VNSG 1230

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VNSG 1230
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2012-01-04 07:19:40
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MATERNAL HEALTH UNIT CH4
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UNIT 1, CHAPTER 4
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  1. VNSG 1230
    • Maternal � Neonatal
    • Nursing
    • Unit III Chapter 4
  2. Spring 2012
  3. A. McEachern, RN, BSN
  4. 12/30/2011 A. McEachern, RN, BSN
  5. Prenatal Care and
    Adaptations to Pregnancy
  6. 12/30/2011
  7. 2 A. McEachern, RN, BSN
    Pregnancy
  8. .Pregnancy is a temporary,
    • physiological process that affects
    • the woman physically and
    • emotionally
    • .All systems of her body adapt to
    • support the developing fetus
  9. 12/30/2011
  10. 3 A. McEachern, RN, BSN
  11. Three Phases of Pregnancy
  12. .Antepartum � before birth
    • .Intrapartum � during birth
    • .Postpartum � after birth
  13. 12/30/2011
  14. A. McEachern, RN, BSN
  15. 4
    Goals of Prenatal Care
  16. .Ensure a safe birth
    • .Teach health habits
    • .Educate in self-care
    • .Provide physical care
    • .Prepare for responsibilities of
    • parenthood
  17. 12/30/2011 A. McEachern, RN, BSN
  18. 5 untitled.bmp
  19. Prenatal Visits
  20. .Ideally begins before conception
    • .Complete history is important
    • .Get baseline weight and vital signs
    • .To assess for signs of pregnancy
  21. 12/30/2011 A. McEachern, RN, BSN
  22. 6
    • Frequency of Pre-natal
    • Visits
  23. .For an uncomplicated pregnancy:
    • .Conception to 28 weeks = every 4
    • weeks
    • .29 to 36 weeks = every 2 to 3
    • weeks
    • .37 weeks to birth = weekly
    • .More often if complications
  24. 12/30/2011 A. McEachern, RN, BSN
  25. 7
  26. Prenatal Laboratory Tests �
    1st Trimester Routine
  27. .Blood type and RH factor antibody
    • screen
    • .CBC
    • .H & H (hemoglobin and hematocrit)
    • .VDRL (RPR or rapid plasma reagin) �
    • screening for syphilis mandated by
    • law
  28. 12/30/2011 A. McEachern, RN, BSN 8
  29. Prenatal Laboratory Tests
    • Cont. � 1st Trimester
    • Routine
  30. .TB screening
    • .Rubella titer
    • .Hep B
    • .HIV
    • .UA
    • .Pap test � if not done within 6 mos of conception
    • .Cervical culture � detects group B streptococci or
    • sexually transmitted infections such as Gonorrhea or
    • Chlamydia
  31. 12/30/2011 A. McEachern, RN, BSN 9
  32. Prenatal Laboratory Tests
    • Cont. � 1st trimester if
    • Indicated
  33. .Hemoglobin electrophoresis �
    • identifies sickle cell trait in
    • Mediterranean or African descent
    • .Endovaginal ultrasound � when
    • high risk of fetal loss is suspected
  34. 12/30/2011 A. McEachern, RN, BSN 10
  35. Prenatal Laboratory Tests
    • Cont. � 2nd Trimester
    • Routine
  36. .Blood glucose screen � 24-28 weeks to
    • identify gestational diabetes
    • .Above 135 mg/dl requires
    • monitoring
  37. .Serum alpha fetoprotein � identifies
    • neural tube or chromosomal defects
    • .Ultrasonography � to identify some
    • anomalies and confirm EDD
    • (estimated date of delivery)
