Ch.8 - Nursing Care of the Family During Pregnancy Flashcards
Great deal responsibility as nurses during pregnancy
is education
Pregnancy
Trimesters
Nursing care during pregnancy
Spans 9 calendar months
10 lunar months of 28 days (280 days total) - carried to 40 weeks
Pregnancy
First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through 40
Trimesters
Estimating date of birth (EDB)
Formulas for calculating EDB but none infallible
Estimated date of confinement (EDC)
Estimated due date
IT IS AN ESTIMATE
Not know when sperm and egg met exactly
Nägele rule
Diagnosis of pregnancy
LMP - first day started bleeding; beginning of cycle; pregnant during that cycle
Determine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year depending when LMP OR Alternatively count forward 9 months from the LMP and add 7 days
ADD 7 days either way because Most women give birth from 7 days before to 7 days after EDB - guess because not there for conception
Nägele rule
Maternal adaptation
Partner adaptation
Sibling adaptation
Grandparent adaptation
Adaptation to pregnancy
Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships
Establishing a relationship with fetus
Preparing for childbirth
Maternal adaptation
Maybe little denial but then pregnancy - something stretch and then transition that going to be mother - differently for women - some ready for it, some not
First thing have do
Not everyone do same
50% pregnancies unplanned
Some not accept readily
Want baby excited
Accepting the pregnancy
Nurturing, loving
Ready for it
Some not have relationship
Narcissist; abandoned her; relative raise
Terrified - not want be same mother; not know how be mother - who mothered - not know if how supposed be mother
Therapeutic communication - easy tunnel vision and exciting event
Not every woman okay with it; most maternal nursing - happy nursing - bonding - first person every supported her; beautiful but terrifying ordeal
Giving birth traumatizing - traumatic birth, no support sys, chronic conditions, how got pregnant - consider therapeutic communication - emotional intelligence
Wanted pregnancy - husband left or died
Be neutral as a nurse
Identifying with the mother role
Not go out anymore
Friend group change - decline invitation eventually stop
Who home with baby
Relationships start changing; career and fam hard
Huge transition and some not prepared
Reordering personal relationships
Bonding
Not everybody talking to baby and in love - not mean mental health disorder - see baby to find bond
See where are in attachment of fetus - diff parts of pregnancy for woman
Emotional attachment
Establishing a relationship with fetus
Nursery
Wash clothes
Santize everything
Nesting
Tell everybody what roles are - nurse can do this as well
Preparing for childbirth
Go through same type phases in diff phases
Couvade Syndrome
Accepting the pregnancy
Identifying with father role
Reordering personal relationships
Establishing relationship with fetus
Preparing for childbirth
Partner adaptation
Get same type symptom that women; psychological thing
Couvade Syndrome
Three phases (announcement - ok go announce and tell everybody that going to be a parent - may take awhile, moratorium - acceptance of and adjust to reality, focus - period of active involvement, carseat, most direct route to hospital, childbirthing class)
Not all do same
Accepting the pregnancy
Men not have present father
No relationship with dad
Not know how be dad
Terrified
Identifying with father role
Successful relationships they do
Takes more than 1 person
Invitations less and less - identify with and accepting of it
Reordering personal relationships
Depends on person
Some may be just as excited or terrified
Sometimes later on when feel child and interaction and see what happens and see belly moving see human moving; some talking to belly nonstop
Establishing relationship with fetus
Nesting
Apprehension high closer to due date
Do everything can
Great outcome - cannot fix pain - mess - huge issues; painful - great outcome - high anxiety - cannot fix the problem and very upsetting for them
Preparing for childbirth
Sibling rivalry
Upset and issue going into sibling role
Sibling adaptation
First grandbaby - react amazing
Find role; not parents; still mothering and giving ideals how feed and bathe and love and read
Give advice and need respect roles
Grandparent adaptation
Goal of prenatal care is to promote the health and well-being of the pregnant woman, the fetus, the newborn, and family - health promotion, disease prevention - LOT in 9 months
Emphasis on preventive care and optimal self-care - lot self-management
Prenatal care is sought routinely by women of middle or high socioeconomic status - access to care
