Nursing Management during pregnancy

Conceiving

• needs to be done before 35

  • if past, genetic testing for trisomy and down syndrome

Amniocentesis

small amount of amniotic fluid pulled out for genetic testing for genetic disorders

Biophysical profile (BPP)

• test for assessing fetal well being; performed in third trimester

• determines if it is safe to deliver the baby

• score of 8 desirable

• looks at breathing and movement via ultrasound

chorionic villus sampling

• sample of tissue from the placenta through vagina

• tests for genetic disorders such as:

  • cystic fibrosis

  • down syndrome

• done late first trimester

Perinatal education

• nutrition

• optimal weight gain

• smoking cessation/avoiding those who smoke (ask them to stop if within household)

• abstaining from alcohol

Preconception care

• promote health and well being of woman and her partner before pregnancy

• identify and modify biomedical, behavioral, and social risks to woman’s health or pregnancy outcome through prevention and management intervention

• i.e. monitoring sickle cell traits before conceiving

Risk factors for adverse pregnancy outcomes

• Isotretinoins (accutane or acne meds)

• alcohol misuse → fetal alcohol syndrome

• antiepileptics → increased risk of birth defects

• Diabetes (preconception) → pre-term labor and birth defects + preeclampsia

• folic acid deficiency

• HIV/AIDs

• Hypothyroidism → miscarriage, pre-term, and difficulty with labor → daily synthroid needed

• maternal phenylketonuria → high lvls = brain damage to fetus

• rubella seronegativity (birth defects)

• obesity → LGA, insulin resistance

• oral anticoagulants → most likely will be switched to low molecular weight heparin (Lovenox)

• STI

• smoking

HIV/AIDs effect on baby

• attacks immune system

• can transmit virus to baby

• with appropriate antiretroviral therapy, risk can be reduced

Smoking effects on baby

• growth restriction

• fetal lungs cannot develop

• increased risk for preeclampsia

• placenta abruption (placenta separates from uterus)

Preconception Care

• immunization status: Hep B

• Underlying medical conditions: cystic fibrosis, sickle cell

• Reproductive healthcare practices: people with back to back pregnancies = increased risk for hemorrhage

• sexuality and sexual practices: refrain from bondage and sadism if pregnant

• nutrition: more veggies

• lifestyle: activity and rest (no partying all night)

• psychosocial: hx of substance abuse, STIs, or mental health disorders

• medications

• support system

First prenatal visit

• establishes trust

• focus is on education and overall wellness before pregnancy (trying for it)

• detection + prevention

• comprehensive health hx, physical exam, labs: blood type, anemia?

Comprehensive Health hx

• reason for seeking care

  • suspicion of pregnancy

  • date of last period

  • signs and sxs of pregnancy

  • urine or blood test for hCG: >5 = positive preg

• past medical, surgical, and personal hx

• reproductive hx: how many times have had preterm, miscarriage, live birth, abortion

Menstrual hx

• age of menarche (very first period)

• days in cycle

• flow characteristics

• discomforts

• use of contraception

Gestational or birth calculator

• date of first day of last menstrual period

• subtract 3 months

• add 7 days

• add 1 year

• = expected date of birth

• ultrasound best for dating a pregnancy

Obstetric hx

• gravida

• para

• term births

• abortions

• preterm births

• living children

Gravida

number of pregnancies woman has had regardless of outcome

• primigravida: first pregnancy

• secundigravida: second pregnancy

Para

• woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more

• before completion of 37 weeks (preterm births)

Term birth

Number of pregnancies ending > 37 weeks gestation, at term

Abortions

number of pregnancies ending before 20 weeks or viability

Assessments for pregnant woman

• fundal height at 12 weeks or more (umbilicus)

• weight and BP compared to baseline

• urine test for protein, glucose, ketones, nitrites

• fetal HR

• quickening/fetal movement

• teaching of danger signs

Nonstress test

• can be used to induce labor

• non-invasive

• assessing fetal HR → accelerations

• i.e. baseline 130 bpm, rise up 15 bpm to 145 bpm then goes back to 130 bpm; needs to happen x amount of times

• 3 accels within 30 min is reassuring

• monitor contractions

First trimester discomforts

• Urinary frequency or incontinence

  • dribbling

• Fatigue

• Nausea and vomiting

• Breast tenderness

• Constipation

  • Senocate / stool softeners to avoid hemorrhoids 

• Nasal stuffiness, bleeding gums, epistaxis (loss of blood from tissue lining of nose)

• Cravings

• Leukorrhea

Second trimester discomforts

• Backache (pillow behind back when lying down)

• Varicosities of the vulva and legs

• Hemorrhoids

• Flatulence with bloating

Third trimester discomforts

• Return of first trimester discomforts

• SOB and dyspnea

• Heartburn and indigestion → Tums

• Dependent edema → elevate legs

• Braxton Hicks contractions → fluid bolus

Nursing management to promote self care

• personal hygiene

• avoiding saunas or hot tubs

• perineal care

• dental care

• breast care

• clothing

• exercise: lifting weights can cause hernia → squats ok

• sleep 8 hours

• sexual activity and sexuality

• employment + maternity leave

• try not to travel in third trimester

• immunizations and medications

Lamaze (psychoprophylactic method)

• focus on breathing and relaxation techniques

• Sit eye-to-eye and copy breathing of partner

Bradley (partner-coached) method

• focus on exercises and slow abdominal breathing

Dick-Read (Natural childbirth) method

• focus on fear reduction via knowledge and abdominal breathing techniques

• quick naps ok