Maternity Nursing Day 1 PDF

MATERNITY NURSING DAY 1 The Nurse’s Role in a Changing Maternal-Child Healthcare Environment (Reading Assignment) Family-Centered and Community-Based Maternal & Pediatric Nursing (Reading Assignment) Structure and Function of...

MATERNITY NURSING DAY 1 The Nurse’s Role in a Changing Maternal-Child Healthcare Environment (Reading Assignment) Family-Centered and Community-Based Maternal & Pediatric Nursing (Reading Assignment) Structure and Function of the Reproductive System Fetal Development Maternal Adaptations During Pregnancy Prenatal Care Marian College Vocational Nursing Program Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 3: Structure and Function of the Reproductive System Menstrual Cycle #1 ❖ Recurring changes in woman’s reproductive tract ❖ Menstruation: casting away of blood, tissue, debris from uterus as endometrium sheds o Average flow lasts 4 to 6 days o Total blood loss 25 to 60 mL ❖ Hormones regulate process ❖ Responding to hormones (hypothalamic, pituitary) ❖ Components: ovarian cycle, uterine cycle Copyright © 2022 Wolters Kluwer · All Rights Reserved Menstrual Cycle #2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Ovarian Cycle #1 ❖ Cyclical changes occur in response to FSH and LH ❖ Two phases o Follicular phase ▪ Controlled by FSH, days 1-14 o Luteal phase ▪ Controlled by LH, days 15-28 Copyright © 2022 Wolters Kluwer · All Rights Reserved Ovarian Cycle #2 ❖ Follicular phase o Follicle begins to develop in response to rising FSH levels o Follicle produces estrogen o Pituitary gland notes increased estrogen, releases surge of LH o Results in ovulation o Fimbriae draws ovum toward fallopian tube Copyright © 2022 Wolters Kluwer · All Rights Reserved Ovarian Cycle #3 ❖ Luteal phase o LH remains elevated, causes remnants of follicle to develop corpus luteum o Progesterone o If no fertilization, corpus luteum degenerates, estrogen and progesterone levels fall o Leads back to day 1 of cycle Copyright © 2022 Wolters Kluwer · All Rights Reserved Uterine Cycle #1 ❖ Refers to the changes that occur in the inner lining of the uterus ❖ Response to estrogen and progesterone ❖ Four phases o Menstrual o Proliferative o Secretory o Ischemic Copyright © 2022 Wolters Kluwer · All Rights Reserved Uterine Cycle #2 ❖ Menstrual phase o Onset of menstruation o Uterine lining is shed due to low levels of progesterone and estrogen o Follicle begins to develop, starts producing estrogen ❖ Proliferative phase o Endometrium begins to regenerate when estrogen levels are high enough o Endometrium begins to develop in preparation for pregnancy Copyright © 2022 Wolters Kluwer · All Rights Reserved Uterine Cycle #3 ❖ Secretory phase o Corpus luteum begins producing progesterone o Uterine lining prepares for pregnancy o Estrogen levels remain high o If no pregnancy, enters ischemic phase ❖ Ischemic phase o Estrogen and progesterone levels fall o Uterine lining becomes ischemic and starts to shed Copyright © 2022 Wolters Kluwer · All Rights Reserved Uterine Cycle #4 ❖ Cervical mucus changes o During menstrual phase, cervix does not produce mucus o Cervix produces yellow or white mucus that is tacky and crumbles when dried o As ovulation nears, mucus becomes progressively clear and thin with lubricating properties o Spinnbarkeit o After ovulation, mucus becomes scanty, thick, and opaque Copyright © 2022 Wolters Kluwer · All Rights Reserved Uterine Cycle #5 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 5: Fetal Development Cellular Processes #1 ❖ Soma cells o Make up the organs and tissues of the human body o Nucleus contains 23 pairs of chromosomes ▪ 22 pairs of autosomes ▪ One pair of sex chromosomes o Chromosomes composed of genes Copyright © 2022 Wolters Kluwer · All Rights Reserved Cellular Processes #2 ❖ Gametes (germ cells or sex cells) o Found in the reproductive glands only o Ovum is female gamete o Spermatozoon (sperm) is male gamete o Each gamete has 23 chromosomes Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #1 ❖ Three stages o Pre-embryonic o Embryonic o Fetal ❖ Pre-embryonic o Begins at fertilization o Lasts through the end of the second week postfertilization Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #2 ❖ Pre-embryonic (cont.) o Conception usually occurs when the ovum is in the ampulla (the outermost half) of the fallopian tube o Zygote is formed and has diploid number of chromosomes o Sex determination ▪ Occurs at time of fertilization ▪ Dependent on whether sperm has X or Y chromosome ▪ Research indicates that there is an approximately 50–50 chance of either occurrence Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #3 ❖ Pre-embryonic (cont.) o Cellular reproduction ▪ Cleavage begins ▪ 3 days after fertilization morula forms ▪ 5 days after fertilization blastocyst forms Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #4 ❖ Pre-embryonic (cont.) o Implantation ▪ By 10th day after fertilization, blastocyst is buried in uterine lining ▪ Begins to produce human chorionic gonadotropin (hCG) ▪ Endometrium is called the decidua from implantation through end of pregnancy Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #5 ❖ Embryonic stage o Lasts from the end of the second week postfertilization until end of eighth week o Developing conceptus becomes the embryo o Differentiation begins o Third week, three germ layers develop Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #6 ❖ Embryonic stage (cont.) o Three germ layers of the embryo ▪ Ectoderm: Outer layer of cells (skin, nervous system, nasal passages, crystalline lens of eye, pharynx, mammary glands, salivary glands) ▪ Mesoderm: Middle layer (muscles, circulatory system, bones, reproductive system, connective tissue, kidneys, ureters) ▪ Endoderm: Inner layer (GI tract, respiratory tract, bladder, pancreas, liver) Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #7 ❖ Fetal stage o From the beginning of the ninth week after fertilization and continues until birth o Additional growth and maturation of the organs and body systems Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Fetal Development #8 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 In the embryonic stage of fetal development what occurs? a. Implantation begins b. Gender differentiation takes place c. Maturation of germ cells in ovaries d. Differentiation begins Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 d. Differentiation begins Rationale: During the embryonic period, the cells of the embryo multiply, and tissues begin to assume specific functions, a process known as differentiation. Copyright © 2022 Wolters Kluwer · All Rights Reserved Development of Supportive Structures #1 ❖ Fetal membranes o Amniotic cavity begins to develop around 9 days postconception ▪ Surrounded by amnion o Amnion is a thick fibrous lining, composed of several layers, that protects the fetus, and forms inner part of the sac in which the fetus grows o Chorion is a second layer of thick fibrous tissue ▪ Surrounds amnion Copyright © 2022 Wolters Kluwer · All Rights Reserved Development of Supportive Structures #2 ❖ Amniotic fluid o Fills the amniotic cavity o Mostly water (98% to 99%) o Serves four main functions ▪ Physical protection ▪ Temperature regulation ▪ Provision of unrestricted movement ▪ Symmetrical growth Copyright © 2022 Wolters Kluwer · All Rights Reserved Development of Supportive Structures #3 ❖ Placenta o Organ that sustains, nourishes growing pregnancy o Three main functions ▪ Provides for transfer, exchange of substances ▪ Acts as barrier to certain substances ▪ Functions as an endocrine gland, producing hormones Copyright © 2022 Wolters Kluwer · All Rights Reserved Steps in Exchange of Nutrients and Wastes ❖ The placenta transfers nutrients, such as oxygen and glucose, to the fetus while removing waste products, such as carbon dioxide and urea. ❖ Maternal blood rich in oxygen and nutrients reaches the placenta at the level of the intervillous spaces that are surrounded by the chorionic villi. ❖ The chorionic villi contain the fetal blood vessels. ❖ Exchange of nutrients for wastes occurs by simple diffusion or active transport across a thin membrane that separates the fetal and maternal bloodstreams. Copyright © 2022 Wolters Kluwer · All Rights Reserved Development of Supportive Structures #4 ❖ Umbilical cord o Extends from fetal umbilicus to fetal surface of the placenta o Two arteries