Antepartum Nursing Care Student Copy PDF

MODULE 1 – PART II Durham, Chapman, Miller: Chapters 4-6 ATI chapters 2-6  2  Describe the anatomical and physiological changes during pregnancy.  Link the anatomical and physiological...

MODULE 1 – PART II Durham, Chapman, Miller: Chapters 4-6 ATI chapters 2-6  2  Describe the anatomical and physiological changes during pregnancy.  Link the anatomical and physiological changes of pregnancy to signs, symptoms, and common discomforts of pregnancy. Objective  Describe appropriate interventions to relieve common discomforts of pregnancy in the antepartum setting. s  Identify the critical elements of assessment and nursing care during initial and subsequent prenatal visits.  Describe the elements of patient education and anticipatory guidance in the antepartum setting. 3  4 Physiological Changes of Pregnancy PHYSIOLOGICAL 5 CHANGES OF PREGNANCY: REPRODUCTIVE SYSTEM - UTERUS  Size changes  Weight changes  Vascularity changes  Menses  Uterus (3 parts) Fundus (upper part) Isthmus (lower segment) Cervix (lower/narrow part or neck) Before pregnancy – size of small pear, weighs Reproductive 40-50g. Increases in size, enlargement of uterus (20x System - its nl size), increase in weight from 1100g- Uterus 1200g in ATI capacity from 10mL to 5000mL Hypertrophy of uterine wall, increased vascularity Cessation of menses Irregular contractions occur beginning 16 weeks (Braxton hicks) By mid-pregnancy – Fundus reaches umbilicus height 6 PHYSIOLOGICAL 7 CHANGES OF PREGNANCY: REPRODUCTIVE SYSTEM – CERVIX & VAGINA  Cervical changes  Muscular changes  Vascularity changes  Vaginal changes  8 Reproductive System – Cervix & Vagina  Cervix Becomes shorter, more elastic and larger in diameter Endocervical glands secrete a thick mucus plug, which expelled from the canal when dilation begins Increased vascularization and an increase in estrogen causes a softening and a violet discoloration (Chadwick's sign) – at about week 6 Vagina Hypertrophy and thickening of the muscle occurs Increase of vaginal secretions – thick, white and acidic Increased Acid Ph (increase risk for yeast infection) PHYSIOLOGICAL 9 CHANGES OF PREGNANCY: REPRODUCTIVE SYSTEM - OVARIES  Progesterone  Muscular changes  Vascularity changes  Vaginal changes  Ovaries High levels of hCG first couple months of pregnancy keeps corpus leutum maintained. Corpus Leutem produces progesterone, Reproductive allows implantation. System - By 6-7 weeks placenta begins to produce progesterone and corpus leutem Ovaries degenerates. Block maturation of new follicles so ovulation ceases Cease ovum production 10 PHYSIOLOGICAL 1 CHANGES OF 1 PREGNANCY: REPRODUCTIVE SYSTEM - BREASTS  Estrogen  Progesterone  Size changes  Vascularity changes  Areolar changes   Breast Increased estrogen and progesterone tenderness, fullness, enlargement, Reproductive darkening and growth in circumference of System – areola Increase in mammary gland/ducts and Breast colostrum production Superficial veins become prominent Colostrum may leak from breast 12  1 3 PHYSIOLOGICAL CHANGES OF PREGNANCY: CARDIOVASCULAR SYSTEM  Circulating blood volume increases Plasma volume increases 40-60% Total RBCs increases 30% WBCs increase up to 16,000mm3 without infection TOTAL cardiac output increases 30-50% (peaking at 25-30 weeks) *note: ATI states 30-45% (ATI) Decrease blood pressure (decrease in peripheral vascular resistance) Cardiovascular Increase heartbeat, - around 32 weeks and maintains high System until after delivery Increase demand for iron in fetal development Changes Sodium and water retention may occur Increase venous pressure and decreased blood flow to lower extremities due to compression of iliac veins and inferior vena cava (causing edema and supine hypotension) Anemia may occur, as plasma increase exceeds the production of RBCs Heart size is increased Heart moves slightly up to the left due to uterine enlargement 14  1 PHYSIOLOGICAL 5 OF PREGNANCY: RESPIRATORY SYSTEMS  Increased vascularity  Lung capacity changes  Today volume changes  Diaphragm changes  Increased oxygen demand – 15% Increased oxygenation consumption 20-40% Tidal Volume increase 30-40% Respiratory rate increases, lung capacity Respiratory decreases Slight respiratory alkalosis occurs (promotes System CO2 away from fetus) Changes Displacement in diaphragm by enlarged uterus – upward approx. 