Nursing Care of the Childbearing Family Flashcards
Gravida
a woman who is pregnant
Nulligravida
A woman who has never been pregnant and is not currently pregnant
Primigravida
A woman who is pregnant for the first time
Multigravida
A woman who has had two or more pregnancies
Nullipara
A woman who has not completed a pregnancy with fetus who have reached 20 weeks
Primapara
A woman who has completed one pregnancy with fetus who have reached 20 weeks
Multipara
A woman who has completed two or more pregnancy with fetus who have reached 20 weeks
Preterm
20 weeks- 37 weeks
Late preterm
34 weeks- 36 weeks 6 days
Full term
37 weeks- 41 weeks 6 days
Postterm
42 weeks +
Viability
The capacity to live outside the uterus: Ectopic Pregnancy
Para
A mother who delivered a child at 20+ weeks
5 Digit
gravida, term birth, preterm birth, abortion/ miscarriage, and living children
2 digit
gravida and para
Gravida 4, Para 2
Been pregnant 4 times, delevered 2 children past 20 weeks
Gravida 4 / 1112
- pregnant 4 times
- 1 term birth
- 1 preterm birth
- 1 abortion/miscarriage before 20 weeks
- 2 living children
Subjective(presumptive) changes
- Amenorrhea
- Nausea and Vomiting
- Excessive fatigue
- Breast tenderness and enlargement
- Quickening(fetal mov’t)
Objective(probable) changes
- Enlargement of the abdomen
- Cervical changes
- Uterine changes> Braxton hicks, fetal outline, ballottement
- Pregnancy tests
Positive(diagnostic) changes
- Completely objective
- conclusive proof of pregnancy
- Fetal heartbeat
- Fetal mov’t palpated by examiner
- visualization of the fetus> transvaginal ultrasound
Initial prenatal visit questions
- Desired pregnancy?
- How are you feeling?
- What support do you have?
- health/ family history?
- safe in a relationship?
- changes in mental health?
- what meds are you taking?
- drugs/ alcohol?
- occupational history? Sit/ stand?
Psychological adaptations as a mother
Psychosocial adaptations as a mother
Cultural values and reproductive behavior
- Everyone is unique with their culture
- Each culture has their own health and healing belief system
- prenatal care may not be a priority for some woman and cultures
- should NOT assume or expect certain behavior but anticipate cultural norms/ practices
Maternal Screening Tests
- Glucose Screen(GCT test)
- Blood Type
- Group B Streptococcus
Glucose screening(GCT test)
- Maternal fasting glucose
- women are screened 24-28 weeks> tests for gestational diabetes
- High risk for woman who are tested too early
Blood type test
If mother is Rh negative antibody titer is re-evaluated between 24-28 weeks
- if antibody titer is still negative RhoGAM is given
Group B streptococcus test
- vaginal and rectal cultures are obtained 35-37 weeks gestation
- positive test requires iv antibiotics in labor until delivery to protect the newborn
- lives in vagina> harmless to mother, can be fatal if newborn catches it
Lab eval tests
- Rubella
- Hep B screening
- Urinalysis
- Drug screen
- Cervical cultures
- Varicella> chicken poxs
Fetal screening and diagnostic testing types
- Blood draw from mother
- Ultrasound
- Biochemical
Blood draw from mother tests
- Alpha-Fetoprotein(15-18 weeks)
- Triple/ quad screening(15-18weeks)
- Cell-free (DNA) screening( 10 weeks)
Ultrasound tests
- Nuchal translucency(10-14 weeks)
- Ultrasound> fetal HR, fetal growth, gestational age…
Biochemical tests
- Amniocentesis(15-20 weeks)
- Chorionic Villus Sampling(10-12 weeks)
Weeks gestation should equal the uterine centimeters measured, except after lightening T or F
TRUE, +/- 2 cm is normal as well
Embryonic period growth
- 3-8 weeks
- Embryonic discs develop three layers> ectoderm, mesoderm, endoderm
- end of 8 weeks all major organ systems are in place
- RAPID growth period
- Teratogens are BAD during this period
Fetal period growth
- beginning 9 weeks until birth
- dramatic growth and refinement of organ systems
- CNS is vulnerable to damaging agents
Neural tube formed in ? weeks
3-7 weeks
Heart formed between ? weeks
6- 8 weeks
Cleft lip and palate formed in ? weeks
5- 9 weeks
Fetus development at 4 weeks
- Fetus is developing the structures that will eventually form his face and neck
- home pregnancy test is positive at this time
Fetus development at 5 weeks
- Demonstrates the neural tube which is the fetal spine
Fetus development at 7 weeks
- Lots of development at 7 weeks!
