NURS 2543 Health of Families & Social Groups PDF

NURS 2543 Health of Families & Social Groups Week 9: Nursing Care of the Family During Pregnancy, Labour, and Birth KRISSY JORDAN, RN, MSCN, PHD CANDIDATE Objectives 1. Describe the processes of confirming pregnancy and estimating the date of birth. 2. Learn how to assess client’s psychosocial re...

NURS 2543 Health of Families & Social Groups Week 9: Nursing Care of the Family During Pregnancy, Labour, and Birth KRISSY JORDAN, RN, MSCN, PHD CANDIDATE Objectives 1. Describe the processes of confirming pregnancy and estimating the date of birth. 2. Learn how to assess client’s psychosocial response to pregnancy (e.g., support systems, perception of pregnancy, coping mechanisms). 3. Relate normal growth and development to the assessment of the maternal/fetal client and family. 4. Outline the routine assessments of maternal and fetal health status at the initial and follow- up visits during pregnancy. 5. Outline common health challenges encountered when caring for maternal/fetal clients. 6. Review prenatal care and education. Process of Pregnancy Spans 9 months  10 lunar months of 28 days (280 days total) Pregnancy is divided into 3 trimesters  1st trimester: weeks 1 through 13  2nd trimester: weeks 14 through 26  3rd trimester: weeks 27 through 40 (Keenan-Lindsay et al., 2022) Essential Terms to Maternity Care Gravida A woman who is pregnant Gravidity Pregnancy Nulligravida A woman who has never been pregnant or not currently pregnant Primigravida A woman pregnant for the first time Multigravida A woman who has had two or more pregnancies (Keenan-Lindsay et al., 2022) Essential Terms to Maternity Care Parity the number of pregnancies in which fetus or fetuses have reached 20 weeks, not the number of fetuses (e.g., twins) born. Not affected by whether fetus is born alive or stillbirth Nullipara not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation Primipara completed one pregnancy with fetus or fetuses who have reached 20 weeks of gestation Multipara completed two or more pregnancies to 20 weeks of gestation (Keenan-Lindsay et al., 2022) Gestational Age Terms Preterm (premature) a pregnancy that has reached 20 weeks and 36 weeks 6 days (36+6) gestation Term a pregnancy from 37 to 40 +6 days gestation Late Term a pregnancy in the 41st week Postterm (postdate) a pregnancy after 42 weeks Viability the ability of the baby to live outside of the uterus, usually at 22-25 weeks (Keenan-Lindsay et al., 2022) GTPAL: Assessing Past Pregnancies Gravidity: pregnancies, including current Term births: pregnancy from 37 to 40 +6 days gestation Pre-term births: after 20 but before 36 weeks 6 days (36+6) gestation Aborted: therapeutic or spontaneous (before 20 weeks gestation) Live: currently living children G- T- P- A- L- (Keenan-Lindsay et al., 2022) Examples of use of terms A woman pregnant for the third time, with two previous term pregnancies, no preterm or aborted pregnancies, with two 2 living children : GTPAL = 3-2-0-0-2 Your turn: Your patient is currently 30 weeks pregnant has had one previous abortion, one miscarriage, and has two live children born at 38 weeks by c-section. G- T- P- A- L- Confirmation of Pregnancy Based on signs and symptoms reported during history or physical examination Classified as presumptive, probable, or positive Presumptive: subjective changes reported by the client Probable: objective changes assessed by HCP Positive: objective signs assessed by HCP that can only be attributed only by the presence of the fetus (Keenan-Lindsay et al., 2022) Signs & Symptoms of Pregnancy Presumptive Probable Positive Amenorrhea Hegar sign Visualizing the fetus by ultrasound Fatigue Chadwick sign Fetal heart tones by ultrasound Breast changes Goodell sign Visualization of fetus by Doppler or fetal stethoscope Nausea & Positive pregnancy test Fetal movements palpated vomiting Urinary Braxton Hicks or Fetal movements visible frequency prelabour contractions Quickening (Keenan-Lindsay et al., 2022) Ballottement Hegar, Chadwick & Goodell Signs Hegar sign Compressibility & softening of the cervical isthmus (the portion of the cervix between the uterus and the vaginal portion of the cervix) Around 6 to 12 