Week 2 Chapters 11 and 12 Flashcards
Pregnant woman and number of pregnancies incurred regardless of length or outcome
Gravida
Viable outcomes of pregnancy described as term, preterm, and living
Parity
Fetal loss before the age of viability, either spontaneous or therapeutic
Abortion
Woman pregnant for the first time
Primigravida
Woman who has been pregnant two or more times
Multigravida
Woman who has been pregnant for 5 or more times and delivered all
Grand Multipara
Woman who has never given birth to a viable fetus
Nullipara
Woman who has given birth to one viable fetus
Primipara
Woman who has given birth to two or more viable fetuses
Multipara
GTPAL
G: Refers to number of pregnancies
T: Number of term deliveries for this patient
37-42 weeks
P: Preterm Delivery 22- 36 weeks
A: Number of aborted gestations for this patient @ 1-21 weeks(includes elective terminations, ectopic pregnancies)
L: Living children
- Deliveries refers to the number of times a patient delivers, not the number of infants delivered at a time, if a patient deliver twins
ex: 1 delivery, 2 living children
EDC is calculated by taking the first day of the LMP, subtracting 3 months and adding 7 days
Nagele’s Rule
Term Pregnancy= 40 weeks from LMP
_______________________ can be used to calculate the due date. Use it by, place the last “menses” arrow on the date of the woman’s LMP. Then read the EDB at the arrow labeled 40.
EDB Wheel
1 to 12 weeks is
1st Trimester
13 to 28 weeks
2nd Trimester
29-40 weeks is
3rd Trimester
Initial Prenatal Visit
Assessment
S/S of Pregnancy
History
Personal Traits
Habits
Lab Data
Physical Assessment
Psychological Assessment
Sociological Assessment
Changes felt by the woman; amenorrhea, nausea and vomiting, fatigue, breast tingling
Presumptive Signs
Signs observed by the examiner, Hegar’s sign, Chadwick’s sign, ballottement, pregnancy tests
Probable Signs
Signs attributed to fetal presence; audible fetal heart tones, visualization of fetus by US, palpation of fetal movement by a trained practitioner
Positive Signs
Bluish- purple coloration of the vaginal mucosa and cervix
Chadwick Sign
- Sign of Pregnancy
Softening of the cervix
Goodell Sign
- Sign of pregnancy
Softening of the lower uterine segment or isthmus
Hegar Sign
- Sign of pregnancy
Postural changes during pregnancy does occur by what?
Increasing lordosis of the lumbosacral spine and increasing curvature of the thoracic area
Softening of the isthmus of the uterus, can be determined by the examiner during a vaginal examination
Hegar’s Sign
Visits are generally monthly for the first what?
28-30 weeks
Visits at least twice a month is done at what weeks?
30-32 weeks and until 35 weeks
35-36 weeks, visits are done ?
Weekly
High risk pregnancies generally have more frequent visits, and may be seen weekly or twice weekly depending upon the problems.
True
High risk pregnancies may be followed by antepartum testing, weekly or biweekly, depending upon the problem and the severity of the complication.
