Ch.8 - Nursing Care of the Family During Pregnancy Flashcards

1
Q

Great deal responsibility as nurses during pregnancy

A

is education

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2
Q

Pregnancy
Trimesters

A

Nursing care during pregnancy

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3
Q

Spans 9 calendar months
10 lunar months of 28 days (280 days total) - carried to 40 weeks

A

Pregnancy

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4
Q

First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through 40

A

Trimesters

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5
Q

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

A

Diagnosis of pregnancy

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6
Q

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

A

Nägele rule

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7
Q

Maternal adaptation
Partner adaptation
Sibling adaptation
Grandparent adaptation

A

Adaptation to pregnancy

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8
Q

Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships
Establishing a relationship with fetus
Preparing for childbirth

A

Maternal adaptation

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9
Q

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

A

Accepting the pregnancy

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10
Q

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

A

Identifying with the mother role

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11
Q

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

A

Reordering personal relationships

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12
Q

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

A

Establishing a relationship with fetus

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13
Q

Nursery
Wash clothes
Santize everything
Nesting
Tell everybody what roles are - nurse can do this as well

A

Preparing for childbirth

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14
Q

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

A

Partner adaptation

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15
Q

Get same type symptom that women; psychological thing

A

Couvade Syndrome

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16
Q

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

A

Accepting the pregnancy

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17
Q

Men not have present father
No relationship with dad
Not know how be dad
Terrified

A

Identifying with father role

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18
Q

Successful relationships they do
Takes more than 1 person
Invitations less and less - identify with and accepting of it

A

Reordering personal relationships

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19
Q

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

A

Establishing relationship with fetus

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20
Q

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

A

Preparing for childbirth

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21
Q

Sibling rivalry
Upset and issue going into sibling role

A

Sibling adaptation

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22
Q

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

A

Grandparent adaptation

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23
Q

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:

A

Care management

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24
Q

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

A

Women in poverty or lacking health insurance may not have access to public or private care

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25
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:
26
Not realize importance Had many babies - can do it
Lack of motivation to seek care
27
Sometimes lot money
Inadequate finances
28
Not get to appt Telehealth - cannot measure to fundus or listen to fetal heart tones
Lack of transportation
29
Disrepsectful; non inclusive
Unpleasant clinic personnel
30
TSD; previous experiences
Unpleasant facilities or procedures
31
Take days off for 1 hour appointment if only 1 hour
Inconvenient clinic hours
32
Stay at home; not have child care
Problems with child care
33
Interview Physical examination Laboratory tests Follow-up visits
Care management: initial and follow-up
34
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
35
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
36
Interview Physical examination Fetal assessment
Follow-up visits
37
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
38
Multiple-marker or triple-screen blood test Other blood tests (RPR/VDRL, CBC, anti-Rh)
Laboratory tests
39
Ultrasonography Amniocentesis
Other tests
40
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
41
Nutrition Personal hygiene Prevention of urinary tract infections Kegel exercises Preparation for breastfeeding newborn Dental health
Education for self-management
42
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
43
Higher basal metabolic rate Sweat pH changes; deodorant not work - is hormones Wipe front to back Deliberate about this and vaginal hygiene
Personal hygiene
44
Not hold pee Urinary stasis cause these
Prevention of urinary tract infections
45
Pelvic floor exercises Increases pelvic support, pelvic muscles stronger; toned muscle and good blood supply which is important - which helps heal better
Kegel exercises
46
Edu Nothing do to nips Simple but not easy Is a mental game Recommend a class
Preparation for breastfeeding newborn
47
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
48
Physical activity Posture and body mechanics Rest and relaxation Employment Clothing Travel
Education for self-management
49
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
50
Weight relaxed Deliberate when getting out, moving Things bigger; muscles pulled; careful how lifting things
Posture and body mechanics
51
When feels tired, need to rest Body working so hard
Rest and relaxation
52
Not have divulge pregnant to employer; personal and health condition; some jobs may be harder for someone to do
Employment
53
Wear clothing that is comfy and not restrictve
Clothing
54
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
55
Medications and herbal preparations Immunizations Rh Immune Globulin Alcohol, smoke, caffeine, and drugs Recognizing potential complications Recognizing preterm labor
Education for self-management
56
Know putting in body
Medications and herbal preparations
57
Not immune - cannot give live vaccines
Immunizations
58
Rh - moms
Rh Immune Globulin
59
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
60
Recognizing when at risk
Recognizing potential complications
61
More often as pregnancy progresses because more at risk
Recognizing preterm labor
62
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
63
Not accepting pregnancy Depression checking
Psychosocial support
64
Cultural influences Age
Variations in prenatal care: culture and age
65
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
66
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
67
Multifetal pregnancy
Variations in prenatal care: twin pregnancy
68
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
69
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:
70
Pattern of care more often Amount of weight gained more Nutritional intake observed - more
Prenatal care given women with multifetal pregnancies includes changes in:
71
Perinatal education goals Perinatal care choices
Childbirth and perinatal edu
72
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
73
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
74
Birth centers - birth baby - home; no epidurals; natural enviornments Home birth Hospital - most people deliver here
Birth setting choices