Ch.8 Flashcards
Determined based on date of last normal menstrual period (LNMP) and first accurate US exam
Accurate dating vital to healthy outcome
Imp for planning prenatal care, scheduling specific prenatal screening tests, assessing fetal growth, making critical decisions managing comps of prengancy
Most accurate: US measurement during first trimester
Nägele rule: common method for calculating EDB; based on accurate recall LNMP; assumes 28-day cycle and fertilization occured day 14
Some HCP use gestational wheel
Estimating date of birth (EDB)
Takes place within cultural environment influenced by societal trends
Family best source info about personal and cultural beliefs and pracs, needs, and concerns
Maternal adaptation
Adaptation to pregnancy
Complex process social and cognitive learning - much time sleeping in first trimester
Lot movement second trimester
Stressful but rewarding - prepares for new level caring and responsibility
Partner’s emotional support imp factor
Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships
Establishing a relationship with fetus
Preparing for childbirth
Maternal adaptation
Accept idea pregnany and assimilating pregnant state into way of life
Acceptance reality of child
May feel emotional lability - rapid changes in mood
Most experience ambivalence - if baby born with abnormality often need reassurance that this feeling not cause it
Some experience hostility
Accepting the pregnancy
Begins early in each woman’s life when she is being mothered as a child
Social group constitutes feminine role and influence choice between motherhood and career
Identifying with the mother role
Close relationships as prepares for motherhood
Periods tension and conflict can arise
Promote effective communication
Relationship with mother sig
Sexual expression highly indiv - affected by phys, emotional, interactional factors; highest in 2nd trimester
Reordering personal relationships
Emotional attachment in the prenatal period
Phase 1: accepts biologic fact pregnancy
Phase 2: accepts growing fetus as disctinct from herself
Phase 3: prepares realistically for birth and parenting for child
Mother alone experiences child within her - and responds in very individiualized, personal manner
Establishing a relationship with fetus
Actively prepare for birth by reading books and info
Seek advice
Anxiety can arise
Fear pain
Education by nurse can alleviate fear
Toward end trimester breathing more diff and fetal movements more vigorous to disturb sleep
Strong desire for end pregnancy and be over and done with it and ready to move on to birth
Preparing for childbirth
Reflect on future role and adapt to changes in relationship as prepare for arrival
Nurturing or feel alone
Intense learning
Proof masculinity and dominant role
Accepting the pregnancy
Identifying with parent role
Reordering personal relationships
Establishing relationship with fetus
Preparing for childbirth
Partner adaptation
Changing cultural and professional attitudes encouraged fathers’ participation in birth experience
Emotional response, concerns, information needs change during pregnancy
Three phases
Accepting the pregnancy
Announcement
Moratorium
Focus
Three phases
Accept fact pregnancy
Ambivalence common
Some joy or diff accept
IPV most likely occur
Announcement
Introspective and engage about philosophy life, religion, childbearing, child-rearing pracs, relationship with fam members (part own fathers)
Moratorium
Negotiate with partner role play in labor and preparing for parenthood
Concentrates on his experience and think as self as father
Focus
Attitudes affect way adjust to pregnancy and role
Memories parenting received, experiences in childcare, perceptions parent role impact them
Identifying with parent role
Nurture and respond to feeling vulnerability
Rivalry - common
Feel uneasy because woman away from partner mentally because focused on baby
Reordering personal relationships
Strong
Names; nicknames used
Daydreaming about parenting
Identify concerns and prepare for reality of baby
As date approaches - more questions about behaviors
Traditions, customs, continuation names imp
Establishing relationship with fetus
Anticipation and anxiety
Boredom and restlessness common
Surge creative energy at home and on job - last 2 months
Imp to be able to verbalize fears
Preparing for childbirth
Sharing spotlight major crisis
Impacted by attitudes, roles parents, length separation from mother, visitation policy, way child preared for new baby
Begin process of role transition
People lose hierarchy
Response depends on age and dependency needs
Sibling adaptation
Most delighted
Reawakens feelings routh, excitement giving birth, delight behavior of parents-to-be as infants themselves
Link between past and present
Transmits family history, shares knowledge, role model, support person
Strengthens fam sys
Some react negatively - non-supportive and decrease self-esteem of parents-to-be
Grandparent adaptation
Choice maternity HCP depends on availability of proviers, services, facilities in region; insurance coverage; preferences care; health status
Menthal HCPs may be involved - teamwork imp
Nurses likely interact with pregnant indiv and partners at each visit, providing continuity care and opportunity to provide therapeutic relationship
Do all therapeutic communication and follow cultural beliefs and pracs
Care management
Interview
Physical examination
Laboratory tests
Follow-up visits
Care management: initial and follow-up
Therapeutic relationship between nurse and women begins at initial assessment; try gain women’s trust; one or more people come with coman; includes those in prenatal interview - observations and information about fam included in database - note any special needs
Current pregnancy
Childbearing and reproductive history
Health history
Nutrition history
Family history
Social, experiential, and occupational history
History of physical abuse
Review of systems
Interview
Hx current pregnancy: signs (n&V)
Review symp and how coping
Desire for pregnancy assessed
Current pregnancy
Menarche, menstrual hx, contraceptive hx, infertility, reproductive sys conditions, hx STIs, sexual hx; date last Pap test; last LNMP
OB hix: type and number pregnancies; birth outcome
Risk factors for STIs
Childbearing and reproductive history
Diseases
Surgical procedures
Phys conditions
Genetic conditions or disorders - indication for genetic testing
Type and dates surgeries - esp involving reproductive organs
Trauma to pelvis
Recent infections or exposures
Travel to areas with endemics
Health history
Direct effect of growth and development of fetus
Reveal: special dietary pracs, food allergies, eating behaviors, prac PICA, etc
BMI calc at first visit
Referral to registered dietician
Nutrition history