Chapter 5 Health Care During Pregnancy

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Chapter 5Health Care During Pregnancy
2
Preconception Care

• Health care and screening before pregnancy to
  identify medical risk factors and/or lifestyle
  behaviors that can be managed before conception

3
Goals of Prenatal Care

• Promote good health habits and reduce risk
  factors to ensure a safe birth for mother and
  child
• Teach health habits that may be continued after
  pregnancy
• Educate for self-care during pregnancy
• Provide physical assessment and care
• Prepare parents for parenthood

4
Cultural Competence

• Awareness and acceptance of and respect for
  beliefs, values, traditions, and practices
  different from ones own
• The ability to adapt health care so that it does
  not violate the culture or religion of the
  patient and her family
• Avoid cultural stereotyping

5
Prenatal Visits

• Initial health and social history
• personal information social hx
• medical hx of client family
• past obstetrical hx
• Physical examination
• head to toe of all body systems
• wt, ht, v/s urine
• pelvic examination have the woman empty her
  bladder prior
• labs table 5-1
• (Contd)

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Prenatal Visits

• Subsequent visits
• Every month for 7 months, every 2 weeks during
  8th month, then every week until delivery
• Weight, blood pressure, urine (protein, acetone,
  and glucose)
• Uterine height measurement for fetal growth
• (cont)

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Prenatal Visits

• (Contd)
• Subsequent visits (cont)
• Leopolds maneuvers to assess presentation and
  position of fetus
• Listen to fetal heart rate
• Assess for CVA and calf tenderness
• Identify discomforts and suggest nursing or
  medical relief measures
• Discuss birth plans and infant feeding

8
Patient Teaching for Self-Care and Common
Discomforts of Pregnancy

• Bathing
• avoid hot tubs or saunas because they increase
  body temperature which may cause fetal
  abnormalities
• Physical activity and exercise
• Special considerations mild to moderate
  exercise is good she should not lie supine,
  twist, bounce, or make jerky movements during
  exercise, box 5-1
• helpful exercises pelvic tilt-fig 5-6 Kegel
  exercise-box 5-2
• avoid supine hypotensive syndrome
• Sexual activity
• should not have to be restricted except if the
  bag of waters has ruptured or after labor begins
• (Contd)

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Patient Teaching for Self-Care and Common
Discomforts of Pregnancy

• Douching do not douch during pregnancy
• Clothing wear adjustable, loose, washable, and
  lightweight clothing. Do not wear knee highs,
  tight garters or high heeled shoes once the
  center of gravity starts to shift
• Breast and nipple care wear supportive bra do
  not apply soap to nipples during bathing because
  it causes a drying effect breasts may secrete
  colostrum, a yellow fluid, before or during the
  last trimester may need to wear pads inside bra

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Patient Teaching for Self-Care and Common
Discomforts of Pregnancy

• (Contd)
• Dental care continue routine care except avoid
  xrays
• Immunizations
• Avoid MMR and varicella (potential fetal damage)
• Employment no heavy lifting or exposure to
  harmful substances
• Travel maximum of 6 hours per day driving stop
  every 2 hrs for 10 minutes to walk around
• Medications
• No medications unless prescribed by health care
  provider (includes OTCs and herbal remedies)
  box 5-3
• (Contd)

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Patient Teaching for Self-Care and Common
Discomforts of Pregnancy

• Danger signs
• Provide information on reportable danger signs,
  written at an appropriate level and in a language
  she can read fast focus 5-2
• Weight gain and fetal growth
• 25 to 35 lb total--with 3 lb in 1st trimester,
  then 1 lb per week
• Dieting is not recommendedmay limit fetal growth

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Nutrition

• Obtain nutritional history of food habits and
  preferences, monitor nutritional status, and
  provide nutritional education
• Food guide pyramid
• Nutritional requirements during pregnancy table
  5-3
• Pica eating substances usually considered
  inedible, with no nutritional value
• Pregnant adolescent

13
Education for Childbirth

• Principles
• Partner participation and support
• Relaxation and breathing strategies
• Muscle conditioning
• Knowledge of choices and alternatives
• Breathing patterns used during labor
• First-stage
• Slow-paced
• Modified-paced
• Patterned-paced
• (Contd)

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Education for Childbirth

• (Contd)
• Breathing patterns used during labor (cont)
• Second-stage (expulsion breathing)
• Open-glottis technique-pushing as if blowing out
  a candle
• Closed-glottis technique-not recommended because
  it decreases blood flow to fetus if done do not
  hold breath for more than 6 sec