Fetus development at 9 weeks
- now called a fetus
- umbilical vessels, the ribs, ear buds, and placenta attachment
- neural tube is closing
Fetus development at 14 weeks
- All three umbilical cord vessels are visible
Fetus development at 20 weeks
- Fetus weighs about 10 oz and is little more than 6 inches long
- uterus at the level of the belly button
- fetus can suck thumb, yawn, stretch, and make faces
Gas exchange comes from fetus to mom T or F
False, exchange from mom to fetus
Where does gas exchange take place from mother to fetus?
Gas exchange takes place in the placenta
Auxiliary Structures
- Fetal membranes
- Amniotic fluid
- Umbilical cord
Fetal memebranes
- Amnion> inner membrane> towards fetus
- Chorion> outer membrane
Amniotic fluid
- Derived from fetal urine and maternal blood cells
- protects the fetus and promotes development
- fetus breathes in amniotic fluid while in utero
Umbilical cord
- two arteries and one vein
- Arteries carry non oxygenated blood to placenta from the fetus
- Veins carry oxygenated blood to the fetus
Amniotic fluid is fetal urine T or F
TRUE
Placenta has a very highly resistant T or F
FALSE, it has very low resistance, so blood resorts towards it
Fetal circulation adaptations
1.) umbilical vein
2.) ductus venosus> short cut
3.) Foramen Ovale> lets blood cross sides of heart
4.) Ductus arteriosis> pulmonary artery to aorta
5.) Umbilical artery
Air sacs are full of fluid in the fetus in utero T or F
TRUE
The lungs have a lot of resistance T or F
TRUE, pressure in pulmonary artery is high as well
Common discomforts of pregnancy
- nausea & vomiting
- urinary frequency
- Fatigue
- Breast tenderness
- increased vaginal discharge
- nasal stuffiness and epistaxis
- heartburn
- constipation
- Hemorrhoids
- varicose veins
- legs cramps
- ankle edema
- Backache
Nausea and vomiting
- first trimester
- cause> unknown, believed to be related to elevate levels of hCG and estrogen and decreased blood sugar
- treatment> dry crackers/ toast before rising, eat small amounts of carbs, drink fluids, avoid spicy
Urinary Frequency
- first trimester
- cause> bladder squeezed by enlarging uterus
- treatment> urinate frequency, do kegel exercises to strengthen muscles
Fatigue
- first trimester
- cause> effects of relaxin or hypoglycemia, anemia
- treatment> rest and good night sleep, iron-rich diet, eat small meals with carbs
Breast tenderness
- first trimester
- cause> effects of the hormones estrogen and progesterone
- treatment> wear good supportive bra
Increased vaginal discharge
- first trimester
- cause> increased production of mucus due to increased estrogen levels
- treatment> frequent bathing, use cotton underwear and loose fitting clothes
Nasal stiffness and epistaxis
- first trimester
- cause> elevated estrogen levels
- treatment> increased humidity(cool air vaporizer), normal saline nose drops
Heartburn
- 2nd/ 3rd trimester
- cause> diminished gastric motility, displacement of the stomach by the enlargin uterus, relaxation of the cardiac sphincter
- treatment> small frequent meals, stop smoking and coffee drinks, use low sodium antacids, sit upright
Constipation
- 2nd/ 3rd trimester
- cause> decreased bowel motility due to increased progesterone levels, diet and decreased fluid, lack of exercise
- treatment> increased fluid and fiber in diet, increase exercise
Hemorrhoids
- 2nd/3rd trimester
- cause> vascular engorgment of the pelvis, constipation, prolonged standing, straining of the stool
- treatment> establish regular bowel patterns of elimination, increase fluid intake, warm bathtub soaks, topical ointment, or anesthetic agents
Varicose Veins
- 2nd/3rd trimester
