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NURSING CARE DURING ANTEPARTUM

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Title: NURSING CARE DURING ANTEPARTUM


1
NURSING CARE DURING ANTEPARTUM
2
  • Maternal Nursing care given by the nurse to the
    expectant family before, during, following
    birth
  • Obstetrics branch of medicine that pertains to
    the care of women during pregnancy, childbirth,
    the postpartum period
  • Obstetrician physician

3
Family-Centered Care
  • Recognizes the strength integrity of the family
    as the core of planning implementing health
    care
  • Nurse family members need to be partners

4
History
  • Before the 1900s most babies born _at_ home
  • By 1960 more than 90 of births occurred in
    hospitals
  • And Now???

5
Merging of the Maternity Unit
  • Used to be separate labor room, delivery room,
    postpartum room, newborn nursery
  • Now combining labor, delivery, recovery (LDR)
    may still be transferred to a postpartum unit,
    but baby usually rooms-in
  • Some facilities combine keep woman in same area
    throughout her entire experience (LDRP)

6
Lengths of Stay
  • Mandated by legislation
  • Vaginal delivery 24-48 hrs.
  • Cesarean delivery 72 hrs.

7
Statistics r/t Maternal Nursing
  • Birthrate
  • Fertility rate
  • Fetal Mortality rate
  • Infant Mortality rate
  • Maternal Mortality rate
  • Neonatal Mortality rate
  • Perinatal Mortality rate

8
How are these statistics used?
  • To become aware of reproductive trends
  • To determine populations at risk
  • To evaluate the quality of prenatal care
  • To compare relevant information from state to
    state country to country

9
Male Reproductive System
10
Male Reproductive System
  • Penis deposits sperm into females vagina to
    fertilize an ovum
  • Testes Manufacture sperm secrete male sex
    hormones
  • Semen seminal plasma sperm together excreted
    during sexual intercourse
  • Testosterone most abundant male sex hormone
  • ? muscle mass strength
  • Promotes growth of long bones
  • ? basal metabolic rate
  • Enhanced production of RBCs
  • Produces enlargement of vocal cords
  • Affects distribution of body hair

11
Female Reproductive System
12
Female Reproductive System
13
Female Reproductive System
  • Vagina tubular structure made of muscle
    membranous tissue
  • provides passageway for sperm to enter uterus
  • allows for drainage of menstrual fluids other
    secretions
  • provides passageway for infants birth
  • Cervix lower part of uterus
  • Lubricates vagina
  • Acts as a bacteriostatic agent
  • Provides alkaline environment for sperm
  • Produces mucus plug during pregnancy
  • Thins and dilates during labor

14
Female Reproductive System
  • Uterus hollow muscular organ site of
    implantation of fertilized ovum houses
    developing fetus
  • Consists of 3 parts cervix, corpus, fundus
  • Begins a pelvic organ, becomes temporary
    abdominal organ
  • Layers
  • Perimetrium outermost
  • Myometrium middle
  • Endometrium - innermost

15
Female Reproductive System
  • Fallopian Tubes from uterus to ovary on each
    side
  • Provide passageway in which sperm meet ovum
  • Site of fertilization
  • Safe nourishing environment for ovum
  • Means of transporting ovum to uterus
  • Ovaries almond-shaped glands
  • Produce estrogen progesterone
  • Maturation of ovum during each reproductive cycle

16
Female Reproductive System
  • Breasts accessory organs of reproduction
  • produce milk after birth to provide nourishment
    maternal antibodies to infant

17
Hormones
  • Follicle Stimulating Hormone (FSH)
  • Stimulates maturation of the follicle in the
    ovary that contains a single ovum
  • Luteinizing Hormone (LH)
  • Stimulates final maturation release of the ovum
  • Corpus Luteum empty follicle after ovum is
    released
  • Produces increasing amounts of estrogen
    progesterone which lead to a build-up of the
    endometrium

18
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19
  • Anterior pituitary secretes FSH LH maturation
    of ovum
  • Ovulation occurs when mature ovum is released
    from follicle 14 days before onset of next
    menstrual cycle
  • Corpus luteum turns yellow secretes ? amounts
    progesterone
  • If no fertilization corpus luteum degenerates -
    ? amts. estrogen progesterone (after 12 days)
  • Endometrium breaks down menstruation occurs
  • Anterior pituitary secretes more FSH LH
    beginning a new cycle
    (refer to picture in book-pg 27)

