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The flashcards below were created by user
NurseFaith
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Focus of Nursing Care Prior to Pregnancy:
Assessment of health of the woman and potential risk factors
Education on health promotion and disease prevention
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Focus of Nursing Care During Pregnancy:
Regular Assessment of the health of the pregnancy
Regular assessment and screening of risk factors for potential complications
Education on health promotion and disease prevention
Inclusion of significant others/family in care and education to promote pregnancy adaptation
Implementation of appropriate interventions based on risk status or actual complications
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Set of interventions that aim to identify medical, behavioral and social risks to a woman's health or pregnancy outcome through prevention and management
Preconception Care
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The physical examination of woman during preconception:
Ht/Wt to calculate BMI and access whether it is a healthy weight
Comprehensive physical exam
Breast Exam
Pelvic Exam
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Labs/Diagnostic Tests that are done on a woman preconception visit:
- Pap Smear- screening test for cervical cancer
- Blood type and Rh factor
- CBC
- Serum Cholesterol
- Serum Glucose
- Urinalysis
- HIV
- Syphilis
- STD
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Provision of information and guidance to women and their families that enables them to be knowledgeable and prepared as the process of pregancy and childbirth unfolds
Anticipatory Guidance
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Preconception Education:
- Nutrition
- Prenatal Vitamins
- Exercise
- Self-care
- Contraception Cessation
- Timing of Conception
- Modifying behaviors to reduce risks
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BMI classification:
- Underweight- <18.5
- Normal- 18.5-24.9
- Overweight- 25-29.9
- Obese- >30
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Obesity increases a woman's risk for:
Antepartum complications: HTN, Preeclampsia, Gestational Diabetes, Thromboembolism, UTI
Complications during childbirth (LGA-large for gestational age), macrosomia
Prolonged labor and difficult delivery
Csection
Postpartum Hemorrhage
Poor wound healing
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Nutritional Education for Women of Childbearing Years:
Educate on diet and physical activity and their role in reproductive health
Advice on importance of achieving and maintaining a healthy weight prior to conception
Encourage nutritious food choices with emphasis on fresh fruits, veggies, lean protein, low/non fat
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Types of Prenatal Vitamins/Nutrients
Folic Acid-- decreases risk for neural tube defect (0.4mg daily recommended)
Calcium, magnesium, vitamin D-- bone health
Iron
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Nursing Actions in Preconception Care:
Provide comfort and privacy
Use therapeutic communication techniques
Obtain the health history
Conduct Review of Systems
Teaching about procedures
Assist with physical, pelvic exams and obtaining specimens
Provide anticipatory guidance and education related to plan of care and appropriate follow-up
Assess the patient's understanding
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All subjective signs of pregnancy
Presumptive Signs
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Presumptive Signs of pregnancy:
- Amenorrhea (absence of period)
- N/V
- Breast Changes (englargement, tenderness)
- Fatigue
- Urination Frequency
- Quickening (around 18-20 weeks)
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Objective signs of pregnancy (all physical and anatomical changes)
Probable Signs
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Probable signs of pregnancy:
Chadwick's Sign-- bluish color of vaginal mucosa, cervix and vulva
Goodell's Sign-- Softening of cervix with increased leukorrheal discharge (8 weeks)
Hegar's Sign-- softening of uterine segmant (6 weeks)
Uterine Growth/Abdominal Growth
Skin Hyperpigmentation-- Melasma, Linea nigra
Ballottement-- light tap on cervix causes fetus to rise
Positive Pregnancy Test
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Objective signs of pregnancy that can only be attriubuted to the fetus
Positive
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Positive signs of Pregnancy:
Auscultation of the fetal heart by 10-12 weeks with Doppler
Observation and palpation of fetal movement by the examiner after 20 weeks gestation
Sonographic Visualization of the fetus (Cardiac movement noted at 4-6 weeks)
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Prenatal period, begins with the first day of the last normal menstrual period
Antepartum Period
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First Trimester time frame