  38. 12/30/2011 A. McEachern, RN, BSN 11
    • Prenatal Laboratory Tests �
    • 2nd Trimester if Indicated
  39. .Amniocentesis � 16-20 weeks
    • when high-risk problem is
    • indicated
  40. 12/30/2011
  41. A. McEachern, RN, BSN 12 amniodiag.gif
  42. Prenatal Laboratory Tests �
    3rd Trimester if Indicated
  43. .Real-time ultrasonography
    • .Detects excess or reduced amniotic fluid
    • .Confirms gestational age or
    • cephalopelvic disproportion
    • .With amniocentesis, determines fetal
    • lung maturity
    • .May confirm fetal anomaly
    • .Cervical fibronectin assay � determines
    • risk of preterm labor
  44. 12/30/2011 A. McEachern, RN, BSN 13
    Ultrasound
  45. images.jpg
    12/30/2011
  46. A. McEachern, RN, BSN 14
    3D Ultrasound
  47. imagesCAMB2ZIX.jpg
    12/30/2011 A. McEachern, RN, BSN
  48. 15
    Leopold�s Maneuver
  49. .Assesses the presentation and
    • position of the fetus by abdominal
    • palpation
  50. 12/30/2011 A. McEachern, RN, BSN
  51. 16
    Definition of Terms
  52. .Gravida � Any pregnancy, regardless of
    • duration; also the number of pregnancies,
    • including the one in progress, if applicable
    • .Primigravida � A woman who is pregnant
    • for the first time
    • .Multigravida � A woman who has been
    • pregnant before, regardless of duration
    • .Nulligravida � A woman who has never
    • been pregnant
  53. 12/30/2011 A. McEachern, RN, BSN
  54. 17
  55. Definition of Terms Cont.
  56. .Para � A woman who has given
    • birth to one or more children who
    • reached the age of viability (20
    • wks) regardless of number of
    • fetuses delivered or of whether
    • those children are still living
  57. 12/30/2011
  58. A. McEachern, RN, BSN 18
  59. Definition of Terms Cont.
  60. .Primipara � A woman who has
    • given birth to her first child (past
    • point of viability) regardless of
    • whether the child was alive at
    • birth or is now living. Also used
    • informally to describe a woman
    • before the birth of her first child
  61. 12/30/2011 A. McEachern, RN, BSN 19
  62. Definition of Terms Cont.
  63. .Multipara � A woman who has given
    • birth to two or more children past point
    • of viability regardless of whether
    • children were alive at birth or are
    • presently alive. Also used informally to
    • describe a woman before the birth of
    • their second child.
    • .Nullipara � A woman who has not
    • given birth to a child who reached point
    • of viability
  64. 12/30/2011 A. McEachern, RN, BSN 20
  65. Definition of Terms Cont.
  66. .Abortion � termination of pregnancy before
    • viability (20 wks)
    • .Gestational age � prenatal age of developing
    • fetus calculated from the first day of the
    • woman�s LNMP (last normal menstrual
    • period)
    • .Fertilization age � prenatal age of the
    • developing fetus as calculated from date of
    • conception � approx. 2 wks less than
    • gestational age
  67. 12/30/2011 A. McEachern, RN, BSN
  68. 21
    Scenario 1
  69. .Jean Sanchez has one child born at 38 weeks and is
    • pregnant for the second time. At Jean�s initial
    • prenatal visit, the nurse indicates her obstetric
    • history as:
    • .Gravida 2 para 1
  70. Her present pregnancy terminates at 16 weeks gestation.
  71. She is now:
  72. .Gravida 2 para 1 ab 1
  73. 12/30/2011 A. McEachern, RN, BSN 22
    Scenario 2
  74. .Liz Buehl is pregnant for the fourth time. She has a
    • child born at 35 weeks at home. She lost one
    • pregnancy at 10 weeks gestation and gave birth to
    • another infant stillborn at term. She would be
    • documented as:
    • .Gravida 4 para 2 ab 1
  75. 12/30/2011 A. McEachern, RN, BSN 23
    TPALM
  76. .It is used if more comprehensive
    • data is needed in some settings
    • .Gravida keeps same meaning
    • .Para is altered to focus on # of
    • infants born rather than # of
    • deliveries
  77. 12/30/2011 A. McEachern, RN, BSN 24
  78. TPALM � To Describe
    Parity
  79. .T- # of term infants born (after at least 37 wks
    • gestation)
    • .P- # of preterm infants (after 20 wks or before 37
    • wks)
    • .A- # of pregnancies aborted before 20 wks
    • .L- # of children now living
    • .M- Multiple birth # of multiple gestations (optional)
  80. 12/30/2011
  81. A. McEachern, RN, BSN 25
    Scenario 1- Using TPALM
  82. .Jean Sanchez has one child born at 38 weeks and is
    • pregnant for the second time. At Jean�s initial
    • prenatal visit, the nurse indicates her obstetric
    • history as:
    • .Gravida 2 para 1
    • .Using TPALM: gravida 2 para 1001
  83. Her present pregnancy terminates at 16 weeks gestation.
  84. She is now:
  85. .Gravida 2 para 1 ab
    .Using TPALM: gravida 2 para 1011
  86. 12/30/2011 A. McEachern, RN, BSN 26
    • Nagele�s Rule to
    • Determine EDD
  87. .1. Determine 1st day of LNMP
    • .2. Count backwards 3 months
    • .3. Add 7 days
    • .4. Correct year if necessary
  88. 12/30/2011 A. McEachern, RN, BSN 27
    Example of Nagele�s Rule
  89. 1.1st day of LNMP : October 15, 2010
    • 2.Count backward 3 months: July 15
    • 3.Add 7 days (correcting the year since
    • the 9 months spanned across the new
    • year) July 22, 2011
  90. 12/30/2011 A. McEachern, RN, BSN
  91. 28
    Signs of Pregnancy
  92. .Divided into 3 groups:
    • .Presumptive
    • .Probable
    • .Positive
  93. *Depending on how likely they are
    • to be caused by factors other than
    • pregnancy
  94. 12/30/2011
  95. A. McEachern, RN, BSN 29
    • Presumptive Signs of
    • Pregnancy
  96. .Amenorrhea
    • .Nausea
    • .Breast tenderness
    • .Deepening pigmentation
    • .Urinary frequency
    • .Quickening
  97. 12/30/2011 A. McEachern, RN, BSN 30
    • Probable Signs of
    • Pregnancy
  98. .Goodell�s sign � is the softening of
    • the cervix and vagina caused by
    • increased vascular congestion
  99. 12/30/2011 A. McEachern, RN, BSN 31
  100. Probable Signs of
    Pregnancy
  101. .Chadwick�s sign � is the purplish
    • or bluish discoloration of the
    • cervix, vagina, and vulva caused
    • by increased vascular congestion
  102. 12/30/2011
  103. A. McEachern, RN, BSN
  104. 32
    • Probable Signs of
    • Pregnancy Cont.