20
  • Menarche beginning of menstruation
  • Climacteric period of years during which
    womans ability to reproduce gradually declines
  • Menopause end of menstruation
  • ___________________________________
  • Conception (Fertilization) sperm joins with ovum

21
Physiology of Pregnancy
  • Fertilization
  • During sexual intercourse, the sperm carried in
    the ejaculatory semen of the male enters the
    vagina of the female.
  • Through flagellation, the sperm travel through
    the mucus of the cervical canal, enter the
    uterine chamber, and move into the ampulla, the
    outer third of the fallopian tube.
  • If the timing is such that an ovum has been
    produced and is also within the ampulla of the
    tube, fertilization may occur.

22
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23
Physiology of Pregnancy
  • Fertilization (continued)
  • Fertilization takes place when the sperm joins or
    fuses with the ovum this is called conception.
  • Once fertilization has occurred, the new cell is
    referred to as a zygote or fertilized ovum.
  • At the moment of fertilization, the sex of the
    zygote and all other genetic characteristics are
    determined and they do not change.
  • 46 chromosomes- xx-girl xy-boy

24
Physiology of Pregnancy
  • Implantation
  • The zygote moves through the uterine tube through
    ciliary action and some irregular peristaltic
    activity.
  • It requires about 3 or 4 days to enter the
    uterine cavity.
  • During this time, the zygote is in a phase of
    rapid cell division called mitosis further
    changes result in formation of a structure called
    the morula.
  • The morula develops into a blastocyst.

25
  • Implantation (continued)
  • The condition of the uterine lining is critical
    if implantation of the zygote is to occur.
  • Implantation usually occurs in the fundus of the
    uterus on either the anterior or posterior
    surface.
  • If uterine conditions are not suitable, it is
    unlikely that implantation will occur.
  • If the intrauterine vascular or hormonal
    conditions cannot sustain the implanted embryo, a
    spontaneous abortion will occur usually during
    the first 8 weeks of pregnancy.

26
  • Implantation (continued)
  • After the blastocyst is free in the uterine
    cavity for 1 or 2 days, the exposed cell walls of
    the blastocyst (called the trophoblast) secrete
    enzymes that are able to break down protein and
    penetrate cell membranes.
  • These enzymes allow the blastocyst to enter the
    endometrium and implant.
  • The action of the enzymes normally stops short of
    the myometrium but may cause slight bleeding
    this is called implantation bleeding.
  • The bleeding may confuse some women who think
    they had a very light and short menstrual cycle.

27
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28
Physiology of Pregnancy
  • Implantation (continued)
  • Ectopic pregnancy, in which implantation occurs
    outside of the uterine cavity, also poses serious
    problems.
  • During the first few weeks after implantation,
    primary villi appear these villi are able to use
    maternal blood vessels as a source of nourishment
    and oxygen for the developing embryo.

29
Physiology of Pregnancy
  • Implantation (continued)
  • It is also during these first few weeks that the
    first stages of the chorionic villi occur.
  • Chorionic villi secrete human chorionic
    gonadotropin (hCG), a hormone that stimulates the
    continued production of progesterone and estrogen
    by the corpus luteum this is the reason that
    ovulation and menstruation cease during
    pregnancy.
  • The chorionic villi become the fetal portion of
    the placenta.

30
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31
PLACENTA
  • Is a disc-like endocrine organ that secretes HCG,
    estrogen, progesterone. Only present during
    preg.
  • Site of nutrient waste exchange
  • Circulation thru to fetus is well established
    after 4th week gest.
  • Able to block transfer of certain substances
    placental barrier
  • Meds such as Insulin Ephedrine do not cross
  • Most bacteria do not cross (too large), some
    viruses able to cross
  • Shiny Schultz fetal side, Dirty Duncan- maternal
    side

32
  • Amniotic Sac 2 layers amnion (fetal side)
    chorion (outer layer) appears fragile but strong
    enough to hold fetus amniotic fluid _at_ full term
  • Amniotic Fluid acts as cushion against
    mechanical injury helps regulate fetal body
    temp., allows room for growth, indicator of fetal
    well being renal perfusion

