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N107 Essentials of Nursing Care: Reproductive Health Needs of the Childbearing Family: Preconception Chapter Objectives Know which topics to counsel and plan with ... – PowerPoint PPT presentation

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Title: N107

N107 Essentials of Nursing Care Reproductive
  • Needs of the Childbearing Family Preconception

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

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

Counseling and Planning for Parenthood
  • Many women dont realize they are pregnant and
    dont seek prenatal care until way into 1st
  • 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)

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

Health and Lifestyle ChoicesPreconception Care
  • Why assess for and treat Risk Factors
  • Every woman of childbearing age is a potential
  • 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
  • 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

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

Prenatal Care
  • To promote positive outcomes for both mother
  • Should begin prior to conception
  • First prenatal visit
  • Typically scheduled between weeks 8-12 of
  • 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,

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

Testing (The Triple Screen)
  • Alpha-fetoprotein test
  • Performed between week 16 18
  • Indicates neural tube defects and chromosomal
  • High incidence of false positives
  • If complication indicated amniocentesis is

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

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

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

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

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

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
  • Currently pregnant females should not receive
  • Those planning pregnancy should wait 3 months
    before becoming pregnant after receiving

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

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
  • OTHERS PPD, HIV, toxicology screen, thalassemia

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

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

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

The Nursing Process
  • Specify goals of nursing action
  • ID specific nursing interventions appropriate for
    attaining the outcomes
  • Interventions should be listed in preferential
  • Interventions should be individualized as well as
    age, gender, and culture-appropriate
  • Can the implementation of the intervention be
  • 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

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.

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

The Nursing Process
  • Implementation
  • Plan of care is put into use
  • The nurse (RN) assumes responsibility for the
    implementation and coordinate activities of all
  • 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.

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)

The Nursing Process
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