True
Information is collected at each visit and recorded on the prenatal record
11-13% mg measurement of oxygen carrying ability of RBC
Hemoglobin
35-40% mg measurement of RBC concentration
Hematocrit
Done to identify possible maternal- fetal incompatibilities and identifications for the possible transfusion after delivery
Blood Types
Measurement of a protein factor( D antigen) on RBC
Rh factor Positive or negative
rh negative clients need RhoGAM shot
Measurement of Blood Group related antibodies in a random sample, examples are antibodies
Positive finding could indicate fetal RBC hemolysis
Normal is negative
Antibody Screen
Indirect Coombs
Titer will indicate immunity to rubella
> 1:10, Rubella
Various tests to measure syphilis
Normal is negative
Serology
VDRL
RPR
Negative surface for antigen
Measure for infectious hepatitis b; presence of antibody but no antigen indicates prior disease but not currently infections
Hep B
Measures presence of gonnorhea done from vaginal/cervical secretions
Normal negative
GC
Measure of a sexually transmitted disease which can cause neonatal pneumonia and eye infections
Normal is Negative
Chlamydia Culture
Measurement of normal morphology of cervical cells and may see Class II during pregnancy
Normal is Class I
Pap Smear
Positive levels of GBS may cause neonatal sepsis and contribute to neonatal mortality
Prophylactic antibiotics are used in labor to decrease neonatal susceptibility. Neonate may not be dismissed from nursery until after 48 hours and may require lab work
Group B Strep
Normal is negative
Positive during pregnancy
Measurement of HCG which should only be present in a pregnant individual
Urine Pregnosis
Negative for
Glucose
Ketones
Protein
Blood
Urinalysis
Measure of serum glucose level, possible diabetes
Measurement of cellular nutrition
Measurement of renal function, PIH
Measurement of renal function, bleeding, infection
Blood test done between 15 and 20 weeks of gestation to determine presence of neural tube defects (High Value) or Down’s Syndrome ( Low Value)
AFP
Normal is negative
Measurement of exposure of TB or active disease
If positive, may be followed by X RAY
TB Skin Test
Normal is negative
Normal is lower than norm standards
Testing for gestational diabetes; measures of blood sugar after measurable glucose level
Glucose Tolerance Testing
Normal is lower than norm standards
Use of sound waves to and resultant echo detect and measure objects
Ultrasound
Obstetrical Use
1st Trimester- Number, size, and location of gestational sacs, fetal cardiac and body movement, uterine and/ or adnexal mass, pregnancy dating (BPD, crown- rump length)
Fetal growth, age and viability fetal anomalies/ amnio amniotic fluid volume, uterine and/ or adnexal anomalies, placental location and maturity, biophysical profile
2nd Trimester
Fetal growth, age and viability, fetal anomalies, uterine and/ or adnexal anomalies, placental location and maturity, biophysical profile ( w/ AFI), lung maturity ( amniocentesis)
3rd Trimester
Involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis
Amniocentesis
When is amniocentesis performed?
Second trimester usually between 15 and 20 weeks gestation
Increases of 20 weeks usually for
Fetal Lung Maturity
Scanning permits visualization of the fetus in the utero
Ultrasound
Inform patient of procedure and consent if needed
Patient needs full bladder for placenta location
Position supine with head pillow and hip bump
Allow patient to watch and provide explanation
Point out fetus and fetal parts
Assist to sitting position
Assist to restroom as soon as possible
Nursing Interventions
Prenatal Nursing Assignments Include
History
Interviewing techniques
Determination of EDC
Menstrual History
Obstetrical History
Family History
Medical- Surgical History
Personal Traits
Habits
- Smoking
- Caffeine
- Alcohol
- Cocaine
- Heroin
- Methamphetamine
Laboratory Data
- Pregnancy testing
- Screening and diagnostic tests
Physical Assessment
- Physiological adaption of pregnancy
- Physical Exam
- Pelvic Exam
- Nursing Role
- Review of Findings
Prenatal Assessments
Psychological Assessments
Sociocultural Assessment
- Cultural norms
- Primary language
- expectations of prenatal care
- view of pregnancy state
Spiritual influences
Community Resources
Current issues/ trends
Prenatal Nursing Assessments
Implementation of Nursing Care
- Compile a plan of management for the antepartal family for each trimester of pregnancy
Initial Visit
- Nutritional needs and nursing management
Prenatal Nursing Assessments
Common concerns and nursing management employment
- Physical Activity
- Dental Care
- Medications
- Substance Use
Sexuality
Prenatal Nursing Assessments
Danger Signs of Prenatal Assessments
Nausea, vomiting, anorexia
Abdominal pain, bleeding
Fever, chills, malaise
S/S UTI
Diarrhea
Schedule of Care of Prenatal Nursing Care
Every 4 weeks from 28-32 weeks
Every 2 weeks from 32-36 weeks
Every week from 37- delivery at 40-42 weeks
Prenatal Nursing Assessments for 1st Trimester
Screening for problems
