N107

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N107 Essentials of Nursing Care Reproductive
Health

• Needs of the Childbearing Family Preconception

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Chapter Objectives

• Know which topics to counsel and plan with
  childbearing females/families
• Review health and lifestyle choices that affect
  childbearing females/families
• Be able to perform a risk assessment
• Be able to create a care plan via the nursing
  process regarding a patient with a preconception
  issue specifically

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Counseling and Planning for Parenthood

• Preconception care focuses on risk assessment and
  promoting healthy behaviors
• Healthy well-informed women who plan pregnancy
  have better outcomes
• Contraception is important aspect in planning
  process

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Counseling and Planning for Parenthood

• Many women dont realize they are pregnant and
  dont seek prenatal care until way into 1st
  trimester
• Half of all pregnancies in US are unintended
• The period of greatest danger for developing
  fetus is 17 56 days after fertilization
• By end of first trimester, major structural
  anomalies in the fetus are already present
• Fetus may be exposed to intrauterine
  environmental hazards
• Radiation (x-rays, microwaves), carcinogens
  (smoke, fumes)

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Health and Lifestyle ChoicesPreconception Care

• Purposes
• Establish life-style behaviors to maintain
  optimum health
• Diet, weight control, safe sex practices, rest
  exercise, substance abuse
• ID and treat Risk Factors before conception
• Medical conditions, substance abuse, test for
  immunity, history of genetic defects, the need
  for genetic counseling
• To conceive absent of unnecessary Risk Factors
• Monitor chronic illnesses (medications),
  environmental hazards (home, work)
• ID carriers of inherited diseases
• African Americans/Southeast Asians (sickle cell
  disease), Jewish Americans (Tay-Sachs disease)
• Prepare people psychologically for pregnancy and
  responsibilities of parenthood

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Health and Lifestyle ChoicesPreconception Care

• Why assess for and treat Risk Factors
• Every woman of childbearing age is a potential
  mother
• Nurses can make a difference through education
  and counseling preconception education/counseling
  can decrease the incidence of birth defects
• Type I diabetic with excellent glucose control
  reduces risk for congenital malformations in
  fetus
• Adequate intake of folic acid (0.4 mg/day)
  decreases possibility for neural tube defects
• Endocrine disorders interfere with female
  menstrual cycle and male libido
• Renal and GU disorders affect sexual performance
  reproductive capacity

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Health and Lifestyle ChoicesPreconception Care

• Treating Risk Factors (Contd)
• Hx of cholecystitis and hepatitis may be
  contraindications for oral contraceptives
• Women under 15 and 0ver 40 at higher risk
• Cigarette smoking may delay conception
• Maternal smoking ? low birth weight
• Increases risk for spontaneous abortion, fetal
  death, neonatal death SIDS
• Smoking
• increases morbidity in those using oral
  contraception, and ? early menopause (Females)
• In males who also use drugs
• Affects sperm count, causes impotence or decrease
  libido

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Prenatal Care

• To promote positive outcomes for both mother
  child
• Should begin prior to conception
• First prenatal visit
• Typically scheduled between weeks 8-12 of
  gestation
• Obtain health hx (first menarche, sexual family
  hxs, Gravida/Para)
• Physical exam (vaginal exam, pap smear
• Confirm pregnancy
• Prenatal labs (blood type, Rh factor, rubella
  status, Hep B status, STD, pap smear,

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Prenatal Care

• Prenatal Visit (Contd)
• Calculate EDC
• Nagels Rule
• LMP 3 months 7 days
• Tables
• Wheels
• Lines up LMP to indicate EDC due date
• Auscultate fetal hear tones
• May be difficult to hear prior to 12 weeks
• Only Positive signs of pregnancy
• Presence of fetal heart tones
• Detection of fetus by US or X-ray

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Testing (The Triple Screen)

• Alpha-fetoprotein test
• Performed between week 16 18
• Indicates neural tube defects and chromosomal
  disorders
• High incidence of false positives
• If complication indicated amniocentesis is
  recommended

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The Triple Screen (Contd)

• Gestational Diabetes Screening
• Performed at week 28
• Fasting glucose test
• If failed, glucose tolerance test
• If positive, dietary consult and/or diabetes
  educator consult
• Instruct on proper diet
• How to monitor blood glucose levels (glucometer)
• If diet control unsuccessful, insulin injections
  may be required

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The Triple Screen (Contd)

• Group Beta Strep Bacteria detection
• Not an uncommon finding
• Requires Abx upon rupture of membrane or onset of
  active labor
• Recommended that one dose of Abx be administered
  at least 4 hours prior to delivery to reduce risk
  of infant contracting group beta strep
• Can cause serious illness in infant but harmless
  to mother

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The Nursing Process

• Assessment
• The Interview Process Ask about current
  lifestyle choices
• Nutrition, exercise, rest, substance abuse,
  alcohol tobacco use, occupation, stressors,
  depression, support system domestic violence, and
  financial resources
• Immunization status Rubella, Hepatitis B
• Current medications to include OTC,
  non-prescription and prescription meds

