chapter 7: promoting a healthy pregnancy ppt Flashcards
1
Q
focus on the pt
A
- the pregnant woman will experience a lot of hormonal and physiological changes in her body that will cause physical discomfort
- she will have questions on: maintaining her health, managing the discomforts of pregnancy, providing self care, ensuring safety for herself and her fetus, relief of common discomforts of pregnancy
2
Q
promotion of self care during pregnancy
A
- self care is personal, medical care performed voluntarily by the pt
- most pregnant women are motivated to learn self care by reading and researching, but some may be inaccurate
- nurses have an important role in supporting self care by providing accurate information
- empowers the woman to make healthy lifestyle choices to maintain or improve her health and of her fetus
- personal hygiene: excessively hot showers/baths may cause hyperthermia and may cause neural tube defects
- breast care
- clothing
- exercise
3
Q
breast care
A
- daily shower or bath for breast cleanliness
- colostrum may crust on the nipples during late pregnancy and can be removed with a washcloth and warm water
- avoid using strong soap due to its drying effect
- wear a well fitting bra to prevent back strain and to retain breast shape
4
Q
clothing
A
- loose enough to allow movement and circulation
- avoid high heeled shoes due to risk of falling
5
Q
exercise
A
- safe and beneficial
- prevents excess in maternal weight gain
- promotes normal fetal growth
- prevents gestational diabetes
- decreases the risk of preeclampsia
- stop exercising and see your provider if you experience: dizziness, fluid leaking from vagina, bleeding from vagina, chest pain, headache, increased sob, decreased fetal movement
- yoga: avoid hot yoga classes, avoid lying flat on the abdomen or back, avoid twisting, hopping, and jumping, maintain adequate hydration
6
Q
sleep and rest
A
- fatigue increases as fetus gets larger
- incorporate rest periods during the day and have at least 8 hours of sleep at night
- use of additional pillows to support the uterus and remove the strain of the lower back
7
Q
employment
A
- pregnant women without complications can continue to work throughout the pregnancy
- avoid environmental hazards to fetal wellbeing, prolonged standing, heavy lifting
8
Q
seatbelts
A
- should be worn to protect both the mother and the fetus
- belt should be placed across the abdomen and the hip bones
- shoulder strap should be between the breasts and over the clavicle
- keep abdomen 10 in away from the air bag
9
Q
travel restrictions
A
- second trimester is the safest time
- prolonged sitting may cause thrombosis
- ambulate every 2 hours and maintain adequate hydration to decrease the risk of developing thrombosis
10
Q
dental care
A
- gums are commonly edematous and may bleed easily
- if tx is required, the dentist should be informed of the pregnancy
- x ray only if necessary and appropriate abdominal shield must be worn
11
Q
sexual activity
A
- limit or avoid sex with preterm labor; has had more than one miscarriage; has placenta previa, an infection, or bleeding; or has ruptured amniotic membranes
- try different positions for comfort as pregnancy advances
- the nurse needs to initiate the conversation w/ open ended questions and a matter of fact approach if the patient feels uncomfortable asking questions
12
Q
avoiding infections
A
- infections are major causes of maternal and fetal morbidity and mortality
- the fetus usually acquires infection by transmission through the placenta
- infections causing congenital defects are known as TORCH: toxoplasma, others, rubella, cytomegalovirus, herpes
- signs and symptoms may be apparent at birth or not until years later
13
Q
toxoplasmosis
A
- from raw or undercooked meat or through exposure to cat feces
- body aches, headache, fatigue, sore throat
- infants may develop chorioretinitis: the inflammation of the choroid and retina of the eye that can lead to blindness; obstructive hydrocephalus; mental retardation; seizures, motor delays; developmental delays
14
Q
parvovirus b19
A
- causes erythema infectiosum (fifth disease), rash with fever
- transmission is by respiratory route, through blood products, or by the placenta
- woman is often asymptomatic; neonate may have liver swelling, heart failure, jaundice, and edema of the body
15
Q
varicella-zoster virus
A
“chickenpox”
- a medical emergency in pregnancy
- airborne
- causes fever, anorexia, itchy vesicles, and pneumonitis in the pregnant patient
- causes life threatening respiratory complications, spontaneous abortion, chorioretinitis, cataracts, limb malformations, and brain dysfunction in fetus
- health teaching includes avoiding people with teh disease and keeping immunization up to date for children in the home
16
Q
rubeola (measles)
A
- causes severe consequences for the pregnant woman
- airborne route of coughing and sneezing
- symptoms include fever, cough, conjunctivitis, and rash
- may cause pneumonitis, spontaneous abortion, premature labor, and low birthweight
- travel outside of north America increases the risk o fexposure
