Week 3 Teacher Care In Pregnancy (2) PDF

Nursing Care & Complication of Pregnancy Management of Pregnancy © 2002 Delmar, a Thomson Learning company 1 Class Objectives 1. Describe the health promotion activities and prenatal monitoring required in a routine pregnancy 2. Discuss the current antenatal record, an...

Nursing Care & Complication of Pregnancy Management of Pregnancy © 2002 Delmar, a Thomson Learning company 1 Class Objectives 1. Describe the health promotion activities and prenatal monitoring required in a routine pregnancy 2. Discuss the current antenatal record, and consider how pertinent information is documented 3. Discuss domestic abuse, and approaches to care 4. Review common warning signs in pregnancy and common complications (including treatment) © 2002 Delmar, a Thomson Learning company 2 Preconception Care Preconception assessment In-depth health history of self and family Early interventions E.g. nutritional adjustment, cessation of smoking, drinking etc. © 2002 Delmar, a Thomson Learning company 3 Preconception Care Con’t Evidence shows that healthy babies equal healthy moms Preconception care emphasizes the most critical and vulnerable time is the interval between day 17 to 56 after fertilization of the ovum 4 to almost 10 weeks Important to take folic acid to prevent neural tube defects © 2002 Delmar, a Thomson Learning company 4 Goals of Prenatal Care Ensure a safe birth for pregnant person and child by promoting good health habits and reducing risk factors. Teach health habits that may be continued after pregnancy. Educate in self care for pregnancy. Provide physical care & promote health of the pregnant person, fetus, newborn & family Prepare clients for the responsibility of parenthood © 2002 Delmar, a Thomson Learning company 5 The Initial Prenatal Visit Longest visit Obtain the baseline data Major objectives of this visit Confirm or rule out a diagnosis of pregnancy Ascertain risk factors Determine the due date Provide education on maintaining a healthy pregnancy © 2002 Delmar, a Thomson Learning company 6 Presumptive Signs of Pregnancy – subjective – noticed by mom Amenorrhea – no menustration Nausea Breast Changes – tender / increased pigmentation Urinary frequency Fatigue and drowsiness Quickening – feeling baby moving Chapter 15 © 2002 Delmar, a Thomson Learning company 7 Probable Signs of Pregnancy – objective – noticed by dr Goodell’s sign – softening of the cervix – due to increased vascular congestion Chadwick’s sign – blueish or purplish in colour on vag exam Uterine enlargement – palpate uterus Braxton Hicks contractions – feel mild tightenings Pregnancy tests – relatively accurate – can have false negatives Chapter 15 © 2002 Delmar, a Thomson Learning company 8 Positive Signs of Pregnancy – not explained by anything else Fetal heart sounds Fetal movement noted by the examiner Visualization of fetus by ultrasound Chapter 15 © 2002 Delmar, a Thomson Learning company 9 Reproductive History (Terminology) Gravida The number of pregnancies the person has had (including the current pregnancy) Primigravida A person who is pregnant for the first time Multigravida A person who has had more than one pregnancy Parity Communicates the outcome of previous pregnancies © 2002 Delmar, a Thomson Learning company 10 Recording the Obstetric History (GT/PALS) GP: Gravida - # pregnancies, Para is delivery after 20 weeks T: Term - the number of pregnancies that ended at term (at or beyond 37 weeks’ gestation) P: Preterm - the number of pregnancies that ended after 20 weeks and before the end of 36 weeks’ gestation A: Abortions - the number of pregnancies that ended before 20 weeks’ gestation L: Living - the number of children delivered who are alive when the history is taken S: Stillbirths – 20 or more weeks’ gestation, which after being completely delivered shows no © 2002 Delmar, a Thomson Learning company 11 First Prenatal Visit (cont.) Objectives met through (cont.) Physical examination Head-to-toe physical Pelvic exam for pelvic size Laboratory work Complete blood count Blood type and antibody screen Tests for presence of infection Pap smear © 2002 Delmar, a Thomson Learning company 12 Risk Assessment Takes into account all of the information gathered from The history Physical examination Laboratory tests Factors that are risks during pregnancy Negative attitude toward the pregnancy