weeks Chadwick sign Violet/bluish colour of the vaginal mucosa and cervix as early as the sixth week caused by increased vascularity Goodell Softening of the cervix around 6 to 8 weeks gestation (Keenan-Lindsay et al., 2022) Estimating Date of Birth (EDB) Accurate dating of pregnancy is important to promote healthy outcomes for client & fetus Ultrasound in first trimester is considered gold standard for dating Nägele’s rule Determine the first day of LMP, subtract 3 months, add 7 days plus 1 year Alternatively, add 7 days to LMP & count forward 9 months Most women give birth from 7 days before to 7 days after the EDB (Keenan-Lindsay et al., 2022) Calculate Estimated Date of Birth (EDB) = Sept 10, 2021 Determine the first date of LMP, subtract 3 months, add 7 days plus 1 year Subtract 3 months = June 10th, 2021 Add 7 days = June 17th, 2021 Add 1 year = June 17th, 2022 Alternatively, add 7 days to LMP and count forward 9 months Add 7 days = Sept 17th, 2021 Count forward 9 months = June 17th, 2022 Maternal Adaptation to Pregnancy Accepting the pregnancy Identifying with the mother role Reordering personal relationships Establishing a relationship with the fetus Preparing for childbirth (Keenan-Lindsay et al., 2022) Paternal Adaptation Accepting the pregnancy Identifying with the father role Reordering personal relationships Establishing a relationship with the fetus Preparing for childbirth (Keenan-Lindsay et al., 2022) Sibling Adaptation Often child experiences a sense of loss or feels jealous Factors influencing a child’s response are: Age & dependency needs Parent’s attitudes Father’s role Length of separation from mother Hospital visitation policy Preparing the child for change (Keenan-Lindsay et al., 2022) Grandparent Adaptation Variations in adaptation Supportive versus nonsupportive behaviours Presence & support strengthens family systems (Keenan-Lindsay et al., 2022) Maternal Psychological Response to Pregnancy First trimester Ambivalence; disbelief Focus on self and pregnancy Introspective; fantasizes the baby Second trimester Quickening – separate person Excited+/– change in body image Third trimester Pride, anxiety; increased physical discomfort; fatigue; nesting behaviors; safety of child (Keenan-Lindsay et al., 2022) Prenatal Care Visit Schedule Initial Visit Occurs during the 1st trimester Routine Visits Monthly until week 28 Every 2 weeks from week 28 to 36 Weekly from week 36 until birth Additional Monitoring Increased frequency for clients with chronic conditions or other specific needs (Keenan-Lindsay et al., 2022) Factors Influencing Prenatal Care Cultural Influences Different views on modesty, activity, diet, and sexual practices Some cultures see pregnancy as healthy, not requiring early medical care Age Differences Adolescents: Higher risk of poor outcomes, often lack adequate prenatal care. 35+: Increased risks (e.g., chromosomal issues, preterm birth, maternal health complications) Multifetal Pregnancy Higher risk of complications (e.g., anemia, preterm birth, placenta issues, twin-to-twin transfusion) (Keenan-Lindsay et al., 2022) Barriers to Obtaining Health Care During Pregnancy Inadequate numbers of healthcare providers Inadequate prenatal Lack of culturally sensitive care & communication Low socioeconomic levels care is associated Unpleasant facilities or procedures with low-birth- Inconvenient clinic hours XX% weight infants (less Long distance from healthcare facilities Key than takeaway 2500 grams) & Lack of transportation Fragmentation of services here infant morality Inadequate finances (Cunningham et al., 2014) Conflicting personal attitudes (Keenan-Lindsay et al., 2022) Goals of Prenatal Nursing To promote the health & well-being of the pregnant women, fetus, & their family during pregnancy, labour, & birth by: Identifying existing risk factors & other deviations from normal Emphasizing preventive care & optimal self-care Prenatal care is sought routinely by women of middle or high socioeconomic status (Keenan-Lindsay et al., 2022) Psychosocial Support During Pregnancy Respectful and Compassionate Care Show respect, affection, trust, and concern; actively listen Cultural Sensitivity Respect cultural and religious beliefs Open