MCN Semifinals Antepartum Coverage PDF

Second Trimester Most comfortable for MCN – SEMIFINALS the mother Continued growth of Coverage: Antepartum...

Second Trimester Most comfortable for MCN – SEMIFINALS the mother Continued growth of Coverage: Antepartum the fetus. 1. Normal Antepartum Period Third Trimester Rapid deposition of Reproductive System Changes fats, iron and calcium Endocrine System Changes The period of most Respiratory System Changes rapid fetal growth. Circulatory System Changes Gastrointestinal System Changes Reproductive System Changes Urinary System Changes Integumentary System Changes Uterus Musculoskeletal System Changes ↑ d uterine size 2. Emotional or Psychosocial Adaptation of Pregnancy From globular to oval uterine shape Psychologic Tasks of Pregnancy New fibroelastic tissues are formed o Nursing Implementation Fundal height changes Dimensions of Maternal Development ↑ d vascularity to the pelvic region. 3. Signs of Pregnancy Braxton Hicks Contractions Presumptive Ballottement Probable Secondary amenorrhea Positive Uterine electrical activity 4. Common Discomforts of Pregnancy 5. Prenatal Management NORMAL ANTEPARTUM PERIOD Length of Pregnancy Cervix Duration Number Shorter, thicker and more elastic Days 267 to 280 With edema and hyperplasia of the mucus lining Calendar Months 9 ↑ d mucus production Lunar Months 10 ↑ d vascularity causes the cervix to be soft Weeks 40 Vagina Trimester 3 Hypertrophy and hyperplasia Leukorrhea Gestational age or length of pregnancy is best express in weeks. ↑ d vascularity results in bluish discoloration At the expected date of confinement (EDC), the Perineum fetus is 40 weeks old. Hypertrophy, edema and relaxation Trimesters of Pregnancy ↑ d vascularization; changes into deeper color. First Trimester Period of rapid organogenesis, teratogens such as alcohol, drugs, viruses and radiation are highly damaging. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Ovaries Endocrine System Changes Ovum production, ovulation cease, and the Placenta maturation of the new follicles are suspended A major endocrine organ during pregnancy The corpus luteum persists and takes over the hormonal production tasks in early pregnancy. The chorion of the placenta secretes hCG, which o It functions maximally during the first 6 to 7 functions to: weeks of pregnancy. o Maintain corpus luteum o Aid in diagnosis pregnancy Breast o Elevated in case of excessive vomiting ↑ d size and firmness Anterior Pituitary Gland Tingling sensation in the nipples in 4 weeks and No ovulation tenderness The breast is prepared for lactation with ↑ d Enlargement of the areola, alveoli duct and alveoli prolactin. system Darkening of the areola and skin around it Posterior Pituitary Gland Oxytocin is stored and secreted by the PPG. Thyroid Gland Changes in thyroid activity resulting in elevated BMR are due to: Enlargement and prominence of superficial veins o Elevated serum estrogen o Placental effects on thyroid function o ↑ d renal clearance of iodide. Elevated BMR (up to 25%) with return to normal at 6th week postpartum Signs of ↑ d thyroid activity: o ↑ d PR Enlargement of Montgomery’s glands o Elevated CO o Slight rise in temperature o Heat intolerance Parathyroid Gland Enhanced calcium & phosphorus metabolism to meet fetal needs for ↑ d calcium Colostrum (4 to 5 months): Thin, watery light The leading cause of cramps in pregnancy is a yellow, high protein secretion calcium – phosphorus imbalance Pancreas ↑ d insulin secretion in response to ↑ d metabolism in pregnancy INSULIN secreted by the pancreas is rendered ineffective by insulin antagonists in pregnancy Adrenal Cortex ↑ d cortisol works at multiple sites: o Promote metabolism of macronutrients. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  o Activates gluconeogenesis to convert stored Diaphragm protein to glucose ↑ d aldosterone promotes sodium retention and It rises by 1 inch at 36 to 38 weeks which may thereby water reabsorption result in dyspnea It also enhances the water – retaining effect of Can be relieved by lightening progesterone resulting in the cushingoid feature o Lightening refers to the baby descending in pregnancy into the pelvis Respiratory System Changes Lungs Nose Slight ↑ in vital capacity. o Max exhalation ↑ d vascularity o To have enough space for another set of O2 o estrogen level ↑ s it also ↑ s vascularity like ↑ O2 consumption by 15% at 6 to 40 weeks congestion o To supply O2 demand of mother & baby Common discomforts are: Tendency to hyperventilate due to: o Epistaxis o The mother’s need to blow off CO2  occurred due to vessel rupture resulting transferred to her from the fetus from ↑ d vascularity  This is because both the mother and the o Nasal stuffiness fetus require oxygen.  manifestation of this is that the patient o The direct effect of progesterone on the speaks with a cleft-like speech pattern respiratory center (ngo-ngo) Signs of Hyperventilation o Hoarseness o Dizziness o Eustachian tube blockage o Pallor  Anatomically, it involves the connection o Tingling sensation on fingertips/lips between the nose and ears, leading to  Due to lack of oxygenation blockage and temporary deafness, MANAGEMENT especially during the 2nd to 3rd o Encourage the patient to breathe into a trimester. paper bag or her cupped hands Respiratory Rate  To ↑ carbon dioxide levels in the blood  ↑ CO2 in blood alleviates s/sx of Not much change hyperventilation rate slightly ↑ d to 4 breaths per minute and Circulatory System Changes deeper. Normal RR: 16 to 24 bpm CARDIAC RATE ↑ s by 10 to 15 bpm during 2nd Tidal volume ↑ by 30 to 40% and 3rd trimesters. o Tidal volume refers to the amount of air PALPITATION in early and late pregnancy are due we inhale and exhale with each breath to: o Due to upward displacement of the o Sympathetic nervous system disturbances diaphragm, lung movement is restricted (early) o This change supports the ↑ d oxygen o ↑ d intra – abdominal pressure (late) demands of both the baby and the Transient murmurs and slight cardiomegaly mother. o Upward displacement of heart resulting to o Inhalations become deeper, and blood flow disturbances exhalations longer, allowing for greater o ↑ d size due to overworked heart oxygen intake and carbon dioxide Circulating volume ↑ s from the end of the 1st expulsion, which helps prevent trimester (30%) up to the period just before labor hyperventilation. (cup hands or use paper (50%) bag) o To support the mother, baby, and placenta. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  o Plasma volume is responsible for o WBC: transporting blood throughout the body.  5,500 to 11,500/mm3 (during Blood pressure changes: pregnancy) o It slightly drops in the 2nd trimester.  20,000/ mm3 (in labor) o Due to estrogen relaxing smooth muscles  25,000/mm3 (postpartum) Cardiac output ↑ s by 20 to 30% in 1st and 2nd  Cortisol level stimulates hormone to trimesters. produce WBC o Because the development of the zygote is  Prepares the body for susceptible rapid. infections o Especially during the second trimester.  Estrogen stimulates bone marrow of Vascularity ↑ s as an effect of ↑ d estrogen: WBC production o Dilatation of pelvic veins or deep pelvic vein  Rh incompatibility (when the mother is varicosities Rh-negative) could potentially affect the o Leg varicosities growth and development of the baby if not properly managed, particularly if the fetus is Rh-positive. Gastrointestinal System Changes Mouth ↑ acidity of saliva o Due to estrogen level ↑ saliva in women with nausea – Ptyalism. Fibrinogen level ↑ s by 50% o Drooling o There is a high risk of developing deep vein ↑ vascularity; soft & swollen gums/gingivitis; thrombosis (DVT) difficulty chewing and gum bleeding.  assessed using Homan's sign. To test, o Use soft bristles toothbrush flex the patient's foot—if they feel pain At risk to mouth tumors due to ↑ vascularity. in the calf muscle, the sign is considered positive o Fibrinogen is produced by the mother's liver. o It needs to ↑ to help prevent excessive bleeding during labor Edema of the lower extremities is common in the last 6 weeks of pregnancy o Blood is left in the interstitial space due to amniotic fluid. Hematologic changes: o RBC ↑ d by 30% but usually drop Stomach  Lagging instances compare to plasma Displaced backward or upward volume to the production of RBC o Bowel sounds may not be auscultated in four whenever it is produced abdominal quadrants due to displacement o Hgb drops to 11 – 12 g/dL (1st - 2nd) and Difficulty in food digestion due to upward 10.5 – 11 g/dL (3rd). displacement and compression.  