  105. .Hegar�s sign � is a softening of the
    • lower uterine segment. Because of
    • the softening, it is easy to flex the
    • body of the uterus against the
    • cervix, which is known as
    • .McDonald�s sign
  106. 12/30/2011 A. McEachern, RN, BSN 33
    • Probable Signs of
    • Pregnancy Cont.
  107. .Abdominal enlargement � occurs
    • irregularly in beginning
    • .end of twelfth week, uterine fundus
    • may be felt just above the symphysis
    • pubis
    • .extends to the umbilicus between
    • the 20th and 22nd week
  108. .Uterine or abdominal tumors can also
    cause enlargement
  109. 12/30/2011 A. McEachern, RN, BSN 34
    • Probable Signs of
    • Pregnancy Cont.
  110. �Braxton-Hicks contractions
    • �irregular, painless uterine
    • contractions that give the abdomen
    • the sensation of being hard and
    • tense
    • � Can become quite strong as term
    • approaches and be mistaken for true
    • labor.
  111. 12/30/2011 A. McEachern, RN, BSN
  112. 35
  113. Probable Signs of
    Pregnancy Cont.
  114. .Ballottement � is a maneuver by
    • which the fetal part is displaced by
    • a light tap of the examining finger
    • on the cervix and then rebounds
    • quickly
    • . Small tumors or polyps can also
    • cause this sensation.
  115. 12/30/2011 A. McEachern, RN, BSN 36
    • Probable Signs of
    • Pregnancy Cont.
  116. .Striae � or stretch marks are
    • pinkish white or purplish gray
    • lines some women develop
    • .Due to stretching of elastic tissue
    • to it�s capacity
    • .Can also occur from weight gain
  117. 12/30/2011 A. McEachern, RN, BSN 37
    Striae - Stretch Marks
  118. 12/30/2011 A. McEachern, RN, BSN 38
  119. Probable Signs of
    Pregnancy Cont.
  120. .Positive pregnancy test �
    • .Uses urine or blood to test
    • presence of human chorionic
    • gonadotropin (hCG)
    • .produced by the chorionic villi of
    • the placenta
    • .home tests are capable of being
    • 97% accurate if done correctly
  121. 12/30/2011 A. McEachern, RN, BSN 39
    • Pregnancy Tests � Probable
    • Sign
  122. .Pregnancy tests of all kinds are only
    • probable signs due to the possibility
    • of factors interfering with their
    • accuracy.
    • .Anti-anxiety medications
    • .Anticonvulsant drugs
    • .Blood in the urine
    • .Malignant tumors
    • .Premature menopause
  123. 12/30/2011 A. McEachern, RN, BSN 40
    • Positive Signs of
    • Pregnancy
  124. .Caused only by a developing fetus
    • .Include:
    • .Demonstration of fetal heart
    • activity
    • .Fetal movements felt by examiner
    • .Visualization of fetus by
    • ultrasound
  125. 12/30/2011 A. McEachern, RN, BSN 41
    • Positive Signs of
    • Pregnancy Cont.
  126. .Audible fetal heartbeat �
    • .Doppler device as early as 10
    • weeks
    • .Fetoscope can be used between
    • 18th and 20th weeks
    • .Assess woman�s pulse rate at same
    • time to be sure it is fetal heartbeat
    • that is being heard
  127. 12/30/2011 A. McEachern, RN, BSN 42
    • Positive Signs of
    • Pregnancy Cont.
  128. .Fetal movement felt by examiner �
    • in second trimester
    • .Ultrasound visualization of fetus �
    • may be possible as early as 4-5
    • weeks but routinely not done until
    • around 20 weeks
  129. 12/30/2011 A. McEachern, RN, BSN 43
    • Scan 10.tiff
    • 12/30/2011
  130. A. McEachern, RN, BSN 44
    Fetoscope
  131. 12/30/2011
  132. A. McEachern, RN, BSN 45
    Fetal Heart Rate
  133. .Fetal heart rate
    • .low of 110 to 120 beats/min
    • .high of 150-160
    • .Rate is higher in early gestation
    • and slows as term approaches
  134. 12/30/2011
  135. A. McEachern, RN, BSN 46
    • Physiological Changes in
    • Pregnancy
  136. .The woman�s body undergoes
    • dramatic changes as she houses
    • and nourishes her growing child
    • .Most of these changes reverse
    • shortly after birth
  137. 12/30/2011
  138. A. McEachern, RN, BSN
  139. 47
    • Physiological Changes -
    • Endocrine
  140. .Hormones are essential to maintain
    • pregnancy
    • .Most hormones are produced by the corpus
    • luteum initially and later by the placenta
    • .Placenta functions an a temporary endocrine
    • organ producing:
    • .estrogen and progesterone
    • .hCG (human chorionic gonadotropin)
    • .hPL (human placental lactogen)
  141. 12/30/2011 A. McEachern, RN, BSN
  142. 48
    • Physiological Changes �
    • Reproductive System
  143. .Uterus � undergoes obvious
    • changes
    • .Weighs 2 oz. before pregnancy
    • .Weighs 2.2 lbs. at term
  144. 12/30/2011 A. McEachern, RN, BSN
  145. 49
    • Physiological Changes �
    • Reproductive System Cont.