Unwanted pregnancy Seeking prenatal care late in the pregnancy © 2002 Delmar, a Thomson Learning company 13 Risk Assessment (cont.) Factors that are risks during pregnancy (cont.) Substance use History of complications with previous pregnancies Presence of preexisting disease, advanced age Socioeconomic Considerations: Living conditions Domestic or intimate partner violence How do we screen? Pg. 123 © 2002 Delmar, a Thomson Learning company 14 Intimate Partner Violence Be aware of signs and behaviours Assess person in private, keep info confidential from partner, as this may escalate abuse Person-led, build rapport Can refer to shelters and services, however the decision is up to the person experiencing the abuse. Abuse to children must be reported to appropriate authorities. © 2002 Delmar, a Thomson Learning company 15 World Health Organization Defines IPV as: Any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. Examples of types of behaviour are listed below. Acts of physical violence, such as slapping, hitting, kicking and beating. Sexual violence, including forced sexual intercourse and other forms of sexual coercion. Emotional (psychological) abuse, such as insults, belittling, constant humiliation, intimidation (e.g. destroying things), threats of harm, threats to take away children. Controlling behaviours, including isolating a person from family and friends; monitoring their movements; and restricting access to financial resources, employment, education or medical care. © 2002 Delmar, a Thomson Learning company 16 Subsequent Prenatal Visits Client usually seen once monthly from weeks 1-28 Weeks 29-36, prenatal visits are biweekly Week 36 until delivery, client seen weekly Visits include specific assessments Weight Blood pressure Urine protein and glucose Fetal heart rate © 2002 Delmar, a Thomson Learning company 17 Subsequent Prenatal Visits (cont.) Practitioner measures the fundal height in centimeters Between weeks 18 and 30, the fundal height in centimeters should match the number of weeks the pregnancy has progressed © 2002 Delmar, a Thomson Learning company 18 Fundal Height © 2002 Delmar, a Thomson Learning company 19 © 2002 Delmar, a Thomson Learning company 20 Pregnant abdominal assessment https://www.youtube.com/watch?v=bwHx-RC-Pj4 © 2002 Delmar, a Thomson Learning company 21 Subsequent Prenatal Visits (cont.) Screening done throughout pregnancy Prenatal Screening At 28 weeks, a woman who is Rho(D)- negative Screened for antibodies Given anti-D immune globulin (RhoGam) Group B streptococcus (GBS) after 35 weeks and before the end of 37 weeks. © 2002 Delmar, a Thomson Learning company 22 Subsequent Prenatal Visits (cont.) MSAFP – Maternal Serum Alpha Fetoprotein - main reason this test is done is to screen for neural tube defects, or chromosomal defects anencephaly, spina bifida, downs syndrome NB for parents to know that when levels are abnormal approximately 90% will deliver normal babies Other markers are tested Amniocentesis – needle into amniotic sac between 15 to 20 weeks gestation, can determine genetic makeup as fetal cells present, has a risk of spontaneous abortion Chorionic Villus sampling – can be done earlier in pregnancy (elective abortions) placental tissue obtained through vagina © 2002 Delmar, a Thomson Learning company 23 The Physical Examination Laboratory tests (Page 61/67) Ultrasonography Pelvic examination Assessment of the bony pelvis Relative to existing conditions. E.g. size and position of fetus at term and quality of contractions in labor. © 2002 Delmar, a Thomson Learning company 24  Lab tests Blood work – CBC, (see next slide), RH status, sickle cell, STD, rubella titre, HIV, hep Urinanlysis – glucose, protein, erythrocytes, leukocytes, bacteria Pelvic lab tests – pap, gonorrhea, chlamydia/strep Ultrasonography- 5 to 6 weeks after LMP can detect gestational sac. FHB 10 weeks Detects, FHR, sex, internal structures of developing fetus and well being Deviations Pelvic Exam Collection of pelvic cultures smears, determine uterine size, determine normal cervical/uterine changes © 2002 Delmar, a Thomson Learning company 25 © 2002 Delmar, a Thomson Learning company 26  Monitoring and Evaluating the Pregnant Woman in Subsequent Visits Blood pressure Weight Fundal height Fetal heart tones Urine Edema Sharing questions and concerns © 2002 Delmar, a Thomson Learning company 27