Intro to Maternity

1
Intro to Maternity Pediatric Nursing

• Prenatal Care and Adaptions to Pregnancy Chapt 4

2
Prenatal Care

• Phases of Pregnancy
• Antepartum
• Intrapartum
• Postpartum
• Nursing Involvement in Prenatal Care
• Education

3
Goals of Prenatal Care

• Safe birth for mother and child
• Promoting good health habits reducing risk
  factors
• Patient Education
• Provide physical care
• Prepare Patient for Parenthood

4
Healthcare Prior to Conception

• Advantages
• Permits diagnosis and treatment of maternal
  disorders
• Accurate Health History
• Physical Examination

5
1st Prenatal Visits

• Should begin with a positive pregnancy test
• Base line data
• Complete history
• Baseline vital signs, height, and weight
• Nutritional status and
• Psychosocial situation

6
Prenatal Visits

• Establishment of Estimated Date of Delivery (EDD)
• Lab tests
• Scheduled appointments
• Prenatal Visits
• Extra Appointments

7
Routine Visits

• Review of history
• Vital Signs
• Weight
• Urine Analysis
• Glucose screening (not on every visit)
• Fundal height
• Fetal position
• Fetal heart rate
• Nutrition screening
• complications

8
Definitions

• Gravida
• Nulligravida
• Primigravida
• Multigravida
• Para
• Primipara

• Multipara
• Nullipara
• Abortion
• Gestational age
• Fertilization age
• Age of viability

9
Estimated Date of Delivery

• 40 Weeks
• Nageles Rule
• 1st day of LNMP (-) months () 7 days
• Gestational wheel
• Electronic calculator
• Physical examination and
• Ultrasound

10
Trimesters

• Three 13 week periods
• Each with unique developmental stages

11
Signs of Pregnancy

• Presumptive
• Amenorrhea
• Nausea
• Breast tenderness
• Deepening pigmentation
• Urinary frequency
• Quickening

12
Signs of Pregnancy

• Probable
• Goodells sign
• Chadwicks sign
• Hegars sign
• McDonalds sign
• Abdominal enlargement
• Braxton-Hicks contractions
• Ballottement
• Striae
• Positive pregnancy test

13
Signs of Pregnancy

• Positive
• Audible fetal heartbeat
• Fetal movement felt by examiner
• Ultrasound visualization of fetus

14
(No Transcript)
15
Effects of Pregnancy on the Reproductive System

• Uterus
• Becomes temporary abdominal organ
• Capacity is 5000 ml (fetus, placenta, and
  amniotic fluid)
• Cervix
• Changes in color and consistency, glands in
  cervical mucosa increase
• Mucous plug formed to prevent ascent of organisms
  into uterus

16
Effects of Pregnancy on the Reproductive System
(continued)

• Ovaries
• Produce progesterone to maintain decidua (uterine
  lining) during 1st 6 to 7 weeks of gestation
  until placenta can take over task
• Vagina
• Increased blood supply causes it to have a bluish
  color
• Vaginal secretions increase, pH more acidic
• Higher glycogen level, which promotes Candida
  albicans (yeast) growth

17
Effects of Pregnancy on the Reproductive System
(continued)

• Breasts
• High levels of estrogen and progesterone prepare
  breasts for lactation
• The Areolae usually become deeply pigmented and
  sebaceous glands become prominent
• Montgomerys tubercles secrete substance to
  lubricate nipples
• Colostrum Premilk is
• high in protein, fat-soluble vitamins, and
  minerals
• Low calories, fats, and sugar

18
Effects of Pregnancy on the Respiratory System

• Oxygen consumption increases by 15
• Diaphragm rises 4 cm (1.6 inches)
• Causes ribs to flare
• Dyspnea can occur until fetus descends into
  pelvis
• Lightening is the relief of the upward pressure
  on the diaphragm
• Increased estrogen causes edema or swelling of
  mucous membranes of nose, pharynx, mouth, and
  trachea
• Woman may complain of nasal stuffiness,
  epistaxis, and vocal changes