Interview
Resolution of previous problems
Appearance of danger signs
Prenatal Nursing Assessments
Assessments
- B/P
- Urinalysis
- Weight
- Edema
- Assessment of fundal height
- Auscultation of fetal heart
Second Trimester Nursing Management
Screening for problems ( same as the 1st trimester plus those noted below)
Interview
Appearance of danger signs
S/S Pre eclampsia ( HA, right upper gastric pain, edema)
Leaking water
- Cramping, contractions
- Resolution of previous problems
Second Trimester Physical Assessments
- B/P
- weight
- urinalysis
- edema
- Fundal Height
- Auscultation of fetal heart
- Palpation of fetal movement
- Common discomforts and nursing management
Common concerns of 2nd Trimester
Clothing
Physical Activity
Sexuality
Danger Signs- as before but include no fetal movement after quickening
- Infant feeding method
- Breast -feeding preparation
Prenatal Nursing Assessments Third Trimester
Third Trimester
- Screening for problems
- Interview
- Appearance of danger signs
- as in first two trimesters, but include loss of fetal movement, ROM, uterine contractions
- Resolution of previous problems
Palpation of fetal position
Leopold’s Maneuver
Common discomforts and nursing managements
Prenatal Nursing Assessments
- Common Concerns
- Danger Signs- preterm- same as 1st and 2nd trimester plus decrease or change in fetal activity
- Signs of labor
- Education of childbirth
- Sexuality
- Learning Needs weeks 29-40 and nursing management
- Summary of nursing care
Prenatal Nursing Assessments
Physical Assessments
- B/P
- Weight
- Edema
- Urinalysis
- Fundal Height
- Fetal Heart tones
-Leopold’s Maneuver
- Vaginal Exam
Substance Abuse includes
Smoking- There is a well established relationship between maternal smoking and low birth weight infants and respiratory problems in infants and children
Alcohol- Alcohol intake during pregnancy can result in a variety of neonatal neurological disorders including Fetal Alcohol Syndrome (FAS), Fetal Alcohol Exposure Syndrome (FAEs), Learning disabilities and behavioral problems
Substance Abuse
Drugs of Abuse
Management of the substance abuse client
Neonatal management
CNS stimulant also known as speed, meth or crank; easy to manufacture
Methamphetamines
Physiological effects of Substance Abuse
Tachycardia of mother and fetus
Tachypnea
Seizures, violent behaviors, difficulty staying in bed
Preterm Labor
Addicted when born usually
Methamphetamines
Psychological Effects
- Paranoia, delusions
Neonatal Effects
- Altered sleep patterns
- Irritability high pitch cry
- Uncoordinated reflex activity
( Suck swallow reflex)
Convulsions (seizures)
Management of Antepartal Substance Abuse Clients
Assessment
Screening includes
- History of substance use/ abuse
- Start with over the counter drugs; prescription medications, alcohol, smoking, then street drugs
Ask about amount and the frequency of use
Important to be non- threatening and non judgmental
Management of Antepartal Substance Abuse Clients
Assessment
- Screening includes
- History of substance abuse/ use
- Start with over the counter drugs; prescription medications, alcohol, smoking, then “ street drugs”
- Ask amount and frequency of use
- Important to be non threatening and non judgmental
Management of Antepartal Substance Abuse Clients
Related History Items
- History of late, inconsistent or absent prenatal care in prior pregnancies
- Late onset of care or no prenatal care in this pregnancy
- Poor obstetrical history: SAB, preterm labor, multiple gynecological and urinary tract infections, hepatitis, positive HIV, small fetal size, poor pregnancy weight gain
- History of multiple pregnancies
Physiological Adaptation by
Hormones
Initial enlargement of the uterus
- Increase in uterine blood supply
- Enlargement of the breast
- Growth of glandular tissue ducts, alveoli and nipples
- Increased thyroid activity
- Promotes sodium and water retention by kidney tubules
- Increases coagulability
- Decreases fibrinolytic activity
- Stimulates melanin- stimulating hormone
Estrogen
Hormone that promotes the development of decidual cells of endometrium
Decreases contractility of the gravid uterus
Promotes the development of the secretory portion of the lobular ductal system
Increases sensitivity of the respiratory to CO@
Progesterone
Reduces tone of smooth muscle
- Decreases gastric motility
- Relaxes gastric sphincter
- Reduces tone of the bladder
- Decreases vascular tone
- Decreases colonic activity
- Decreases tone in the gallbladder
- Raises body temperature 0.5 degrees C
Progesterone
Maintains the corpus luteum in early pregnancy
May cause allergic response
May have immunologic properties
HCG
Myometrial changes; changes from thick walled muscular structure to thin walled sac at term
Uterus
_________ keeps the smooth muscle relaxed and “quiet” during pregnancy
Progesterone
Uterine growth occurs at a predictable pattern and rate
True
Uterine enlargement in 1-20 weeks increase due to
Estrogen
Uterine enlargement 20-40 weeks increase due to what?