4cm Chest circumference increase of 6 cm. Shift from abdominal to thoracic breathing occurs as pregnancy progresses 16  1 7 PHYSIOLOGICAL CHANGES OF PREGNANCY: RENAL SYSTEM  Frequency in urination in 1st and 3rd trimesters – 1st hormones and sensitivity , 3rd from pressure of enlarged bladder. GFR rate increases Shift occurs in fluid and electrolyte balance Renal System Ureters become elongated, and dilated Changes Bladder tone decreases – increase of progesterone and estrogen Renal stasis may occur – causing increased risk for UTIs and pyelonephritis Renal ability to breakdown glucose may occur 18  1 9 PHYSIOLOGICAL CHANGES OF PREGNANCY: GASTROINTESTINAL SYSTEM  N/V – usually subsides by 3rd month – from increased hCG. hCG stabilizes or decreases around week 12 Poor appetite may occur due to decreased gastric mobility Alterations in taste and smell may occur Gastrointestin Constipation may occur – increase in progesterone al System Heartburn - due to slow motility and slow Changes emptying of the stomach Hemorrhoids – increased venous pressure Gum tissue – sensitive, swollen, may bleed from increase in estrogen PICA – craving for or consumption of non food substances (starch or clay) – can cause toxicity 20  2 PHYSIOLOGICAL 1 CHANGES OF PREGNANCY: INTEGUMENTARY  Linea Negra  Chloasma  Pregnancy Acne  Striae Gravidarum  Hyperpigmentation Linea Negra Darkened line midline of the abdomen Melasma – (mask of pregnancy) – Brownish pigmentation of cheeks, nose and forehead. Occurs after 26th week Exacerbated by sunlight Integumentary Striae gravidarum (SG) are atrophic linear scars that represent one of the most common connective tissue changes during pregnancy. SG can cause emotional and psychological distress for System many women. Most notably found on the abdomen and thighs. Changes Varicosities, spider nevi – vascular changes ALSO: increased pigmentation of areolas hot flashes and increased perspiration from increased blood increased oiliness and acne from hormones 22  2 3 PHYSIOLOGICAL CHANGES OF PREGNANCY: MUSCULOSKELETA L SYSTEM   General Changes Pelvic joints relax Posture adjusts according to body alterations and increase in weight altered gait (waddle due), also causes back and pelvic pain/discomfort,  Lordosis Musculoskeletal  Abnormal shift in the anterior curvature of the spine to make up for shift in gravity System  Higher risk for falls Changes  Round ligament pain  Abdominal distension stretches round ligaments – spasms and pain Diastasis Recti (3rd trimester) Split of rectus abdominus muscles to accommodate growing fetus abd muscles stretch due to enlarging uterus, muscles separate in midline 24  2 5 PHYSIOLOGICAL CHANGES OF PREGNANCY: ENDOCRINE SYSTEM  Increased hCG, progesterone, estrogen, lactogen and prostaglandins relaxation of smooth muscle decrease GI motility Endocrine hormone levels facilitate breast/uterine growth System lactation, Ucs Changes thyroid enlargement heat intolerance and fatigue Water retention is increased 26  2 7 PHYSIOLOGICAL CHANGES OF PREGNANCY: IMMUNE SYSTEM  2 Preconception 8 Health Care  Identify Risks  Medical  Behavioral  Social  Environmental  Preconception health care  Routine physical exam  Health screening  Education  Nutrition  2 9 NUTRITION IN PREGNANCY  NUTRITIONAL ASSESSMENT  CLIENT EDUCATION  NUTRITIONAL RISK FACTORS DIETARY COMPLICATIONS 30  3 NUTRITION IN 1 PREGNANCY  CALORIC INTAKE  PROTEIN  FOLIC ACID  IRON  CALCIUM  FLUID  CAFFEINE 32  3 3 NAUSEA IN PREGNANCY  3 4 Diagnosis of Pregnancy  3 5 Signs of Pregnancy  Presumptive signs  Probable signs  Positive signs  3 6 Presumptive Signs of Pregnancy 37  3 8 Probable Signs of Pregnancy 39 Positive Signs of Pregnancy 40 41  42 Calculating the due date: Nagele’s Rule  4 Prenatal 3 Assessment Terminology  Gravida  Parity  Nulligravida  Primigravida  Multigravida  4 4 GTPAL: An acronym used to assess pregnancy outcomes  4 Tests of Fetal Status 5 and Fetal Well Being  Ultrasonography  Biophysical Profile (BPP)  Nonstress Test (NST)  Amniotic Fluid Index (AFI)  Maternal/Fetal tests  Fetal Heart Monitoring  ContractionStress Test (CST)*done when other well being tests have failed.  4 6 BIOPHYSICAL PROFILE  4 NonStress Test 8 (NST)  External monitoring for fetal well-being  Indications  High-risk pregnancy  20-40 minutes monitoring  FHR within normal limits  2 contractions in 10 minutes  15 x 15 (32 weeks or greater)  10 x 10 (less than 32 weeks)  Moderate variability  No decelerations  No contractions Fetal Kick Counts  Starts at 28 weeks  Do twice a day or more  Same time every day  Sit in comfortable position or lay on side  Record 1st kick time  Count until 10th kick and record time  Need 10 movements in 2 hours or less  5 Contraction Stress 0 Test (CST)  Baseline FHM for 20 min - CST  No decelerations with UCs + CST  Late decelerations with 50% of UCs  Initiates UCs  Nipple stimulation  Oxytocin IV Video Links Healthy People 2030 website: https://health.gov/healthypeople Fertilization video: https://www.youtube.com/watch?v=_5OvgQW6FG4 Role of folic acid: https://www.youtube.com/watch?v=NQffB6RcXjs Infertility Causes: https://www.youtube.com/watch?v=UTZKFfEdv20 9 Month in the womb (4:36) https://youtu.be/WH9ZJu4wRUE Conception video (2 min) https://www.youtube.com/watch?v=DGyRD9HnXVs (fetal circulation 11:51 min) https://www.youtube.com/watch?v=-IRkisEtzsk (newborn circulation (13:24) https://www.youtube.com/watch?v=jFn0dyU5wUw Placental development and function (11:52) https://youtu.be/Y30KYViqFCs Development of the placenta: https://www.osmosis.org/learn/Development_of_the_placenta What is amniotic fluid made of (4:48) https://youtu.be/zjD9Ky4zFME Taxoplasmosis - https://www.osmosis.org/answers/torch-infection 51 52