Nursing Mangement During Pregnancy + Maternal Adaptation During Pregnancy

presumptive signs of pregnancy

-tired

-sore

-no cycle

-frequent urination

fetal movements (quickening)

-nausea and vomiting

-breast tenderness

probable signs of pregnancy

-braxton hicks contractions

-positive pregnancy test

-abdominal enlargement

-ballottement: floating ballon

-goodell sign: cervix is softer

-chadwick sign: bluish color of cervix

-hegar sign: softening of the lower uterine segment

positive signs of pregnancy

-ultrasound verification of embryo or fetus 4 to 6 weeks

-fetal movement felt by experienced clinician 20 weeks

-auscultation of fetal heart tones via doppler 10-12 weeks

when is the best time to take a pregnancy test

-the morning

changes in uterus

-increase in weight size ect.

-positive hegar sign

-the fondus will be at the umbilicus (belly button)

-ascent into abdomen after first 3 months

changes in cervix

-softening

-mucus plug formation

-increase vascularization (chadwick sign)

-ripening about 4 weeks after birth

changes in vagina

-secretions more acidic, white and thick, leukorrhea

-lengthening of vaginal vault

-increase in vascularity with thickening

change in ovaries

-enlargement until the 12th to 14th week gestation

-cessation of ovulation

changes in breasts

-increase nipple size

-production of colostrum: yellowish- fluid

chnages in GI

-gums may bleed more

-increase salvation (Ptyalism)

-constipation

-heartburn: slow gastric emptying

-prolonges gallbladder emptying

-nausea and vomiting

-dental problems: gingivitis

changes in cardiac

-increase in blood volume

-increase in cardiac output

-slight decline in blood pressure until midpregnancy

-increase in number of RBC:can lead to anemia

-increase in iron demands

respiratory changes

-more diaphragmatic than abdominal breathing

-increase oxygen consumption

-congestion is common

renal/urinary changes

-dilation of renal pelvis, increase in curvature of ureters

-increase in length and weight of kidneys

-increase in glomerular filtration rate… increase flow in urine and volume

-increase in kidney activity with woman lying down

musculoskeletal changes

-softening and stretching of ligaments

-increased sway back and upper spine extension

-forward shifting of center of gravity

-increase in lumbosacral curve (lordosis)

-waddle gait

integumentary changes

-hyperpigmentation (facial melasma)

-linea nigra (line on the belly)

-striae gravidarum (stretch marks)

-varicosities

-vascular spiders

-palmar erythema (red palms)

endocrine changes

-pancreas: insulin resistance du to hPl and other hormones in second half of pregnancy

-adrenal glands: increase in cortisol and aldosterone secretions

-prostaglandin secretion

-placental secretions: hCG, hPl, relaxin, progesterone, estrogen

immune system changes

-enhancement of inflammatroy response

-increased risk of developing infections

-influences the course of automimmune diseases

-chronic diseases such as diabetes may worsen

-asthma may improve: then later in pregnancy may go back to normal ti to decrease in relaxin

changes in nutrition

-normally the lower BMI the more you will gain in pregnancy

-increase fruits and vegetables

-high fiber

-2 servings of fish weekly

-limit caffeine intake

-reduce fat and dairy products

-choose whole grains

reducing nausea and vomiting

-small frequent meals

-reduce fried, greasy, and spicy foods

-eat bland foods like crackers and toast

-sit up on side of bed before standing

-avoid laying down right after you eat

-eat ice chips

AVOID: food

-high mercury fish

^shark, swordfish, mackerel, ahi tuna, orange roughy and tilefish

-mercury exposure is liked to pregnancy complications and fetal developmental problems

listeriosis

-primarily affects pregnant women, newborns, older adults, and people with weakened immune system

-symptoms: nausea, diarrhea, muscle weakness, fever, chills, headache

-treatment: antibiotics

listeriosis patient education

-avoid uncooked hotdogs and deli meats unless heated to steaming hot

-avoid unpasteurized milk

-avoid soft cheese like brie, feta, and blue-veined cheeses

-avoid salads made in deli store that are mayonnaise based such as ham salad, chicken salad, egg salad, tuna salad

expected weight gain based on BMI

-underweight: gain 28-40 lbs

-normal weight: 25-35 lbs

-overweight: 15-25 lbs

-obese: 11-20lbs

pica

-chalk

-laundry detergent

-clay

-ice

-soil/dirt

-charcoal

-mothballs

-baking soda

-burnt matches/ashes

-cornstarch

pica concern

soil: iron deficiency

clay: constipation, parasitic infection

ice: iron deficiency, tooth fractures

laundry starch: iron deficiency, impaired fetal development

gastrointestinal upset: heartburn, diarrhea, vomiting, blockages,ulcers

maternal emotions: ambivalence

-proud, excited, fearful, anxious

maternal emotions: introversion

-focusing on self

maternal emotions: acceptance

-reality of being pregnant sinks in

maternal emotions: mood swings

-rollercoaster emotions, fluctuates quickly happy/ sad/ angry

maternal emotions: changes in body image

-varies from person to person

pregnant women and sx

-first and 3rd trimester don’t really want to

-may be more sexual in the second trimester

-let them know the different positions they can be in (not on back)

couvade syndrome

-partners may have physical changes

-if water break, pre tern birth

^don’t have sex

^can lead to infection to mother and baby

pregnancy and siblings

toddlers: may regress back to wanting a bottle or pacifier

school age child: may want details of pregnancy- how they baby got there, how will it get out… may ignore baby once born

teenagers: may be accepting it grossed out

*include siblings in preparation for the baby

what are the risk factors for adverse pregnancy outcomes

-isotretinoins (accutane)

