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
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
