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Nursing Care During Pregnancy

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Chapter 11 Nursing Care During Pregnancy Debbie Hogan RN Nursing Care During Pregnancy Prenatal period Period of physical and psychologic preparation for birth and ... – PowerPoint PPT presentation

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Title: Nursing Care During Pregnancy


1
Chapter 11
  • Nursing Care During Pregnancy
  • Debbie Hogan RN

2
Nursing Care During Pregnancy
  • Prenatal period
  • Period of physical and psychologic preparation
    for birth and parenthood
  • Opportunity for nurses and members of health care
    team to influence family health
  • Healthy women seek care and guidance
  • Health promotion interventions can affect
    well-being of woman, child, and rest of family

3
Nursing Care During Pregnancycontd
  • Pregnancy
  • Spans 9 months
  • 10 lunar months of 28 days (280 days total)
  • Trimesters
  • First weeks 1 through 13
  • Second weeks 14 through 26
  • Third weeks 27 through 40

4
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5
Diagnosis of Pregnancy
  • Signs and symptoms
  • Presumptive indicators
  • Missed menstrual period
  • Home pregnancy test positive
  • Amenorrhea, nausea, vomiting, breast tenderness,
    urinary frequency, fatigue (morning sickness)
  • Quickening (perception of fetal movement)

6
Diagnosis of Pregnancycontd
  • Signs and symptoms
  • Probable indicators
  • Uterine enlargement
  • Braxton Hicks contractions
  • Uterine souffle
  • Ballottement
  • Positive pregnancy test

7
Diagnosis of Pregnancycontd
  • Signs and symptoms
  • Positive indicators
  • Presence of fetal heartbeat distinct from
    mothers
  • Fetal movement felt by someone other than mother
  • Visualization (e.g., ultrasound examination)

8
Diagnosis of Pregnancycontd
  • Estimated date of birth (EDB)
  • Formulas for calculating EDB but none infallible
  • Nägeles rule
  • Determine first day of last menstrual period
    (LMP), subtract 3 months, add 7 days plus 1 year
  • Alternatively add 7 days to LMP and count forward
    9 months
  • Most women give birth from 7 days before to 7
    days after EDB

9
Adaptation to Pregnancy
  • Maternal adaptation
  • Accepting pregnancy
  • Identifying with mother role
  • Reordering personal relationships
  • Establishing relationship with fetus
  • Emotional attachment
  • Preparing for childbirth

10
Adaptation to Pregnancycontd
  • Paternal adaptation
  • Accepting pregnancy
  • Identifying with father role
  • Reordering personal relationships
  • Establishing relationship with fetus
  • Emotional attachment
  • Preparing for childbirth
  • Sibling adaptation
  • Grandparent adaptation

11
Nursing Care Management
  • Purpose of prenatal care is to identify existing
    risk factors and other deviations from normal
  • Emphasis on preventive care and optimal self-care
  • Prenatal care is sought routinely by women of
    middle or high socioeconomic status

12
Nursing Care Managementcontd
  • Women in poverty or lacking health insurance may
    not have access to public or private care
  • Lack of culturally sensitive care and
    communication interferes with access to care
  • Immigrant women may not seek prenatal care
  • Birth outcomes are less positive, with higher
    rates of maternal and newborn complications
  • Problems with low birth rate and infant mortality
    associated with inadequate prenatal care

13
Nursing Care Managementcontd
  • Barriers to obtaining prenatal care include
  • Inadequate number of providers
  • Unpleasant facilities or procedures
  • Inconvenient clinic hours
  • Distance to facilities
  • Lack of transportation
  • Fragmentation of services
  • Inadequate finances
  • Personal and cultural attitudes

14
Nursing Care Managementcontd
  • Effectiveness of home visiting by nurses during
    pregnancy has been validated
  • Current model of prenatal care used for more than
    a century
  • Model is being questioned, and tendency to fewer
    visits with women at low risk for complications

15
Nursing Care Managementcontd
  • Initial visit interview
  • Reason for seeking care
  • Current pregnancy
  • Obstetric and gynecologic history
  • Medical history
  • Nutrition history
  • History of drug use and herbal preparations

16
Nursing Care Managementcontd
  • Initial visit interview
  • Family history
  • Social, experiential, and occupational history
  • History of physical abuse
  • Review of systems
  • Initial visit physical examination
  • Initial visit laboratory tests