Fetal Distension
Now fetus is pushing the uterus up
Growth is primarily due to?
Hypertrophy of existing muscle fibers
Growth norm at 7 weeks
Size of the Hen
Growth norm at 10 weeks
Size of orange
Growth norm at 12 weeks
Size of grapefruit
Growth norm at 12- 13 weeks
Fundus at symphysis pubis
Growth norm at 20 weeks
Fundus at umbilicus
Growth norms at 36 weeks
Fundus at xyphoid process
Growth norms at 13- 40 weeks
Measurement from symphysis pubis to fundus measurement in cm should equal weeks of gestation with normal deviation +/- 1-2 weeks
What contractions may facilitate uterine blood flow?
Braxton- Hicks Contractions
Increased blood flow through the dilated uterine arteries can be _______________; called the
auscultated, uterine souffle
Swish Swish Sound
Uterine lining is called what after implantation?
Decidua
- Endometrial changes
____________ layer is maintained during pregnancy due to high levels of __________ and ___________ resulting in amenorrhea
Decidua
Estrogen; Progesterone
Cervical change that is bluish color of cervix due to increased vascularity
Chadwick’s Sign
Cervical change due to increased tendency for cervical tissue to bleed due to increased vascularity
Friability
Softening of the cervix later part of pregnancy
Goodell’s Sign
Closes the cervix and protects the uterus from infection
Mucous Plug
Vaginal discharge that is common with pregnancy
Leukorrhea
Mucosa thickens and becomes more vascular under influence of__________ and ____________.
Vagina/Vulva
Estrogen and progesterone
Increased tissue and sloughing plus increased cervical mucus causes formation of copious white discharge called
Leukorrhea
Gravid women are more prone to ?
Monilial Vaginitis - Yeast infections
Due to the vaginal epithelial cells contain more glycogen than in non-pregnant state
Increased relaxation of vaginal walls to allow for
Marked distention during delivery of the fetus
External structures enlarge and become ?
More vascular and relaxed
The labial edema, varicosities increase and “flabbiness” to perineal area common
True
Perineal tissues relax to allow for distention during delivery
True
High levels of estrogen and progesterone secreted first from corpus luteum then from the placenta suppress hypothalamic- pituitary- ovarian axis
Ovaries
Increased ___________ and increased_________ cause decreased secretion of releasing hormone from _____________.
Estrogen, progesterone
Hypothalamus
Decreased ____ and ____ from the _______ ________.
FSH and LH
Anterior Pituitary
No follicular development, maturation, and ANOVULATION.
The corpus luteum remains viable until week?
Week 10.
Then degenerates since placenta can now take over estrogen and progesterone production.
Breast changes occur to prepare for?
Lactation post-delivery
Changes occur due to influence of
Estrogen and progesterone
Estrogen is
Mediated adaptation.
Breast enlargement due to growth of
Alveolar cells and secreting ducts
Increased prominence of Montgomery tubercles
Darkening of areola
Vasodilation of vessels supplying breast tissue
Progesterone mediated Adaptation
Development of secretory lobular alveolar system resulting in increased breast size and “lumpy” consistency.
Progesterone Mediated Adaptation helps with production
Colostrum
Creamy white to yellow pre milk fluid produced from 16 weeks
Colostrum
Present at birth to nourish neonate until breast milk is established
Breast milk usually not produced until what?
Estrogen levels drop after delivery of the placenta
Estrogen inhibits what?