33
  • Umbilical Cord joins embryo to placenta
  • 20-22 long, lt1 diameter
  • Whartons jelly major part of the cord
  • Vessels (remember AVA)
  • 1 vein carries oxygenated blood to fetus
  • 2 arteries carries deoxygenated blood back to
    placenta
  • No pain receptors
  • Can have knots, wrapped around fetus

34
Placental Hormones
  • Progesterone
  • Maintains uterine lining
  • ? uterine contractions
  • Prepares glands of breasts for lactation
  • Stimulates testosterone production in male fetus
  • Estrogen
  • Stimulates uterine growth
  • ? blood flow to uterine vessels
  • Stimulates development of breast ducts to prepare
    for lactation

35
Placental Hormones
  • Human Chorionic Gonadotropin (HCG)
  • Causes corpus luteum to persist continue
    production of estrogen progesterone to sustain
    pregnancy
  • Basis of most pregnancy tests
  • Human Placental Lactogen (HPL)
  • ?s insulin sensitivity utilization of glucose
    by mother making more glucose available to fetus.
    Is Insulin Antagonist.
  • Relaxin
  • Increases. Helps decrease contractions and
    remodel
  • collagen in cervix

36
Tissue Layers of the Zygote
Tissue Layer Gives rise to
Ectoderm (Outermost layer) Skin, nails, hair
Mesoderm (Middle layer) Muscles, CT, bone, blood, lymphoid tissue, epithelial tissue, conn tissue
Endoderm (Innermost layer) Lining of cavities passages, covering of most internal organs
37
Stages of Prenatal Development
  • Germinal fertilization to implantation
  • Called Zygote, up to 2 weeks
  • Embryonic implantation (2nd wk) thru 8 weeks,
    basic form of all major organs systems develop,
    simple heart beat, human appearance
  • Called Embryo
  • Fetal 9 weeks to birth (38-40 wks. considered
    full term)
  • Called Fetus

38
Stages of Pregnancy
  • Trimesters
  • First conception-12 weeks
  • Second 13-27 weeks
  • Third 28- delivery

39
4 weeks
8 weeks
3 weeks
40
16 weeks
12 weeks
41
Maternal-Fetal circulation
42
Fetal Neonatal Circulation
43
Fetal Circulatory Shunts
  • Ductus Venosus diverts some blood away from the
    liver as it returns from the placenta and goes to
    Rt atrium
  • Foramen Ovale diverts most of the blood from
    the Rt. Atrium directly to Lt. Atrium, rather
    than circulating to the lungs
  • Ductus Arteriosus diverts most of the blood
    from the pulmonary artery into the aorta

44
Fetal Circulation
45
Fetal Circulation
46
Fetal Circulation
Rest of blood from Rt. Ventricle
Blood from Left Ventricle
Join thru Ductus Arteriosus
Circulates thru fetal body
Returns to placenta thru Umbilical Arteries
47
Closure of Fetal Shunts
  • Foramen Ovale pressure in Rt. side of heart ?s
    as lungs become fully inflated now is little
    resistance to blood flow
  • Functional 2 hrs. post birth
  • Permanent by 3 months
  • Ductus Arteriosus blood O2 level ?s
  • Functional 15 hrs. post birth
  • Permanent 3 weeks
  • Ductus Venosus flow from umbilical cord stops
  • Functional when umbilical cord is cut
  • Permanent 1 week

48
  • Conditions that impede full lung expansion
    decrease blood O2 levels may cause the Foramen
    Ovale /or Ductus Arteriosus to reopen
  • Example Respiratory Distress Syndrome
  • Can give Prostaglandins to keep open
  • Can give Indomethacin to help close

49
Determination of Pregnancy
  • Presumptive Signs
  • Amenorrhea
  • Nausea and vomiting
  • Frequent urination
  • Breast changes
  • Changes in shape of the abdomen
  • Quickening
  • Skin changes
  • Chadwicks sign discoloration of cervix
  • Fatigue

50
Determination of Pregnancy
  • Probable Signs
  • Changes in the Reproductive Organs
  • Hegars sign softening of uterus
  • Goodells sign softening of cervix
  • Chadwicks sign discoloration of cervix
  • Ballottement
  • Enlargement of uterus
  • Positive Pregnancy Test

