Physiological Aspects of Antepartum Care

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Physiological Aspects of Antepartum Care
2014-09-05 21:25:15
Chapter Four
Chap Four
Chap 4
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  1. Focus of Nursing Care Prior to Pregnancy:
    Assessment of health of the woman and potential risk factors

    Education on health promotion and disease prevention
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. Preconception Education:
    • Nutrition
    • Prenatal Vitamins
    • Exercise
    • Self-care
    • Contraception Cessation
    • Timing of Conception
    • Modifying behaviors to reduce risks
  8. BMI classification:
    • Underweight-  <18.5
    • Normal-  18.5-24.9
    • Overweight-  25-29.9
    • Obese-  >30
  9. 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


    Postpartum Hemorrhage

    Poor wound healing
  10. 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
  11. Types of Prenatal Vitamins/Nutrients
    Folic Acid-- decreases risk for neural tube defect  (0.4mg daily recommended)

    Calcium, magnesium, vitamin D-- bone health

  12. 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
  13. All subjective signs of pregnancy
    Presumptive Signs
  14. Presumptive Signs of pregnancy:
    • Amenorrhea (absence of period)
    • N/V
    • Breast Changes (englargement, tenderness)
    • Fatigue
    • Urination Frequency
    • Quickening (around 18-20 weeks)
  15. Objective signs of pregnancy (all physical and anatomical changes)
    Probable Signs
  16. 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
  17. Objective signs of pregnancy that can only be attriubuted to the fetus
  18. 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)
  19. Prenatal period, begins with the first day of the last normal menstrual period
    Antepartum Period
  20. First Trimester time frame
    First day of last normal menstrual period (LMP) - 14 completed weeks
  21. Second Trimester time frame
    15 weeks - 28 weeks
  22. Third Trimester time frame
    29 weeks-40 weeks/delivery
  23. Date that best represents an estimation of when the baby will be born
    Estimated Date of Delivery (EDD)
  24. Ways to calculate the EDD
    • LMP
    • Physical Exam/Uterine Size
    • First Auscultation of FHR
    • Date of quickening
    • Ultrasound Exam
    • History of Assisted Reproduction
  25. 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
  26. Two digit system to denote pregnancy and birth history

    G=gravida (total number of times the woman has been pregnant)

    P=number of births after 20 weeks gestation whether live or still birth
  27. 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
  28. Irregular, intermittent, painless and physiological uterine contractions
    Braxton-Hicks contractions
  29. Cardiovascular changes during pregnancy:
    Hypervolemia (blood volume increases by 40-50%)

    • Plasma fibrin increases
    • Fibrinogen increases
    • Coagulation inhibiting factors decrease

    Supine Hypotensive Syndrome
  30. Hypotensive condition resulting from woman lying on her back in mid-late pregnacny
    • Supine Hypotensive Syndrome
    • (woman may get dizzy and faint)
  31. 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
  32. Most common bacterial infection during pregnancy

    • *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
  33. Craving for and consumption of nonfood substances
  34. Darkened line in midline of abdomen
    Linea Nigra
  35. Mask of Pregnancy, brownish pigmentation of skin over cheeks, nose, and forehead...from sun exposure
    Melasma (chlasma)
  36. 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
  37. 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
  38. Screening for gestational diabetes occurs during:
    Second Trimester: 24-28 weeks
  39. 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)
  40. 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!)
  41. Foods to avoid during pregnancy
    • Unpasteurized juice or dairy products
    • Raw sprouts of any kind
    • Soft Cheeses like Brie or Feta
  42. 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