Prolactin
From binding to alveolar cells in the breast thus initiating the lactation process
Estrogen causes increased production of
Melanotropin resulting in increased pigmentation
Lupus like pigmentation on face
Chloasma
Dark pigmented extended from the symphysis pubis to the umbilicus and/or fundus
Linea Nigra
Formed arterioles, appear 2nd to 5th month, generally disappear after pregnancy may or may not
Angiomas Vascular Spiders
Diffuse mottling/ blotches on palmar surface of hands
Palmer Erythema
Integumentary System Progesterone- Mediated Adaptation
Increased perspiration
Striae gravidarum
Occurs due to separation of collagen under skin which fills in with scar tissue
Will lighten in color but will never disappear
Familial Tendency
Striae Gravidarum
Caused by fluid retention mediated by estrogen and decreased vascular tone mediated by progesterone
Edema
Caused by vessel wall relaxation mediated by progesterone
Increased blood volume
Varicose Veins
Most neurological problems are caused by ?
Mechanical pressures and hormonal influences
Compression of median nerve in wrist from edema
Carpel Tunnel Syndrome
Symptoms include
Burning/ tingling in hand, pain, and numbness
Carpel Tunnel Syndrome
Neurologic problem more prone to
Vertigo, syncope, lightheadedness due to vasomotor changes and/or hypoglycemia
Leg pain due to compression of
Pelvic Nerves
Vascular Stasis
DTRs should remain
2+ normal
Cardiovascular system anatomic adaptation with slight….
Slight cardiac enlargement due to increased blood volume
Shift in Heart position
Hemodynamic adaptation
What type of murmur may be heard?
Grade I/II due to increased blood flow
Increased cardiac output in response to increased …
Tissue demands for oxygen probably secondary to increased vascular volume
___________ relaxes smooth muscle present in arterial vessel walls thus creating a state of generalized vasodilation to a accommodate the increased blood volume
Progesterone `
B/P changes for 1st trimester
Normal BP
2nd Trimester BP changes
Decrease due to arteriolar relaxation
3rd Trimester BP changes
BP returns to pt norm due to increased blood volume
BP highest when patient is sitting, lowest when in left lateral recumbent position
Supine hypotension/vena cava syndrome
Orthostatic hypotension
Gravid and heavy uterus puts pressure on the vena cava reducing venous return and causing hypotension
Supine Hypotensive Syndrome
At 32-34 weeks blood volume is increased by
40%
Purpose of increase blood volume
Hydrate and oxygenate maternal and fetal tissue
Protect from blood loss at delivery
Maintain BP up
Plasma component increases more than RBCs resulting in
Hemodilution
Observed on CBC report as decrease in:
hemoglobin and hematocrit levels known as
(pseudo-anemia) at 28-32 weeks
RBC production increases up to
30%
Provide hemoglobin for maternal and fetal tissue oxygenation
Fetus is dependent upon adequate maternal blood volume, adequate hg level, and adequate blood pressure to meet oxygen level needs
True
Maternal Hg releases ______ more readily during pregnancy.
Oxygen
Coagulation changes
_____________ causes increased tendency to __________ during pregnancy
Estrogen; coagulate
May result in increased tendency to clot during the postpartal period
Respiratory system anatomic adaptation increased
Antero-posterior diameter to facilitate lung expansion
Increased vascularity of upper respiratory tract with resultant edema
Causes of resultant edema
Nasal and Sinus stuffiness
Epistaxis
Earaches, feeling of fullness in ears, decreased hearing
___________ causes a mild ___________ during pregnancy resulting in ___________ ____________.
Progesterone
Hyperventilation
Respiratory Alkalosis
Decreased concentration of ______ ___________ in alveoli.
Carbon Dioxide
Respiratory changes to increase_____________ to maternal and fetal tissues and facilitate ________ ___________ removal.
Oxygen
Carbon dioxide
GI system is ______ mediated adaptation
Estrogen and Progesterone mediated
Increased vascularity to gums resulting in
Edema and bleeding
Decreased secretion of HCL
Progesterone mediated adaptation
Heartburn due to esophageal regurgitation and decreased gastric motility
Constipation from decreased peristalsis
_____________ from relaxation of vessel walls and increased pressure
Hemorrhoids
Increased incidence of gallstones from _____________ of gallbladder
Hypotonicity
Excessive salivation
Ptyalism
Slight increase in size pregnancy
BMR is increased during pregnancy
Parathyroid Gland
Pituitary Gland/ Placenta
Adrenal Gland
Pancreas
Endocrine System
Thyroid Gland
Pregnancy places additional demands for insulin production upon the pancreas which may result in _________ _____________.
