Nursing managment during pregrancy.pdf

Nursing Management During Pregnancy Preconception and Interconception Care Goal of preconception care: optimize the health & well-being of the patient and partner before pregnancy ○ Optimize pregnancy outcomes & eliminate potential problems. Ide...

Nursing Management During Pregnancy Preconception and Interconception Care Goal of preconception care: optimize the health & well-being of the patient and partner before pregnancy ○ Optimize pregnancy outcomes & eliminate potential problems. Identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management intervention Preconception care includes: ○ Immunization status ○ Underlying medical conditions ○ Reproductive health care practices ○ Sexuality and sexual practices ○ Nutrition ○ Lifestyle practices ○ Psychosocial issues ○ Medication and drug use ○ Support system Risk factors for adverse pregnancy outcomes Isotretinoins: alcohol misuse, illicit drugs, smoking, etc. Drugs: anticoagulants, most diabetics drugs, most cancer drugs, antiepileptic drugs Diseases / infection: diabetes, hypothyroidism, STD/STI (RUBELLA), obesity, maternal phenylketonuria Nutritional status: folic acid deficiency The FIRST Prenatal visit (1) Comprehensive health history (2) physical examination (3) laboratory tests Comprehensive Health history The initial comprehensive health history questions involves 3 main areas: ○ (1) Reason for seeking care: Suspicion of pregnancy Date of last menstrual period Signs and symptoms of pregnancy Urine or blood test for hCG ○ (2) History (medical, surgical, family) ○ (3) Reproductive history (menstrual, obstetric, and gynecological) Menstrual history: How is the estimated due date (EDD) or EDC (expected date of confinement) determined? ○ Knowing the estimated EDC is a very important aspect of the menstrual history assessment. It provides guidance for the timing of maternal and fetal tests throughout pregnancy, fetal growth parameters, and establishes timelines for specific interventions for the management of prenatal complications. ○ Ultrasound is the best method to determine the EDC ○ Nagele’s Rule can be used to establish the EDC with the LMP! The LMP is the first day of the patient’s last period Step #1: Subtract 3 months from the LMP Step #2: Add 7 days Step #3: Add 1 year ○ Example of Nagele’s rule: LMP (1/1/23) - 3 months = 10/1/23 10/1/23 + 7 days = 10/8/23  10/8/23 + 1 year = 10/8/24 EDC Obstetric history! Pregnancy Terms (Table 12.1) *NEED TO KNOW* Gravid State of being pregnant Gravida/Gravidity Total number of times a woman has been pregnant regardless of whether the pregnancy resulted in a termination (miscarriage or abortion) or if multiple infants were born from a pregnancy. -***Multiple gestation is considered 1 pregnancy always*** Nulligravida A woman who has never experienced a pregnancy Primigravida A woman who is pregnant for the first time Secundigravida A woman who is pregnant for the 2nd time Multigravida A woman who is pregnant for the third time Para The number of times a woman has given birth to a fetus of at least 20 weeks gestation (viable or not) -In other words, the amount of times a woman has had a viable pregnancy (>20 weeks). -20 weeks > is considered the time of viability -***Multiple gestation / births are considered to be 1 always*** Parity Refers to the number of pregnancies carried to the point of viability (20 weeks >), regardless of outcomes Nullipara A woman who has not produced a viable offspring (20 weeks >) -Ex. A nulliparous woman had a misscarriage at 12 weeks gestation. She is considered primigravida but nullipara. Primipara A woman who has given birth once after pregnancy (at least 20 weeks gestation). Multipara A woman who has had 2 > pregnancy (at least 20 weeks gestation). GPTPAL MODEL *NEED TO KNOW* Gravida -how many times she has been pregnant -current pregnancy & miscarriages/abortion included -twins & triplets count as ONE Para -produced one or more viable offspring carrying a pregnancy 20 weeks or more (total number of pregnancies after 20 weeks) Term -born at or after 37 weeks Preterm -born between 20 - 36 weeks Abortion / -intentional or spontaneous premature death before viability (