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Chapter 4 Physiological Aspects of Antepartum
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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
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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
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Anticipatory Guidance
Anticipatory guidance and teaching include information on Nutrition Medication Self-care Contraception Timing of conception Modifying behaviors to reduce risks
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Diagnosis of Pregnancy
Based on combination of the following Presumptive signs Probable signs Positive signs
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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
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Physiological Changes of Pregnancy
Breast Uterus Vagina Ovaries Cardiovascular system Respiratory system Renal system
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Physiological Changes of Pregnancy (Cont.)
Gastrointestinal system Musculoskeletal system Integumentary Endocrine system Immune system
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Antepartal Nursing Care
Components of prenatal care Family-centered maternity care
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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?
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Prenatal Assessment Terminology
Gravida Parity GTPAL Nulligravida Primigravida Multigravida
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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
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Second Trimester Includes components of initial assessment
Confirm established due date Laboratory and diagnostic studies Administer Rhogam (if indicated) Patient education and anticipatory guidance
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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
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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
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Answer 3
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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
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Answer 2
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Chapter 5 Psychosocial Cultural Aspects Of Antepartal Period
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Maternal Adaptation to Pregnancy
Factors affecting adaptation Psychological Physical Social
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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
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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
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Factors That Influence Maternal Adaptation
Parity Maternal age Sexual orientation Single parenting Multiple pregnancies Socioeconomic factor Abuse
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Paternal Adaptation During Pregnancy
Effect of pregnancy on fathers
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Developmental Tasks of Fathers: Three Phases (May)
Announcement phase Moratorium phase Focusing phase
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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
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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
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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
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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
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Childbearing and Culture
Statistics of U.S. population Behavioral practices Barriers to culturally competent care Ethnocentrism
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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?
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Chapter 8 Intrapartum Assessment and Interventions
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Factors That May Trigger Labor
Maternal factors Fetal factors
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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
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Factors Affecting Labor (4 Ps)
Powers (the contractions) Passage (the pelvis) Passenger (the fetus) Psyche (the response of woman)
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Labor Process Premonitory signs of labor are Lightening
Braxton-Hicks contractions Bloody show Spontaneous rupture of membranes
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Mechanism of Labor Engagement Descent Flexion Internal rotation
Extension External rotation Expulsion
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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
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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
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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
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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
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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
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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
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Fourth Stage This stage begins the postpartum period
Ends 4 hr after delivery Mechanism of homeostasis occurs Medical intervention Nursing actions
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Management of Discomfort During Labor
Nonpharmacological management Pharmacological management Care of a woman before and after epidural anesthesia
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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
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Answer 1
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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
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Answer 1
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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
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Answer 1
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