First day of last normal menstrual period (LMP) - 14 completed weeks
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Second Trimester time frame
15 weeks - 28 weeks
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Third Trimester time frame
29 weeks-40 weeks/delivery
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Date that best represents an estimation of when the baby will be born
Estimated Date of Delivery (EDD)
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Ways to calculate the EDD
- LMP
- Physical Exam/Uterine Size
- First Auscultation of FHR
- Date of quickening
- Ultrasound Exam
- History of Assisted Reproduction
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Standard formula for determining EDD
Naegele's Rule
LMP - 3months + 7 days
ex: LMP is Sept 7 - 3months is June 7 + 7 days= June 14
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Two digit system to denote pregnancy and birth history
G/P
G=gravida (total number of times the woman has been pregnant)
P=number of births after 20 weeks gestation whether live or still birth
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GTPAL
- G= Gravida (# of times being pregnant)
- T= number of term infants (after 37 weeks)
- P= number of pre-term (between 20-37 wks)
- A= number of abortions
- L= number of children currently living
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Irregular, intermittent, painless and physiological uterine contractions
Braxton-Hicks contractions
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Cardiovascular changes during pregnancy:
Hypervolemia (blood volume increases by 40-50%)
- Plasma fibrin increases
- Fibrinogen increases
- Coagulation inhibiting factors decrease
Supine Hypotensive Syndrome
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Hypotensive condition resulting from woman lying on her back in mid-late pregnacny
- Supine Hypotensive Syndrome
- (woman may get dizzy and faint)
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Pt education on Sypine Hypotensive Syndrome:
Educate on causes
Encourage iron-rich foods and supplements to prevent anemia
Instruct the woman in prevention/relief measures for edema and variscosities
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Most common bacterial infection during pregnancy
UTI
- *teach s/s of UTI
- *educate as to why there is increased frequency
- *Encourage UTI prevention measures:
- -empty bladder often
- -wiping front to back
- -washing hands before/after urination
- -urinating after sex
- -at least 8 glasses of liquid a day
- -Kegel exercises
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Craving for and consumption of nonfood substances
Pica
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Darkened line in midline of abdomen
Linea Nigra
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Mask of Pregnancy, brownish pigmentation of skin over cheeks, nose, and forehead...from sun exposure
Melasma (chlasma)
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EBP: Centering Pregnancy ... group prenatal care
- -health assessment occurs w/in group space
- -participants are involved in self care
- -a facilitated leadership style is used
- -each session has overall plan
- -attention given to general outline
- -stability of group leaders
- -group conduct honors contribution of each
- -group conducted in circle
- -opportunity for socializing is provided
- -composition of group is stable, not rigid
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EBP: Benefits of Group Prenatal Care
- Improved birth outcomes
- Improved pt satisfaction
- Improved pt knowledge/readiness for labor
- Higher breastfeeding initiation rates
- Improvement in racial disparities
- No increase in antenatal service costs
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Screening for gestational diabetes occurs during:
Second Trimester: 24-28 weeks
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ABCs of pt care to guide nurses caring for victims of abuse:
- A- alone (they aren't)
- B- belief (not her fault)
- C- confidentiality
- D- documentation
- E- education
- S- safety (when they decide to leave)
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WARNING signs during first trimester
- Abdominal Cramping (possible abortion, UTI, appendicitis)
- Vaginal Spotting
- Absence of FHR
- Dysuria, frequency, urgency-- UTI
- Infection (fever, chills)
- Prolonged N/V-- hyperemesis gravidarum (DEHYDRATION!)
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Foods to avoid during pregnancy
- Unpasteurized juice or dairy products
- Raw sprouts of any kind
- Soft Cheeses like Brie or Feta
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Total Weight needed to Gain in relation to patient's BMI
- Underweight (<18.5) -- 28-40lbs, 1 per wk
- Normal (18.5-24.9) -- 25-35lbs, 1 per wk
- Overweight (25-29.9) -- 15-25, <1 per wk
- Obese (>30) --11-20, <1 per wk
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