- cause> family history, obesity, weight of uterus compresses venous return causing stais, prolonged standing
- treatment> avoid restricting clothing and crossing legs at kness, rest with legs elevated
Leg Cramps
- 2nd/3rd trimester
- cause> imbalnce of calcium/ phosporius ratio, low magnesium levels, increased pressure of uterus on nerves
- treatment> elevate legs during the day, practice moving feet and stretching muscles, avoid foods high in phosphorus and increase calcium
Ankle Edema
- 2nd/3rd trimester
- cause> prolonged sitting or standing, increased sodium due to hormonal influences
- treatment> practice dorsiflexion of feet, avoid restrictive bands around the legs, elevate legs when sitting
Backache
- 2nd/3rd trimester
- cause> increased curvature of lumbosacral spine as uterus enlarges, softening of cartilage from increased hormone levels, poor body mechanics
- treatment> use proper body mechanics, practice pelvic tilt exercise , avoid high-heeled shoes and heavy lifting
True Labor
- Contractions at regular intervals
- Intervals between contractions gradually shorten
- Contractions increase in duration and intensity
- Discomfort begins in back and radiates to the abdomen
- Intensifies when walking
- CERVICAL DILATION/ SOFTENING
False Labor
- Contractions are irregular
- Not getting closer together or stronger
- Usually decrease with rest and fluid
- Usually felt in the abdomen
- Walking has no effect or lessens contractions
- NO cervical dilation
5 P’s of Labor
- Passenger
- Passageway
- Powers
- Positions
- Psychosocial Responses
Passenger
- Fetal head or presenting part
- bones are not fused allowing the fetal head shape to change
- Placenta, amniotic fluid, amniotic membranes
- The altitude of the fetus changes> head/ body is now tilted
- Fetus presentation: Cephalic/ Breech
- Easiest to deliver is complete flexion cephalic
- Frank breech: toes up to face Complete breech: feet criss/crossed, Footing breech: one foot down
- Most common and easiest to deliver fetal positioning> LOA/ROA
- Sunny side up baby> LOP/ROP
Passageway
Bony Pelvis
True pelvis: inlet, mid and outlet
False pelvis: upper, flaring part
Size & Shape> never know shape until you physically look
Soft tissues
Cervix, muscles, ligaments, fascia
Ischial spine> pooky things on the pelvis
Smallest part
+> is the head is out
-> is the head is still inside
Powers
Uterine contractions
Frequency, intensity, and duration
Effacement: thinning of the cervix
Dilation: opening of the cervix
Position
Psychosocial response
A womans mental status and expectations can influence the course of her labor and her response to the childbirth experience
Relaxation should be promoted
Anxiety should be assessed
How can patient be comfortable?
Loss of control of body functions
Accomplishment of tasks of pregnancy
Good to have good support people
educational needs of a childbearing family
- Know the warning signs of Pregnancy
- spotting/ bleeding
- Painful urination
- Severe and persistent vomiting
- Fever higher than 100
- Sudden gush or leakage of fluid from vagina
- Perorbital or facial edema
- Severe upper abdominal pain
- Headache with visual changes
- How to prepare for a newborn> first child or not
- Prepare children into having siblings> acclimate them
First stage of changes has how many phases
two, Latent and Active phases
Latent Phase
- 0-6 cm dilated
- Frequency every 5-10 minutes
- Duration 30-45 sec
- Intensity mild to palpation
- Mother more interactive when contractions occur
Active Phase
- 6-10 cm dilated
- Frequency every 2-5 minutes
- Duration 45-60 sec
- Intensity moderate to palpation
- Mother more focus and less interactive with others
What phases are in stage 2 of labor?