  146. .Cervix � changes in color and
    • consistency soon after conception
    • .Chadwick�s and Goodell�s signs
    • appear
    • .Secretion of thick mucous forms a
    • mucous plug that seals off the
    • cervical canal
  147. 12/30/2011 A. McEachern, RN, BSN
  148. 50
  149. Physiological Changes �
    Reproductive System Cont.
  150. .Ovaries � they do not produce
    • eggs (ova) during pregnancy
    • .The corpus luteum remains on the
    • ovary and produces progesterone
    • to maintain the decidua (uterine
    • lining) during the first 6-7 weeks
    • until placenta takes over
  151. 12/30/2011 A. McEachern, RN, BSN 51
  152. Physiological Changes �
    Reproductive System Cont.
  153. .Vagina � blood supply increases
    • causing Chadwick�s sign
    • .Vaginal pH becomes more acidic to
    • protect vagina and uterus from
    • pathogenic microorganisms
    • .Also have higher level of glycogen
    • which promotes Candida albicans, the
    • organism that causes yeast infections
  154. 12/30/2011 A. McEachern, RN, BSN 52
  155. Physiological Changes �
    Reproductive System Cont.
  156. .Breasts � high levels of estrogen and
    • progesterone prepare the breasts for
    • lactation
    • .In the last few months of pregnancy, thin
    • yellow fluid called colostrum may be
    • expressed from breasts
    • .It is pre-milk and is high in protein, fat-
    • soluble vitamins, and minerals but low in
    • calories, fat, and sugar.
    • .Contains mother�s antibodies to diseases and
    • is secreted for the first 2-3 days after birth in
    • breastfeeding woman
  157. 12/30/2011 A. McEachern, RN, BSN 53
  158. Physiological Changes �
    Respiratory System
  159. .Pregnancy causes more deep
    • breathing but not an increase in rate
    • .Increased estrogen levels during
    • pregnancy cause edema or swelling of
    • mucous membranes of nose, pharynx,
    • mouth, and trachea. This can cause
    • nasal stuffiness, epistaxis
    • (nosebleeds), and changes in her voice
  160. 12/30/2011 A. McEachern, RN, BSN 54
    • Physiological Changes �
    • Cardiovascular System
  161. .The growing uterus displaces heart
    • upward and to the left
    • .Blood volume increases 45% by term
    • .Blood pressure should not increase
    • though because resistance to blood
    • flow through the vessels decreases
  162. 12/30/2011 A. McEachern, RN, BSN 55
    • Physiological Changes �
    • Cardiovascular System
    • Cont.
  163. .A BP of 140/90 mm Hg or significantly
    • above a woman�s baseline calls for attention
    • .Supine hypotension syndrome (aortocaval
    • compression) can occur if woman lies on her
    • back
    • .The heavy uterus compresses her inferior
    • vena cava
    • .Can also cause decreased circulation to
    • placenta
  164. 12/30/2011 A. McEachern, RN, BSN 56
    Vena Cava Syndrome
  165. .What are S/S of vena cava
    • syndrome (or aortocaval
    • compression or supine
    • hypotension syndrome)??
    • .Dizziness
    • .Lightheadedness
    • .Faintness
    • .Agitation
  166. 12/30/2011 A. McEachern, RN, BSN 57
    Vena Cava Syndrome
  167. .What intervention could
    • you do??
    • .Turn patient to left side
    • .This displaces the uterus
    • to one side
  168. 12/30/2011 A. McEachern, RN, BSN 58
    • Physiological Changes �
    • Cardiovascular System
    • Cont.
  169. .Orthostatic hypotension � occurs
    • when rising from recumbent
    • position resulting in faintness or
    • lightheadedness.
    • .Why?
    • .Venous return drops causing a
    • decrease in cardiac output
  170. 12/30/2011
  171. A. McEachern, RN, BSN 59
    • Physiological Changes �
    • Cardiovascular System
    • Cont.
  172. .Both plasma (fluid) and red blood
    • cells (erythrocytes) increase during
    • pregnancy but not by same
    • amount
    • .Fluid portion increases more
    • causing a dilutional anemia or
    • pseudo anemia (false anemia)
  173. 12/30/2011 A. McEachern, RN, BSN 60
    • Physiological Changes �
    • Cardiovascular System
    • Cont.