-alcohol/ drugs misuse

-medications

-diabetes. HTN, seizures

-folic acid deficiency

-HIV/AIDS

-rubella

-STIs

-obesity

-smoking

what is the greatest environmental sensitivity

-17 to 56 days after conception

laboratory tests

-urinalysis

-complete blood count

-blood typing

-rh factor

-rebella titer

-hepatitis B surface antigen

-HIV, VDRL, and RPR testing

-cervical smears

-ultrasound

nagele’s rule

-calculating estimated or expected date of birth based on a 28 day cycle

-date of last menstrual period (LMP)

1. use first day of LMP (11/21/21)

2. subtract 3 months (8/21/21)

3. add 7 days (8/28/21)

4. add 1 year (8/28/22) EDB

gravida

-number of pregnancies

para

-number of pregnancies past 20 weeks

term

-number of delivered pregnancies at 38 weeks or greater

preterm

-number of pregnancies delivered between 20 weeks to 37.6 weeks

abortions

-number of pregnancies ending before 20 weeks or viability

*abortions can be elective or spontaneous

living

-number of current living children

gravida: obstetric history

gravida: pregnant women

-gravida 1 (primigravida): first pregnancy

-gravida 2: second pregnancy

-multigravida: third or more pregnancy

-nulligravida: never been pregnant

para: obstetric histroy

para: a women who has produced one or more viable offspring carrying a pregnancy 20 weeks or more

primipara: one pregnancy of at least 20 weeks (“primip”)

multipara: two or more orgnancies resulting in biable offspring (“multip”)

nullipara: no viable offspring, para 0

follow up visits prenatal schedule

-every 4 weeks: up to 28 weeks

-every 2 weeks from 29 to 36 weeks

-every week from 37 weeks to birth

what is a normal fetal heart rate

110-160

danger signs of pregnancy: 1st trimester

-spotting or bleeding, painful urination, fever, low abd pain with shoulder pain

danger signs of pregnancy: 2nd trimester

-regular contractions, pain in calf, gush or leaking of fluid, no fetal movement

danger signs of pregnancy 3rd trimester

-sudden weight gain, facial edema, severe upper abd pain, headache with visual changes, decrease in fetal movement

assessment of fetal well-being

-alpha fetoprotein (AFP) analysis

^positive suggests neural tube defect or spina bifida 16-18 weeks

-marker screening tests: multiple, triple, quad occurs at 15-22 weeks

-nuchal translucency screening: 11-14 weeks

-amniocentesis 15-18 weeks

-chorionic villus sampling 10-13 weeks

-doppler flow studies:assesses blood flow umbilical veins/arteries

-ultrasonography: HR, growth, movement

assessment of fetal well-being (additional tests)

-percutaneous umbilical blood sampling (PUBS)

-nonstress test (NST): FHT and uterine activity

-contraction stress test (CST): FHT with contractions by giving pitocin

biophysical profile (BPP)

-combination of ultrasound and NST

-BPP score of 0-10 given for

1. fetal tone

2. fetal movement

3. breathing movement

4. amniotic fluid level

5. NST (reactive or non-reactive)

first trimester discomforts 0-12 weeks

-urinary frequency or incontinence

-fatigue

-nausea and vomiting

-breast tenderness

-constipation

-nasal stuffiness, bleeding gums, epistaxis

-cravings

-leukorrhea

second trimester discomfort 13-27 weeks

-backache

-varicosities of the vulva and legs

-hemorrhoids

-flatulence

-bloating

third trimester discomfort 28-40 weeks

-return of first-trimester discomforts

-shortness of breath and dyspnea

-heartburn and indigestion

-edema

-braxton hicks contractions

nursing management to promote self-care

-perineal care: increase in leukorrhea (clear discharge)

-dental care:increase risk of gingivitis and periodontal disease

breast care: larger supportive bra, avoid soap on nipples

clothing: nonrestrictive

shoes:comfortable

exercise: moderate

^if athletic may continue normal activities

-avoidance of saunas and hot tubs: bacteria, fetal tachycardia

-avoid traveling overseas 3rd trimester

preparations for labor, birth and parenthood

-breathing exercises classes: focus on breathing and relaxation techniques (lamaze, dick-read, bradley)

breastfeeding advantages

-convenient & no cost

-increasing bonding

-suppresses ovulation

-reduces risk of breast and ovarian cancer

-uses extra calories an promotes weight loss

-prevent infection to the baby

-food allergies are less likely to develop

-reduce ear and respiratory infections in babies

breastfeeding disadvantages

-sore nipples

-mastitis (inflammation of the breast tissue)

-engorgement

-inverted nipples

-decreased libido in some women

-food/drug/alcohol limitations

-unless you pump no one can help with feeding

-returning to work and pumping

-feed every 2-3 hours

bottle feeding advantages

-can prepare several bottles at a time

-can be prepared up to 24 hours in advance

-other care givers can assist with feeding

-different formula choices if allergies or discomforts arise

-feed every 3-4 hours

bottle feeding disadvantages

-cost

-have to mix properly

-needs to be room temperature at least

-not recommended to warm in microwave

-do not prop the bottle as it could cause chocking

-baby may have increased risk of ear and respiratory infections, reflux, diarrhea, and atopic dermatitis