bringing deoxygenated blood from fetus to placenta and one vein carrying oxygenated and nourished blood from placenta to fetus o Wharton jelly surrounds these three vessels Copyright © 2022 Wolters Kluwer · All Rights Reserved Fetal and Placental Circulation ❖ Fetal circulation o Low oxygen tension o Three fetal shunts ▪ Ductus venosus ▪ Foramen ovale ▪ Ductus arteriosus ❖ Placental circulation o Exchange occurs in intervillous spaces Copyright © 2022 Wolters Kluwer · All Rights Reserved Fetal Circulation Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Is the following statement true or false? The ductus arteriosus carries oxygenated blood from the pulmonary artery to the aorta. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 False Rationale: The ductus arteriosus does connect the pulmonary artery and the aorta, but it carries deoxygenated blood. Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #1 ❖ Teratogens and the fetus o Substances that can cause birth defects o Severity of the defect depends upon when during development the conceptus is exposed to the teratogen (i.e., which body systems are developing at the time of exposure) and the particular teratogenic agent to which the fetus is exposed Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #2 ❖ Types of teratogenic agents o Ingested ▪ Prescription and OTC medications, illicit drugs, and alcohol o Infectious ▪ Varicella, cytomegalovirus (CMV), and rubella o Environmental substance ▪ Ionizing x-rays, radioactive substances, and certain chemicals Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #3 ❖ Ectopic pregnancy o The zygote implants in places other than the uterus o 95% occur in the fallopian tube o Usually caused by blockage or scarring of the fallopian tubes either from infection or from trauma o Leading cause of maternal death in first trimester Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #4 ❖ Multifetal pregnancy o Monozygotic twins: Identical twins derived from one zygote ▪ Share same genetic material; always the same sex o Dizygotic twins: Fraternal twins develop from separate egg and sperm fertilizations ▪ Genetic material is not identical; may or may not be the same sex Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #5 ❖ Multifetal pregnancy (cont.) o Classification of twins ▪ Diamniotic-dichorionic twins Each develop in own amniotic sac Placentas do not share any vessels ▪ Diamniotic-monochorionic twins Each have own amniotic sac but share a common chorionic sac Each have a separate placenta but the placentas share some vessels ▪ Monoamniotic-monochorionic Have one amniotic cavity that they both share Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #6 ❖ Multifetal pregnancy (cont.) o Contributing factors for multifetal pregnancy ▪ Family history of twins ▪ Recent stoppage of oral contraceptive ▪ Tall or large stature of mother ▪ African American heritage ▪ Fertility medication use Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations of Fetal Development #7 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 Is the following statement true or false? It will be okay for the client to update any vaccinations as soon as the pregnancy is confirmed to help prevent any possible complications. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 False Vaccinations are considered teratogens which can have a devastating effect on the developing embryo leading to birth defects or death of the growing embryo. The mother should be encouraged to keep all vaccinations up-to-date before becoming pregnant to prevent this potential complication. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 6: Maternal Adaptation During Pregnancy Signs of Pregnancy #1 ❖ Presumptive (possible) signs: Subjective data woman experiences and reports to healthcare provider o Taken alone, each sign can have other causes besides pregnancy ❖ Probable signs: Objective signs measured by trained examiner ❖ Positive signs: Diagnostic confirmation o Ultrasound, fetal heartbeat, etc. Copyright © 2022 Wolters Kluwer · All Rights Reserved Signs of Pregnancy #2 ❖ Presumptive signs of pregnancy and other potential causes o Tender breasts ▪ Could be caused by hormonal changes o Amenorrhea (missed period) ▪ Hormonal imbalance, emotional distress, or illness o Frequent urination ▪ UTI, nervousness, etc. Copyright © 2022 Wolters Kluwer · All Rights Reserved Signs of Pregnancy #3 ❖ Probable signs of pregnancy and other potential causes o Presence of hCG in blood ▪ May be due to hydatidiform mole o Presence of hCG in urine ▪ May be due to choriocarcinoma o Uterine growth ▪ May be due to tumors Copyright © 2022 Wolters Kluwer · All Rights Reserved Signs of Pregnancy #4 ❖ Probable signs of pregnancy (objective) o Chadwick sign ▪ The bluish-purplish color of the cervix, vagina, and perineum o Hegar sign ▪ Softening of the uterine isthmus o Goodell sign ▪ Softening of the cervix o Ballottement ▪ Fetus bounces back against examiner’s fingers Copyright © 2022 Wolters Kluwer · All Rights Reserved Signs of Pregnancy #5 ❖ Positive signs of pregnancy o Visualization of fetus by ultrasound o Fetal heart sounds by fetal stethoscope or Doppler o Fetal movements palpable by a trained practitioner Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Starting somewhere around the sixth week of the pregnancy hCG begins to be found in the urine. However, hCG in urine is not a positive sign of pregnancy. What could its appearance in the urine be due to? a. Choriocarcinoma b. Hydatidiform mole c. UTI d. Pelvic tumor Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 a. Choriocarcinoma Rationale: Pregnancy tests measure the presence of human chorionic gonadotropin (hCG) in the urine or the blood. hCG levels can be elevated in conditions other than pregnancy, such as hydatidiform mole and choriocarcinoma. Copyright © 2022 Wolters Kluwer · All Rights Reserved Physiologic Adaptation to Pregnancy #1 ❖ Reproductive changes o Uterine changes ▪ Change in weight, capacity ▪ Changes in wall structure ▪ Expansion from pelvis into abdominal cavity ▪ Blood supply increases ▪ Braxton Hicks contractions Copyright © 2022 Wolters Kluwer · All Rights Reserved Physiologic Adaptation to Pregnancy #2 ❖ Reproductive changes (cont.) o Cervix and ovaries ▪ Vascularity increases, and glandular tissue multiplies during pregnancy ▪ Thick mucus plug develops in the opening of the cervix ▪ Ovulation stops ▪ Corpus luteum continues to function and produces progesterone for approximately 6 to 7 weeks Copyright © 2022 Wolters Kluwer · All Rights Reserved Physiologic Adaptation to Pregnancy #3 ❖ Reproductive changes (cont.) o Vagina and perineum ▪ Affected by hormonal changes and increased blood supply to the area ▪ Vagina takes on a bluish-purplish hue, Chadwick sign ▪ Increased secretions Copyright © 2022 Wolters Kluwer · All Rights Reserved Physiologic Adaptation to Pregnancy #4 ❖ Reproductive changes (cont.) o Breasts ▪ Tenderness in the first few weeks of pregnancy ▪ Nodularity of breast tissue ▪ Prominent areola with deepened pigmentation ▪ Prominent projections of Montgomery tubercles ▪ Striae: stretch marks ▪ Colostrum: thick, yellow fluid that precedes milk production Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #1 ❖ Endocrine changes o Pituitary enlarges o Prolactin levels increase progressively o Increased protein binding o Oxytocin needed for labor contractions and lactation o Thyroid gland increases in size o Need for insulin increases Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #2 ❖ Hematologic changes o Blood volume increases by 40% to 45% o Red blood cell volume increases up to 30% o Plasma volume increases by 50% o Hemoglobin slightly decreases to 11 to 12.5 g/100 mL o Hematocrit decreases Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #3 ❖ Cardiovascular changes o Blood pressure decreases slightly o Heart rate increase averages 10 to 15 beats per minute o Cardiac output increases o Supine hypotensive syndrome ▪ Latter half of pregnancy Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #4 ❖ Respiratory changes o Nasal mucosa edematous due to vasocongestion o Nasal congestion and voice changes possible o Accommodations to maintain lung capacity o May feel short of breath when eupneic o Third trimester diaphragm pressure Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #5 ❖ Musculoskeletal changes o Lordosis increases o Diastasis recti