Due to ↑ plasma volume o Due to slow intestinal peristalsis and  Decrease of iron & low diffusion of RBC emptying time of the stomach Hematologic changes: Relaxed cardiac & pyloric sphincter o Hematocrit drops to 33% - 35% during the 2nd trimester. Emptying time is delayed.  Due to ↑ production of plasma Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  GI Tract Relaxation o Urea: waste of protein; creatinine: waste of muscle Morning sickness o We must be cautious if urea levels increase, o n/v - ↑ acidic component as this could be a sign of dehydration, Flatulence particularly if the patient is experiencing o Slow movement resulting to ↑ air morning sickness. Constipation and Hemorrhoids  Hyperemesis Gravidarum - can o Constipation – decreased peristalsis & dehydration motility Frequency in voiding o Hemorrhoids – due to pressure caused by o 1st trimester: ↑ constipation o 2nd trimester: not usually happen Gall Bladder  Uterus goes up to the abdominal cavity resulting in not compressing the Delayed emptying time bladder. o Cholesterol in the bile likely to crystalize  Bladder Capacity: 1,500 mL  Cholecystitis & Cholelithiasis (liver) o 3rd trimester: ↑  ↑ chance of gall stone  Due to the descent of the uterus to prepare for labor and delivery Liver Glycosuria Displaced by the uterus o More glucose found in the urine o The uterus displaces the liver upward and may o Common in pregnancy due to low glucose cause slight compression threshold No changes in blood flow Relaxed smooth muscles of bladder and ureters. Expected liver laboratory findings mimic liver o Due to progesterone disease. o Urinary statis o Due to overuse of proteins  Bladder cannot empty properly Expected liver laboratory findings are:  cause urinary tract infection o Decreased serum albumin concentration by  Important to always to check up 30%. because there will be increased bacteria o ↑ serum phosphatase levels up to 2 to 3 in the mother but doesn't experience times the normal. symptoms (take urinalysis every  From 90 – 345 mU/g/mL (normal: 30 prenatal visit) to 115) Integumentary System Changes o Serum cholesterol is 2 times than the nonpregnant level Present from the 2nd trimester onwards  300 – 400 mg/dL(Normal: 150 to 200 Chloasma – dark patches on the cheeks, nose mg/dL) and neck o Caused by presence of HcG, estrogen, & Urinary System Changes prolactin that stimulates melasma cell ↑ in renal plasma volume by 25% to 50% in the production first and second trimesters. ↑ Glomerular Filtration Rate (GFR) by 50% in the 2nd and 3rd trimesters with decreased specific gravity. o Due to ↑ in blood volume: blood becomes thin ↑ renal tubular reabsorption rate o ↑ in blood volume, ↑ in reabsorbed fluid ↑ urea & creatinine clearance Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Musculoskeletal System Changes Relaxed ligaments and joints: o Softening & relaxation of the symphysis pubis and sacroiliac joints to increase birth canal. o Pelvic looseness results in a duck – Linea Nigra – dark line from the symphysis pubis waddle/waddling gait. upward to the xyphoid process o Difficulty maintaining balance predisposes to o Due to increased estrogen level slips & falls. Stress on the ligaments & muscles of the mid and lower spine – Backache. Lumbar lordosis – Backache & Fatigue. Muscle Cramps Striae Gravidarum – Stretch marks, silvery streaks on the abdomen, upper thighs and lower breasts. o Common in pregnancy due to adrenal hypertrophy, adrenal cortex size increases EMOTIONAL or PSYCHOSOCIAL ADAPTATION OF PREGNANCY First Normal denial to confirmation of Trimester pregnancy o Not all pregnant women are Palmar Erythema – Reddened palms and vascular happy due to unreadiness with spider nevi consequences & physiologic o Due to increased estrogen changes. Ambivalence about pregnancy, child and parenting. o Ambivalence - when a person has mixed or conflicting feelings about something, leading to uncertainty or indecision o Mood swing or emotional lability o commonly happens because of Diaphoresis – ↑ d activity of sweat and sebaceous the peak of estrogen and glands progesterone level o Due to increase metabolic rate Focusing on the self o Protects themselves to protect their baby. o Can be abortion – my body, my choice. