Antepartum: Nursing Care during Pregnancy

Prenatal Period
Period of physical and psychologic preparation for birth and parenthood. This period is the best opportunity for nurses and members of the health care team to influence family heath and promote prenatal care.

Last 10 lunar months of 28 days (280 days total) and is broken up into trimesters. First trimester is weeks 1-13, Second trimester is weeks 14-26 and third trimester is weeks 27-40.

Signs and Symptoms of Pregnancy: Presumptive Signs
These signs are least reliable.
Missed menstrual period (amenorrhea) , positive home pregnancy test, nausea, vomiting, breast tenderness, urinary frequency, fatigue, quickening (fetal movement occurs at 16 wks), and Chadwick’s sign (dark bluish color of the vaginal mucosa)

Signs and Symptoms of Pregnancy: Probable Signs
Uterine enlargement, Goodell’s Sign (Hegar’s Sign), Braxton Hix contractions, Uterine souffle (auscultation of uterine blood flow), Ballotement (occurs at 20 wks and is a sudden tap on abdomine causes fetus to rise and rebound), and positive pregnancy test

Signs and Symptoms of Pregnancy: Positive Signs
Presence of fetal heartbeat distinct from mother’s, fetal movement felt by someone other than the mother, and visualization such as an ultrasound.

What hormone do pregnancy test test for?

Estimated Date of Birth (EDB)
Determine first day of last menstrual period (LMP), subtract 3 months and add 7 days plus 1 year.
Add 7 days to LMP and count forward 9 months

Maternal Adaptation
Accepting pregnancy, Identifying with the mothering role, Reordering personal relationships, Establishing relationship with fetus, Preparing for childbirth

When do fathers bond with the child?
When they can feel the child move.

Adaption to Pregnancy
Paternal adaptation (the same as maternal adaptation just add in the father figuring out his role), Sibling adaptation, Grandparent adaptation and Financial, space and other lifestyle changes (these can cause good or bad stress)

Prenatal Care
Purpose: to identify existing risk factors and other deviations from normal. Emphasis on preventive care and optimal self-care.
It is best for this to begin EARLY in pregnancy

Access to Prenatal Care
Women of middle or high socioeconomic status tend to seek prenatal care routinely; however, women of poverty and/or those lacking health insurance often do not have access to public or private care. Immigrants women also may not seek prenatal care due to fear of being deported.

Birth Outcomes for Babies with Inadequate Prenatal Care
Low birth rate and infant mortality

Barriers to Prenatal Care
inadequate number of providers, unpleasant facilities or procedures, inconvenient clinic hours, distance to facilities, lack of transportation, fragmentation of services, inadequate finances, personal and cultural attitudes

Initial Visit
Reason for seeking care, current pregnancy, obstetric and gynecologic history, medical history such as immunizations, nutritional history, history of drug and herbal preparation use, family history, social and experiential history, history of physical abuse, review of systems, physical examination, laboratory tests such as CBC or H&H to get a baseline, WBC, Platelet, Electrolytes, Hematocrit, Hemoglobin, Group B Strep, STD’s, Glucose, Blood type and Rh status.

Normal Range for women 11.7-15.5
<11 = anemic which could mean a decrease in oxygen carried through the blood stream

Follow-up Visits
Interview (Has anything changed since your last visit? Any new symptoms?, etc)
Physical examination,
Fetal assessment (Fundal height, tells you if the baby is growing at a normal rate, Gestation age, and Health Status of the baby, hearing the heart beat at 4-5 wks with vaginal ultrasound and 12 wks with the dop ultrasound)
Laboratory test (multiple-marker or triple screen blood test or other blood test like RPR/VDRL, CBC, anti-Rh)

Perinatal Education Goals
Establish lifestyle behaviors for optimal health, Prepare psychologically for pregnancy and the responsibilities that come with parenthood, Identify, minimize and treat risk factors, Screen health hazards in workplace and home such as chemicals, radiation, lead, etc., Obtain genetic counseling for inherited diseases, compare perinatal care options available.

Education for Self-Care
Personal hygiene, Prevention of urinary tract infections, Kegal exercises, Preparation for breastfeeding, Dental Health (Fluoride), Immunizations, Physical activity, Posture and body mechanics, Rest and relaxation (left side lying), Employment and travel, Clothing, Medications and herbal preparations, Avoidance of alcohol, cigarettes, drugs, Warning signs of potential complications, Nutrition, Caffeine in moderation, Seat belt can and should be worn at all times throughout pregnancy.