19
Effects of Pregnancy on the Cardiovascular System

• Blood volume increases by 45 compared to
  prepregnant state
• Increase provides for
• Exchange of nutrients, oxygen, and waste products
  within the placenta
• Needs of expanded maternal tissue
• Reserve for blood loss at birth
• Pulse rate increases by 10 to 15 beats/min

20
Aortocaval Compression
21
Cardiovascular System

• Orthostatic hypotension occurs with rising from
  the recumbent position
• Palpitations R/T increase in thoracic pressure
• Dilutional anemia (pseudoanemia) drop in
  hematocrit to 33-40
• Increased clotting factors in 2nd and 3rd
  trimesters
• Increased risk of thrombophlebitis

22
Effects of Pregnancy on the Gastrointestinal
System

• Growing uterus displaces stomach and intestines
• Increased salivary secretions
• Oral mucosa may become tender and may bleed more
  easily because of the increased estrogen levels
• Increased appetite and thirst
• Decreased gastric acid secretions
• Delayed gastric emptying and intestinal movement
• Heartburn is R/T relaxation of the cardiac
  sphincter of the stomach which permits reflux
• Progesterone and estrogen relax muscle tone of
  gallbladder
• Leads to retained bile salts
• Can cause pruritus during pregnancy

23
(No Transcript)
24
Effects of Pregnancy on the Urinary System

• Excretes waste products of woman and fetus
• Glomerular filtration rate of kidneys increases
• Glycosuria and proteinuria more common
• Water retention due to increased blood volume and
  dissolving nutrients provided for fetus
• Progesterone causes renal pelvis and ureters to
  lose tone, leads to urinary stasis
• Woman more susceptible to UTIs
• Because of the increase of pregnancy hormones 99
  of sodium is reabsorbed, which leads to fluid
  retention

25
Effects of Pregnancy on the Integumentary and
Skeletal Systems

• Striae
• Spider nevi
• Sweat and sebaceous glands become more active
• To dissipate heat from woman and fetus
• Posture changes
• Low back aches
• Relaxation of pelvic joints
• Waddling gait
• Change in center of gravity
• Balance may become an issue

26
Nutrition for Pregnancy and Lactation

• Nutritional education
• Good nutrition is vital for healthy growth and
  development
• Encourage
• healthy food choices
• Read food labels
• Eat foods that are nutrient dense rather than
  nutrient empty
• Protein versus sugary foods

27
(No Transcript)
28
Weight Gain

• Women of normal weight 25 to 35 pounds (11.5 to
  16 kg)
• Underweight women 28 to 40 pounds (12.6 to 18
  kg)
• Overweight women 15 to 25 pounds (7 to 11.5 kg)
• If multifetal twins woman should gain 4 to 6
  pounds in 1st trimester, 1.3 pounds per week in
  2nd and 3rd trimester, for a total of 35 to 45
  pounds

29
Nutritional Requirements

• Increase intake by 300 kcal per day should also
  include
• Protein60 g/day
• Calcium1200 mg/day
• Iron30 mg/day
• Folic acid400 mcg (0.4 mg)/day

30
Special Nutritional Considerations

• Pregnant adolescent
• Sodium intake
• Vegetarian
• Pica
• Lactose intolerance
• Gestational diabetes mellitus

31
Nutrition during Lacation

• Caloric intake during lactation should be about
  500 calories more than the nonpregnant womans
  RDA
• Protein intake should be 65 mg/day
• Calcium and iron intake should be the same as
  during pregnancy
• Vitamin supplements are often continued during
  lactation
• Fluid intake imit intake of caffeine and
  alcohol drink 8-10 glasses of water/day
• Drugs should only be taken upon the advice of the
  health care provider

32
Exercise During Pregnancy

• Maternal cardiac status and fetoplacental reserve
  should be the basis for determining exercise
  levels during all trimesters of pregnancy
• It is important to assess the exercise practices
  of the woman
• Goal of exercise during pregnancy should be
  maintenance of fitness, not improvement of
  fitness or weight loss