17
Nursing Care Managementcontd
  • Follow-up visits
  • Interview
  • Physical examination
  • Fetal assessment
  • Fundal height
  • Gestational age
  • Health status

18
Nursing Care Managementcontd
  • Follow-up visits
  • Fetal assessment
  • Laboratory tests
  • Multiple-marker or triple-screen blood test
  • Other blood tests (RPR/VDRL, CBC, anti-Rh)
  • Other tests
  • Ultrasonography
  • Amniocentesis

19
Nursing Care Managementcontd
  • Nursing care
  • Care paths
  • Education for self-management
  • Nutrition
  • Personal hygiene
  • Prevention of urinary tract infections
  • Kegel exercises
  • Preparation for breastfeeding newborn
  • Dental health

20
Nursing Care Managementcontd
  • Nursing care
  • Care paths
  • Education for self-management
  • Physical activity
  • Posture and body mechanics
  • Rest and relaxation
  • Employment
  • Clothing
  • Travel

21
Nursing Care Managementcontd
  • Nursing care
  • Care paths
  • Education for self-management
  • Medications and herbal preparations
  • Immunizations
  • Alcohol, cigarettes, and other substances
  • Normal discomforts
  • Recognizing potential complications
  • Recognizing preterm labor

22
Variations in Prenatal Care
  • Cultural influences
  • Emotional response
  • Clothing
  • Physical activity and rest
  • Sexual activity
  • Nutrition

23
Variations in Prenatal Carecontd
  • Age differences
  • Adolescents
  • Much less likely than older women to receive
    adequate prenatal care
  • Women older than 35 years
  • Multiparous women
  • Nulliparous women

24
Variations in Prenatal Carecontd
  • Multifetal pregnancy
  • Twin pregnancies often end in prematurity
  • Rupture of membranes before term common
  • Congenital malformations twice as common in
    monozygotic twins as in singletons
  • No increase in incidence of congenital anomalies
    in dizygotic twins

25
Childbirth and Perinatal Education
  • Perinatal education goals
  • Establish lifestyle behaviors for optimal health
  • Prepare psychologically for pregnancy and the
    responsibilities that come with parenthood
  • Identify, minimize, and treat risk factors
  • Screen health hazards in workplace and home
  • Get genetic counseling for inherited diseases
  • Compare perinatal care options available

26
Childbirth and Perinatal Educationcontd
  • Options for care
  • Physicians
  • Nurse-midwives
  • Direct-entry midwives
  • Independent midwives
  • Doula
  • Birth Plans

27
Childbirth and Perinatal Educationcontd
  • Birth setting choices
  • Labor, delivery, recovery, postpartum (birthing)
    rooms
  • Birth centers
  • Home birth
  • Factors increasing the safety of birth at home

28
Childbirth and Perinatal Educationcontd
  • Components of perinatal education programs
  • Pain management
  • Relaxation
  • Imagery and visualization
  • Conscious breathing
  • Biofeedback
  • Massage and acupressure

29
Childbirth and Perinatal Educationcontd
  • Preparation for cesarean birth
  • Almost 30 of births in the United States are
    surgical
  • Vary by provider and care setting
  • More common in women who choose epidurals
  • Vaginal birth after cesarean
  • Childbirth education outcomes

30
Key Points
  • Prenatal period is physically and psychologically
    preparatory
  • Psychosocial aspects may affect pregnancy,
    childbirth, and adjustment of the new family
  • Pregnant womans readiness to learn is high level
    and excellent time to help expand her self-care
    skills

31
Key Pointscontd
  • Maternal physical and familial adaptations to
    pregnancy generate needs that nurse can
    anticipate and meet
  • Nurse must be alert to hazards such as supine
    hypotension, warning signs and symptoms, and
    signs of family maladaptation
  • Each pregnant woman needs to know how to
    recognize and report preterm labor

32
Key Pointscontd
  • Parent-child, sibling-child, and
    grandparent-child relationships are affected by
    pregnancy
  • Cultural prescriptions and proscriptions
    influence responses to pregnancy and health care
  • Childbirth education helps parents make
    transition from role of expectant parents to role
    and responsibilities of parents
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