Chapter 4 Physiological Aspects of Antepartum

Goals of Prenatal Care Regular assessment of health of pregnancy Regular assessment and screening of risk factors for potential complications Implementation of appropriate interventions based on risk status or actual complications Inclusion of significant others/family in care and education to promote pregnancy adaptation Education on health promotion and disease prevention of complication

Preconception Health Care Defined as a set of interventions aiming to identify medical, behavioral, and social risks to a woman’s health. Two components of preconception health care include Routine physical exam Health screening

Anticipatory Guidance Anticipatory guidance and teaching include information on Nutrition Medication Self-care Contraception Timing of conception Modifying behaviors to reduce risks

Diagnosis of Pregnancy Based on combination of the following Presumptive signs Probable signs Positive signs

Formula for Naegele’s Rule Calculating Due Date Formula for Naegele’s Rule LMP April 27 4 – 27 Subtract 3 months –3 months January 27 1 – 27 Add 7 days +7 days EDD: February 3 2 – 3

Physiological Changes of Pregnancy Breast Uterus Vagina Ovaries Cardiovascular system Respiratory system Renal system

Physiological Changes of Pregnancy (Cont.) Gastrointestinal system Musculoskeletal system Integumentary Endocrine system Immune system

Antepartal Nursing Care Components of prenatal care Family-centered maternity care

Intimate Partner Violence How do you recognize a pregnant woman who has been abused? What strategies would you utilize to approach her? What is the nurse’s role?

Prenatal Assessment Terminology Gravida Parity GTPAL Nulligravida Primigravida Multigravida

First Trimester Initial assessment includes History of current pregnancy Physical and pelvic exam Assessment of uterine growth Assessment of fetal heart tones Laboratory and diagnostic studies Patient education and anticipatory guidance

Second Trimester Includes components of initial assessment Confirm established due date Laboratory and diagnostic studies Administer Rhogam (if indicated) Patient education and anticipatory guidance

Third trimester Focused assessment Assessment of fetal well-being Pelvic examination Leopold’s maneuver Nutritional follow-up Screening for group B streptococcus Laboratory tests Patient education and anticipatory guidance

Review Questions Goals of prenatal care include all of the following except Regular assessment of health of pregnancy and screening of risk factors Implementation of appropriate interventions based on risk status or actual complications Exclusion of significant others/family in care an education to promote pregnancy adaptation Education on health promotion and disease prevention of complication

Answer 3

Diagnosis of pregnancy is based on a combination of the following 1. Presumptive, definitive and positive signs 2. Presumptive, probable signs and positive signs 3. Presumptive, assumed and positive signs 4. Presumptive, physiological and positive signs

Answer 2

Chapter 5 Psychosocial Cultural Aspects Of Antepartal Period

Maternal Adaptation to Pregnancy Factors affecting adaptation Psychological Physical Social

Maternal Tasks of Pregnancy (Rubin) Ensuring safe passage for herself and her child Ensuring social acceptance of the child by significant others Attaching or “binding-in” to the child refers to the development of maternal — fetal attachment Giving of oneself to the demands of being a mother

Seven Dimensions of Maternal Role Development (Lederman) Acceptance of pregnancy Identification with the motherhood role Relationship to her mother Reordering relationship with her husband or partner Preparation for labor Prenatal fear of control in labor Prenatal fear of loss of self-esteem in labor

Factors That Influence Maternal Adaptation Parity Maternal age Sexual orientation Single parenting Multiple pregnancies Socioeconomic factor Abuse

Paternal Adaptation During Pregnancy Effect of pregnancy on fathers

Developmental Tasks of Fathers: Three Phases (May) Announcement phase Moratorium phase Focusing phase

Couvade Syndrome Ritual couvade Couvade syndrome is a condition in which men may experience pregnancy symptoms and discomforts similar to their pregnant partner. Ritual couvade

Sexuality in Pregnancy Physical, emotional, and interactional factors The desire for sex depends on the trimester Sexual desire decreases during third trimester Body image changes Concerns related to pregnancy

Family Adaptation During Pregnancy Changing structures of the family Eight stages in the life cycle of a family Grandparent adaptation Sibling adaptation Maternal adaptation to pregnancy Psychosocial adaptation to pregnancy complications

Social Support During Pregnancy Types of support include Material support assistance with chores, meals, managing finances Emotional support — affection, approval, encouragement, and feelings of togetherness Informational support — sharing information, and helping women investigate new sources of information Comparison support

Childbearing and Culture Statistics of U.S. population Behavioral practices Barriers to culturally competent care Ethnocentrism

Culturally Competent Nursing When practices, beliefs, and culture conflict, nurses must consider the following questions Is the practice safe? Is it feasible? Is it important to the woman?