  174. .Increased levels of clotting factors VII,
    • VIII, and X and plasma fibrinogen
    • during 2nd and 3rd trimesters
    • .This helps prevent excessive bleeding
    • after delivery when placenta separates
    • from uterine wall but does increase
    • possibility of thrombophlebitis
    • .Good teaching should be done to
    • prevent venous stasis
  175. 12/30/2011 A. McEachern, RN, BSN 61
    • Physiological Changes �
    • Gastrointestinal System
  176. .Acidity of gastric secretions is
    • decreased
    • .Emptying of the stomach and
    • motility (movement) of the intestines
    • are slower
    • .This can cause constipation and
    • hemorrhoids
  177. 12/30/2011 A. McEachern, RN, BSN
  178. 62
    • Physiological Changes �
    • Gastrointestinal System
  179. .Pyrosis � (heartburn) is caused by the
    • relaxation of the cardiac sphincter of
    • the stomach, permitting reflux of acid
    • secretions into lower esophagus
    • .Glucose metabolism is altered
    • because of increased insulin
    • resistance which puts the woman at
    • risk of gestational diabetes
  180. 12/30/2011 A. McEachern, RN, BSN 63
    • Physiological Changes �
    • Urinary System
  181. .More susceptible to UTI due to
    • decreased peristalsis to the
    • bladder
    • .Diameter of ureters and the
    • bladder capacity increase due to
    • relaxing effects of progesterone,
    • causing urine stasis
  182. 12/30/2011 A. McEachern, RN, BSN 64
    • Physiological Changes �
    • Urinary System
  183. .Fluid and Electrolyte Balance �
    • .Increased glomerular filtration rate
    • (GFR) in kidneys increases sodium
    • filtration by 50%, but the increase
    • in the tubular resorption rate
    • results in 99% reabsorption of the
    • sodium
    • .Fluid retention can cause edema
  184. 12/30/2011 A. McEachern, RN, BSN 65
  185. Physiological Changes �
    • Integumentary and
    • Skeletal Systems
  186. .High levels of hormones during pregnancy cause
    • a variety of temporary changes in skin:
    • .Pigmentary changes from presumptive signs of
    • pregnancy
    • .Sweat and sebaceous glands more active to
    • dissipate heat
    • .Spider nevi may occur
    • .Lordotic curve in lumbar spine becomes more
    • pronounced
    • .�Waddling� gait in last few weeks due to
    • separation of symphysis pubis
  187. 12/30/2011 A. McEachern, RN, BSN 66
    Spider Nevi
  188. spider-naevi-pregnancy.jpg
    12/30/2011
  189. A. McEachern, RN, BSN 67
    Lordotic Curve
  190. blogpic.jpg
    12/30/2011 A. McEachern, RN, BSN
  191. 68
    Vs Kyphosis
  192. kyphosis1.jpg
    12/30/2011 A. McEachern, RN, BSN
  193. 69
  194. Scan 13.tiff
    • 12/30/2011 A. McEachern, RN, BSN 70
    • Nutrition
  195. .Good nutrition is vital to good
    • health and essential for normal
    • growth and development along
    • with establishing and maintaining
    • a healthy pregnancy and give
    • birth to a healthy child.
  196. 12/30/2011 A. McEachern, RN, BSN 71
  197. Nutrition
  198. .A calorie increase of about 300
    • kcal/day is recommended to
    • provide for the growth of the
    • fetus, placenta, amniotic fluid, and
    • maternal tissues
  199. 12/30/2011 A. McEachern, RN, BSN
  200. 72
    Normal Weight Gain
  201. .Based upon a woman�s pre-pregnant weight and
    • BMI
    • .BMI considers the height and weight of the average
    • American adult
    • .BMI of 18.5-24.9 are considered normal weight
    • .Normal weight gain for a normal weight woman
    • prior to pregnancy is 25-35 lbs.