Communication Allow client and family to express concerns Guidance & Health Promotion Offer anticipatory guidance and health strategies Mental Health Screening Assess for depression & anxiety using This Photo by Unknown Author is licensed under CC BY-SA-NC the Edinburgh Postnatal Depression Scale (EPDS) Ensure timely referral and follow-up if needed (Keenan-Lindsay et al., 2022) Initial Visit: Interview Presumptive signs of current pregnancy Review client’s symptoms; teaching may be provided Childbearing & female reproductive system history Age at menarche, menstrual hx, contraceptive hx, nature of any infertility or gynecological conditions, hx of STIs, sexual hx, detailed hx of all pregnancies, last Pap test, date of LMP Health history Any physical or surgical procedures Allergies Nutritional history Dietary assessment to reveal diet practices, food allergies, eating behaviours, practice of pica, or other factors Consider cultural influences on food & diet selection (Keenan-Lindsay et al., 2022) Initial Visit: Interview History of use of drugs & herbal preparation use Past & present use (legal OTC & prescription meds, vitamins, caffeine, alcohol, nicotine & problematic substances) Family history Identify familial or genetic disorders/conditions Social, experimental, & occupational history Situational factors, client’s perception of pregnancy, occupational hx Mental health screening Screen for depression & anxiety symptoms – Edinburgh Postnatal Depression Scale (EPDS) (Keenan-Lindsay et al., 2022) Initial Visit: Interview Physical, sexual abuse, & intimate partner violence (IPV) IPV increases during pregnancy Hx of sexual abuse can impact labour & delivery Review of systems Pre-existing or concurrent health concerns in any of the body systems Assess mental status Presence of physical symptoms Each sign or symptom obtain:  Quality  Quantity  Chronology  Aggravating or alleviating factors  Associated manifestations (onset, character, and course) (Keenan-Lindsay et al., 2022) Initial Visit: Physical Examination Vital Signs ALERT: systolic BP 140 or > and diastolic BP of 90 or > based on average of at least 2 measurements is hypertension Height & Weight For calculation of BMI Urine Specimen Presence of protein & glucose Head-To-Toe Assessment Pelvic examination if required Height of fundus – after 1st trimester (Keenan-Lindsay et al., 2022) Initial Prenatal Lab Tests Blood Tests Baseline: Hemoglobin, hematocrit, WBC count & differential Hemoglobin Electrophoresis: For blood disorders Blood Type & Antibodies: Rh factor and antibody screening Immunity Titers: Rubella, varicella, parvovirus B19 Infection Screening: HIV, Hep B, syphilis (VDRL), toxoplasmosis Screening for Infections & Conditions Pap Test: For cervical health (CIN, HSV-2, HPV). Vaginal/Rectal Smears: Tests for gonorrhea, chlamydia, HPV Tuberculin Test: Based on medical history Urine Testing Urinalysis: Assesses for renal dx, pregnancy induced HTN, infection, hematuria Urine Culture: Assesses for infection (Keenan-Lindsay et al., 2022) Follow-up Prenatal Visits: Interview Key Components Update Health History Review changes in medical, surgical, and personal history Emotional & Physiological Well-being Screen with Edinburgh Postnatal Depression Scale (EPDS) to assess mental health Address emotional concerns and overall well-being Client’s Understanding Discuss warning signs: bleeding, abdominal pain, decreased/increased fetal movement Educate on signs of preterm and term labor Address anxieties about labor and provide reassurance Offer information on childbirth preparation classes Prenatal Education Educate on maternal & fetal changes Teach about recognizing potential complications, especially preterm labor (Keenan-Lindsay et al., 2022) Common Discomforts of Pregnancy Urinary frequency Fatigue, sleep difficulties, & discomforts Nasal stuffiness Epistaxis Excessive salivation Nausea & vomiting Heartburn Backache Hemorrhoids Dependent edema Leg cramps Dyspnea Leukorrhea Round ligament pain Carpal tunnel syndrome (Keenan-Lindsay et al., 2022) Prenatal Education About Maternal & Fetal Changes Nutrition: Adequate calories, nutrients, vitamins & minerals Personal Hygiene: Tub baths okay if membranes intact (