1. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Essentials of Maternity and Pediatric Nursing Chapter 12 Nursing Care During Pregnancy

2. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins

3. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Preconception Care Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system

4. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins 1 st Prenatal Visit Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests

5. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Comprehensive Health History Reason for seeking care –Suspicion of pregnancy –Date of last menstrual period –Signs and symptoms of pregnancy –Urine or blood test for hCG Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric and gynecologic history

6. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Menstrual History Menstrual cycle –Age at menarche –Days in cycle –Flow characteristics –Discomforts –Use of contraception

7. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Menstrual History (cont’d) Date of last menstrual period (LMP) Calculation of estimated or expected date of birth (EDB) or delivery (EDD) –Nagele’s rule Use first day of LNMP 11/21/07 Subtract 3 months 8/21/07 Add 7 days 8/28/07 Add 1 year 8/28/08 = EDB –Gestational or birth calculator or wheel (see Fig. 12- 3) –Ultrasound

8. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Obstetric History Gravida: a pregnant woman –Gravida I (primigravida): first pregnancy –Gravida II (secundigravida): second pregnancy, etc. Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more –Primapara: one birth after a pregnancy of at least 20 weeks (“primip”) –Multipara: two or more pregnancies resulting in viable offspring (“multip”) –Nullipara: no viable offspring; para 0

9. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Obstetric History (cont’d) Terminology –G (gravida): the current pregnancy –T (term births): the number of pregnancies ending >37 weeks’ gestation, at term –P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks –A (abortions): the number of pregnancies ending before 20 weeks or viability –L (living children): number of children currently living

10. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? A multipara refers to a woman who is pregnant for the first time.

11. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. A multipara refers to woman who has had two or more pregnancies resulting in viable offspring.

12. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Examination Vital signs Head-to-toe assessment –Head and neck –Chest –Abdomen, including fundal height if appropriate –Extremities

13. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Examination (cont’d) Pelvic examination –Examination of external and internal genitalia –Bimanual examination –Pelvic shape: gynecoid, android, anthropoid, platypelloid –Pelvic measurements: diagonal conjugate, true (obstetric) conjugate and ischial tuberosity

14. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Tests Urinalysis Complete blood count Blood typing Rh factor Rubella titer Hepatitis B surface antigen HIV, VDRL, and RPR testing Cervical smears Ultrasound

15. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Follow-up Visits Visit schedule: –Every 4 weeks up to 28 weeks –Every 2 weeks from 29 to 36 weeks –Every week from 37 weeks to birth

16. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Follow-up Visits (cont’d) Assessments –Weight & BP compared to baseline values –Urine testing for protein, glucose, ketones, and nitrites –Fundal height (see Fig. 12-5) –Quickening/fetal movement (see Box 12-3) –Fetal heart rate (see Nursing Procedure 12-1) Teaching: danger signs

17. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? A woman who is 24 weeks pregnant would arrange for a follow-up visit every 2 weeks.

18. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. A woman who is 24 weeks pregnant would have follow-up visits scheduled every 4 weeks until she reaches 29 weeks’ gestation.

19. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Fetal Well-Being Ultrasonography (see Fig. 12-6) Doppler flow studies Alpha-fetoprotein analysis Marker screening tests Amniocentesis (see Figs. 12-7 and 12-8) Chorionic villus sampling (CVS) Percutaneous umbilical blood sampling (PUBS) Nonstress test; contraction stress test Biophysical profile

20. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins First-Trimester Discomforts Urinary frequency or incontinence (see Teaching Guidelines 12-1) Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea

21. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Second-Trimester Discomforts Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating

22. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Third-Trimester Discomforts Return of first-trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions

23. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Management to Promote Self- Care Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise (see Teaching Guidelines 12-2)

24. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Management to Promote Self- Care (cont’d) Sleep and rest Sexual activity and sexuality Employment (see Teaching Guidelines 12-3) Travel (see Teaching Guidelines 12-4) Immunizations and medications

25. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Question While assessing a woman at 18 weeks’ gestation, which of the following would the nurse report as unusual? A.Urinary frequency B.Backache C.Leukorrhea D.Flatulence with bloating

26. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. During the second trimester, urinary frequency typically improves when the uterus becomes an abdominal organ and moves away from the bladder region. Backache and flatulence with bloating are common during the second trimester. Leukorrhea begins in the first trimester and continues throughout pregnancy.

27. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Preparation for Labor, Birth, and Parenthood Perinatal education Childbirth education –Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques –Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing –Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

28. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Preparation for Labor, Birth, and Parenthood (cont’d) Options for birth setting –Hospitals: delivery room, birthing suite –Birth centers –Home birth Options for care providers –Obstetrician –Midwife –Doula

29. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins Preparation for Labor, Birth, and Parenthood (cont’d) Feeding choices –Breastfeeding: advantages and disadvantages –Bottle feeding: advantages and disadvantages –Teaching Final preparation for labor and birth

30. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation

31. Copyright © Wolters Kluwer Health | Lippincott Williams & Wilkins