Introduction to Childbearing Family Nursing & Physiology of Pregnancy PDF

Introduction to Childbearing Family Nursing & Physiology of Pregnancy Bachelor of Science (Honours) in Nursing School of Nursing Dr Vivian Ngai 6 September 2024 Email: [email protected] Learning Outcomes By the end of this session, students will be able to: Describe principles of...

Introduction to Childbearing Family Nursing & Physiology of Pregnancy Bachelor of Science (Honours) in Nursing School of Nursing Dr Vivian Ngai 6 September 2024 Email: [email protected] Learning Outcomes By the end of this session, students will be able to: Describe principles of care to childbearing family using family-centered approach Describe theoretical perspective of childbearing family nursing Describe aims & components of preconception care Explain the process of reproduction, fetal growth & development Explain physiological & psychosocial changes of pregnancy Discuss nutritional needs for pregnancy & lactation Identify subjective, objective & diagnostic signs of pregnancy Discuss common discomforts of pregnancy Discuss nursing role in promoting maternal self-care & minimizing common discomforts of pregnancy Childbearing Family Nursing ❖Philosophy Family-centered care Community centered Evidence-based practice Family-Centered Care Family at the center Family-professional communication Family-professional collaboration Holistic family-centered care Cultural diversity of families Coping differences & support Family-centered peer support Specialized service & support system (London et al., 2022) Theoretical Perspectives of Family Family Systems Theory ❖Family as a system: all parts of the system are interconnected the whole is more than the sum of the parts all systems have some form of boundaries or borders between the system & its environment system can be further organized into subsystems ❖Childbearing family, changes in husband-wife subsystem occur as a response to development of the new parent-child subsystems ❖Childbearing family system interacts in the environmental suprasystem Open system Closed system Family Developmental & Life Cycle Theory Focus on family as it moves across time, through phases from dependence, independence, to interdependence Developmental stages Early Family with Family with Marriage childbearing preschool child school-age child family Family in Family with Family with Family of retirement or adolescent young adult middle years older age Family Developmental & Life Cycle Theory ❖ Developmental tasks for childbearing family Arranging space (territory) for a child Financing childbearing & childrearing Assuming mutual responsibility for child care & nurturing Facilitating role learning of family members Adjusting to changed communication patterns Realigning intergenerational patterns Maintaining family members motivation & morale Establishing family rituals & routines (Robinson et al., 2022) Family-Centered Maternity Care ❖ “A model of obstetrical care based on a view of pregnancy & childbirth as a normal life event, a life transition that is not primarily medical but rather developmental.” (Durham & Chapman, 2023) Family-Centered Maternity Care Birth is a normal, healthy process for most women Care must be individualized Decision-making should be a collaborative effort between pregnant woman, her family & healthcare providers Information should be shared freely between pregnant woman, her family & each of her healthcare providers Education should reflect current, evidence-based knowledge Presence of supportive people during labor & birth is beneficial to mother & family Freedom of movement is beneficial for laboring woman & should be encouraged All members of healthcare team should be educated about physiologic birth & non-pharmacologic methods of pain management Routine interventions that are unsupported by scientific evidence should be avoided Skin-to-skin contact immediately after birth & exclusive breastfeeding should be standards of practice Mothers are the preferred care providers for their children Mothers & babies should stay together (rooming in) (International Childbirth Education Association, 2023) Childbearing Family Nursing Continuum of care Preconception Pregnancy Childbirth Postpartum Preconception Care Physical Newborn Assessment & Psychosocial Changes of Stages of Labor & Care Pregnancy Antenatal Assessment Pain Relief Postnatal Care Pregnancy at Risk Childbirth at Risk Breastfeeding  Definition of