51
Hegars Sign
52
Figure 25-5
(From Wong, D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Internal ballottement (18 weeks).
53
Determination of Pregnancy
  • Positive Signs
  • Visualization ultrasound. lt8 wks, vaginal. gt8
    weeks, abdominal.
  • Fetal movement detected by Healthcare
    Professional
  • Auscultation of fetal heartbeat

54
Determination of Pregnancy
  • Determination of the Estimated Date of Birth
    (EDB) (EDC)
  • Normal human pregnancy, counting from the first
    day of the last menstrual period, is about 280
    days, 40 weeks, or 10 lunar months (slightly more
    than 9 calendar months).
  • Nägeles rule
  • Start with the first day of the womans last
    menstrual period and count back 3 months then
    add 7 days.
  • Birth Date Calculator Wheel

55
Determination of Pregnancy
  • Determination of the Estimated Date of Birth
    (continued)
  • If the woman does not keep a menstrual record,
    the primary care provider must then rely on
    observations such as quickening, estimation of
    fetal size by palpation, or ultrasonic tests, all
    of which can be unreliable.

56
Determination of Pregnancy
  • Obstetric Terminology
  • Terms used to describe the number of times a
    woman has been pregnant and given birth
  • Gravida indicates a pregnant woman of times
    woman has been pregnant including present one
  • Primigravida one pregnancy 1st pregnancy
  • Nulligravida no pregnancies
  • Multigravida multiple pregnancies

57
  • Para woman who has given birth to a
    child/children who have reached 20 wks. gestation
  • Primipara given birth to 1st child
  • Nullipara no births that have reached 20 wks.
  • Multipara multiple births
  • Abortion termination of pregnancy before 20 wks.
    gestation spontaneous or induced
  • Gestational Age prenatal age of developing fetus
    calculated from 1st day of LMP
  • Age of Viability stage where fetus is capable of
    living outside of the uterus usually 20 wks.
    gestation

58
  • TPALM TERM, PRETERM, ABORTION, LIVING, MULTIPLES
  • FPAL FULLTERM, PRETERM, ABORTION, LIVING

59
Maternal Physiology
  • Hormonal Changes
  • Estrogen and progesterone levels remain elevated
    for the first 8 weeks of pregnancy as a result of
    hCG.
  • After this time, the placenta takes over
    production and maintains necessary levels.
  • As long as these levels are high,
    follicle-stimulating hormone (FSH), luteinizing
    hormone (LH), and ovulation are suppressed, as is
    menstruation.

60
Maternal Physiology
  • Uterus
  • The uterus enlarges during pregnancy as a result
    of hormonal stimulus, increased vascularity,
    hyperplasia, and hypertrophy.
  • The nonpregnant uterus is pear-shaped and weighs
    about 2 oz. has a capacity of 10ml.
  • _at_ term weighs 2.2 has a capacity of 5000ml.
  • In a nonpregnant state, it is a pelvic organ
    when the pregnancy reaches completion, the
    superior aspect of the uterus will be located at
    the level of the xiphoid process.

61
  • Cervix color consistency change produces
    mucus plug thins dilates near onset of labor
    mucus plug is expelled
  • Ovaries do not ovulate corpus luteum persists
    until placenta takes over hormone production (6-7
    weeks)
  • Vagina - ?d blood supply bluish color rugae
    become prominent mucosa thickens ?d
    secretions pH becomes more acidic

62
  • Breasts
  • Hypertrophy of the mammary glandular tissue and
    increased vascularization, pigmentation, size,
    and prominence of nipples and areola.
  • Sebaceous glands secrete lubrication for nipples
  • Respiratory System
  • ?d O2 consumption (15)
  • Depth increases, slight increase in rate
  • Dyspnea until fetus descends into pelvis
  • Swollen mucous membranes nasal stuffiness nose
    bleeds voice changes

63
  • Cardiovascular System
  • Heart displaced up to left by uterus
  • Blood volume ?s by 45
  • HR (10-15 bpm) cardiac output ?s
  • Vascular resistance ?s
  • Vena Cava Syndrome
  • Orthostatic hypotension
  • Palpitations
  • Dilutional anemia
  • Vericose veins
  • ? in clotting factors WBC