Pancreas
Gestational Diabetes
Endocrine system in pregnancy include
HCG, estrogen, and progesterone
Prostaglandins
GU system changes anatomically due to
Hormonal influence and mechanical pressure
______________ of renal pelvis and ureters
Dilatation
Decreased bladder tone
Due to above urinary stasis and increased risk of ____ exist during normal pregnancy.
UTI
Increased vascularity of bladder
Urinary frequency due to
Bladder compression and inability to fully empty due to pressure will resolve usually after 12 weeks then comes back again after lightening occurs at 36 weeks
Increased _____ from increased blood volume
GFR
Decreased effectiveness of filtration system resulting in increased secretion of small molecule substances such as
Sodium and glucose
Increased _______ retention to maintain increased _______ volume and can be hampered by sodium intake and use of diuretics
Sodium
Blood
What hormone will promote ________ and _____ retention?
Estrogen
Sodium and fluid
Enlarging uterus causes what?
Diastasis of rectus abdominus muscles, change in center of gravity and hypertrophy and increased stress of uterine supportive ligaments
Which ovarian hormone causes decreased muscle tone of ligaments and increased mobility of pelvic joints
RELAXIN
Pelvic joints including - symphysis pubis and Sacro-iliac) resulting in pelvic instability
Symptoms of pelvic instability are
Waddling gait
Lower back pain, leg pain, and difficulty walking
What are considered crisis events since they require adjustment of previously developed roles and development of new roles ?
Pregnancy, childbirth, and early parenting
Pregnancy affects the entire family, both nuclear and extended
True
Nursing management must encompass ____ members of the pregnant family
ALL
Most research has been done on whom?
White, middle class families, and it may not be applicable to other cultural groups
Maternal task of Psychological Adaptation
Pregnancy Validation
Typical Behaviors 1st trimester psychological adaptation
Ambivalence regarding pregnancy
Concern with body image and appearance
Concern with formation of “mother” identify ( client’s mother response to pregnancy is important)
Sexuality concerns 1st trimester psychological adaptation
Nausea and vomiting, fatigue, and breast tenderness may decrease sexual desire
Important for both partners to know this is normal and usually temporary
Maternal Psychological Adaptation
Stress Normalcy of mood swings and dependency of both partners
Encourage verbalization of concerns regarding sexual activity
Client usually interested in appearance and abilities of the fetus
Good time to use pictures of fetus in utero
Can start to include fetal needs in client education ( nutrition)
2nd Trimester Maternal Psychological Adaptation
Maternal task is FETAL DISTINCTION
Typical behaviors of 2nd trimester of maternal psychological adaptation
Experience quickening- 1st maternal perception of fetal movement
18-20 weeks for primigravida
16-18 weeks for multigravida
Easier to perceive fetus as a unique individual after quickening
Emotional lability; mood swings
Introversion
Increased emotional dependency
Usually more interested in sexual activity because feeling better
Increased vascularity and sensitivity of genitalia may allow for stronger and quicker orgasm
Fear of pregnancy gone and no need for contraception so better spontaneity
Sexuality Concerns of Maternal Adaptation
Stress normalcy of mood swings and dependency to both partners
Encourage verbalization of concerns regarding sexual activity
Client usually interested in appearance and abilities of fetus inside
Good time to use pictures of fetus in utero
Can start to include fetal needs in client education ( nutrition, balance, fluids.)
Client teaching of Maternal Psychological Adaptation
3rd Trimester of Maternal Psychological Adaptation
Maternal Tasks: Fetal Separation and Role Transition
Typical Behaviors of 3rd trimester Maternal Psychological Adaptation
Concern with body image, feeling large
Frequently express being “ tired of being pregnant”
May have fears regarding labor and delivery
Dream about labor and infant
Sexuality Concerns - May have decreased desire due to discomfort, fetal movement, fear or harming infant
Maternal Psychological Adaptation Client Teaching
Good time to begin labor preparation classes
Discuss plans for delivery
Discuss preparation for infant
Discuss alternatives to meet sexuality needs
Discuss signs of labor
Main role of partner is to nurture and respond to partner’s feelings of vulnerability
True
Changes occur for expectant fathers during each trimester but usually occur when?