abdominis ❖ GI changes o Intestines are displaced to the sides and upward o Pressure changes in stomach and esophagus ▪ Leads to pyrosis (heartburn) o Constipation Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #6 ❖ Urinary changes o Renal and ureteral dilation o Glomerular filtration rate increases by 50% o Glycosuria Copyright © 2022 Wolters Kluwer · All Rights Reserved Changes to Body Systems During Pregnancy #7 ❖ Integumentary changes o Chloasma (mask of pregnancy) ▪ Brown blotchy areas on the forehead, cheeks, and nose o Linea nigra ▪ The skin in the middle of the abdomen may develop a darkened line o Striae (stretch marks) ▪ May develop on the abdomen in response to elevated glucocorticoid levels Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? During pregnancy, the pituitary gland and thyroid gland shrink in size. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: The pituitary and thyroid glands both increase in size during pregnancy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Psychological Adaptation to Pregnancy ❖ First-trimester task o Accept the pregnancy ❖ Second-trimester task o Accept the baby ❖ Third-trimester task o Prepare for parenthood Copyright © 2022 Wolters Kluwer · All Rights Reserved Changing Nutritional Requirements of Pregnancy #1 ❖ Fetus needs nutrients and energy to build new tissue ❖ Woman needs nutrients to build her blood volume and maternal stores ❖ Increased demand for energy and for almost every nutrient type ❖ Most nutrient requirements can be met through careful attention to diet ❖ Several nutrients require supplementation during pregnancy Copyright © 2022 Wolters Kluwer · All Rights Reserved Changing Nutritional Requirements of Pregnancy #2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Changing Nutritional Requirements of Pregnancy #3 ❖ Energy requirements and weight gain o Increased caloric intake of 300 kcal/day during second, third trimesters o Recommended weight gain dependent upon prepregnancy BMI ▪ First trimester: 1 to 4 lb total ▪ Remainder of pregnancy: 1 lb per week ▪ Total weight gain: 25 to 35 lb for a woman with a normal BMI Copyright © 2022 Wolters Kluwer · All Rights Reserved Dietary Restrictions During Pregnancy ❖ Practices to avoid o Limiting intake to avoid weight gain, consumption of unwashed fruits and vegetables, unpasteurized dairy products, raw eggs, undercooked meats ❖ Food preparation guidelines ❖ Listeria precautions ❖ Seafood recommendations Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Nutritional Considerations ❖ Vegetarianism o Different categories o Protein area of concern o Iron and zinc requirements area of concern ❖ Lactose intolerance o Calcium deficiency major concern ❖ Pica o Iron deficiency anemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #4 Is the following statement true or false? A vegan who is pregnant should consider taking vitamin supplements during the pregnancy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #4 True A vegan is a strict vegetarian who does not eat milk, eggs, or any other dairy products. They also will not eat meat or any meat products. This client will need to take vitamin and mineral supplements to ensure they are getting enough nutrition to support the pregnancy. Copyright © 2022 Wolters Kluwer · All Rights Reserved  Chapter 7: Prenatal Care Goal of Early Prenatal Care ❖ Optimize health of woman and fetus and increase odds fetus will be born healthy to healthy mother ❖ Early prenatal care allows for initiation of strategies to promote good health and early intervention in the event a complication occurs ❖ Assessment of maternal and fetal well-being focus of prenatal care ❖ Role of nurse o Screen woman, monitor vital signs, provide information, collect data, answer questions, complete ordered procedures Copyright © 2022 Wolters Kluwer · All Rights Reserved First Prenatal Visit #1 ❖ Confirm a diagnosis of pregnancy ❖ Usually the longest visit ❖ Collecting baseline data ❖ Major objectives of visit o Identify risk factors o Determine the due date o Answer questions Copyright © 2022 Wolters Kluwer · All Rights Reserved First Prenatal Visit #2 ❖ History o Chief complaint o Reproductive history ▪ Gravid: pregnant ▪ Gravida: number of pregnancy ▪ Nulligravida: first pregnancy ▪ Multigravida: more than one pregnancy ▪ Parity: number of pregnancies past age of viability ▪ Primipara: delivered for first time ▪ Multipara: delivered more than once Copyright © 2022 Wolters Kluwer · All Rights Reserved First Prenatal Visit #3 ❖ History (cont.) o Recording GTPAL ▪ G: Gravida—total number of pregnancies ▪ T: Term—number of pregnancies that ended at term ▪ P: Preterm—number of pregnancies that ended after 20 weeks and before the end of 37 weeks ▪ A: Abortions—number of pregnancies that ended before 20 weeks’ gestation ▪ L: Living—number of children delivered who are alive when history is taken Copyright © 2022 Wolters Kluwer · All Rights Reserved First Prenatal Visit #4 ❖ History (cont.) o Medical surgical history ▪ Risk factors for infectious diseases, HIV/AIDS and other STIs, immunization status o Family history ▪ Need for genetic testing or counseling o Social history ▪ Environmental factors, resources, employment, support system, risk for IPV, substance use/abuse, hobbies (gardening), animals in home Copyright © 2022 Wolters Kluwer · All Rights Reserved First Prenatal Visit #5 ❖ Physical examination o Head-to-toe physical o Vaginal speculum examination o Bimanual examination of the uterus ❖ Laboratory work o Complete blood count, blood type, and antibody screen; hepatitis B, HIV, syphilis, gonorrhea, chlamydia, rubella titer; urine culture; Pap test; vaginal and anal cultures; screening for hypothyroidism; glucose tolerance test Copyright © 2022 Wolters Kluwer · All Rights Reserved Due Date Estimation ❖ EDD: estimated date of delivery ❖ EDC: estimated date of confinement (older term) ❖ Naegele rule: Add 7 days to the date of the first day of the LMP, then subtract 3 months ❖ Uterus size ❖ Landmarks in the pregnancy o Quickening: woman feels movement for first time ❖ Sonogram: measurement of fetal structures Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following question true or false? When doing a GTPAL you know that the T stands for how many pregnancies a woman has had that ended at term (or beyond 38 weeks’ gestation). Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: “T” stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation). Copyright © 2022 Wolters Kluwer · All Rights Reserved Risk Assessment ❖ Incorporates and evaluates data o History o Physical examination o Laboratory tests ❖ A history of difficult pregnancy or pregnancy complications puts subsequent pregnancies at risk ❖ Social factors ❖ Age Copyright © 2022 Wolters Kluwer · All Rights Reserved Subsequent Prenatal Visits #1 ❖ Shorter in length ❖ Once a month for weeks 1 to 32, every other week between weeks 32 and 36, weekly after week 36 until birth ❖ Visits include specific assessments o Weight, blood pressure, urine protein and glucose, fetal heart rate , fundal height ❖ Inquiry danger signals of pregnancy Copyright © 2022 Wolters Kluwer · All Rights Reserved Subsequent Prenatal Visits #2 ❖ Recommended screenings o Maternal serum alpha-fetoprotein (MSAFP) between weeks 15 and 20 o Gestational diabetes between weeks 24 and 28 o Rho(D) negative woman screened for antibodies o Screening for group B streptococci o Cell-free DNA blood test for mothers with high risk for Down syndrome Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #1 ❖ Fetal movement (kick) counts o Done by woman at the same time each day o Should not take longer than 2 hours to get to 10 counts o If does, the woman should call her healthcare provider. Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #2 ❖ Ultrasonography o Uses high-frequency sound waves to visualize fetal and maternal structures o Done to determine or confirm gestational age, observe the fetus, and diagnose fetal and placental abnormalities o Transabdominal o Transvaginal o Doppler flow studies Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #3 ❖ Maternal serum alpha-fetoprotein testing (MSAFT) o Recommended for every pregnant woman between 16 and 18 weeks o Elevated levels are associated with various defects, in particular fetal spinal defects Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #4 ❖ Amniocentesis o Aspiration of