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala Second Acceptance of the baby as distinct Dimensions of Maternal Development Trimester from self. When they reach this, they are experiencing a healthy o Enhanced by quickening pregnancy o This the stage where the mother realize she is with a child 1. Acceptance of the pregnancy With fantasy and daydreaming 2. Motivation & preparations for motherhood Introspective (self-reflection); evaluates marriage, career and in – 3. Relationship with husband/partner laws. o Thinks about the roles as a 4. Relationship with her own mother mother, spouse, daughter-in- If a patient doesn't have a mother either they law, as a woman. have a good relationship with their mother in o Thinks what the baby looks like law or grandmother o Thinks about the roles of their spouses 5. Preparation for labor Most comfortable stage 6. Sense of control in labor o Body has adapted to the pregnancy We can access it if the mother is able to count Third Fear, anxiety, or dreams about labor, the number of minutes during contractions Trimester pain, mutilation and death If the mother Is able to answer your question Anxiety related to responsibilities during labor. o Baby’s future Preparation for birth; nesting 7. Self – esteem and well – being in labor. behavior; role – playing o Nesting – preparing for the Instances that the woman is aware with what baby’s arrival; buying baby is happening to her; giving out signals in things preparation in delivery that makes them collaborative and easy to work with Psychologic Tasks of Pregnancy SIGNS OF PREGNANCY Presumptive Signs Acceptance of pregnancy as a reality and incorporation of the fetus into body image  Subjective Preparations for physical separation from the  May be noticed by the woman but not conclusive fetus proof of pregnancy. Attainment of the maternal role - Ultimate task Amenorrhea: first sign at 2 weeks Nausea & Vomiting are the most common forms Nursing Implementations of discomfort. Encourage the pregnant woman to verbalize and Urinary Frequency is the most disturbing sign express her feelings. especially during 3rd trimester. Validate the normalcy of women’s feelings and Fatigue: Estrogen – induced in early pregnancy. reactions. Breast Changes Improve the level of maternal comfort. Skin changes Recommend attendance in prenatal classes in the Quickening: usually felt stronger at 20 weeks third trimester. Leukorrhea due to ↑ d estrogen o Perfect for first time mom Weight ↑ o Not common in the Philippines since it is expensive o Suggest consistent prenatal checkup – at least twice a month Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Probable Signs  Objective Burning sensation &  May be observed by the healthcare provider but Heartburn regurgitation still not conclusive of pregnancy. Usually happens during Abdominal enlargement 2nd and 3rd trimesters. Goodell’s Sign – softening of cervix Relief Measures: Hegar’s Sign – softening of the uterus Bend at the knees and not at the waist when Chadwick’s Sign – bluish color or the cervix and picking things from the floor. vagina o To avoid injury in the back and lumbar Braxton Hicks Contraction – False labor to muscle prepare the body for delivery. Remain upright for 3 to 4 hours after eating. Ballottement – bouncing back of the uterus when Avoid taking sodium bicarbonate palpated o Sodium bicarbonate reacts and increases Positive pregnancy test – not a confirmatory test, acidity just a possibility Take aluminum – bearing antacids as ordered. Radioimmunoassay (RIA): Test for the beta subunit of hCG. Accurate enough to diagnose pregnancy. Gas buildup & bloating Flatulence Usually happens during Positive Signs 2nd and 3rd trimesters.  