Nursing Care of the Family During Pregnancy

Presumptive diagnosis of pregnancy

Complaints of the client; Subjective!

• N/V

• Missed menstrual cycle

• Fatigue

Probable diagnosis of pregnancy

Observed by the provider (objective)

• Hegar sign, Goodell sign, Chadwick sign

Positive diagnosis of pregnancy

Indicates proof of pregnancy

• Fetal heart on doppler

• Visualization on u/s

• Palpation on fetal parts

Estimating EDB using Naegele’s Rule

-3 months, +7 days, +1 year

30 days: April, June, September, November

31 days: January, March, May, July, August, October, December

Adapting to pregnancy

• Accepting the pregnancy

• Identifying the parent role

• Establishing relationship w/ fetus

• Preparing for birth

• Partner adaptation; accepting the pregnancy

Gravida

Woman who is pregnant, or the # of pregnancies

• a woman who has multiple fetuses (twins, triplets, quads)= ONE PREGNANCY

Parity

Number of pregnancies in which the fetus/es have reached 20 weeks of gestation

• if the woman delivered 2+ fetuses after 20 weeks of gestation, it remains parity 1

GTPAL

• Gravita

• Term; how many were >37wks

• Preterm; how many were <37wks

• Abortion

• Living

PreNatal Care Management QUESTIONS

● Who provides prenatal care to clients?

● Where is prenatal care provided?

● What is the goal of care?

● How early should PNC begin? ASAP!

● What are the barriers to attending PNC? No insurance, lack of knowledge

● What care is offered during PNC visits? U/S, exam, education screening

1st trimester

1-13 weeks

2nd trimester

14- 26 weeks

3rd trimester

27-40 weeks

Frequency of doctor visits during pregnancy

• Every 4 weeks until 28 weeks

• EVery 2 weeks until 36 weeks

• every week until birth

Initial visit

• Prenatal interview (Last LMP))

• Reasons for seeking care

• Histories & screening: current pregnancy, OB/GYN, health, nutrition & medication, mental health & IPV (violence)

• Physical exam: assess all systems & fundal height

• Teaching: self mx, changes in pregnancy, nutrition & hygiene, preventing infix, exercises, prep for breast-feeding, labs

Consequent Visits

• Interview: collect data

• Perform VS

• Weight check

• UA- dipstick

• Physical exam & fundal height; ask mom

• Fetal assessment

• Teaching recap touchback

Conducting Abdominal assessment

• Position, supine w/ pillow & wedge under right hip (prevents supine hypotension)

• Inspect, Palpate

• Assess fundal height *measure from symphysis pubis to fundus (2nd trimester; 28 wks). measurements should match LMP 2 weeks before?)

Conducting fetal assessment

• Gestational age

• Fetal heart tones (use doppler ~ 12wks)

• Health status: fetal movements

• Fundal height findings

• Quickening felt 16&20 weeks

*Refer to ultrasound measurements:

• Biparietal diameter; fetal head (BPD)

• Fetal foot length (FFL)

• Abdominal circumference (AC)

Read over IPV section

lols

IPV nursing interventions

A; Reassure that she is not alone

B: Expressing the belief that violence is unacceptable

C: Refers to confidentiality

D: Descriptive documentation (exact quote of client)

E: Educates on options/community resources)

S: Refers to safety; most dangerous time is when woman decides to leave

Labs at initial visit

PLATELETS MUST NOT DROP BELOW <100,000

• CBC w/ diff, hgb/hct, WBC

• AbO; type & RH factor (antibody screen)

• Urine - analysis & c/s (asymptomatic bacteriuria)

• Rubella titer; immunity [CANNOT give in early pregnancy because injury can cause ir eye and cardiac problems)

• STI panel: VDRL (syphillis), HIV, HEP B

• GC/CT smears (Gonorrhea, chlamydia trachomatis

• Pap test

• Ultrasound

Landmarks in pregnancy

• 13 weeks uterus is an abdominal organ

● 16 weeks midway between symphysis pubic and umbilicus

● 20-22 weeks at level of umbilicus

● 28-32 weeks, height of fundus ~to gestational weeks (+/- 2 weeks)

● 26-28 weeks midway between umbilicus and xiphoid process

● 36 weeks at xiphoid

● 38-40 weeks lightening can occur (drop in fundal height)

Education for self mx

● Nutrition & medication – food types, prenatal vitamins, fluid intake, pica

● Personal hygiene – bath frequency, oral health

● Prevention of infections – UTIs, URTIs

● Exercises – Kegel exercises

● Prep for breastfeeding – presence of colostrum, education on b/f

● Physical activity, rest & relaxation, clothing

● Work and travel

● Sexual activity

3rd trimester labs & immunizations

Labs at 28 weeks

○ Repeat CBC, RPR, HIV, Hep B

○ Glucose screening (24-28)

○ Quad screen (trisomy testing)

○ MSAFP – neural tube defects

● Immunization at 28 weeks

○ Rhogam

○ Tdap

○ Hep B, Flu (avoid other live virus imm.)

● Labs at 35-37 weeks

○ Group Beta Strep (GB

Foods to avoid during pregnancy

Fish

○ shark, swordfish, tilefish, king, mackerel

○ smoked or raw seafood

EAT CHEDDAR CHEESE INSTEAD.

● Dairy products

○ soft cheeses (brie, feta, queso fresco)

○ uncooked eggs, sprouts, milk (unpasteurized)

○ unheated hotdogs or deli meat

● Alcohol /wine