Persistent Vomiting, Sudden Gush of Fluid from Vagina, Vaginal Bleeding, Abdominal Pain, Temperature of 101 or 38.3, Dysuria, Dizziness, Blurred/Double Vision (Diplopia), Severe Headache, Edema of Face, Hands, Legs, Feet, Epigastric pain, Convulsion, Muscular Irritability, Oliguria (low output of urine), Absence of Fetal Movement

Development of a Birth Plan
Get a support person, Determine preferences for delivery including type of anesthesia, and Enroll in childbirth classes

Recognizing Preterm Labor
can occur after the 20th week and before the 37th week, Uterine contractions if untreated can cause the cervix to open earlier resulting in preterm labor. The symptoms are pain/cramping in the abdomen, constant back pain, and pelvic pressure.

Variations in Prenatal Care: Cultural Influences
Emotional response, Clothing, Physical activity and rest, Sexual activity, Diet, and Psychosocial support systems

Variations in Prenatal Care: Age Differences
Adolescents: much less likely than older women to receive adequate prenatal care, there are compliance issues and social/psychologic barriers
Women Older than 35: multiparous women, primiparous women are more likely to have planned but some may have fertility issues

Multifetal pregnancy
Twins or more pregnancies often end in prematurity, rupture of membranes before term is common, congenital malformations are twice as common in monozygotic twins as in singletons, no increase in incidence of congenital anomalies in dizygotic twins though

Multifetal Pregnancy Probability Increased by:
History of dizygous twins in female lineage, Use of fertility drugs, Rapid uterine growth for weeks of gestation, Hydramnios (excess of amniotic fluid), palpation of more small or large parts than expected. An ultrasound is done to verify

Prenatal Care Given to Women with Multifetal Pregnancies Include Changes in:
Pattern of care, Amount of weight gained, Nutritional intake, and also knowledge that uterine distention can cause severe backache.

Pregnancy Nutrition Surveillance System
developed to identify and reduce pregnancy related health risks

Nutritional Needs Before Conception
First trimester is crucial in terms of embryonic and fetal organ development. Healthy diet before conception ensures adequate nutrients are available for developing fetus. Folic Acid intake is important in preconception period because it can prevent neural tube defects

Nutrient Needs During Pregnancy
1 quart of FLUID a day, 60 grams or 6 servings of PROTEIN a day, Energy needs: increase of 300 calories a day.

Weight Gain During Pregnancy
Determined by BMI
1lb/month = first trimester (3lbs total)
1lb/week = second and third trimesters (24lb total)
Average women should gain approximately 27lbs
Women with a BMI of 26 or more, are overweight or obese will expect to gain <25lbs and someone expecting twins should gain around 35-45lbs

Purpose: Fetal and infant skeleton and tooth formation; maintenance of maternal bone and tooth mineralization.
Sources: Milk, cheese, yogurt, sardines or other fish eaten with bones left in, deep green leafy vegetables except spinach or Swiss chard, calcium-set tofu, baked beans and tortillas
Suggestion: Take with Vitamin D for absorption

Purpose: Maternal hemoglobin formation; fetal liver iron storage
Sources: Liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes and dried fruit.
Suggestion: Take with Vitamin C for absorbtion

Purpose: skin integrity, components of numerous enzyme systems, possibly important in preventing congenital malformations
Sources: liver, shellfish, meats, whole grains and milk

Purpose: mother and fetus’s teeth
Sources: city water

Purpose: increased maternal metabolic rate
Sources: iodized salt, seafood, milk and milk products, commercial yeast breads, rolls and donuts

Vitamin A
Purpose: essential for cell development, tooth bud formation, and bone growth
Sources: deep green leafy vegetables, dark yellow vegetables and fruits, chili peppers, liver, and fortified margarine and butter

Vitamin D
Purpose: Involved in absorption of calcium and phosphorus, improves mineralization
Sources: fortified milk and margarine, egg yolk, butter, liver, seafood and the SUN

Vitamin E
Purpose: antioxidant especially important for preventing breakdown of RBCs
Sources: vegetable oils, green leafy vegetables, whole grains, liver, nuts and seeds, cheese and fish

Vitamin C
Purpose: tissue formation and integrity, formation of connective tissue, enhancement of iron absorption
Sources: citrus fruit, strawberries, melons, broccoli, tomatoes, peppers, and raw deep green leafy vegetables

Multivitamin/Mineral Supplement
will cause constipation and darken stools and may worsen nausea and vomiting early in pregnancy
take with food later in the day
if it does not have folate take a folate supplement 600mcg a day

abnormal cravings for things that are not food such as dirt, rocks, laundry detergent, etc.

qualify if you are anemic

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