic acid See Box 12.2 deficiency  Risk Factors for Adverse Pregnancy Outcomes #2 Maternal Rubella Hypothyroidis phenylketonu seronegativit Obesity m ria y STI Smoking Hypertension Preconcepti Immunization status on Care Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system First Prenatal Visit Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests Comprehen Reason for seeking care sive Health History Suspicion of pregnancy Date of last menstrual period Signs and symptoms of pregnancy Urine or blood test for hCG Past medical, surgical, and personal history Patient's reproductive history: menstrual, obstetric, and gynecologic history Menstrual History #1 Menstrual cycle oAge at menarche oDays in cycle oFlow characteristics oDiscomforts oUse of contraception Menstrua Date of last menstrual period (LMP) l History Calculation of estimated or #2 expected date of birth (EDB) or delivery (EDD) Nagele’s rule Use first day of last normal menstrual period 11/21/07 Subtract 3 months 8/21/07 Add 7 days 8/28/07 Add 1 year 8/28/08 = EDB Gestational or birth calculator or wheel (see Figure 12.3) Ultrasound is the best method of dating a pregnancy. Menstrual History #3 Copyright © 2025 Wolters Kluwer. All rights reserved. 11 Obstetri Gravida: a pregnant person c History #1 Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc. Para: a person who has produced one or more viable offspring carrying a pregnancy 20 weeks or more Primipara: one birth after a pregnancy of at least 20 weeks (“primip”) Multipara: two or more pregnancies resulting in viable offspring (“multip”) Nullipara: no viable offspring; para 0 Obstetric History #2 Terminology oG (gravida): the current pregnancy oT (term births): the number of pregnancies ending >37 weeks’ gestation, at term oP (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks oA (abortions): the number of pregnancies ending before 20 weeks or viability oL (living children): number of children currently living Question #1 Is the following statement true or false? A multipara refers to a person who is pregnant for the first time. Physical Examination #1 Vital signs Head-to-toe assessment oHead and neck oChest oAbdomen, including fundal height if appropriate oExtremities Physical Examination #2 Pelvic examination oExamination of external and internal genitalia oBimanual examination oPelvic shape: gynecoid, android, anthropoid, platypelloid oPelvic measurements: diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity Physical Examination #3 Pelvic measurements. A. Diagonal conjugate (solid line) and true conjugate (dotted line). B. Ischial tuberosity diameter. Copyright © 2025 Wolters Kluwer. All rights reserved. 17  Urinalysis Laborato Complete blood count ry Tests Blood typing Rh factor Rubella titer Hepatitis B surface antigen HIV, VDRL, and RPR testing Cervical smears Ultrasound Follow-Up Visits #1 Visit schedule: oEvery 4 weeks up to 28 weeks oEvery 2 weeks from 29 to 36 weeks oEvery week from 37 weeks to birth  Assessments Weight and BP compared to Follow- baseline values Urine testing for protein, glucose, Up ketones, and nitrites Fundal height (see Figure 12.5) Visits Quickening/fetal movement Fetal heart rate (see Nursing #2 Procedure 12.1) Teaching: danger signs  Question #2 Is the following statement true or false? A patient who is 24 weeks’ pregnant would arrange for a follow-up visit every 2 weeks.  Assessment of Fetal Well-Being #1 Ultrasonography (see Figure 12.6) Doppler flow studies Alpha-fetoprotein analysis Marker screening tests Nuchal translucency screening Amniocentesis (see Figure 12.7)  Chorionic villus sampling (CVS) Percutaneous umbilical blood sampling (PUBS) Assessmen t of Fetal Nonstress test; contraction stress test Well-Being #2 Contraction stress test Biophysical profile  First Trimester Discomforts Urinary frequency or incontinence (see Teaching Guidelines 12.1) Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea  Second Trimester Discomforts Varicosities Flatulence of the Hemorrhoi Backache with vulva and ds bloating legs  Return of first trimester Third discomforts Trimester Shortness of breath and Discomfort dyspnea s Heartburn and indigestion Dependent edema Braxton Hicks contractions  Question #3 While assessing a patient at 18 weeks’ gestation, which of the following would the nurse report as unusual? a. Urinary frequency b. Backache c. Leukorrhea d. Flatulence with bloating Nursing Management to Promote Self-Care #1 Avoidance of Personal saunas and Perineal care Dental care hygiene hot tubs Exercise (see Teaching Breast care Clothing Guidelines 12.2)  Sleep and rest Nursing Sexual activity and sexuality Managem ent to Employment (see Teaching Promote Guidelines 12.3) Self-Care Travel (see Teaching #2 Guidelines 12.4) Immunizations and medications (see Box 12.5)  Perinatal education Preparation Childbirth education for Labor, Lamaze (psychoprophylactic) method: focus on breathing and Birth, and relaxation techniques Parenthood Bradley (partner-coached childbirth) method: focus on #1 exercises and slow, controlled abdominal breathing Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques  Options for birth setting Preparati Hospitals: delivery room, birthing suite on for Birth centers Labor, Home birth Birth, and Options for care Parenthoo providers d #2 Obstetrician Midwife Doula  Feeding choices Preparati on for Breastfeeding: advantages and disadvantages Labor, Bottle-feeding: advantages and Birth, and disadvantages Parenthoo Teaching d #3 Final preparation for labor and birth