    • .Adjustments are made for underweight and
    • overweight
  202. 12/30/2011
  203. A. McEachern, RN, BSN 73
    Nutrition
  204. .Four nutrients that are especially
    • important in pregnancy are:
    • .Protein � 60 g/day
    • .Calcium � 1200 mg. (50% increase)
    • .Iron � 30 mg/day (50% increase)
    • .Folic acid � 400 mcg/day
  205. 12/30/2011 A. McEachern, RN, BSN 74
    Nutrition
  206. food_pyramid.gif
    12/30/2011
  207. A. McEachern, RN, BSN 75
    Fluids
  208. .The pregnant woman should
    • drink 8-10 8 oz. glasses of fluid
    • each day, most of which should be
    • water
  209. 12/30/2011
  210. A. McEachern, RN, BSN 76
  211. Special Nutrition
    Considerations
  212. .Pregnant Adolescent
    • .Greater nutritional needs
    • .Consider their characteristics of
    • resistance, ambivalence, and
    • inconsistency when planning
    • nutritional interventions
    • .Inadequate weight gain and nutrient
    • deficits are more likely
    • .May need additional 200 kcal/day
  213. 12/30/2011
  214. A. McEachern, RN, BSN 77
    Vegetarian or Vegan Diets
  215. .Should focus on protein-rich foods
    • such as soy milk, tofu, tempeh,
    • and beans
    • .Should supplement diet with
    • prenatal vitamins
  216. 12/30/2011
  217. A. McEachern, RN, BSN
  218. 78
    PICA
  219. .It is the craving for and ingestion of
    • nonfood substances such as clay, starch,
    • raw flour, and cracked ice
    • .Small amounts may be harmless but
    • large amounts of starch can interfere
    • with iron absorption and large amounts
    • of clay can cause a fecal impaction
    • .Can be a difficult habit to break
  220. 12/30/2011 A. McEachern, RN, BSN
  221. 79
    PICA in Kenya
  222. .In Kenya, 74% of antenatal women in low income
    • group are reported to practice pica regularly on
    • daily basis. The substances the women
    • swallow/chew are soft stones called odowa at 90%;
    • soil at 61%, and other substances at 10%. This means
    • majority of these women are mixing up more than
    • one substance that they ingest. The women say they
    • practice pica because they experience strong
    • cravings prior to swallowing/chewing pica items.
    • This means pica prevalence was significantly high
    • among pregnant women in that country.
  223. 12/30/2011 A. McEachern, RN, BSN
  224. 80
    Lactose Intolerance
  225. .This is a deficiency of the enzyme
    • lactase which digests the sugar in milk
    • .Higher incidence in Native Americans,
    • Latinos, and persons of African, Middle
    • Eastern, and Asian descent
    • .May have abdominal distention,
    • flatulence, nausea, vomiting, and loose
    • stools after ingestion of dairy products
  226. 12/30/2011
  227. A. McEachern, RN, BSN
  228. 81
  229. But I Don�t Like Milk
  230. .What substitutions can you suggest to a client who does not
    • like milk who is concerned about getting enough calcium?
    • .Enriched cereals
    • .Legumes
    • .Nuts
    • .Dried fruits
    • .Broccoli
    • .Green leafy vegetables
    • .Canned salmon and sardines that contain bones
    • .Supplements
  231. .
  232. 12/30/2011 A. McEachern, RN, BSN 82
  233. Cultural Preferences
  234. .Varied cultures believe that specific
    • foods have a dominant trait that
    • affects the �humoral balance� in the
    • body when ingested
    • .�hot� and �cold� foods have nothing
    • to do with the actual temperature
  235. 12/30/2011 A. McEachern, RN, BSN 83
  236. Cultural Preferences
  237. .Examples of �hot� foods are peanuts,
    • mangoes, ice cream, tea, cereal grains,
    • and hard liquor
    • .Examples of �cold� foods are milk,
    • green leafy vegetables, fresh water fish,
    • chicken, bananas, and citrus fruits
    • .Teaching must consider these cultural
    • beliefs and practices
  238. 12/30/2011 A. McEachern, RN, BSN
  239. 84
  240. Gestational Diabetes
    Mellitus
  241. .First diagnosed during pregnancy
    • rather than being present before
    • .Calories should be evenly
    • distributed during the day among
    • three meals and three snacks to
    • maintain adequate and stable
    • blood glucose levels
  242. 12/30/2011 A. McEachern, RN, BSN 85
    • Gestational Diabetes
    • Mellitus
  243. .Pregnant women are susceptible to
    • hypoglycemia during the night
    • because the fetus continues to use
    • glucose while the mother sleeps
    • .Protein and complex carbohydrate
    • snack before bed
    • .If not controlled, macrosomia can
    • occur (abnormally large newborn)
  244. 12/30/2011 A. McEachern, RN, BSN 86
    Hang in there!!!!
  245. imagesCAWATP10.jpg
    12/30/2011
  246. A. McEachern, RN, BSN 87
    • Nutritional Requirements
    • During Lactation
  247. .Caloric intake should be about 500
    • calories more than the
    • nonpregnant woman�s RDA
    • .Indicator is stable maternal weight
    • and increasing infant weight
    • .65 mg of protein are
    • recommended per day
  248. 12/30/2011
  249. A. McEachern, RN, BSN 88
    • Nutritional Requirements
    • During Lactation
  250. .Hydration of mother is important
    .8-10 glasses of non-caffeine beverages
  251. .Foods that cause gastric upset should
    • be avoided
    • .Mothers should be aware that some
    • drugs or medications are secreted in
    • milk so they should consult HCP before
    • taking anything
  252. 12/30/2011
  253. A. McEachern, RN, BSN 89
    Exercise During Pregnancy
  254. .Mild to moderate exercise has
    • been shown to be beneficial but
    • vigorous should be avoided
    • .Consult HCP before beginning
    • any exercise regimen, especially if
    • not exercising prior to pregnancy
  255. 12/30/2011
  256. A. McEachern, RN, BSN
  257. 90
    • Exercising During
    • Pregnancy
  258. .Some factors that should be evaluated
    • and discussed with the pregnant client:
    • .Elevated temperature � exercise can
    • elevate mother�s temp causing decreased
    • fetal circulation and cardiac function
    • (NO hot tubs or saunas)
    • .Temp of mother should not exceed 100.4
  259. .Hypotension risk � supine hypotension
    syndrome
  260. 12/30/2011 A. McEachern, RN, BSN
  261. 91
    • Exercising During
    • Pregnancy
  262. .Factors cont.