Pelvic and Perineal Phase
Pelvic Phase
Period of fetal disent
Perineal Phase
- Period of active pushing
- Frequency every 2-3 minutes
- Duration 60-90 sec
- Intensity strong to palpation
- Strong urge to push
- Crowning/ seeing head- birth
What is the third stage of labor?
Separation and delivery of the placenta, usually takes 5-10 minutes
What phases are in the third stage of labor
Placental separation and placental expulsion
What phases are in the third stage of labor
Placental separation and placental expulsion
What phases are in the third stage of labor
Placental separation and placental expulsion
Placenta expulsion
Placenta Coming outside the vaginal opening
Placenta Separation
Detaching from uterine wall
What is the fourth stage of labor?
- 1-4 hours after the birth of the newborn, time of maternal physiological adjustment
- Bonding/ skin to skin
Mother/ Antepartum Assessments
- Vaginal exam
- Leopold’s Maneuver’s
- vital signs/ assess contractions
Vaginal exam
- Check for cervical dilation and effacment
- Check fetal descent and presenting part
- Check rupture and movement
Leopold’s Maneuver’s
- Which fetal part is in the uterine fundus
- Where is the fetal back located?
- What is the presenting fetal part?
vital signs/ assess contractions
- HR, Resp, BP, Temp
- Frequency, duration, intensity
Warning signs of pregnancy> when to go get checked
- spotting/ bleeding
- Painful urination
- Severe and persistent vomiting
- Fever higher than 100
- Sudden gush or leakage of fluid from vagina
- Perorbital or facial edema
- Severe upper abdominal pain
- Headache with visual changes
Fetal circulation adaptations
1.) umbilical vein
2.) ductus venosus> short cut
3.) Foramen Ovale> lets blood cross sides of heart
4.) Ductus arteriosis> pulmonary artery to the aorta
5.) Umbilical artery
Cardinal Movements
Engagement: Baby’s head is engaged in pelvis
Descent: Baby moving down
Flexion: Crowning(seeing head)
Internal Rotation: Turn head towards one side
Extension:
External Rotation: Rotating shoulders and body to pull out
Expulsion: Baby Out
Nursing intervention stage 1
General hygiene
Nutrient & fluid intake
Elimination
Gravity positive, allow labor to begin on own
Practice pushing
Nursing intervention stage 2
Assess bladder distention
Assist with pushes/ encourage
Prepare the room for delivery
position changes
Support father/ partner
Pain Management
Pharmacologic strategies
NonPharmacologic strategies
Lighting/ temperature
Cleanliness/ mouthcare
Positioning/ pressure points
Pharmacologic strategies
opioids> morphine, fentanyl
Inhaled Analgesics
Anesthesia> regional, epidural, spinal narcs
Pudendal block
NonPharmacologic strategies
Relaxation
Cutaneous Stimulation
Massage, counterpressure, acupressure
Thermal Stimulation
Hydrotherapy
Position changes
Breathing techniques
Aromatherapy
Intradermal block
Most common side effect of epidural
Hypotension
Procedures in Labor and Delivery
Episiotomy: Surgical incision of the perineal body to enlarge the outlet
Forceps-Assisted Birth: Assist in the birth of the fetus by providing either traction or rotate the head
Vaccum-Assisted Birth: Same as forceps but with a vacuum
Nursing intervention Stage 3 of labor
Assist provider with delivery of placenta, get bucketl to catch placenta
Nursing Care Stage 4 of Labor
Monitor for hemorrhage
Observe bladder function/ output
Evaluate recovery form anesthia
Providing initial care to the newborn
Promote bonding and attachment