Terms Antepartum/Antenatal/Prenatal – the time between conception & onset of labor Intrapartum – the time from onset of labor till the birth of baby & placenta Postpartum/Postnatal – the period after giving birth Puerperium – birth to 42 days postpartum Gestation – the period of pregnancy Trimester – a period of 3 months, divided into first, second & third trimesters Preterm – pregnancy less than 37 weeks of gestation Term – pregnancy between 37-42 weeks of gestation Postterm/Postdate – pregnancy beyond 42 weeks of gestation Preconception Care Aim: To identify medical, behavioral & social risks to a woman’s health or pregnancy outcome through prevention & management (Centers for Disease Control and Prevention, 2023) Components Health promotion Nutrition, healthy diet, optimal weight, exercise & rest Avoidance of substance abuse Use of risk-reducing sex practices Risk assessment Chronic diseases, STIs, genetic conditions Medications, substance abuse, environmental exposures, IPV Interventions Nutrition, diet, weight management, exercise, modifying risk behaviors Treatment of relevant medical conditions, medications, immunizations Referral for genetic counseling, family planning services Anatomy & Physiology of Reproductive System: Hormonal Cycle Hypothalamus → anterior pituitary gland → Gonadotrophin releasing factor (GnRF) → Follicle stimulating hormone (FSH) stimulates development of ovarian follicle Luteinising hormone (LH) further development of ovarian follicles → ________________________ Ovaries Oestrogen proliferation of uterine endometrium Progesterone Secretory changes of uterine lining endometrium proliferation blood supply thick, vicious cervical secretion Fetal Development Gametogenesis: Oogenesis, spermatogenesis Fertilization: Zygote → Morula → Blastocyst Blastocyst Copyright © Lippincott Williams & Wilkins Inner cell mass: Embryo + amnion + umbilical cord 3 germ layers: Ectoderm, mesoderm, endoderm Trophoblast: Placenta + chorion Fetal Development Stage Weeks Fetal development Embryonic 0-4 Formation of embryonic plate stage Primitive central nervous system, heart develop (3-8 week) 4-8 Rapid cell division, major organs in primitive form Head & facial features develop, external genitalia Visible in USG from 6 weeks Fetal stage 9-12 Kidneys begin to function & pass urine from 10 weeks Fetal circulation functioning properly Sucking & swallowing begin, eyelids fuse Sex apparent, move freely but not felt by mother 12-16 Rapid skeletal development & visible on X-ray Meconium present in gut, lanugo appears Nasal septum & platelet fuse 16-20 Quickening – first fetal movement felt by mother (Primipara - ________________ week, multipara - ________________week) Fetal heart heard on auscultation Vernix caseosa appears, fingernails, skin cells renewed Fetal Development Stage Weeks Fetal development Fetal 20-24 Most organs capable of functioning stage Period of sleep & activity, responds to sound Skin red & wrinkled 24-28 Survival may be expected if born Eyelids reopen, respiratory movement 28-32 Begins to store fat & iron, testes descend into scrotum Lanugo disappears from face Skin paler & less wrinkled 32-36 fat, body more rounded Lanugo disappears from body, head hair lengthens Nails reach tips of fingers, ear cartilage soft Plantar creases visible 37-40 Term is reached & birth is due Contour rounded, skull firm Physiological & Psychosocial Changes in Pregnancy Physiological changes Psychosocial changes Endocrine system Uncertainty, ambivalence Reproductive system Acceptance Cardiovascular system Mood swings Respiratory system Concern body image Gastro-Intestinal system Anxiety, fear about childbirth Renal/urinary system Role adjustment Musculoskeletal system Change in lifestyle, social activities Integumentary system Metabolism - Weight gain  Endocrine System - Placenta Hormones Descriptions Human chorionic Produced by trophoblast gonadotrophin (hCG) Maintain corpus luteum → continue produce estrogen & progesterone Detectable in urine ______ days after conception →indicator of pregnancy test, rise rapidly during the first trimester, then a rapid decline Estrogen Produced by ____________________in early pregnancy & later by _______________ Stimulate uterine growth & ↑blood supply to uterine vessels Development of glands & ductal system in breasts Progesterone Produced initially by ________________________& later by ___________________ Maintain endometrium & inhibit uterine contractility Stimulate