    • .Cardiac output � pregnancy increases
    • the workload of the heart
    • .If exercise is allowed to exceed the ability
    • of the cardiovascular system, blood can
    • be diverted from the uterus, causing fetal
    • hypoxia
    • .Exercise increases catecholamine levels
    • which the placenta may not be able to
    • filter, causing fetal bradycardia and
    • hypoxia
  263. 12/30/2011 A. McEachern, RN, BSN
  264. 92
    • Exercising During
    • Pregnancy
  265. .Factors cont.
    • .Hormones � exercise can cause
    • changes in oxygen consumption and
    • epinephrine, glucagon, cortisol,
    • prolactin, and endorphin levels
    • .Early on, these changes can
    • negatively affect implantation of the
    • zygote and vascularization of uterus
    • .Later, the increase in catecholamines
    • during exercise can trigger labor
  266. 12/30/2011 A. McEachern, RN, BSN
  267. 93
  268. Exercising During
    Pregnancy
  269. .Moderate exercise several times a
    • week from 8th week to delivery
    • has many benefits:
    • .More positive self image
    • .Decrease in musculoskeletal
    • discomforts
    • .More rapid return to pre-pregnant
    • weight after delivery
  270. 12/30/2011 A. McEachern, RN, BSN 94
  271. Travel During Pregnancy
  272. .Generally safe for pregnant
    • women to travel
    • .Research medical care at
    • destination ahead of time
    • .Increased risk of
    • thromboembolism already so do
    • not sit for long periods of time
  273. 12/30/2011 A. McEachern, RN, BSN 95
  274. Common Discomforts in
    Pregnancy
  275. .What can we teach the pregnant woman about
    • relieving or preventing the following?
    • .Nausea
    • .Vaginal discharge
    • .Fatigue
    • .Backache
    • .Constipation
    • .Varicose veins
    • .Hemorrhoids
    • .Heartburn
    • .Nasal stuffiness
    • .Dyspnea
    • .Leg cramps
    • .Edema of lower extremities
  276. 12/30/2011
  277. A. McEachern, RN, BSN 96
  278. Impact of Pregnancy on
    the Mother
  279. .Four maternal tasks that are accomplished
    • during pregnancy as she becomes a mother:
    • .Seeking safe passage for herself and her fetus
    • .Securing acceptance of herself as a mother
    • and for her fetus
    • .Learning to give of self and receive the care
    • and concern of others
    • .Committing herself to the child as she
    • progresses through pregnancy
  280. 12/30/2011 A. McEachern, RN, BSN 97
    • Impact of Pregnancy on
    • the Mother
  281. .First Trimester �
    • .Non-belief � confirmation of
    • pregnancy
    • .Ambivalence � conflicting feelings
    • on being pregnant whether
    • planned or not
    • .Physical & hormonal changes
  282. 12/30/2011 A. McEachern, RN, BSN 98
    • Impact of Pregnancy on
    • the Mother
  283. .Second Trimester �
    • .Pregnancy becomes more real
    • .A more stable time for the mother
    • .Body changes become more evident �
    • this can be welcome or unwelcome
    • .Tries to visualize what her child will
    • look, act like
    • .Starts planning
    • .Sexual relationship changes
  284. 12/30/2011 A. McEachern, RN, BSN
  285. 99
    • Impact of Pregnancy on
    • the Mother
  286. .Third Trimester �
    • .Body changes are more dramatic
    • .Can go from feeling beautiful to
    • ugly and as big as a house
    • .Feels like pregnancy will never
    • end
  287. 12/30/2011 A. McEachern, RN, BSN 100
    Impact on the Father
  288. .Varies widely
    • .Cultural influences play a part
    • .Fathers go through phases similar to those of
    • expectant mother
    • .Announcement phase
    • .Adjustment phase
    • .Focus phase
  289. .Nurse�s role is to help father achieve positive
    outcomes in each phase
  290. 12/30/2011 A. McEachern, RN, BSN 101
    Impact on the Father
  291. .He is often asked to provide
    • emotional support to his partner
    • while struggling with issue of
    • fatherhood himself
    • .He has needs also
    • .He is trying to learn role of father just
    • as mother is learning her new role
  292. 12/30/2011 A. McEachern, RN, BSN 102
  293. Impact of Pregnant
    Adolescent
  294. .Unplanned pregnancies
    • .How to handle breaking the news
    • to parents and to the father
    • .Denial of pregnancy until late in
    • gestation is not uncommon
    • .There may be financial problems,
    • shame, guilt, relationship
    • problems with the infant�s father
  295. 12/30/2011 A. McEachern, RN, BSN 103
    • Impact on the Pregnant
    • Adolescent
  296. .Nurse must anticipate resistive