Chapter 8 Intrapartum Assessment and Interventions

Factors That May Trigger Labor Maternal factors Fetal factors

Management of Discomfort During Labor and Delivery Pain may result due to the following factors Decreased blood supply to uterus Increased pressure and stretching of the pelvic structures Cervical dilatation and stretching

Factors Affecting Labor (4 Ps) Powers (the contractions) Passage (the pelvis) Passenger (the fetus) Psyche (the response of woman)

Labor Process Premonitory signs of labor are Lightening Braxton-Hicks contractions Bloody show Spontaneous rupture of membranes

Mechanism of Labor Engagement Descent Flexion Internal rotation Extension External rotation Expulsion

Labor Stage one Stage two Stage three Stage four Labor is the process in which the fetus, placenta, and membranes are expelled spontaneously Stages of labor Stage one Stage two Stage three Stage four

First Stage Medical interventions Nursing actions Latent phase Cervix 0 – 3 cm Contraction every 5 – 10 min, mild intensity, lasting 30 – 45 sec Medical interventions Nursing actions

First Stage Average dilation 1.2 cm/hr depending on gravida Active phase Average dilation 1.2 cm/hr depending on gravida Dilation progresses 4 – 7 cm, 40 – 80% effacement Fetal descent Intense contraction q 2 – 5 mins, lasting 40 – 60 sec Increase in pain Medical interventions Nursing actions

First Stage Dilation from 8 – 10 cm, 100% effacement Transition phase Dilation from 8 – 10 cm, 100% effacement Contractions intense, q 1 – 2 min lasting 60 – 90 sec Feels exhausted Bloody show N/V, backache, diaphoresis, and trembling Medical interventions Nursing actions

Second Stage Complete dilatation Sudden burst of energy Shorter duration with multips than primips Intense contraction every 2 min, lasting 60 – 90 sec Increase in bloody show Perineum flattens, with bulging rectum and vagina Medical interventions Nursing actions

Third Stage of Labor Occurs after delivery of infant Period involving separation and expulsion of placenta/membranes Last 5 – 20 min Medical interventions Nursing actions

Fourth Stage This stage begins the postpartum period Ends 4 hr after delivery Mechanism of homeostasis occurs Medical intervention Nursing actions

Management of Discomfort During Labor Nonpharmacological management Pharmacological management Care of a woman before and after epidural anesthesia

Review Questions Latent phase of labor is indicated by Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of mild intensity, lasting 30 – 45 sec Cervix 0 – 4 cm dilated with contractions every 5 – 15 min, of mild intensity, lasting 30 – 45 sec Cervix 0 – 2 cm dilated with contractions every 3 – 10 min, of mild intensity, lasting 45 – 60 sec Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of strong intensity, lasting 30 – 60 sec

Answer 1

Active phase of labor is indicated by Average dilation 1.2 cm/hr, dilation progresses 4 – 7 cm Average dilation 1.2 cm/hr, dilation progresses 4 – 10 cm Average dilation 2 cm/hr, dilation progresses 4 – 7 cm Average dilation 1 cm/hr, dilation progresses 2 – 6 cm

Answer 1

Transition phase of labor is indicated by Dilation from 8 to 10 cm, contractions intense, q 1 – 2 min lasting 60 – 90 sec Dilation from 6 to 10 cm, contractions intense, q 1 – 2 min lasting 60 – 90 sec Dilation from 7 to 10 cm, contractions intense, q 2 – 4 min lasting 60 – 90 sec Dilation from 8 to 10 cm, contraction moderate, q 1 – 2 minutes lasting 60 sec

Answer 1