Objective Usually happens when  Emanate from the fetus; conclusive for pregnancy. there is no peristaltic Fetal heart tones (FHT) movement, or the mother is not eating Fetal outline: Ultrasound Relief Measures: Fetal parts: Leopold’s maneuver Eat small, frequent meals. Fetal skeleton: (X – ray not before 16 weeks) Avoid gas – forming foods COMMON DISCOMFORTS OF Stay hydrated PREGNANCY Regular but gentle exercises such walking and prenatal yoga Nausea & vomiting of Morning pregnancy Sickness Usually begins at 6 weeks Due to ↑ progesterone & peaks between 8 – 12 Frequent and blood volume weeks Urination Common during 1st & 3rd Relief Measures: trimesters Eat dry crackers or toast in the morning for 30 Relief Measures: minutes before getting up. ↑ fluids to replace losses, except at bedtime to o Lessens the acidity of the stomach in the prevent nocturia. morning Practice regular voiding. Drink adequate fluid between meals Practice frequent flushing: “Front to back” o Water is alkaline technique Avoid highly spicy and fatty foods. Report any burning sensation, dysuria, cloudy o Spicy can irritate the stomach and fatty urine, or tea – colored urine. foods are hard to digest Eat small, frequent meals; avoid overeating Avoid fatty, highly seasoned foods. o Eat bland food to not stimulate the appetite of the mother Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Mild to severe exhaustion Supine hypotension & Fatigue Severe during 1st & 3rd Vena Cava faintness trimesters. Syndrome Occurs during 2nd & 3rd Relief Measures: trimesters Have adequate rest and sleep Relief Measures: Avoid prolonged standing. Avoid sudden changes in position. Practice good body mechanics or posture. Avoid the supine position in the 2nd to 3rd Report increasing fatigue with regular activities. trimesters. o Anemia Arise in bed from a lateral position and gradually. Avoid staying in one position for a long time. Difficulty in defecation Assume frequent left – lateral position in bed. Constipation Starts early pregnancy & persist throughout the entire pregnancy. Typically occurs in calf Relief Measures: Leg Cramps muscles often after sleep. ↑ fluid intake Occurs during 2nd & 3rd ↑ roughage in the diet (fiber) trimesters Regular exercise is recommended. Relief Measures: Observe daily/regular bowel movements. Include adequate calcium and phosphorus in Drink warm water in the morning. the diet. o Decreases acidity level and increase fluid Avoid prolonged standing and sitting. intake Dorsiflex the foot while extending the leg; this hyperextends the involved muscle, causing relief. Swollen veins in the rectal Hemorrhoids & anal areas. Occurs during 2nd & 3rd Swollen, twisted & bluish trimesters Varicose in color veins Relief Measures: Veins Occurs in any point of Avoid constipation and other forms of straining. pregnancy but common Promote comfort: Sitz bath, warm compresses. during 2nd & 3rd trimesters. Reinsert hemorrhoids, upon the doctor’s recommendation. Relief Measures: No round garters around the abdominals and legs; avoid knee – high stockings. Wear supportive panty hose. Frequent elevation of the legs and hips is advised. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  It varies in intensity any Backaches may occur in at any stage. PRENATAL MANAGEMENT But it is prevalent during 2nd & 3rd trimesters. First Visit Relief Measures: Occurs as soon as the mother misses a Maintain good postures. Avoid prolong menstrual period when pregnancy is suspected. standing. Wear flat shoes. Schedule of Visits o High heels strain the calf muscles Engage in regular, gentle physical activities Once a month for the first 32 weeks. such as walking, pelvic rock & tailored sitting. Twice a month from 32 to 36 weeks. Use a supportive mattress. Four times a month from 36 to 40 weeks. Wear a maternity girdle in selected situations as Conduct of the Initial Visit recommended. Baseline Data Collection Obstetrical History Swelling in the feet & Medical & Surgical History Pedal Edema ankles. Family History Due to fluid retention & ↑ Current Health Problems pressure from the growing Estimates Pregnancy fetus. o EDC/EDD Relief Measures: o AOG Assume a left – lateral position/elevation of the o EFW legs frequently to promote venous return. o EFL Avoid prolonged standing. No round/constricting garters