64
  • Gastrointestinal System
  • Stomach intestines displaced
  • ? appetite thirst
  • ?d acidity of gastric secretions
  • ?d gastric emptying intestinal motility
  • Cardiac sphincter of stomach relaxes
  • Alteration in glucose metabolism (GDM)
  • Urinary System
  • GFR ?s d/t maternal fetal waste excretion
  • Renal tubules ? reabsorption
  • Bladder capacity ?s, lead to urinary stasis
  • Skeletal System
  • Posture changes rounded shoulders back ache
  • Waddling gait
  • Joint instability d/t softening of ligaments

65
Evaluating Fetal Well-being
  • A variety of technologic and assessment tools can
    be used to evaluate fetal well-being.
  • These tools are used to evaluate maternal and
    fetal health problems, fetal congenital
    anomalies, and fetal growth and maturity.
  • Ultrasonographylt8 wk, vaginal. gt8wk, abd.
  • Maternal serum alpha-fetoprotein screening
  • Chorionic villus sampling
  • Amniocentesis
  • Lecithin-Sphingomyelin Ratio
  • Nonstress test
  • Contraction stress test
  • Magnetic resonance imaging
  • Biophysical profile
  • Fetal kick count

66
Figure 25-3
(Courtesy of Marjorie Pyle, RNC, LifeCircle,
Costa Mesa, California.)
Transabdominal amniocentesis.
67
21 week fetus diagnosed with spina bifida
undergoing surgery while still in the womb.
68
Antepartal Assessment
  • General Physical Assessment
  • Ideally, the woman has been receiving regular
    medical attention and is already known by the
    health care provider.
  • On the first visit, demographic data, such as
    age, occupation, marital status, and insurance
    information, are obtained this helps the primary
    care practitioner identify potential areas of
    concern.
  • A basic family and personal medical history is
    obtained it should include genetic diseases.

69
Antepartal Assessment
  • Lifestyle patterns
  • Basic physical examination
  • Psychosocial history
  • Cultural practices health beliefs that affect
    pregnancy
  • Prenatal labs Blood type, Rh, Rubella, Hepatitis
    B, Syphilis, HH, HIV, Urinalysis, Urine culture.
  • New Test RHD Test- only for Rh- moms, test mom
    serum for Rh of infant and infant sex. Mom must
    be 12wks or gt preg.

70
Antepartal Assessment
  • Obstetric Assessment
  • Information about the womans gynecological,
    menstrual, and obstetric history is obtained.
  • The number of pregnancies and their outcomes are
    discussed.
  • Gynecological Examination
  • The gynecological examination is also performed
    at this time. Pap, GC, Chlamydia
  • The nurse is often called on to prepare the
    necessary equipment and assist with this
    examination.

71
Antepartal Care
  • Health Promotion
  • Pregnancy is a time in life when most women see
    the importance of regular medical supervision and
    are more willing to make changes in their habits
    than any other time.
  • Once pregnancy is diagnosed, prenatal care is
    instituted.
  • Early in pregnancy, the woman often begins to
    seek information and make choices regarding how
    and where she wishes to give birth.

72
  • Health Promotion (continued)
  • Routine care during pregnancy begins with the
    initial examination and history.
  • Appointments are recommended once a month through
    the seventh month (28 wks), once every 2 weeks
    for the next month (29-36 wks), and then once
    every week until delivery(36-40 wks).
  • Smoking, doing drugs, and drinking alcoholic
    beverages during pregnancy are contraindicated.
  • Taking any medications during pregnancy,
    including over-the-counter drugs, should be taken
    only under the direction of a doctor.