amniotic fluid through the abdominal wall to obtain fetal cells for chromosomal analysis o Usually done between 15- and 20-weeks' gestation ❖ Chorionic villus sampling o Similar to amniocentesis, but it can be performed earlier, usually at 10 to 12 weeks o Placental tissue is aspirated through a catheter that is introduced through the cervix or it can be done transabdominally Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #5 ❖ Percutaneous umbilical blood sampling (PUBS) o Similar to an amniocentesis; however, fetal blood is withdrawn from the umbilical cord for testing, rather than amniotic fluid ❖ Nonstress test (NST) o Measures fetal heart rate acceleration patterns o A reactive NST is reassuring Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #6 ❖ Contraction stress test (CST) o Done to determine how well the fetus can handle the stress of contractions; three contractions are needed within a 20-minute period; can occur spontaneously or may be induced by nipple stimulation or oxytocin infusion o A “negative” (desired) result occurs when there are no decelerations during the test o If decelerations occur with one half or more of the contractions, this is a “positive” (undesirable) result Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of Fetal Well-Being During Pregnancy #7 ❖ Biophysical profile o Combines the NST and several ultrasound measures, breathing, movements, tone, and amniotic fluid volume to predict fetal well-being o Score of 8 to 10: fetal well-being o Score of 6: possible fetal asphyxia o Score of 4: probable fetal asphyxia o Score of 0 to 2: poor fetal well-being, requires immediate delivery of fetus Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 If the results of a maternal serum alpha-fetoprotein (MSAFP) are lower than expected, it may indicate that the baby will be born with what? a. Neural tube defect b. Omphalocele c. Down syndrome d. Trisomy 17 Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 c. Down syndrome Rationale: Low MSAFP levels may also indicate a problem, in particular, Down syndrome. Copyright © 2022 Wolters Kluwer · All Rights Reserved Common Discomforts of Pregnancy #1 ❖ Bleeding gums ❖ Nasal stuffiness and epistaxis ❖ Nausea and vomiting: morning sickness, hyperemesis gravidarum ❖ Feeling faint ❖ Frequent urination ❖ Increased vaginal discharge ❖ Shortness of breath ❖ Breast tenderness Copyright © 2022 Wolters Kluwer · All Rights Reserved Common Discomforts of Pregnancy #2 ❖ Heartburn ❖ Backaches ❖ Round ligament pain ❖ Leg cramps ❖ Constipation and hemorrhoids ❖ Trouble sleeping ❖ Fatigue ❖ Varicose veins and ankle edema ❖ Flatulence Copyright © 2022 Wolters Kluwer · All Rights Reserved Self-Care during Pregnancy #1 ❖ Maintaining a balanced nutritional intake ❖ Dental hygiene ❖ Exercise ❖ Hygiene ❖ Breast care ❖ Clothing ❖ Sexual activity ❖ Employment ❖ Travel Copyright © 2022 Wolters Kluwer · All Rights Reserved Self-Care during Pregnancy #2 ❖ Medications and herbal remedies o FDA pregnancy categories ▪ A: adequate studies have not demonstrated a risk ▪ B: animal studies have not demonstrated risk to fetus, no adequate studies in pregnant women ▪ C: animal studies have shown adverse effect on fetus, but no adequate studies in humans ▪ D: evidence of human fetal risk, but potential benefits from use may be acceptable despite potential risk ▪ X: studies demonstrate fetal abnormalities or adverse reaction, do not use Copyright © 2022 Wolters Kluwer · All Rights Reserved Major Components of Prenatal Self-Care ❖ Avoid alcohol and smoking ❖ Eat healthy, well-balanced diet of approximately 300 calories more per day than before pregnancy ❖ Take extra 400 mcg folic acid per day ❖ Avoid dieting during pregnancy ❖ Continue to exercise during pregnancy ❖ Avoid handling raw meat and cat litter ❖ Handle cold cuts carefully ❖ Avoid douching ❖ Avoid taking any medication, OTC, or herbals without consulting healthcare provider Copyright © 2022 Wolters Kluwer · All Rights Reserved References ❖ Hatfield, N.T. & Kincheloe, C.A. (2022). Introductory Maternity & Pediatric Nursing. 5th ed. Philadelphia, PA: Wolters Kluwer / Lippincott, Williams and Wilkins Copyright © 2022 Wolters Kluwer · All Rights Reserved