ANTEPARTUM #3 CARE OF CHILDBEARING FAMILY Flashcards
OBJECTIVE/PROBABLE
- cervix increased vascularity
- enlargement of the abdomen
- Braxton hicks contractions
- uterine soufflé
- ballottement
- fetal outline palpation after 24 weeks
- skin pigmentation changes
- pregnancy tests
SIGNS OF PREGNANCY: 3 CATEGORIES
- presumptive- changes felt by the women
- probable - changes observed by an examiner
- positive - signs that attributable only to the presence of a fetus
SUBJECTIVE/PRESUMPTIVE
-AMENORRHEA
earliest sign of pregnancy
-NAUSEA AND VOMITING
hormonal influences appears by 6weeks disappear 6-12 weeks later
- EXCESSIVE FATIGUE
- URINARY FREQUENCY
- BREAST CHANGES
- QUICKENING
DIAGNOSTIC/POSITIVE SIGNS OF PREGNACY
-FETAL HEARTBEAT
electronic Doppler: 8-12 wk
-FETAL MOVEMENTS
palpable at about 20wks
-VISUALIZATION OF THE FETUS (VAGINAL SONO)
~the gestational sac can be observed by 4-5 wks (10 days after implantation)
~cardiac activity at 6-7 weeks gestation
~fetal parts 8 weeks
PREGNANCY TESTS -PROBABLE
- serum and urine testing for hCG levels
- urine tests best with “first AM void” 5th week
- 95% accurate
- 98% in determining the absence of pregnancy
- Eliza testing most popular for OTC home kits, earlier detection affords prompt pre natal care
HORMONES IN PREGNANCY
PROGESTERONE
- produced by the placenta
- maintains pregnancy
- develops acini and lobules of the breast
RELAXIN
- produced by the corpus luteum
- inhibits uterine contractions
- softenining of the cervix
PROSTAGLANDINS
- high concentration found in the female reproductive tract and decidua
- maintains placental vascular resistance
- initiates labor
HORMONES IN PREGNANCY
HUMAN CHORIONIC GONADOTROPIN (HCG)
- secreted by the trophoblast
- stimulate progesterone and estrogen production by the corpus luteum to maintain pregnancy
HUMAN PLACENTAL LACTOGEN (HPL)
- promotes growth of fetus by regulating glucose available to it
- promotes breast development and lactation
ESTROGEN
- produced by the placenta -7 weeks stimulates uterine development
- ductal development of the breast
UTERUS
BEFORE PREGNANCY
- small semi solid ,pear shaped organ
- weight 60g
- capacity 10ml
TERM PREGNANCY
- increased in size
- weight 1000g
- capacity 5000ml
CERVIX
- increases in cell number
- secretes thick tenacious mucus
- mucus plug
-increased vascularization
VAGINA
- vaginal epithelial hypertrophy and hyperplasia
- thick white discharge known as leucorrhea
- Acid PH
OVARIES
- ovulation ceases
- HCG maintains corpus luteum
- corpus luteum prduces progesterone, estrogen and HCG
BREAST
- progesterone causes tissue hypertrophy and increased glandular size
- colostrum production
- straie- purplish stretch marks
CARDIOVASCULAR SYSTEM
- heart displaced laterally upward
- blood colume increased by 40-50%
- HR increases 10-15bpm may have murmur
- BP slightly decreased in 2nd trimester
- increased femoral pressure leads to dependent edema and varicose veins
- physiological anemia of pregnancy
- WBC increases (15000 without infection)
- hyper coagulation along with increased venous pressure =risks of thrombosis
VEBAL CAVAL SYNDROME
- pressure on the vena cava by the enlarging uterus
- pressure interferes with returning blood flow= decresed BP with dizziness, pallor, clamminess
- lie on left side and arise slowly
RESPIRATORY CHANGES
- the diaphragm is elevated with the sub-costal angle increased
- thoracic breathing with increased tidal volume
- nasal stuffiness and congestion along with epistaxis common
- physiological dyspnea of pregnancy common
GENITOURINARY
- 1st trimester growing uterus presses against bladder causing urinary frequency
- better in 2nd trimester then returns in 3rd