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The Nursing Process

• Assessment (Contd)
• Review of Systems
• Head to Toe assessment
• Discussion of any medical conditions
• Reproductive System Review
• Previous pregnancies, miscarriages, living
  childrens disorders
• Abnormal PAP smear results, mammogram results,
  STD hx, sexual practices
• Obstetric History
• Review of family planning and fertility
  counseling information
• Previous abd/reproductive surgery, traumas or
  transfusions

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The Nursing Process

• Assessment (Contd)
• Environmental History
• Home and/or work exposures
• Family History
• Medical conditions
• Genetic conditions
• Sickle cell, cystic fibrosis, bleeding disorders,
  hemophilia, PKU, birth defects
• Should also include companions family history

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The Nursing Process

• Assessment (Contd)
• Risk Assessment
• Pediatric illnesses
• Mumps in males ? sterility
• Rubella in childbearing females increases
  congenital anomalies during 1st trimester
• Encourage immunization if not had or been
  immunized
• Currently pregnant females should not receive
  immunization
• Those planning pregnancy should wait 3 months
  before becoming pregnant after receiving
  immunization

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The Nursing Process

• Assessment (Contd)
• Contraceptive and Obstetric History
• Psychosocial History
• Family situation
• Ask directly Have you been hit, slapped, kicked
  or hurt with the past year? Are you afraid of
  your companion or anyone else?
• Readiness for pregnancy
• Age, life goals, stressors
• Financial stability and resources

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The Nursing Process

• Assessment (Contd)
• Occupational History
• Physical activities
• Standing all day? Heavy lifting?
• Exposures
• Religious and Cultural Preferences
• Physical Examination
• Emphasis placed on thyroid gland, breasts and
  pelvic structure
• Lab studies
• CBC, UA, blood type and Rh, rubella immunity,
  STDs, Hep B surface antigen, PAP smear, cervical
  culture.
• OTHERS PPD, HIV, toxicology screen, thalassemia

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The Nursing Process

• Analysis
• In collaboration with the patient/family and
  members of the healthcare team, synthesize data
  to identify the patients actual or potential
  health problems that can be managed by
  independent nursing actions
• Identify a Nursing Diagnosis (NANDA)
• When choosing a nursing dx, look at all data and
  their commonalities
• The common theme reveals the existence of a
  problem and the need for nursing intervention
• The nurse may use physician (dependent) and
  nursing (independent) interventions to minimize
  complications.

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The Nursing Process

• Analysis (Contd)
• Areas of concern for preconception care
• Health-seeking behaviors,
• Optimum nutrition
• Health maintenance
• Deficient knowledge
• Fear
• Pain
• Risk for Infection

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The Nursing Process

• Planning
• Planning phase consist of determining the
  expected outcomes and formulating specific
  strategies to achieve the expected outcomes.
• Assign priorities to the nursing diagnosis
• Maslows Hierarchy of Needs
• Most crucial to least crucial
• Specify expected outcomes
• Outcomes must be realistic and measurable
• Expected outcomes are the basis for evaluating
  the effectiveness of the nursing interventions
  and deciding whether the plan of care needs to be
  revised.

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The Nursing Process

• Specify goals of nursing action
• ID specific nursing interventions appropriate for
  attaining the outcomes
• Interventions should be listed in preferential
  order
• Interventions should be individualized as well as
  age, gender, and culture-appropriate
• Can the implementation of the intervention be
  rationalized?
• ID interdependent interventions
• Will a physician order be required
• Document plan of care
• Communicate to appropriate personnel any need for
  multidisciplanary approach to plan of care

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The Nursing Process

• Patient Values
• Always include patient and family in process
• What does patient consider to be a priority?
• Conflicts should be resolved in a way that is
  mutually acceptable
• Expected Outcomes (patient centered goals)
• Pt will be able to recite Signs Symptoms of..
• Pt will verbalize understanding of the importance
  of adequate amount of folic acid in the diet.

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The Nursing Process

• Nursing Interventions
• Plan nursing interventions n the basis of
  established standards and priorities to move the
  patient/family toward the expected outcomes
• ANA Standard of Practice, Nurse Practice Acts,
  taxonomy of nursing interventions (NIC)
• Should be patient focused and outcome driven
• Assign patient care activities to be implemented
  by other members of the heath care team as
  appropriate

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The Nursing Process

• Implementation
• Plan of care is put into use
• The nurse (RN) assumes responsibility for the
  implementation and coordinate activities of all
  involved
• FOCUS Resolving pts nursing diagnosis,
  achieving expected outcomes while meeting pts
  health care needs.
• Implement a teaching plan that promotes a
  positive womans health outcomes
• Supervise patient care activities that were
  delegated to other members of health care team
• When nursing interventions have been completed,
  the Implementation phase of the process has ended.

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The Nursing Process

• Evaluation Phase
• Assess the pts response to nursing
  interventions, including progress toward the
  patient-centered goals
• Assess whether objectives were achieved
• Document the extent of the achievements
• Plan of care may need to be revised
• Questions to ask during evaluation phase (see
  page 54)

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The Nursing Process