growth of lobes & lobules in breasts ↓ smooth muscle, ↑ fat deposition Human chorionic Insulin antagonist - ↑ maternal blood glucose level somatomammotropin (Human placental lactogen) Relaxin Inhibit uterine activity, ↓ strength of uterine contraction Softening & relaxing of cervix, connective tissue Endocrine System Pituitary Gland ↑Growth hormone ↑Melanocyte-stimulating hormone → ___________________________ ↑Prolactin → _______________________________ ↑Oxytocin → stimulate uterine contraction during labor stimulate milk-ejection (letdown reflex) after childbirth Thyroid gland Hyperplasia & ↑vascularity → ↑secretion of thyroid hormone → ____________________ Adrenal gland ↑Corticosteroid production  Reproductive System Uterus ↑ size, weight, length, width, depth, volume & overall capacity Palpable at abdomen after 12 weeks (at symphysis pubis)  20 weeks at umbilicus  36 weeks at xiphisternum  Reproductive System Uterus Changes in muscle fibers Endometrium - thicken & become decidua Decidua basalis Decidua capsularis Decidua parietalis Myometrium – hypertrophy & hyperplasia Inner circular layer Middle interlacing layer Outer longitudinal layer Perimetrium Copyright © Lippincott Williams & Wilkins Reproductive System Uterus Positive Hegar’s sign softening & compressibility of lower uterine segment (isthmus) Braxton Hicks contractions irregular, painless contractions that occur intermittently throughout pregnancy Copyright © medicoapps.org Reproductive System Cervix Softening (Goodell’s sign) Bluish discoloration due to ↑vascularization (Chadwick’s sign) ↑secretion → formation of a mucous plug (operculum) Vagina become more vascular, thicken & distensible color change from light pink to deep violet (Chadwick’s sign) ↑vaginal secretion (leukorrhea) Ovaries _____________________ of ovulation  Reproductive System Breasts Increase in size, growth of duct & glandular tissue Nipple more prominent & pigmented Montgomery’s tubercles develop in areola Production of colostrum (______________________________fluid) Copyright © Lippincott Williams & Wilkins Cardiovascular System ↑ Cardiac output (____________L/min), ↑ Heart rate ↑ Total blood volume (______% above prepregnant levels), plasma volume (_____%), red cell mass (______%) → Haemodilution or physiological anemia of pregnancy ↑ Iron demands ↑ Plasma fibrinogen & clotting factors → hypercoagulable state → ↑risk of ________ Blood pressure ↓slightly 2nd trimester, rise to prepregnant level at 3rd trimester Cardiovascular System Supine Hypotensive Syndrome Compression of inferior vena cava by enlarging uterus when women lies in supine position Left lateral recumbent position is optimal for cardiac output & uterine perfusion Copyright © Lippincott Williams & Wilkins Respiratory System ↑ Tidal volume (_______%) ↑ Oxygen consumption (_______%) Diaphragm elevated due to pressure from enlarging uterus → ________ Nasal congestion due to ↑vascularity → ___________________  Gastro-Intestinal System Nausea & vomiting - due to ____________ Gums - hyperemic, swollen, bleeds more easily ↑Salivation (Ptyalism) Oesophageal reflux & heartburn __GI motility, _____________of cardiac sphincter & smooth muscle → ________ gastric emptying _______________ displacement of stomach Constipation - due to _______________________________________ Hemorrhoids - due to pressure from ____________________ on vein, _____________ Prolonged gallbladder emptying predispose to _______________________________formation Renal/Urinary System ↑Urinary frequency in _________& __________ trimesters Dilation & kinking of ureters → urinary stasis ↑Vesico-ureteric reflux ↑GFR (________%) but tubular reabsorption remains constant → ________________________ ↑risk of _____________ Musculoskeletal System Waddling gait relaxation of ligaments, muscles & pelvic joints ↑ lumbosacral curve (lordosis) ______________________ shifting of center of gravity Pelvic girdle pain, back pain Copyright © rickolderman.com Integumentary System Hyperpigmentation Face – Chloasma (Melasma gravidarum) Abdominal wall linea nigra – a pigmented line in middle of abdomen striae gravidarum - pink/reddish streaks on abdomen, thighs Areolae, nipples, vulva, perineal area Vascular spiders (Telangiectasias) Small, fiery-red branching spots Edema, varicosities of vulva, rectum & legs enlarged uterus → ____ pressure on _______________________________vessels → ______ venous return from lower extremities Maternal Weight ↑Energy demand ↑Basal