- teach about avoiding of people with the disease and following vaccination guidelines
17
Q
HIV
A
- major cause of infant and child mortality worldwide
- CDC recommends routine 3rd trimester screening on women with high risk behaviors or symptoms of the disease
- women with HIV should be counseled on highly active antiretroviral therapy to reduce the risk of transmission to the fetus
- risk of transmission is linked to the mother’s viral load
Zidovudine is the most common medication used to reduce viral load - HAART does not show any negative effects on pregnancy and must be started as soon as possible to reduce the risk of transmission to less than 2%
- health teachings include getting tested for HIV; if positive, inform the provider; take antiretroviral medications as described; and avoida high risk lifestyle
18
Q
syphilis
A
- a sti that can cause miscarriage, premature birth, and stillbirth when acquired during pregnancy
- symptoms include painless lesions on the genitals, mouth, or rectum after unprotected sex
- patient teaching includes avoiding unprotected sex; maintaining a monogamous relationship; notifying the provider if symptoms occur
19
Q
West Nile Virus
A
- transmitted by mosquitoes
- symptoms include high fever, headache, stiff neck, tremors, seizures, and coma
- health teaching includes control of mosquitoes; use of insect repellant; and wearing long sleeved shirts and pants
20
Q
hepatitis
A
- can be transmitted to the fetus at the time of delivery (hepatitis b) or during the pregnancy (hepatitis c)
- patient teaching includes avoiding exposure to blood and body fluids; obtaining the hepatitis b vaccination
21
Q
zika virus
A
- transmitted through mosquitoes, sexual contact, and perinatal transmission to the fetus during pregnancy
- can cause severe congenital abnormalities such as microencephaly, hearing loss, glaucoma, retinal dysplasia, optic nerve abnormalities, and nystagmus
- health teaching includes avoiding travel to countries with active zika virus transmission; wearing insect repellant, long sleeves, and pants; use of condoms for 3 months after travel to a high risk area
22
Q
rubella
A
- German measles
- contact transmission with respiratory secretions
- signs and symptoms of maternal infection:
1) rash starting on the face or neck
2) enlarged lymph nodes
3) joint pain
4) fever
5) cough - fetus is infected through placental transmission, most dangerous in the first 12 weeks of pregnancy
- causes miscarriage, stillbirth, and congenital rubella syndrome
- health teaching includes reporting any rash or illness to the provider, and avoiding exposure to young children, especially during the first trimester
23
Q
cytomegalovirus
A
- a herpes virus acquired through contact with saliva, urine, and other body fluids; sexual contact; organ transplantation; transmission through the placnta and breast milk
- maternal infection can be asymptomatic or may have fever, mild depression, and muscle aches
- fetal infection can cause intrauterine growth retardation, hearing loss, seizures, rash, vision loss, microencephaly, hydrocephalus and delayed motor development
- approx 20% of young children shed CMV in their saliva or urine, making them the most important risk factor for CMV infection in pregnant women
24
Q
Herpes Simplex Virus
A
- one of the most common sexually transmitted infections
- symtoms include blister or mulitple blisters on or around the mouth, genitals, or rectum
- greatest risk on third trimester, with most neonatal infections resulting from exposure to genital HSV during the delivery
- cesarean birth for frequent outbreaks or an active case
- newborn infection
1) skin, eye, or mouth lesions
2) encephalitis
3) dysfunctions of the liver, lungs, central nervous system, and brain - health teaching includes informing the provider of any past history and new outbreaks and practicing safe sex
25
Q
nutrition in pregnancy
A
- healthy eating promotes optimal weight gain for the fetus and reduces complications
- take a multivitamin with iron
- increase of 300 calories a day during the last 6 months of pregnancy (single fetus)
- guidelines:
1) avoid empty calories (soft drinks, desserts, fried foods) - healthy eating promotes optimal weight gain for the fetus and reduces complications
- folate (folic acid): prevents neural tube defects, found in cereal grains, beans, spinach, kale, broccoli, romaine lettuce, asparagus, and peanuts, RDA is 600mcg per day
- calcium and vitamin D: for healthy bones and teeth; healthy heart, nerves, muscles, and blood clotting abilities of the fetus, found in dairy products, vegan, RDA of calcium is 1000 mg/day, vitamin D is 15 mcg/day
- protein: imprtant for fetal growth, good sources are lean meat, poultry, eggs, dried beans, tofu, dairy products, and peanut butter. 75-100 grams of daily protein is recommended. Be aware of cultures regarding pregnancy as a “hot” condition, thereby restricting protein intake
- iron: for hemoglobin production, found in lean red meat, poultry, iron fortified cereals, green leafy vegetables, and dried fruits.
