Ch.8 Flashcards by Kelsey Klipfel

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)

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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

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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

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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

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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

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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

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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

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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

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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

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Changing cultural and professional attitudes encouraged fathers’ participation in birth experience
Emotional response, concerns, information needs change during pregnancy
Three phases

Accepting the pregnancy

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Announcement
Moratorium
Focus

Three phases

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Accept fact pregnancy
Ambivalence common
Some joy or diff accept
IPV most likely occur

Announcement

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Introspective and engage about philosophy life, religion, childbearing, child-rearing pracs, relationship with fam members (part own fathers)

Moratorium

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Negotiate with partner role play in labor and preparing for parenthood
Concentrates on his experience and think as self as father

Focus

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Attitudes affect way adjust to pregnancy and role
Memories parenting received, experiences in childcare, perceptions parent role impact them

Identifying with parent role

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Nurture and respond to feeling vulnerability
Rivalry - common
Feel uneasy because woman away from partner mentally because focused on baby

Reordering personal relationships

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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

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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

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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

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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

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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

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Interview
Physical examination
Laboratory tests
Follow-up visits

Care management: initial and follow-up

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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

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Hx current pregnancy: signs (n&V)
Review symp and how coping
Desire for pregnancy assessed

Current pregnancy

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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

Immediate family Identify familial or genetic disorders or conditions - affect woman or fetus Health hx of father; fam hx

Family history

Marital or relationship status Child or other fam members living in home Employment SES Yrs edu Ethnic and cultural background assessed Primary source support Existing relationships with people around her Alert to potential probs: depression, lack support, living conditions

Social, experiential, and occupational history

20% pregnancies Screened at first prenatal visit, at least once trimester, postpartum visit Nurses assess routine interviewing and phys exam Safe, private setting Self-admin or computerized can be used

History of physical abuse

Current probs in any body sys and mental status is assessed Obtain all data about each symp

Review of systems

Initial: baseline; performed by HCP Height and weight measured, BMI calc VS assessed - focused on BP Full head to toe and pelvic exam Nurse determines need for infor on reproductive anatomy; breathing and relaxation techniques Assess breasts

Physical examination

Uterine, cervical, blood samples during initial visit Diagnostic tests for infectious diseases and metabolic onditions Genetic testing

Laboratory tests

According to model care and indiv needs pregnant woman Interview Physical examination Fetal assessment

Follow-up visits

Follow-up visits briefer and less intensive that initial Asked summarize relevant events occurred Explain emotional and physical well-being; go over concers, probs, questions Fam needs identified and taken care of Signs labor

Interview

Reeval constant in care Physiologic changes doc as progresses and reviewed as deviation from norm BP and weight norm Urine checked

Physical examination

Part prenatal visit Fetal growth monitored through fundal height and US measurements Well-being assessed by maternal perception of fetal movements and auscultation of fetal heart tones Record responses and lab results provide continuous and accurate supervision Fundal height Gestational age Fetal Ultrasonography exam

Fetal assessment

Second trimester Measurement height uterus above symphysis pubis Indicator fetal growth Identifies risk factors

Fundal height

Estimated after duration of pregnancy and EDV been determined - based on early US results US - detect number babies and provide info about well-being Note date fetal heart tones first auscultated and the date when felt fetal movement (quickening)

Gestational age

Routine imaging usually done in first trimester confirm pregnancy and/or establish gestational age Fetal anatomy scan 18-22 weeks Number babies, presentation, biometry, location of placenta, amniotic fluid volume, cardiac activity

Fetal Ultrasonography exam

Curious about growth and development of fetus and changes that occur in mother’s body during pregnancy Educational material imp Track development through apps

Education about maternal and fetal changes

Imp for maintenance of maternal health and provision adequate nutrients for embryonic and fetal development Assess nutritional status and weight gain and provide ongoing edu - part nurse’s role Food safety imp Registered dietician often involved

Nutrition

Sweat/apocrine glands highly active: hormonal influences Baths and warm showers therapeutic: relax muscles, counter insomnia, feel fresh

Personal hygiene

Infections common Asymptomatic; can have frequency, urgency, dysuria, dribbling, hesitancy, gross hematuria Given oral antibiotics Bubble bath and bath oils avoided 2.5 L lipique - water drank qday Drink after sex and urinate as well

Prevention of urinary tract infections

Deliberate contraction and relaxation muscle - strength reproductive organs and improves muscle tone Need be exercised regularly - risk urinary incontinence late and after pregnancy

Kegel exercises

First prenatal visit - asks if has decided feeding method - info about breastfeed and formula feeding - benefits of breastfeeding should be emphasized No special prep of nipples or breasts for breastfeeding - cleanse nipples with warm water Break adhesions that cause nipple invert do not work and cause uterine contractions

Preparation for breastfeeding newborn

Imp because it can affect maternal health and pregnancy outcomes Increased incidence of gingivitis and periodontitis HCPs assess oral health initial visit Diagnosis and treatment of oral health probs Teach importance dental hygiene