Report swelling of the hands and face. Estimated Date of Confinement / Estimated Date of Delivery (EDC/EDD) Naegele’s LMP – 3months + 1year & 7 days Rule Mittendorf’s Race, LMP, & gravidity must be Rule considered If Caucasian & Primie: LMP + 15 days – 3 months If Non-Caucasian & Multipara: LMP + 10 days – 3 months Difficulty of breathing Date of Primie: Shortness of especially during physical Quickening DQ + 4 months & 20 days Breath activities or when lying flat. Multi: Occurs during 2nd & 3rd DQ + 5 months & 4 days trimesters Fundal Utilizing a tape measure; measuring Relief Measures: Height from the symphysis pubis to the Maintain good posture. fundus Avoid fatigue Elevate the head with several pillows in sleep; avoid supine position. Avoid constricting bras and other tight clothes. Report increasing dyspnea with minimal activity or dyspnea prior to 36 weeks. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Age of Gestation (AOG) Gestational Age Ultrasound McDonald’s Formula must be used beyond Rule 31/33 weeks FH × 2 ÷ 7 = months Important concerns for physical examination FH × 8 ÷ 7 = weeks o Breast Bartholomew’s Determining the position of the  Tenderness, Montgomery glands, Rule of Fours fundus presence of colostrum or discharge Symphysis pubis – 12 weeks o Abdomen Umbilical – 20 weeks  Leopold’s maneuver – to check for fetal Xyphoid process – 36 weeks heart tone, position & presentation When the height if the fundus ↑ s o Pelvic measurement four finger breadth, add 4 weeks.  Inlet, outlet, midline, cavity It is not applicable when the o Extremities measurement is not 4 finger  Edema, varicosities, Homan’s sign breadth. Not accurate for 36 weeks due to lowering of the uterus. Laboratory Tests Gestational EDD – 280 = LMP Blood studies Age Calculator o Complete blood count Current date – LMP = AOG  To check for pseudo anemia  Hemoglobin 11 to 12 g/dL Estimated Fetal Weight (EFW)  Hematocrit (33% to 36%)  WBC/Leukocytosis Johnson’s Formula is used if fetus is not yet  Antenatal: 5,500 to 11,500 mm3 Rule engaged (36 weeks and below)  Labor: 20,000 mm3 (in gram) (FH – 11) × 155 = EFW  Postpartum: 25,000 mm3 If engaged: (FH – 12) × 155 = EFW o Blood typing & Rh determination  To check for incompatibility with mother Estimated Fetal Length (EFL) & fetus’ blood Haase’s If 5 months & below: o According to institution protocol, serology Rule EFT² for: (in cm) If 6 & above:  Syphilis – mother has natural immunity No. of months × 5 up until 16 weeks  Rubella  Human Immunodeficiency Virus (HIV) Complete Physical Examination  Hepatitis screening as indicated Internal Examination o Alpha – Fetoprotein screening at 16 to 18 Preparations for IE: weeks’ gestation. o Explain the procedure  To check for neural tube defect o Void before IE possibilities o Position: Lithotomy o Screening for sickle cell trait if of Black race. o Drape Urine Test o Hands across the chest & do slow chest o Sugar – check for glycosuria; 1+ is normal. breathing. (more than 1+, might indicate kidney o Feet must be put in the stirrups at the dysfunction) same time to avoid disrupting blood flow o Bacteria – Checks for infection, e.g. UTI Pelvic Lab Test Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  o Collection of pelvic cultures Carbohydrates sufficient intake is necessary o Bimanual examination for added energy needs.  To identify cervical & uterine changes in Avoid “empty” calories like soft pregnancy drinks.  To detect uterine size Fiber Taken from fruits and  To assess for deviations in expected vegetables to prevent size & shape constipation  Done by physicians In all the necessary testing, prepare the client: Fats High – energy foods for  Provide an explanation of the procedure. absorption of vitamins ADEK  Carry out physical preparation specific to Avoid too much fat. the procedure Essential Minerals & Vitamins  Provide support to the patient & spouse. Iron Most important mineral that  Encourage to verbalize concerns must be taken.  