Women in poverty or lacking health insurance may not have access to public or private care
Barriers to obtaining prenatal care include:
Care management
Lack of culturally sensitive care and communication interferes with access to care
Immigrant women may not seek prenatal care - not do in culture - not necessary
Birth outcomes are less positive if not get prenatal care, with higher rates of maternal and newborn complications
Problems with low birth rate and infant mortality associated with inadequate prenatal care
Want them to seek care
Women in poverty or lacking health insurance may not have access to public or private care
Lack of motivation to seek care
Inadequate finances
Lack of transportation
Unpleasant clinic personnel
Unpleasant facilities or procedures
Inconvenient clinic hours
Problems with child care
Personal and cultural attitudes
Barriers to obtaining prenatal care include:
Not realize importance
Had many babies - can do it
Lack of motivation to seek care
Sometimes lot money
Inadequate finances
Not get to appt
Telehealth - cannot measure to fundus or listen to fetal heart tones
Lack of transportation
Disrepsectful; non inclusive
Unpleasant clinic personnel
TSD; previous experiences
Unpleasant facilities or procedures
Take days off for 1 hour appointment if only 1 hour
Inconvenient clinic hours
Stay at home; not have child care
Problems with child care
Interview
Physical examination
Laboratory tests
Follow-up visits
Care management: initial and follow-up
First appt - longest unless do 2 separate appts
First visit: OB hx, labs, edu, phys exam, lengthy one; after that - much shorter
Initial between 8-10 weeks; cannot see anything when 4 weeks - 20% pregnancies end miscarriage
Follow-ups monthly until 28 weeks - third trimester - then biweekly - until 36 weeks - then weekly until 40 or delivers - then daily or until delivers
Issues previous pregnancies
Surgical records requested
Health hx
Med conditions
Mental health
Nutrition recall
BMI - safe gain to eat
What consume
Reason for seeking care
Current pregnancy
Childbearing and reproductive history
Health history
Nutrition history
History of drug use and herbal preparations
Family history
Social, experiential, and occupational history - life; hazardous - change behavior - chem exposure do something diff
History of physical abuse - safe home; SI
Review of systems - complete
LONG APPT
Interview
Check blood type - in case negative - give rhodam - not know blood type until born - make antibodies against positive - give antibodies before know blood type
CBC
Anemic already - H&H decreases - hemodilutional effect
STIs present
Hep B status
Laboratory tests
Interview
Physical examination
Fetal assessment
Follow-up visits
Fundal height - 20 weeks; lay flat for min - not affect supine hypotension; measuring tape in cm; 0 on symphysis pubis and then top fundus - weeks gestation with couple cm - measuring, listening to baby, edu, BP, urine - each visit; make sure baby growing appropriate to gestation
Gestational age - vaginal and abodminal US
Health status
Laboratory tests
Other tests
Fetal assessment
Multiple-marker or triple-screen blood test
Other blood tests (RPR/VDRL, CBC, anti-Rh)
Laboratory tests
Ultrasonography
Amniocentesis
Other tests
Collaborative care
Teach something new every visit
Peer reviewed; legitimate websites; ask educated person
Education about maternal and fetal changes
Education for self-management
Sexual counseling
Psychosocial support
Care management: edu
Nutrition
Personal hygiene
Prevention of urinary tract infections
Kegel exercises
Preparation for breastfeeding newborn
Dental health
Education for self-management
Teach right off bat
Shellfish ok
No raw fish, deli meat - unless steaming hot, shark, mackerel - high mercury fish
Coleslaw, macaroni salad, potato salad - not if premade
Cheese - can not have unpasturized soft cheese
Hot dogs - hot where not chew it
Bacteria - salmonella, listeria (kill fetus)
Careful food recalls
Washing all fruits and veggies
Nutrition
Higher basal metabolic rate
Sweat
pH changes; deodorant not work - is hormones
Wipe front to back
Deliberate about this and vaginal hygiene
Personal hygiene
Not hold pee
Urinary stasis cause these
Prevention of urinary tract infections
Pelvic floor exercises
Increases pelvic support, pelvic muscles stronger; toned muscle and good blood supply which is important - which helps heal better
Kegel exercises
Edu
Nothing do to nips
Simple but not easy
Is a mental game
Recommend a class
Preparation for breastfeeding newborn
Estrogen: Tissues bleed - more vascular
N&V - brushing teeth - gag and throw up
Bacteria easily in there
Hard on baby esp if n&v
Imp that spouse brushes teeth