Oral health

Min risks and promotes a feeling of well-being in pregnant women Improves phys fitness and circ, enhances physiologic well-being, promotes relaxation and rest, counteracts boredom Helps weight management, reduce risk gestational DM, C-section, birth to larger than normal infant At least 150 min mod-intensity aerobic

Physical activity

Skeletal and musculare changes and hormonal changes - backache and possible aging Center gravity changes Poor posture and body mechanics - discomfort and potential for injury Maintain good posture and body mechanics

Posture and body mechanics

Regular rest periods planned Side-lying position - first trimester Rise slowly

Rest and relaxation

Cont work throughout most pregnancies accommodations/modifications in employment may be necessary Do not sit/stand for long periods of time

Employment

Comfy clothing is recommended Nursing bra imp Support stockings good for those with varicosities Comfy shoes Certain exercises relieve leg cramps

Clothing

High-risk pregnancies avoid long-distance travel after fetal viability reached Not travel where healthcare poor, water untreated, or where malaria/Zika prevalent Sit upright Travel up to 36 weeks

Travel

List meds taking Cont prenatal vit supplement Greatest danger of defects in first trimester

Medications and herbal preparations

live/attenuated live viruses contraindicated - potential teratogenicity Live vaccines: measles, varicella, mumps, some flu Can admin: Tdap, recombinant hep B, flu vaccine (inactivated - injection) Pertussis severe comps Tdap admin between 27 and 36 weeks gestation - admin each pregnancy regardless vaccine hx COVID-19 vaccine is safe

Immunizations

Test blood type at first prenatal visit Rh-: antibody screen first and third trimesters - prophylactic Rh-D IG admin to pregnant woman to prevent formationo antibodies at 26-30 weeks Rh+: repeat 72 hrs after birth

Rh Immune Globulin

Use of any substances including these: Alcohol, smoke, caffeine, and drugs at all visits Cause harm to fetus

Substance use

One most imp responsibilities of care providers is alert prengnant s&s indicate comps of pregnancy List warning signs: vaginal bleeding, alteration in fetal movements, symptoms preeclampsia, rupture membranes, preeterm labor Perinatal mood disorders

Recognizing potential complications

Satisfaction with her relationships and support, feeling competence, sense being in control imp issues to be addressed

Psychosocial support

Birth rate decreased Global concern Less likely receive adequate prenatal care More likely smoke and less likely gain adequate weight gain during pregnancy Increased risk for maternal anemia, preeclampsia and/or HELLP syndrome, postpartum hemorrhage and chorioamnionitis Higher risk poor pregnancy outcomes Reduce risks and consequences of pregnancy - refer to social support services as necessary

Adolescents-

Adv maternal age Increasing over the yrs Greater chance will have preexisting conditions Increased genetic risks and miscarriage, ectopic pregnancy, preterm birth, SB, DM, HTN, placenta previa, placental abruption, C-section, postpartum hemorrhage, pregnancy-related mortality, low birth weight infants, multiple birth Associated with anxiety

Women older than 35-risks

Twin rate higher and triplet rate higher Increased risk adverse outcomes Strain on finances, space, workload, coping capabilities Lifestyle changes necessary

Multifetal pregnancy

Expansion of birth edu movement that began over four decages ago, offering a set classes is the third trimester of pregnancy to prepare parents for labor and birth Contemporary perinatal edu programs More to virtual learning Early pregnancy fundamental information Midpregnancy classes emphasize woman’s participation in self-management Late pregnancy - focus on prep for labor and birth Prenatal exercise and yoga classes Classes offered to address learning needs to specific pops of preg women and fams

Classes for expectant parents

Hospital Birth centers Home birth

Birth setting choices

LDR rooms - comfy, private space for labor and birth First 1-2 hrs postpartum there for immediate recovery and to allow time for fams to bond with newborns Woman and her fam stay on unit 6-48 hrs Comprehensive birthing programs

Hospital

Apart from hospital Safe, cost-effective alternative Certified midwives Comprehensive birthing programs

Birth centers

Remains controversial topic in health care Ssafest setting for birth is a hospital or accredited birth center Informed about risks and ebenfits Fewer interventions Increased risk perinatal death and serious appropriate selection candidates for home birth

Home birth

In addition to parents and labor nurses Labor doula trained to provide phys, emotional, informational support - not involved in clinical tasks Decreased need pain med, use epidural anesthesia, shorter labor; increased satisfaction with birth experience, likelihood of spontaneous vaginal birth; reduce risk of cesarean or vaginal birth and reduced risk low 5 min APGAR score Doula meets person before labor

Labor support

Natural evolution of contemporary wellness-oriented lifestyle in which women assume level responsibility in own health Initiate discussion choices related to planning for labor and birth Include birth setting, partner participation, interventions during labor, care of mother and newborn immediately after birth, postpartum care Direct people to websites with information about creating birth plan Created prenatally and implemented on admission to labor and birth unit - needs, desires, expectations

Birth plan