- pressure on the bladder results in urinary stasis and can lead to UTI
- proteinuria (decreases 1+) and glycosuria
- kidney -glomerular filtration rate increases
INTEGUMENTARY
-changes stimulated by increased estrogen, progesterone,melanocte stimulating hormones
- pigmentation of skin
- linea alba -linea nigra
- chloasma- “mask of pregnancy”
- striae gravidarium
- vascular spider nevi
GASTROINTESTINAL SYSTEM
- nausea and vomiting of pregnancy
- hyperemesis gravidarum
- ptyalism
- pyrosis(heartburn)
- constipation
- pica
MUSCULOAKELETAL
- hormones relaxin and progesterone causes the sacroiliac, sacrococcygeal joints to relax =waddling gait
- change in posture due to gravity changes. center of gravity shift forward
METABOLISM
- recommended total weight gain 11.5-16kg=25-35lbs for normal weight woman
- weight may decrease slightly during the 1st trimester due to nausea and vomiting
- low material weight associated with preterm labor ,SGA and IUGAR
- increased maternal weight associated with LGA and birth complications
NEUROLOGICAL
- lightheadedness:r/t vaso instability, postural hypotension or hypoglycemia
- carpal tunnel syndrome: r/t edema and compression of medial nerve
- tension HA
- numbness and tingling of hands
WEIGHT GAIN
1st trimester- 2-4lb total
2nd- 1lb per week
3rd- 1lb per week
WEIGHT GAIN DISTRIBUTION
- 0kg=11lb=fetus,placenta,amniotic fluid
- 9kg=2lb=uterus
- 8kg=4lb=blood volume
- 4kg -3lb= breast tissue
- 3-4.5kg=5-10lb=maternal stores
CALORIC NEEDS
RDA- no caloric increase 1st trimester
increase 300cals during 2nd and 3rd trimesters
fluid 8-10 , 8oz glasses of which 4-6 glasses is water
carbohydrates 50-55%
protein 15-20%
fats 30% (decrease 10% sat)
vitamin and minerals
PSYCHOLOGICAL VARIABLES OF PREGANCY
- ambivalence
- acceptance
- introversion
- mood swings
- changes in body image /role
- rubin’s psychologic tasks (mother)
- response of the father/siblings
NUTRITION PLAN FOR THE DAY
protein - 6oz milk/products- 4 servings (low fat) veggies- 3-5 servings fruit- 2-4 servings grains - 6-11 servings
folic acid- 600mcg/day
ANTEPARTAL NURSING HISTORY
- present history and past medical history
- family history
- current pregnancy
- past pregnancy
- gynecologic history
- psychological history (include abuse)
- cultural history
- paternal health history
ACCOMODATE RELIGIOUS RITUALS AND PRACTICES
- religious beliefs influence experiences and attitudes
- incorporate into plan of care by doing a history
BIOLOGICAL INFLUENCES AMONG GENDER AND RACES
-BLACKS- increase BP, lactose intolerance, sickle cell thalassemia
ASIANS- sickle cell, thalassemia
MEDITERRAINIAN- sickle cell , thalassemia
INDIAN -type II diabetes , lactose intol
MEXICAN -lactose intol
CULTURAL ASSESSMENT
- who in the family must be consulted before decisions are made
- what type of healthcare provider is most appropriate
- what beliefs or traditions may affect the plan of care
DOMESTIC VIOLENCE SCREENING QUESTIONS
are you with a partner who threatens or physically hurts you?
within the past year or in this pregnancy has anyone hit, slapped, kicked ,or otherwise hurt you?
has anyone forced you to have sexual activities that made you uncomfortable
DEVELOP CULTURAL COMPETENCE
- self awareness
- awareness and understanding of cultural differences
- ability to adapt clinical skills and practices as needed
- knowledge
ASSESSING FOR DOMESTIC ABUSE
- does client have inappropriate affect
- delay in reporting symptoms
- serious injuries are left untreated
- intimate partner never leaves client’s side
- “cause” of injury is inconsistent with findings
- missed appointments
- cultural variables
WHAT TO DO?
