Nursing Management During Pregnancy

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Nursing Management During Pregnancy

• Chapter 12

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Preconceptual Counseling

• Why is it important?
• Medical- past or current problems
• Sexual- STI
• Reproductive-AB or losses
• Psychosocial-support system
• Counseling- Folic acid, iron, wgt. SA, violence
  diseases, genetics

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Taking History

• Current pregnancy- any problems
• Past pregnancy-problems, type of delivery,newborn
  info
• Current/past medical hx
• Family-Religion-Culture
• Age-old vs. young
• Identify high risk problems early

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Vocabulary

• Nagles rule minus three months 7days
• Ab- before 20 weeks
• Nullipara- no births before 20 weeks
• Primpara -one birth after 20 weeks
• Gravida- pregnancy regardless of duration
• P- after 20 weeks before 37 wks
• Living- number of living children

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Head to Toe

• Head and Neck- Evaluate thyroid, dental
• Chest- HR, murmur, SOB, breast exam
• Abdomen- check fundal hgt
• Extremities- varicosities, edema, calfs
• Pelvic exam-Lesions, discharge, hematomas
• Pelvimetry- gynecoid, assess for adequate pelvis
• Labs- CBC, Rh, Rubella, Hepatitis, HIV, VDRL,RPR

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Prenatal Care Visits

• Every 4 wks to 28wks
• Every 2 wks to 36 wks
• Every week to delivery

• All visits
• Eval. BP
• Urine fundal hgt.
• FM/FHR
• Edema
• S/S of PTL
• 24-28 wks 1hr GTT
• Anticipatory guidance

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Fetal Movement

• Used to determine fetal well being
• Cardiff- lie or sit, count 10 fetal movements
• Call healthcare provider if more than 1 hour
• Sadovsky- lie on left after eating.
• Should feel 4 movements in 1 hr
• Count movements second hr.
• Call HCP if criteria not met

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Assessment of Fetal Well Being

• UTZ- Low risk assessment tool
• Doppler Flow-Eval for absent or reversed
  diastolic flow
• AFP-16-18wks Eval for NTD or Downs
• Marker Screening test- AFP ,unconjugated estriol,
  hCG and Inhibin A- more accurate
• Amniocentisischromosomes and metabolic defect

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Assessment of Fetal Well Being

• Nsg-Consent, risk of AB, empty bladder
• Assess for FHT and UC- Rhogam?
• Give labor precautions
• CVS-Tissue sample- Get results sooner
• Nsg- same as amniocentisis
• PUBS- blood collected from fetus
• High Risk- Monitor fetus
• NSG-FKC- S/S of infection, cramping

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Assessment of Fetal Well Being

• NST- Fetal Movement Fetal Well Being
• Reactivity 2 accelerations above baseline
  lasting 15 seconds within 20 minutes
• Nsg- Apply monitors, give marker, displace uterus
  to left lateral
• Need for NST determined by risk factors

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Assessment of Fetal Well Being

• CST- Ability of fetus to tolerate stress and
  fetal reserve
• Decrease in oxygenation with ucs
• Initiate 3 ucs in 10 minutes
• Eval. FHR for variations
• Negative results are GOOD
• Positive - 50 of ucs late decelerations

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Biophysical Profile

• Use UTZ to assess fetal well being
• Fetal tone-Breathing- Body movement-Amniotic
  fluid- Reactive NST
• Score 8/10good 6/10 concerning
• Nsg- explain procedure, results, keep informed

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Promotion of Self-Care

• Treat holistically-promote well being
• Personal Hygiene/Dental Hygiene
• Breast Care- Sears or J.C. Penny
• Clothing- loose comfortable
• Balance exercise with rest
• Pelvic Tilt and Kagels

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Promotion of Self Care

• Sleep- use pillows- limit fluids
• Sexual activity- encourage intimacy
• Employment- evaluate risk factors
• Travel- move q 2 hrs
• Immunizations- no live vaccines
• OTC meds- should consult HCP

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Classifications of Drugs

• A- controlled studies- no fetal risks
• B- use frequently- r/t little harm
• C- likely to cause harm risk vs. benefits
• D- fetal risk benefits outweigh risk
• X risks outweigh benefits

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Promotion of Self Care

• Urinary frequency-need 2000 cc/day. Limit 2-3 hrs
  before bed
• Fatigue- feel best 2nd trimester
• N/V- Avoid foods and smell. Crackers, sit up,
  rise slowly- S/S of dehydration
• Constipation- increase fiber-Do not strain
• Nasal- epitaxis-use air vaporizer
• Cravings- Weight? Avoid sodium/sugar

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Promotion of Self Care Second Trimester

• Backache- Good body mechanics
• Leg cramps-increase calcium/magnesium
• Ankle edema- common- legs above heart
• Hemorrhoids- avoid straining
• Constipation- bulk in diet- prune juice
• Flatulence- avoid carbonation, cheese

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Promotion of Self Care Third Trimester

• SOB-pressure on diaphragm, sit up, avoid large
  meals- Lightening
• Constipation- hydration- fruits and vegetables
• Heartburn- sit up, avoid large meals
• Ankle edema- eval for PIH
• Braxton Hicks- Cervix preparing for labor

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Diet

• 30 mg ferrous sulphate/600mcg of folic acid
• Normal weight gain 25-35 pounds
• Alterations in weight- thin vs. obese
• Culture variations
• Special Diets- Lactose Intolerant- Vegans
• Use Dieticians
• Evaluate for Pica

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Perinatal Education

• Knowledge Better Birth Experience
• Lamaze- psychophrophylactic- Breathing controls
  pain
• Bradley-Enjoy process of childbirth-no pain
  medications
• Dick Read- Break cycle of Fear-Tension-Pain

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Birth Options

• Hospital Based Care-Birthing Suites Family
  Centered Care
• Birthing Center- No Rush- Midwife
• Home Birth- Must be low risk
• Choosing a health care provider
• Doula- Continuous support during labor and birth

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Breast vs. Bottle

• Breast is best
• Bonding
• Less infection
• Promotes involution
• Less allergies
• Less obesity
• More digestible

• Bottle
• Need more to get same nutrition
• Expensive
• Less digestible
• No microwave
• Do not prop bottle
• Father can feed

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Danger Signs of Pregnancy

• First Trimester-Spotting- bleeding-persistent
  vomiting- lower ab. Pain
• Second- UCs- calf pain-PROM- decrease in fetal
  movement
• Third- Edema- H/A- epigastric pain visual
  changes- decrease in fetal movement

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Class activities

• Using the wellness /illness model develop nursing
  care plan for parents seeking preconceptual
  counseling.
• Assessment
• Diagnosis
• Outcome
• Interventions

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GTPAL

• Client is a 31 y.o. who comes to the clinic with
  seeking PNC. Previous hx 5 previous pregnancies,
  h/o fetal demise at 39 weeks, twins who delivered
  at 34 week(alive), 2 NSVD at term, 1 ab _at_ 12
  weeks.

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Answer

• Gravida 6
• Term 3
• Pt 1
• Ab 1
• L 4

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Maslow

• Develop nursing care plan using Maslows Human
  needs model to prioritize risk factors related to
  pregnancy.
• Physiological
• Safety

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Diet

• Develop anticipatory teaching guide for women
  with special diets.
• Culture
• Refer to food pyramid (culturally specific)
• Use dietician
• Enroll family

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