Dental health
Physical activity
Posture and body mechanics
Rest and relaxation
Employment
Clothing
Travel
Education for self-management
Can run
Adjust positions
At baseline - need 150 min moderate activity a week
Joints looser; not exercising whole time - not time start doing something crazy - hurt self; how modify
Physical activity
Weight relaxed
Deliberate when getting out, moving
Things bigger; muscles pulled; careful how lifting things
Posture and body mechanics
When feels tired, need to rest
Body working so hard
Rest and relaxation
Not have divulge pregnant to employer; personal and health condition; some jobs may be harder for someone to do
Employment
Wear clothing that is comfy and not restrictve
Clothing
No reason why cannot get in car and travel
Need be able stand up and walk plane
Because adaptions of pregnancy - risk of DVTs - sitting length time - risk DVTs
Travel
Medications and herbal preparations
Immunizations
Rh Immune Globulin
Alcohol, smoke, caffeine, and drugs
Recognizing potential complications
Recognizing preterm labor
Education for self-management
Know putting in body
Medications and herbal preparations
Not immune - cannot give live vaccines
Immunizations
Rh - moms
Rh Immune Globulin
Not do it
Drinking alcohol - fetal alcohol syndrome
Smoking - low birth weight
Caffeine - high amounts in first trimester - miscarriage - limits perfusion; causes vasoconstriction
Alcohol, smoke, caffeine, and drugs
Recognizing when at risk
Recognizing potential complications
More often as pregnancy progresses because more at risk
Recognizing preterm labor
Misinformation - cannot have sex; being too rough; hit baby with dick
Just rocking the boat
Some woman cannot - contraindication to anything sex; long list things - cannot have sex
Using the history
Countering misinformation
Suggesting alternative behaviors - Creative with positioning
Sexual counseling
Not accepting pregnancy
Depression checking
Psychosocial support
Cultural influences
Age
Variations in prenatal care: culture and age
Normal process of life - for all us; how perceive it diff from culture to culture
Do not seek care until illness
Cultural prescriptions (what to do)/proscriptions (taboos) about what do around pregnancy; can work around dietary everything; consider when caring for pats
Cultural influences
Adolescents-risks, access to care - almost always delayed - lot has do with denial
Older than 35-risks, preexisting conditions; routine care changes as progress
Age
Multifetal pregnancy
Variations in prenatal care: twin pregnancy
Twin pregnancies often end in prematurity
Go often - more things happen; rarely to 38 weeks; lungs mature faster - compete in utero
Rupture of membranes before term common
Congenital malformations twice as common in monozygotic twins as in singletons - sharing placenta, sac, twin to twin perfusion
No increase in incidence of congenital anomalies in dizygotic twins
Multifetal pregnancy probability increased by:
Prenatal care given women with multifetal pregnancies includes changes in:
Uterine distention can cause severe backache - discomforts pregnancy - more
Multifetal pregnancy
History of dizygous twins in female lineage
Use of fertility drugs
Rapid uterine growth for weeks of gestation
Polyhydramnios - extra fluid than should
Palpation of more small or large parts than expected
Asynchronous fetal heartbeats or more than one fetal electrocardiographic tracing
Ultrasonographic evidence of more than one fetus
Multifetal pregnancy probability increased by:
Pattern of care more often
Amount of weight gained more
Nutritional intake observed - more
Prenatal care given women with multifetal pregnancies includes changes in:
Perinatal education goals
Perinatal care choices
Childbirth and perinatal edu
Assist individuals and their families to make informed, safe decisions about childbirth - informed so make decisions - lots education so control over their birth
Assist to comprehend the long-lasting effects an empowering birth experience can have - PTSD never goes away; good quality nursing care; therapeutic communication - depends on experience
Ideally this begins in the preconception period
Perinatal education goals
Physicians
Nurse-midwives
Direct-entry midwives
Independent midwives - form relationships of trust with pregnant women, which then help women to feel safe and supported when they go into labour.
Doulas - just support
Birth plans - hope goes that way; more strict and prescribed birth plan - get C-section; control in hospital setting
Birth setting choices
Perinatal care choices
Birth centers - birth baby - home; no epidurals; natural enviornments
Home birth
Hospital - most people deliver here
Birth setting choices