- recommended weight gain: excessive weight gain is associated with gestation diabetes, pregnancy associated hypertension, and delivery of infants who are large for their gestational age
26
Q
recommended weight gain
A
- guidelines for weight gain according to The American College of Obstetricians and Gynecologists
- body mass index less than 18.5 is underweight; should gain 28-40 lbs
- BMI between 18.5 and 24.9 is normal; should gain 25 to 35 lbs
- BMI between 25 and 29.9 is overweight; should gain 15-25 lbs
- BMI greater than 30 s obese; should gain 11-20 lbs
27
Q
nutritional needs of the obese patient
A
- obesity in pregnancy increases the risk of spontaneous abortion, gestational diabetes, preeclampsia, sleep apnea, a large for gestational age fetus, longer labor
- refer to a nutrition counselor
- exercise of at least 30 minutes most days of the week
- patient with BMI over 35 may require a team approach consisting of an obstetrician, endocrinologist, neonatologist, nurse, dietician, and physical therapist to assist with exercise
- weight gain is due to the changes in breasts, blood volume, fat, body fluid, uterus growth, as well as the placenta and amniotic fluid
28
Q
pica
A
- an eating disorder that involves intense craving and ingestion of non nutritive foods or non food substances
- common substances are dirt, clay, laundry starch, charcoal, ice, toothpaste, coffee grounds, baking soda, and cigarette ashes
- may prevent meeting the nutritional needs of the mother and the fetus, and may cause ingestion of toxins or parasites
- patient may be embarassed to admit pica
- be nonjudgmental about pica practices
- encouraging a balanced diet with sufficient vitamins and minerals
- ecommending a support person who can assist in avoiding harmful substances
- limiting access to non nutritive substances
- substituting craving with a gum or a healthy, low calorie snack
- using distractions such as walking, engaging in a conversation, or reading a book
29
Q
care of the pregnant adolescent
A
- adolescence: period of transition between childhood and adulthood
- developmental issues must be considered because it can impact care and compliance in prenatal care
- nurse should use direct, concrete communication, and provide information about the positive effects of healthy behaviors and fetal health
- may require more frequent prenatal visitors or follow up phone calls
- common issues among pregnant adolescents: may resist gaining weight, nurse must stress relationship between healthy nutrition and exercise with good physical appearance
- egocentric thinking: may think that normal pregnancy discomforts are unique to her situation, group teaching sessions may be beneficial
- emotional independence from her parents is being established as she becomes more emotionally reliant on friends
- encourage parents and family to allow pregnant adolescent to take responsibility for her care while allowing her to be a regular teenager
- risk taking behaviors are common; may experiment with alcohol or smoking during pregnancy
- explain the dangers of these risk taking behaviors in relation to pregnancy
30
Q
legal issues for pregnant teens
A
- parents cannot force the teen to make a decision regarding abortion, adoption, or raising the baby
- some states require parental permission for an abortion and for placing the baby for adoption
- emancipation: a legal rocess that allows a teen under age 18 to be independent from parents
- the pregnant teen should obtain information on teen rights and emancipation
31
Q
nutritional needs of the pregnant adolescent
A
- adolescents often do not practice good eating habits due to their lifestyle and schedule
- most pregnant adolescents who choose to maintain pregnancy often want to have a healthy baby, and this can be a goal that can be used to assist the adolescent in making healthier food choices
- pregnant adolescents have additional nutritional needs because of their own growth and development
- prone to inadequate iron calcium and iron
- inadequate weight gain and poor nutritional choices can lead to small for gestational age newborn
- adolescent nutrition: consume an additional 300 calories a day during the last 6 months of pregnancy, keep a diary to record daily food consumption, replace soft drinks and juices with milk or yogurt, take 300mg calcium supplement w/ food to increase absorption
- take iron supplements or food with iron such as meat, beans, and dark leafy vegetables
32
Q
care of lesbian patients
A
- there are between 1 million and 5 million lesbian mothers in the US who have the same physical and educational needs as heterosexual women and their partners, but also have addiitional needs of acceptance and acknowledgement
