CH.12 - Nursing Management During Pregnancy

What are the goals of preconception care?

• Promote the health and well-being of a woman and her partner before pregnancy
• Identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management intervention

What are some preconception care and diagnositc testing that's available?

• Amniocentesis
• Biophysical profile
• Chorionic villus sampling (CVS)
• Natural childbirth
• Perinatal education
• Preconception care

What are the risk factors for adverse pregnancy?

1. Isotrtinoins
2. Alcohol misuse
3. Antiepileptic drugs
4. Preconception diabetes
5. Folic acid deficiency
6. HIV/AIDs

What are some more risk factos for adverse pregnancy outcomes?

1. Hypothyroidism
2. Maternal phenylketonuria
3. Rubella seronegativity
4. Obesity
5. Oral anticoagulant
6. STI
7. Smoking

What is performed within the boundaries of preconception care?

1. Immunization status
2. Underlying medical conditions
3. Reproductive healthcare practices
4. Sexuality, sexual practices and support system
5. Nutrition
6. Lifestyle practices
7. Psychosocial issues
8. Medication and drug use

What are the goals for the first prenatal visit?

1. Establishing a trusting relationship
2. Focus on education for overall wellness
3. Detection and prevention of potential problems
4. Collecting a comprehensive health history, physical examination, and labs

What composes a comprehensive health history?

• Reasons 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)

What is the simple data we collect for menstrual history?

• Age at menarche (first period)
• Days in cycle
• Flow characteristics
• Discomforts
• Use of contraception
• Date of last menstrual period (LMP)

How do you calculate the estimated or expected DOB (EDB) or delivery (EDD)

• Nagele's rule
• Take the first day of LNMP (Ex: 11/21/07)
• Subtract 3 months (8/21/07)
• Add 7 days (8/28/07)
• Add 1 year (8/28/08)
• You can also use a gestational or birth calculator/wheel
• Ultrasound is the best method of dating a pregnancy
  

Define gravida

A pregnant woman; the current pregnancy

Define gravida I

- Aka primigravida
- The first pregnancy

Define gravida II

- Aka secundigravida
- The second pregnancy, etc

What does the suffix -para mean?

- A woman who has produced on or more viable offspring carrying a pregnancy 20 weeks or more
- Ex: primipara (one birth after a pregnancy of at least 20 weeks, "primip"), multipara (two or more pregnancies resulting in viable offspring, "multip") and nullipara (no viable offspring, "para 0")

What is a great system to remember getting obstetric history?

• Gravida (the current pregnancy)

• Term births (the # of pregnancies ending >37 weeks' gestation, AT TERM)

• Preterm births (the # of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks)

• Abortions (# of pregnancies ending before 20 weeks or viability)

• Living children ( # of kids currently alive)

Describe a pelvic examination

• First, we exam the external and internal genitalia 
• Next, we perform a bimanual examination, where a nurse/HCP puts on gloves and applies lube to one hand. Then, they insert their lubed hand into the vagina while applying pressure to the abdomen w/ the other hand. This determines size, shape and position of the uterus and ovaries
• Then pelvic shape will b checked (gynecoid, android, anthropoid, platypelloid)
• Pelvic measurements (diagonal conjugate, true obstetric conjugate, and ischial tuberosity)

POP QUIZ Do we do a head-to-toe assessment??

YES!!! We go vital signs (watch BP for signs of preeclampsia), then head, neck, chest, and at the abdomen we assess for fundal height if it's appropriate. Then we finish off with extremities.

What laboratory tests are available during a pregnancy?

• Urinalysis
• Complete blood count
• Blood typing
• Rh factor
• Rubella titer
• Hep B surface antigen
• HIV, VDRL, and RPR testing
• Cervical smears
• Ultrasound

When would you schedule follow-up visits for mom?

• Every 4 weeks up to 28 weeks
• Every 2 weeks from 29-36 weeks
• Every week from 37 weeks to birth

What assessments are done during these follow-up visits?

• Weight and BP compared to baseline values
• urine testing for protein, glucose, ketones, and nitrites
• Fundal height
• Quickening/fetal movement
• Fetal heart rate

How can we assess the baby's fetal well-being?

• Ultrasonography Doppler flow studies
• Alpha-fetoprotein anaylsis
• Marker screening tests
• Nuchal translucency screening
• Amniocentesis
• Chorionic villus sampling (CVS)
• Percutaneous umbilical blood sampling (PUBS)
• Nonstress test/Contraction stress test
• Biophysical profile

What are the average first trimester discomforts?

• Urinary frequency or incontinence
• Fatigue
• Nausea and vomiting
• Breast tenderness
• Constipation
• Nasal stuffiness, bleeding gums, and epistaxis
• Cravings

What are the average second trimester discomforts?

• Backache
• Varicosities of the vulva and legs
• Hemorrhoids
• Flatulence with bloating

What are the average discomforts of the third trimester?

• Return of first trimester discomforts
• Shortness of breath and dyspnea
• Heartburn and indigestion
• Dependent edema
• Braxton Hicks contractions

What do we promote in self-care for the to-be mom?

• Personal hygiene
• Avoidance of saunas and hot tubs
• Dental, Breast, and Perineal care
• Getting new, comfortable clothing
• Exercise
• Sleep and rest
• Sexual activity and sexuality
• Employment
• Travel immunizations and medications

What is the Lamaze childbirth method?

• Aka the psychoprophylactic method
• Focus on breathing and relaxation techniques

What is the Bradley childbirth method?

• Aka partner-coached childbirth
• Focus on exercises and slow, controlled abdominal breathing
  

What is the Dick-Read childbirth method?

• Aka the natural childbirth method
• Focus on fear reduction via knowledge and abdominal breathing techniques

What options are available for birth setting?

• Hospitals offer a delivery room and birthing suite
• Birth centers
• Home birth

What healthcare providers are available for birthing?

• Obstetrician
• Midwife
• Doula

What feeding choices does mom have available to her?

• Breast-feeding
• Bottle feeding
• Teach on BOTH of their advantages and disadvantages