73
  • Danger Signs During Pregnancy
  • Visual disturbances
  • Headaches
  • Edema
  • Rapid weight gain
  • Pain
  • Signs of infection
  • Vaginal bleeding or drainage
  • Persistent vomiting
  • Muscular irritability or convulsions
  • Absence or decrease in fetal movement once felt

Nursing Action Stress to the pregnant woman to
contact her care provider promptly if she
develops any of these signs!
74
Maternal Nutrition
  • Benefits of optimal nutrition during pregnancy
  • ? risks of complication
  • ? premature deliveries
  • ? rate of low-birth weight babies
  • Nurse must teach pregnant women that nutrient
    needs increase more than calorie needs (select
    nutrient-dense foods)
  • Pregnant woman additional 300 calories
  • Lactating woman additional 500 calories (from
    prepregnant intake)

75
  • All women of childbearing age should be
    encouraged to consume a healthy diet use care
    in the consumption of alcohol caffeine because
  • Many women are unaware of the pregnancy during
    the 1st few weeks after conception
  • Most women dont attend prenatal information
    classes until the later months of their pregnancy

76
Protein
  • Intake 60 g.
  • Importance metabolism, growth repair of
    maternal fetal tissues
  • Sources meat, fish, poultry, dairy products

77
Calcium
  • Intake 1200 mg.
  • Importance bones, proper nerve muscle
    function
  • Sources dairy products, enriched cereal,
    legumes, green leafy veggies, broccoli, dried
    fruits, canned salmon sardines

78
Iron
  • Intake 30 mg.
  • Importance ?d production of RBCs, fetus must
    store iron supply to meet needs for 1st 3-6
    months
  • Sources red organ meats, whole grains, dark
    green leafy veggies, dried fruit, fortified
    cereals breads

79
Folic Acid
  • Intake 400 mcg.
  • Importance ? incidence of neural tube defects
    formation maturation of RBCs WBCs
  • Sources liver, lean beef, kidney lima beans,
    potatoes, fresh dark green leafy veggies, whole
    wheat bread, peanuts, fortified cereals, dried
    beans

80
Fluids during Pregnancy
  • Drink 8-10 glasses (8oz.) per day
  • Most of fluid intake should be water
  • Limit caffeinated high-sugar drinks

81
Recommended weight gains
  • Women of normal weight 25-35
  • Underweight women 28-40
  • Overweight women 15-25
  • Distribution of weight gain
  • Uterus 2.5 Breasts 1.5-3
  • Fetus 7-7.5 Blood volume 3.5-4
  • Placenta 1-1.5 Extravascular fluid 3.5-5
  • Amniotic Fluid 2 Maternal reserves 4-9.5

82
  • Pica
  • This is the craving and eating of substances that
    are not normally considered edible.
  • Substances such as clay or laundry starch are
    commonly ingested.
  • They are not toxic but may interfere with iron
    absorption, resulting in anemia.
  • Large amounts of clay may cause constipation.

83
Common Discomforts of Pregnancy
  • Ptyalism(Excessive salivation)
  • Nausea
  • Hyperemesis gravidarum
  • Constipation
  • Pyrosis (heartburn)
  • Hemorrhoids
  • Urinary Frequency
  • Fatigue
  • Backache

84
Common Discomforts (cont.)
  • Varicose veins
  • Dyspnea
  • Leg cramps
  • Edema
  • Nasal stuffiness

85
Skin Changes during Pregnancy
  • Linea nigra dark line midline of abdomen
  • Chloasma the mask of pregnancy
  • Striae gravidarum stretch marks
  • Spider nevi dilated capillaries on the skin
  • Palmar erythema reddened palms
  • Hirsutism excessive body hair

86
  • Hygiene Practices
  • Bathing and showering during pregnancy should
    continue as part of routine hygiene.
  • Increased perspiration is common, and good
    personal hygiene is important to prevent body
    odor.
  • Some primary care practitioners restrict tub
    baths in the last month, because the cervix may
    have dilated. No bath once ROM.
  • Most primary care practitioners recommend that
    women avoid using hot tubs, sauna baths, and spas
    during pregnancy.

87
  • Activity/Exercise
  • Normal activity should continue throughout an
    uncomplicated pregnancy discuss exercise
    routine with healthcare provider.
  • Fatigue is common pace activities, dont overdo
    it.
  • Avoid high-risk activities or those requiring a
    great deal of coordination or balance.
  • ? exercise 4 wks. before due date.
  • Avoid becoming overheated.
  • Stop exercising if develop SOB, dizziness,
    numbness, tingling, abd. pain, or vaginal
    bleeding contact provider immediately.