- avoid judgmental comments or asking why
- do not speak directly to suspected abuser
- what to say: I am afraid for you , you are not alone, I am here for you
- choose words carefully….survivor is empowering while victim is not
DOMESTIC VIOLENCE DURING PREGNANCY
- incidence from 4-20%
- may occur for 1st time during pregnancy
- intensifies with positive history of abuse
- risks include miscarriage, stillbirths and pre-term delivery
NURSING PROCESS:SUBSTANCE ABUSE
ASSESSMENT
- matter of fact, non judgmental, non punitive approach
- what are the physical /behavioral signs
-DIAGNOSIS
-PLANNING
~therapeutic relationship
-IMPLEMENTATION ~education ~referral ~evaluation ~ongoing
INTERVENTIONS SUBSTANCE ABUSE
- behavioral therapy
- recovery environment
- support groups
- detoxification
- medication therapy
LABORATORY EVALUATIONS
- urine analysis
- complete blood count
- blood type and Rh
- antibody titer (indirect combs)
- VDRL/STD
- rubella titer
- sickle cell screen
- HIV
- genetic screening
- GTT -blood sugar
- GBS -strep
OBSTETRIC EXAM
- mcdonald’s rule
- vaginal exam :increased vascularity hormonal influence
- PAP
- internal pelvic measurement
- breast examination
PHYSICAL ASSESSMENT
-vital signs
report BP > 140/90
-weight
-prenatal visits -for normal pregnancy
every 4 wks for 1st trimester
every 2wks until 36wks
every wk after 36 wks
FUNDAL HEIGHT
- measured in cm to assess gestational age of fetus
- at 20wks fundal ht- @level of umbilicus
- between 22-34wks fundal ht approximates fetal age in weeks +-2 cm
TEACHING THE DANGER SIGNS OF PREGNANCY
report the following to practitioner promptly
- HA, visual disturbance or dissiness
- BP> 140/80
- epigastric ,abdominal or severe flank pain
- burning on urination
- chest pain or SOB with activity
- vaginal bleeding or leakage of fluid from vagina
- decrease in fetal movement
- fever>38C (100.4)
SUBSQUENT ROUTINE ANTEPARTAL EXAM
- glucose tolerance test 28wks
- group B strep 35-37 wks
- VS
- BP
- UA
- weight gain
- uterine size
- fetal HR
- psychological status
- assess danger signs
- education/support
SUBSEQUENT VISITS CONTINUE TO MONITOR
- course of pregnancy
- woman’s responses
- discomfort
- physical changes
- adjustment of the support person,children
SUMMARY DISCOMFORTS:1ST TRIMESTER
- nausea/vomiting
- fatigue
- urinary frequency
- breast sensitivity
- nasal stuffiness
- leucorrhea
- ptylism
THE FOLLOWING DISCOMFORTS Y=TYPICALLY INTENSIFY AS THE PREGNANCY PROGRESSES
- constipation
- hemorrhoids
- backaches
- round ligament pain
SUMMARY DISCOMFORTS 2ND AND 3RD TRIMESTER
heartburn flatulence leg cramps varicose veins edema of feet/ankles feeling faint SOB carpal tunnel syndrome
ALLEVIATING COMMON DISCOMFORTS
NAUSEA
- small frequent meals,fluid between meals
- crackers before arising
- carbonated beverages
URINARY FREQUENCY
-void every 2 hrs
FATIGUE
-napping
BREAST TENDERNESS
-wear supportive bra
INCREASED VAGINAL DISCHARGE
-daily bathing, cotton underwear, avoid douching
NASAL STUFFINESS
-cool air vaporizers, normal saline nasal spray
HEARTBURN
- non sodium antacids
- avoid eating just before be
- head of bed elevated
ANKLE EDEMA
-avoid prolonged sitting or standing ,keep feet and legs elevated
VARICOSE VEINS
-regular exercise, avoid prolonged sitting or standing
FLATULENCE
-regular bowel habits
HEMORRHOIDS
-avoid constipation, gently self reduce hemorrhoid
FAINTNESS
-sit down and lower head between knees avoid standing in one place too long
SOB
-good posture when sitting ,prop up in bed
DIFFICULTY SLEEPING
-avoid caffeine, maximize comfort in bed
BACKACHE
-pelvic tilt,posture,avoid fatigue, body mechanics
CONSTIPATION
-increase fluids and roughage, daily exercise, regular bowel habits
2ND AND 3RD TRIMESTER
sexual activity- generally no limitations until membranes rupture unless stated by practioner but may need to try different positions
physical activity
maintain normal activity as is comfortable for individual mother
MEDICAL RISKS FOR OLDER EXPECTANT MOTHERS
- death
- chronic medical condition
- miscarriage
- gestational diabetes
- hypertension
- placenta previa
- difficult labor
- newborn complications
- low birth weight infants
- preterm births
- perinatal death
- down syndrome
- preeclampsia
EMPLOYMENT AND TRAVEL
- can work until labor starts
- must be aware of environmental hazards
- no restrictions unless complications
- frequent breaks during car travel
- use seat belt
SPECIAL CONCERNS OF EXPECTANT COUPLES OVER AGE 35
- enough energy to care for a new baby
- ability to deal with the needs of the child as they age
ADOLESCENCE
- still growing must gain her expected weight plus that expected for pregnant adult
- support system?
- education
- ongoing prenatal care