33
Q
assisted reproductive technology
A
- opened the possibility of pregnancy and motherhood to lesbian couples
- donor insemination
- in vitro fertilization
- intrauterine insemination
- reciprocal IVF: a way for both women to participate in the pregnancy
34
Q
lesbian patient challenges include
A
- not receiving the same education and assistance as other pregnant patients
- partner may be excluded or ignored during teaching sessions and examinations
- medical forms only have spaces for mother and father
- providers may ask overly inquisitive questions regarding sexuality that are not related to caregiving
35
Q
culturally competent care for lesbian patients and their partners include
A
- open minded accepting attitude
- respectful care
- use of gender neutral terms such as “parent” or “partner” with regard to the couple’s preference
- avoid insensitive questions
- advocate for inclusivity of all individuals
36
Q
care of the expectant woman older than age 35
A
- advanced maternal age for childbearing is set at35 years old and is correlated with poorer outcomes in pregnancy due to higher incidence of chronic medical conditions among older women
- difficulty to conceive
- men older than 45 years have increased risk of father children with neural tube defects, autism spectrum disorders, schizophrenia, and bipolar disorder
- chance of having twins increases with age especially when assisted reproductive technologies are used
- risk of chromosomal abnormlities is higher
- increased risk of miscarriage
- higher risk of pregnancy complications such as gestational diabetes, placenta previa, and high bp
- increased risk of developing labor complications that may lead to a cesarean birth
37
Q
patient teachings to improve pregnancy outcomes for expectant woman older than age 35
A
- have a preconception counseling with a provider
- obtain early and regular prenatal care
- receive education regarding testing for chromosomal abnormalities
- follow all prenatal care recommendations on nutrition, medications, and self care
38
Q
focus on the fetus
A
- pregnancy visits to the provider are important to monitor maternal and fetal well being
- simple non invasive tests are done to determine fetal well being
- more invasive tests are ordered if complications arise
39
Q
focus on the growing family: childbirth prep
A
- many first time parents attend childbirth prep classes
- various classes are available and begin around 30-32 weeks gestation
- childbirth educators should be certified by a national organization
- classes are usually taken with a partner, friend, or relative as the birth coach
40
Q
lamaze
A
- introduced in the 1950s and is the most widely used childbirth preparation class in US
- named after French obstetrician Fernand Lamaze
- centers on breathing patterns with a focal point and relaxation techniques to cope with labor pains and to conserve energy for the pushing stage of labor
- educates the mother to be and her partner on the birth process and on options for pain management and making decisions during the labor and delivery process
41
Q
the Bradley method
A
- developed by obstetrician Dr Robert Bradley and popularized by his book “Husband coached childbirth” in 1965
- it prepares the woman to deliver without medications or unnecessary medical interventions, and the husband to coach his wife through the birth experience
- focuses on muscle control: muscle tension increases labor pains, active relaxation during labor reduces pain
42
Q
childbirth class topics
A
- normal labor, birth, and postpartum care
- relaxation techniques
- breathing techniques
- comfort measures during labor
- medical procedures that may become necessary during labor and/or delivery
- breastfeeding
- tour of the hospital labor and delivery unit
- developing a birth plan
43
Q
birth plan
A
- communicates a woman’s desires for her labor and delivery
- encourage the patient to discuss her birth plan with her family, hcps, and nurses providing labor care
44
Q
before labor or early labor
A
induction preferences, laboring at home, hospital admittance
45
Q
induction of labor
A
timing of the induction, choice of induction techniques
46
Q
environment during labor
A
birthing bed or chair, music and television, shower and birthing tub, comfort measures
47
Q
medical interventions
A
fetal monitoring, epidural, IV access and/or fluids, vaginal examinations
48
Q
second stage of labor delivery
A
pushing positions, pushing methods inclusion of family and friends, episiotomy, cord cutting, placenta delivery
49
Q
the newborn
A
medications, initiating breastfeeding, separation from the mother