LATER
Paternal Adaptation 1st Trimester
Difficulty at times conceiving of pregnancy since can not see physical changes
Frequently have concerns with economic demands and role changes.
May have difficulty dealing with sexual response, or lack of it, from partner
Paternal Adaptation of 2nd Trimester
Validation of pregnancy and fetus facilitated by feeling fetus move and hearing heartbeat
Encourage father to accompany partner to prenatal appointments
May experience weight gain or nausea and vomiting
Some partners feel “left out” since most attention is directed toward female
May experience difficulty dealing with partner’s mood swings and dependency
Paternal Adaptation of 3rd trimester includes
Dream about infant usually as a toddler
Fears about losing partner or infant during labor
May have concerns about sexual activity ( fetal movement during coitus makes it seem like there is a third part; “making love to the mother.”
Encourage participation in labor participation classes; needs a role in delivering this infant
Sibling adaptation of preparation is
Age related
Many families want their children present during the delivery
Important child is prepared for this experience by Sibling Preparation Classes
Why do we not recommend not to tell toddlers pregnancy too soon?
No true concept of time and will expect infant immediately
Plan moves out of crib and toilet training well in advance of the expected delivery to decrease normal sibling rivalry and possible regressive behaviors
Preschoolers sibling adaptation concept
Poor concept of time but may enjoy looking at pictures of infants and fetal heartbeat
Allowed at some deliveries with appropriate preparation and responsible adult present to care for them
School age children and sibling adaptation
Interested in the pregnancy
How did it get there?
May be present ar delivery with right preparation
Adolescents sibling adaptation include
Difficulty dealing with evidence of parental sexual activity
Frequently present at delivery
May have difficulty dealing with intensity of labor and genetalia with birth process
The grandparental adaptation may desire
Active role in both pregnancy and delivery
Client often desires who during labor process?
Mother
Especially true in many cultural groups
May have to deal with misconceptions and dated knowledge regarding childbirth
Try not to discredit these individuals since they are important support to your client
True
Maternal psychological Adaptation for 1st trimester is
Pregnancy Validation
Maternal psychological Adaptation for 2nd trimester is
Fetal distinction
Maternal psychological Adaptation for 3rd trimester is
Fetal Separation and Role Transition
Psychological Adaptation for Paternal Adaptation 1st trimester
Difficult to conceive of pregnancy
Psychological Adaptation for Paternal Adaptation 2nd trimester
Validation of Pregnancy
Psychological Adaptation for Paternal Adaptation 3rd trimester
Dreams, fears, and concerns
1st, 2nd, 3rd trimester fruit daily intake
2 cups daily
Veggies daily intake1st trimester
2.5 cups
Veggies daily intake 2nd and 3rd trimester
3 cups daily
Whole grains 1st trimester intake
6oz
Whole grains intake 2nd and 3rd trimester
8oz
Protein daily intake 1st trimester
5.5 oz
Protein daily intake 2nd and 3rd trimester
6.5 oz
Dairy daily intake 1st trimester
3 cups daily
Dairy daily intake 2nd and 3rd trimester
3 cups daily
Essential for maternal and fetal tissue development, maternal and fetal blood formation and vascular fluid control
Protein
___________ contains __________ which is essential for tissue development
Protein, nitrogen
Protein is also good sources of
Calcium
Iron
B vitamins
Fiber
___ % of pregnancy diet should consist of protein foods
20
These proteins contain all 8 essential amino acids
Complete Proteins
Protein molecules are too large to perfuse, intact, across the placenta molecule is broken down into
Separate Amino Acids on the maternal side of placenta and perfuse across in that form
Fetus then takes each separate amino acid to reconstruct a
Protein Molecule which is then used for tissue development
If insufficient number of amino acids are available
The fetus will be unable to form adequate tissue
If 2 or more incomplete proteins are ingested at same meal, what happens?
Net result should be ingestion of a sufficient number of amino acids to facilitate tissue development
Primary energy source of the body
Needed to spare proteins for tissue development
Carbohydrates
CHOs should be about % of diet?
50%
Ex: breads, cereals, fruits, veggies, milk
Increased need also due to what? CHOs
Increased BMR
Needed for energy
Fats
Supply free fatty acids and fat soluble vitamins
Ex: Butter, Margarine, oils, nuts, ice cream, whole milk