metabolic rate (______________%) Weight gain 0.5-2.0 kg in 1st trimester (up to 13th week) 0.4-0.5 kg/week till term (14th – 40th week) BMI before pregnancy Weight gain during pregnancy for Chinese women (Family Health Service, 2022) BMI < 19.0 13 – 16.7kg (29 – 37lb) BMI 19.0 – 23.5 11 – 16.4kg (24 – 36lb) BMI > 23.5 7.1 – 14.4kg (16 – 32lb) Maternal Nutrition Stage Major Nutritional Needs during Pregnancy (Family Health Service, 2022) 1st trimester of ↑folate, vitamin A, iodine pregnancy ↑energy & protein demands for growing fetus 2nd & 3rd trimester ↑folate, vitamin A, iodine of pregnancy ↑iron, zinc, omega-3 fatty acids, calcium Breastfeeding Needs extra ____________ kcal/day Sufficient intake of protein, folate, iodine, zinc, vitamin A, DHA Maternal Weight Effects of excessive weight gain during pregnancy Mother Baby Gestational diabetes Large babies & related complications Gestational hypertension ↑risk of obesity, DM, ↑cholesterol, ↑BP, cardio- & cerebro-vascular disease in Difficult delivery & ↑C/S adulthood Difficulty in returning to pre-pregnant body weight ↑risk of developing DM, HT, heart disease if persistent overweight  Signs & Symptoms of Pregnancy Subjective changes (Presumptive) Objective changes (Probable) Amenorrhea Positive pregnancy tests Nausea & vomiting Abdominal enlargement Excessive fatigue Braxton Hicks contractions Urinary frequency Ballottement Breast tenderness Pigmentation of skin Fetal movement (Quickening) Changes in pelvic organs: Hegar’s sign Goodell’s sign Chadwick’s sign Uterine enlargement Uterine soufflé – a blowing sound of maternal blood flowing through uterine arteries to placenta Diagnosis of Pregnancy Visualization of fetus by ultrasound ______________ weeks Fetal heartbeat USG _______________________ weeks Doppler _______________________ weeks Fetoscope ______________________ weeks Fetal movement palpable by examiner ______________ weeks Common Discomforts of Pregnancy Nausea & vomiting Urinary frequency Heartburn Leucorrhea Gum bleeding Constipation Nasal congestion Haemorrhoid Faintness Varicose veins Palpitation Backache Dyspnoea Leg cramps Breast tenderness Ankle edema Fatigue Carpal tunnel syndrome Insomnia  Common Discomforts of Pregnancy Discomfort Influencing factors Self-care measures Nausea & vomiting Heartburn Nasal congestion Gum bleeding Faintness Dyspnoea Breast tenderness  Common Discomforts of Pregnancy Discomfort Influencing factors Self-care measures Urinary frequency Leucorrhea Constipation Haemorrhoid Varicose veins Backache Leg cramps Ankle edema Insomnia References Centers for Disease Control and Prevention (2023). Preconception health and health care. Retrieved from http://www.cdc.gov/preconception/index.html Davidson, M. R., London, M. L., & Ladewig, P. W. (2020). Old’s maternal-newborn nursing & women’s health across the lifespan (11th ed.). New York: Pearson Prentice Hall. Family Health Service, Department of Health (2022). Healthy eating during pregnancy and breastfeeding. Retrieved from https://www.fhs.gov.hk/english/health_info/woman/20036.pdf Family Health Service, Department of Health (2021). Your Pregnancy Guide. Retrieved from https://www.fhs.gov.hk/english/health_info/woman/30005.html Durham, R. F., Chapman, L., & Miller, C. (2023). Davis advantage for maternal-newborn nursing: Critical components of nursing care (4th ed.). Philadelphia, PA: F.A. Davis Company International Childbirth Education Association (2023). Family centered maternity care. Retrieved on 1 September 2023 from https://icea.org/wp-content/uploads/2022/09/ICEA-Position-Paper- Family-Centered-Maternity-Care.pdf References London, M., Ladewig, P., Davison, M. R., Ball, J., MacGillis, R. C., & Cowen, K. (2022). Maternal & child nursing care (6th ed.). Hoboken, N.J.: Pearson Education. Lowdermilk, D. L., Perry, S. E., Cashion, K., Alden, K. R., & Olshansky, E. F. (2024). Maternity women’s health care (13th ed.). St. Louis: Elsevier Inc. Robinson, M., Coehlo, D. P., & Smith, P. S. (2022). Family health care nursing: Theory, practice, and research (7th ed.). Philadelphia, PA: F.A. Davis. Silbert-Flagg, J., & Kennedy, C. E. (2023). Maternal & child health nursing: Care of the childbearing & childrearing family (9th ed.). Philadelphia: Wolters Kluwer. World Health Organization (2013). Preconception care: Maximizing the gains for maternal and child health. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/340533/WHO-FWC- MCA-13.02-eng.pdf?sequence=1&isAllowed=y