88
  • Rest/Sleep
  • Early in pregnancy, few changes in sleep patterns
    are experienced.
  • As the size of the abdomen increases, it may
    become increasingly difficult for the woman to
    find a position of comfort.
  • The supine position is not recommended as a woman
    approaches her due date this may cause excessive
    pressure on the aorta and vena cava and may
    result in decreased circulation for the fetus.
  • Rest periods during the day with the feet
    elevated should be encouraged.

89
Figure 25-7
(From McKinney, E.S., James, S.R., Murray, S.S.,
Ashwill, J.W. 2005. Maternal-child nursing.
2nd ed.. Philadelphia Saunders.)
During third trimester, pillows supporting
abdomen and back provide a comfortable position
for rest.
90
  • Sexual Activity
  • Unless there are complications in the pregnancy
    or the bag of water has ruptured, there is no
    physiological reason to limit sexual activity
    during pregnancy.
  • Many women experience a decrease in desire as a
    result of hormonal changes and the multiple
    discomforts that may be occurring.
  • Discussion of various coital positions and sexual
    activity that does not include intercourse is
    appropriate.
  • Fears concerns normal partners need to
    communicate these concerns.

91
  • Vaginal Bleeding
  • Vaginal bleeding at any time during pregnancy
    should be reported to the physician at once.
  • Sexual activity should cease until the cause of
    the bleeding is determined and should be resumed
    only when the physician determines that no danger
    exists.

92
  • Coping/Stress Tolerance
  • All of the physical and hormonal changes of
    pregnancy place additional stress on the woman.
  • Mood swings and ambivalence are common as the
    woman works through her fears and comes to grip
    with the reality of pregnancy and how the
    pregnancy will affect her life.
  • Listening and allowing the woman adequate time to
    verbalize her fears can also help reduce
    anxieties.

93
  • Role/Relationship
  • Pregnancy introduces a totally new role, that of
    a mother father.
  • Culture will have much to do with how the woman
    will define her role.
  • Dynamics also change between the woman and the
    babys father, particularly with the first
    pregnancy. The woman is no longer just a wife or
    girlfriend she is also a mother.
  • Women will look to family friends as role
    models.

94
  • Self-Perception/Self-Concept
  • Rapid changes in body shape and size can lead to
    changes in self-image.
  • Many women feel that they are not attractive when
    they are pregnant.
  • They may also feel a loss of control related to
    the changes taking place.

95
Impact of Pregnancy
  • Adolescents
  • Older couple
  • Single parents
  • Grandparents

96
Preparation for Childbirth
  • Cultural Variations in Prenatal Care
  • It is imperative that the practitioner determine
    and explore cultural practices and beliefs with
    the patient.
  • Hispanic
  • African American
  • Filipino
  • Japanese
  • Chinese
  • Russian
  • Southeast Asian

97
Preparation for Childbirth
  • Prenatal Education special classes offered to
    help the childbearing family understand prepare
    for the demands of pregnancy, labor, the newborn,
    parenthood
  • Review reproductive AP
  • Discuss changes during pregnancy
  • Fetal growth development
  • Nutrition
  • Danger signs
  • Discussion of analgesia anesthesia during labor
  • Care of the newborn
  • breastfeeding
  • Sibling preparation changing family dynamics

98
Preparation for Childbirth
  • Childbirth Preparation Classes
  • Some classes are general in nature, whereas
    others are targeted toward specific groups such
    as adolescents, those having cesarean or vaginal
    birth after cesarean delivery, siblings, or
    grandparents.
  • Common methods of prepared childbirth include
  • Dick-Read
  • Bradley
  • Leboyer
  • Lamaze

99
Figure 25-8
(From Lowdermilk, D.L., Perry, S.E. 2004.
Maternity womens health care. 8th ed.. St.
Louis Mosby.)
Entire family participating in a childbirth
preparation course.
100
Nursing Process
  • Nursing Diagnoses
  • Body image, disturbed
  • Nutrition less than body requirements
  • Injury, risk for
  • Activity intolerance
  • Incontinence, stress urinary
  • Constipation
  • Sleep pattern, disturbed
  • Fatigue

101
Nursing Process
  • Nursing Diagnoses (continued)
  • Knowledge, deficient
  • Family processes, interrupted
  • Fear
  • Parenting, risk for impaired
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