    • behavior, ambivalence, and
    • inconsistency in the adolescent
    • .They are coping with two of life�s
    • most stress-laden transitions
    • simultaneously
  297. 12/30/2011 A. McEachern, RN, BSN 104
    Nursing Diagnosis
  298. .Delayed growth and development
    • r/t pregnancy
    • .Impaired social interaction r/t
    • self-concept disturbance
    • .Noncompliance r/t denial of
    • pregnancy
  299. 12/30/2011 A. McEachern, RN, BSN 105
    • Impact on the Older
    • Couple
  300. .While they are �ready� for
    • parenthood, they may be at risk of
    • impaired social interaction
    • .May be placed in a
    • �high risk� prenatal group
  301. 12/30/2011 A. McEachern, RN, BSN 106
    • Impact on the Single
    • Mother
  302. .Trend of waiting until later to have
    • children
    • .Some are at end of childbearing years
    • and choose in vitro fertilization
    • .Need emotional support
    • .Now more accepted than in the past
  303. 12/30/2011 A. McEachern, RN, BSN 107
    Impact on the Single Father
  304. .May or may not want to be
    • involved emotionally or
    • financially
    • .May be rejected by the woman
  305. 12/30/2011 A. McEachern, RN, BSN 108
    Impact on Grandparents
  306. .Some eagerly anticipate the announcement
    • that a grandchild is on the way
    • .Others associate with getting old
    • .May be subdued if they already have several
    • grandchildren
    • .Conflicts can arise if they have different
    • views on their role and involvement than
    • their children
  307. 12/30/2011 A. McEachern, RN, BSN 109
    Impact on Siblings
  308. .All siblings will be affected by the
    • arrival of a new baby
    • .Requires special time and effort to
    • reassure that they will still be
    • loved as they were before
  309. 12/30/2011
  310. A. McEachern, RN, BSN 110
    Prenatal Education
  311. .Should progress according to the nursing
    • process:
    • .Assess the history and cultural needs
    • .Diagnose the knowledge deficit
    • .Plan the goals and priorities
    • .Outcomes identification clarifies expected
    • outcomes
    • .Teach (implement) the facts and rationales
    • .Evaluate the knowledge gained and the goals
    • achieved
  312. 12/30/2011 A. McEachern, RN, BSN 111
    • Effect of Pregnancy and
    • Lactation on Medication
    • Metabolism
  313. .Subtherapeutic drug levels may
    • occur because of:
    • .Increased plasma volume, cardiac
    • output, and glomerular filtration
    • that occur during pregnancy
  314. 12/30/2011 A. McEachern, RN, BSN 112
    • Effect of Pregnancy and
    • Lactation on Medication
    • Metabolism
  315. .Decreased gastric emptying time
    • during pregnancy changes
    • absorption of drugs and can delay
    • onset of action
    • .Parenteral medication may be
    • absorbed more rapidly due to
    • increased blood flow
  316. 12/30/2011 A. McEachern, RN, BSN
  317. 113
    • Effect of Pregnancy and
    • Lactation on Medication
    • Metabolism
  318. .Drugs can cross the placenta and
    • have an impact on fetal
    • development
    • .Drugs can pass into breast milk by
    • diffusion and be ingested by the
    • neonate during breastfeeding
  319. 12/30/2011 A. McEachern, RN, BSN 114
    • FDA Pregnancy Risk
    • Categories for Drugs
  320. .Category A � no risk
    • demonstrated to the fetus in any
    • trimester
    • .Category B � No adverse effects in
    • animals; no human studies
    • available
  321. 12/30/2011 A. McEachern, RN, BSN 115
    • FDA Pregnancy Risk
    • Categories for Drugs
  322. .Category C � Only prescribed after risks to
    • the fetus are considered. Animal studies
    • have shown adverse reaction; no human
    • studies available
    • .Category D � Definite fetus risks, but may be
    • given in life-threatening situations
    • .Category X � Absolute fetal abnormalities.
    • Not to be used anytime during pregnancy
  323. 12/30/2011 A. McEachern, RN, BSN 116
  324. Good Prenatal Teaching!!!
  325. .Should include teaching on:
    • .Risks of smoking
    • .Alcohol use
    • .Illicit drug use
    • .Advantages of breastfeeding
    • .Good nutrition during pregnancy
  326. 12/30/2011 A. McEachern, RN, BSN 117
    Check It Out!!!
  327. .Table 4-6 on page 73-75
    • .Great interventions and teaching
    • for each trimester of pregnancy
  328. 12/30/2011 A. McEachern, RN, BSN 118
  329. 12/30/2011 A. McEachern, RN, BSN 119 imagesCAHRNDB1.jpg

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