Monitor the patient and fetus after the o 30 to 60 mg/day procedure. o Sources: Liver, red meats,  Document as necessary. green leafy vegetables, egg yolk, cereals, dried fruits & nuts. Needed to ↑ maternal RBC HYGIENE OF PREGNANCY mass & for fetal liver storage in the 3rd trimester. Nutrition o Intake of iron – fortified multivitamins to ensure Always start with diet history when it comes to essential levels. giving nutritional instruction to the mother. Take 1 hour before or 2 hours Nutritional profile assessment should include: after meals. o Pre – pregnant & current nutritional status. o ↑ fluid intake, fiber & o Dietary habits regular ambulation to o Mother’s knowledge of nutritional needs & prevent constipation. daily recommended allowances. o May cause dark stool. o Assess physical indication of poor nutritional status. o Assess conditions that require special Calcium Needed for maternal calcium & attention. phosphorus metabolism & fetal bone & skeletal growth. Nutritional Needs That Should Be Included o 1,200 mg/day Calories Usual daily caloric need in o Sources: Milk, milk pregnancy: 2,100 – 2,500 products & broccoli Kcal/day Avoid “empty” calories like soft Sodium The most abundant cation in drinks. extracellular fluid. Essential Nutrients o Needed in pregnancy for Protein body – building food. tissue growth & : add 30 g/day to ensure 74 to development. 76 g/day o Contained in most kinds of o Rich food sources include foods. milk, meat, fish, poultry & Should not be restricted eggs. without serious indications Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala Folic Acid Needed to meet ↑ metabolic Bath demands in pregnancy & to Daily bath if desired. produce blood products. Avoid soap on nipples with drying effect 0.8 mg (400 – 800 ug) per day. Towel – drying of breast ↑ the integrity of nipples. o Sources: Liver, dark green Avoid tub baths leafy vegetables, avocados, Douching is not needed to manage vaginal papaya & beans discharge. Vitamins Water – soluble vitamins (C & Clothing B group) and fat – soluble vitamins (ADEK) Loose, comfortable clothes made of cotton Major Food Source material. Vit C Boosts immune No constrictions around the breasts, abdomen, or system legs; no round garters Citrus fruits, broccoli, Flat – heeled shoes for comfort & balance bell peppers & Support pantyhose for varicosities. (Avoid knee – tomatoes length stockings) 3 Vit B Cell growth Group Legumes, beans, nuts, whole grain, oatmeal, pork, beef, fish, liver, organ meats, eggs & green leafy vegetables Vit A Cell & fetal growth Milk & dairy products; Supportive, cotton – lined brassiere. dark green & yellow Maternity girdle, as necessary. fruits & vegetables; eggs & liver Vit D Helps to calcium absorption in the bones Milk & foods fortified with vitamin D; egg yolk; fish Sleep & Rest Vit E Collagen production, eyes development Assess activities to identify the need for rest & Nuts, seeds, wheat sleep. germ, whole grain 8 hours at night; 1 – 2 hours nap time. Avoid products, green leafy supine position from 2nd trimester onwards. and vegetable oils Plan rest time during the day. At work, stand & walk at least every 2 hours. Vit K For blood clotting Meats, liver, cheese, Traveling tomatoes, peas & egg Long – distance travel by land needs stopovers yolk so pregnant women can get out of the car and walk. Seatbelt is needed. Air travel/Commercial flights o In healthy pregnancy, commercial air travel before 36 weeks is considered safe. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  o The woman should check with her HCP before Squatting/Tailor - sitting: Strengthen perineal she flies. muscles; makes pelvic joints more pliable. o Traveling by air requires pressurized planes; in late pregnancy, airlines will require MedCert indicating fitness to travel by air. The best time to travel is during the 2nd trimester: o The pregnant woman is most comfortable. o The danger of abortion is not high. o The threat of premature labor is at a minimum. Best to get an aisle seat. Abdominal Breathing: Utilizes the diaphragm Journeys close to term are discouraged. primarily & not the chest muscles; helpful during 1st half of labor Exercises Exercises in pregnancy should be low – impact & moderate in intensity. Common exercises in early pregnancy o Walking on a flat & even surface o Stationary biking or cycling o Routine swimming