33
Risk Factors

• Elevated temperature
• Can impact fetal circulation and cardiac function
• Hypotension
• Can reduce blood flow to the fetus
• Cardiac output
• Peripheral pooling decreases cardiac reserves for
  exercise

34
Risk Factors Continued

• Hormones
• Changes in oxygen consumption and in levels of
  epinephrine, glucagon, cortisol, prolactin, and
  endorphin
• Other factors
• Moderate exercise has many benefitsa more
  positive self-image, a decrease in
  musculoskeletal discomforts during pregnancy, and
  a more rapid return to prepregnant weight after
  delivery

35
Common Discomforts In Pregnancy

• Fatigue
• Nasal stuffiness
• Nausea
• Heartburn
• Constipation
• Hemorrhoids

• Vaginal discharge
• Backache
• Varicose veins
• Leg cramps
• Edema of the lower extremities

36
Psychological Adaptations to Pregnancy

• Identifying and managing psychosocial problems is
  essential to the positive outcome of pregnancy
• Nutritional needs and patterns relating to age,
  ethnicity, or financial constraints should be
  discussed

37
Impact on the Mother

• According to Reva Rubin, 4 maternal tasks
  include
• Seeing safe passage for herself and her fetus
• Securing acceptance of herself as a mother and of
  her fetus
• Learning to give of herself and to receive the
  care and concern of others
• Committing herself to the child as she progresses
  through pregnancy

38
Impact on Father

• Cultural influences determine involvement
• Phases
• Ambivalence Self questioning about
• their readiness
• Acceptance is R/T family support
• and social network
• Adjustment comes with involvement
• in the pregnancy

39
Impact on the Adolescent

• The nurse must assess the girls developmental
  and educational level as well as her support
  system to best provide care for her
• Consider her developmental level and the
  priorities typical of her age
• Must cope with two of lifes most stress-laden
  transitions at the same time adolescence and
  parenthood

40
Impact on the Older Couple

• Tend to adjust well to the pregnancy because they
  tend to be well-educated and to have achieved
  life experiences that enable them to better cope
  with realities of parenthood

41
Impact on The Single Mother

• May be an adolescent or a mature woman
• May have unique emotional needs
• Single women who plan pregnancies often prepare
  for the financial and lifestyle changes

42
Impact on the Single Father

• May take an active interest in and financial
  responsibility for the child
• May want to participate in plans for the child
  and take part in the care of the infant after it
  is born
• His participation is sometimes rejected by the
  woman

43
Impact on the Grandparents

• May eagerly anticipate the womans pregnancy
• Some will take a more active role in the care of
  the grandchild
• If grandparents and expectant couple have similar
  views of their roles, then little conflict is
  likely
• The nurse may be able to help the new parents to
  understand their own parents reactions and help
  them to negotiate solutions to conflicts that are
  satisfactory to both generations

44
Prenatal Education

• Should progress according to the nursing process
• Assess the history and cultural needs
• Diagnose the knowledge deficit
• Plan the goals and priorities
• Outcome identification clarifies expected
  outcomes
• Teach (intervene) the facts and rationales

45
Physiological and Psychological Changes in
Pregnancy and Nursing Interventions

• Maternal changes
• Signs and symptoms to anticipate
• Nursing interventions that can be implemented to
  help the mother cope with the changes throughout
  her pregnancy

46
The Effect of Pregnancy and Lactation on
Medication Ingestion

• Pregnancy affects the metabolism of medications
• May have subtherapeutic levels
• Parenteral medications may be absorbed more
  rapidly due to increased cardiac output
• Drugs can cross the placenta, can be passed
  through breast milk

47
FDA Pregnancy Risk Category for Drugs

• Category A No risk demonstrated to the fetus in
  any trimester
• Category B No adverse effects in animals no
  human studies available
• Category C Only prescribed after risks to the
  fetus are considered. Animal studies have shown
  adverse reaction no human studies available
• Category D Definite fetal risks, but may be
  given in spite of risks in life-threatening
  situations
• Category X Absolute fetal abnormalities. Not to
  be used anytime during pregnancy