Kegel: Improves the tone of pubococcygeal, o Yoga perineal, vaginal & pelvic floor muscles needed for Do exercise outside and maintain a physical pregnancy, labor & delivery. distance (at least 1 meter). If indoor, make sure there’s adequate ventilation. Cleansing Breathing: deep & relaxed breath. o Can be practiced in pregnancy & used in labor. Panting: Best for the crowning period & actual delivery of the baby, leaving the work to be Pelvic Rock: The most important exercise for accomplished by the uterus. comfort during pregnancy, with the following Nursing Considerations benefits: o ↑ the flexibility of the lower back Exercise in loose – fitting clothes & well – o Strengthen the abdominal muscles supportive, well – fitted non – slip footwear. o Shifts the center of gravity back to the Stay hydrated. Avoid fatigue uterine spine Avoid contact sports, those with a risk of falling & o Relieve backache & improves posture & those that cause jarring pressure on the pelvis & appearance in late pregnancy. torso. Avoid high – impact & high – intensity exercises, which cause a marked ↑ in heart rate & difficulty breathing. Regular exercises are needed. Stop the exercise & rest in the presence of danger signs such as: o Dizziness & headache Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  Stop the exercise & rest in the presence of danger Whether standing or sitting at work, the signs such as: pregnant woman should be advised to stop & o Overheating walk about few hours to improve the circulation o Fast & unsteady HR of blood. o Difficulty breathing Adequate periods of rest should be provided o Nausea during workday. o Seek emergency management for: Pregnant women with history of the following o Vaginal bleeding complication should minimize physical work: o Uterine contraction o SGA Seek emergency management for: o Premature labor o Abdominal or pelvic pain o Abortion o Chest pain Exercise in a standing position to prevent Maternity Leave pressure on the inferior vena cava & against the Old Law – RA 7322: diaphragm. o 60 days of ML for NSD Avoid excessive & strenuous exercises. o 78 days for CS Marital Relations / Coitus o 7 days for PL o First 4 pregnancies only Changes in normal sexual response are related to New Law – RA 11210: the physiologic changes in pregnancy: o 105 days of leave with pay, combination of prenatal and postnatal leave, with PPL First Less interest in sex due to fatigue, no less than 60 days. nausea, or adaptation in pregnancy. o With option to extend up to 30 days Second interest in sex may ↑ as this trimester is without pay. the most comfortable period. o Additional 15 days for single parent Third Near term; less interest due to the o No limit on the number of pregnancies, discomforts brought about by positional regardless of the mode of delivery. difficulty & abdominal size. o The PPL should not be less than 60 days. o In public sector, all are qualified to avail Generally, there are no contraindications except: but in private sector, one must be SSS o Premature rupture of membranes member & have paid at least 3 monthly o Premature labor contributions in the 12 – month period. o History of abortion & bleeding. Care of the Teeth o Deep engagement of the head in late pregnancy Regular examination of the teeth and gums o Incompetent cervix should be part of prenatal general PE. In healthy pregnant women, sexual intercourse Dental caries requires prompt management in usually does no harm: pregnancy, but major dental surgeries should o Avoid fatigue, exercise moderation & be postponed for the postpartum period. hygiene. Instruct client to use soft – bristled toothbrush o Couples may need counseling regarding & gentle brushing. more comfortable position Dental care may not be aggravated by o Suggested positions: Side – lying & the pregnancy, but prompt treatment must be woman-on-top position. necessary. Employment Safety & rest are the two most important considerations in deciding whether the pregnant woman should continue working. Care of Maternal & Child - Semifinals | Steffi Aliah C. Zabala  S-A-D Habits of Pregnancy Good luck! Smoking May cause SGA. Prenatal tobacco Kaya natin ‘to, Future RN!