Ch.14 Nursing Care of the Family During Pregnancy lecture notes (completed)

Presumptive Indicators of Pregnancy

Complaints reported by the client (e.g., nausea, missed cycle, fatigue) that are not definitive proof of pregnancy.

Probable Indicators of Pregnancy

Findings observed by healthcare providers (e.g., Hegar sign, Goodell sign, Chadwick sign) indicating potential pregnancy.

Positive Indicators of Pregnancy

Definitive proof of pregnancy (e.g., fetal heart tones, ultrasound visualization, palpation of fetal parts).

What is the Naegele Rule?

The standard calculation used to determine the Estimated Date of Birth (EDB) based on the first day of the client’s Last Menstrual Period (LMP).

What is the formula for the Naegele Rule?

EDB = LMP - 3 months + 7 days + 1 year (with year added depending on the month).

What should you do if the date falls toward the end of the month when using the Naegele Rule?

Adjust the month forward if the 7-day addition pushes into a new month.

Duration of Pregnancy

Total days: $280$ days; Total weeks: $40$ weeks; Lunar months: $\text{approximately } 10$ months.

Gestation

The period of intrauterine development from conception through birth.

Gravida (G)

A woman who is pregnant or the total number of pregnancies a woman has had.

Parity (P)

The number of pregnancies in which the fetus or fetuses reached 20 weeks of gestation.

Nulligravida

A woman who has never been pregnant.

Primigravida

A woman pregnant for the first time.

Multigravida

A woman who has had two or more pregnancies.

Nullipara

A woman who has not completed a pregnancy with a fetus reaching $20$ weeks.

Primipara

A woman who has completed one pregnancy with a fetus reaching $20$ weeks.

Multipara

A woman who has completed two or more pregnancies to $20$ weeks or more.

Antepartum

Before birth; the period from conception to the onset of labor.

Intrapartum

During birth; the period from the onset of labor until the delivery of the placenta.

Postpartum

After birth.

Preterm Pregnancy

A pregnancy that has reached $20$ weeks but ends before completion of $37$ weeks.

Full Term

Pregnancy reaches 37 weeks onward.

Viability

The capacity to live outside the uterus, usually considered to be from approximately 22 to 25 weeks of gestation.

Stillbirth/Stillborn

The birth of a baby who has died after 20 weeks of pregnancy.

Abortion/Miscarriage

Pregnancy loss before 20 weeks, which can be spontaneous or induced.

GTPAL System

A system to summarize a woman's obstetrical history: G (Gravida - number of pregnancies), T (Term - pregnancies reaching 37 weeks and beyond), P (Preterm - pregnancies from 20 weeks to before 37 weeks), A (Abortion/Miscarriage - pregnancies ending before 20 weeks), L (Living children).

What is the timeline for the 1st Trimester of pregnancy?

Week 1 through 13.

What is the timeline for the 2nd Trimester of pregnancy?

Week 14 through 26.

What is the timeline for the 3rd Trimester of pregnancy?

Week 27 through 40.

How often are traditional prenatal visits scheduled until 28 weeks?

Every 4 weeks.

How often are traditional prenatal visits scheduled from 28 to 36 weeks?

Every 2 weeks.

How often are traditional prenatal visits scheduled from 36 weeks until birth?

Every week.

What are the components of the Initial Visit during prenatal care?

The Initial Visit includes a prenatal interview, screening for Intimate Partner Violence (IPV), a physical exam, initial labs, and teaching.

What is included in the Prenatal Interview?

The Prenatal Interview includes reasons for seeking care, current pregnancy status, and detailed histories (OB/GYN, general health, nutrition, medication, mental health).

What is the purpose of screening during the initial visit?

Screening during the initial visit is for Intimate Partner Violence (IPV).

What does a Physical Exam consist of during the initial visit?

The Physical Exam consists of an assessment of all systems and initial fundal height.

What are the Initial Labs conducted during the prenatal visit?

Initial Labs include CBC with differential, ABO typing and Rh factor, urinalysis and culture, rubella titer, STI panel, GC/CT smears, Pap test, and ultrasound if dates are unsure.

What topics are covered in the Teaching component during the initial visit?

Teaching includes self-management, nutrition, hygiene, exercise, and breastfeeding preparation.

Mandatory Assessments in Prenatal Care

Weight checks and Urinalysis (dipstick) are mandatory during follow-up visits.

Abdominal Assessment Technique

Position the client supine with a pillow under the head and a wedge under the right hip to prevent supine hypotension.

Fundal Height Measurement

Measurement is taken from the symphysis pubis to the top of the fundus, typically done during the second trimester and beyond.

Fetal Heart Tones

Assessed using a Doppler starting at approximately 12 weeks.

Quickening

Maternal perception of fetal movement, typically felt between 16 and 20 weeks.

What happens at 13 weeks of pregnancy?

The uterus becomes an abdominal organ.

What is the fundal height measurement at 16 weeks?

Fundus is midway between the symphysis pubis and the umbilicus.

What is the position of the fundus at 20-22 weeks?

Fundus is at the level of the umbilicus.

What is significant about the fundal height at 26-28 weeks?

Fundus is midway between the umbilicus and the xiphoid process; ultrasound is needed to confirm a big baby above 9 lbs.

How does fundal height relate to gestational weeks at 28-32 weeks?

The fundal height in centimeters is approximately equal to the gestational weeks (± 2 cm/weeks).

What does it mean when the fundus reaches the xiphoid process at 36 weeks?

Fundus reaches the xiphoid process.

What occurs during 38-40 weeks of pregnancy?

'Lightening' occurs; the fundal height drops as the fetus descends into the pelvis.

Patterns of Violence During Pregnancy

1. Commencement of violence with the onset of pregnancy. 2. Violence before and during pregnancy with no change in intensity. 3. Termination of violence during pregnancy. 4. No violence before or during pregnancy.

What are the steps of nursing intervention for domestic violence during pregnancy?

• Nursing Intervention (A-B-C-D-E-S):

  • A: Reassure the client she is Alone no longer.

  • B: Express the Belief that violence is unacceptable.

  • C: Ensure Confidentiality.

  • D: Use Descriptive Documentation (use exact quotes from the client).

  • E: Educate on options and community resources.

  • S: Focus on Safety; the most dangerous time is when the woman decides to leave the relationship.

Initial Laboratory Tests for Pregnancy

CBC with differential, ABO type & Rh factor, Urinalysis & culture, Rubella titer, STI panel (VDRL, HIV, Hep B), GC/CT smears, Pap test, Ultrasound (if unsure of dates).

What is the timing for glucose screening for gestational diabetes?

At 24-28 weeks; done earlier if there is a family history of diabetes.

What repeat labs are done at 28 weeks?

CBC, RPR (syphilis), HIV, Hepatitis B, Quad screen for Trisomy testing, and MSAFP for neural tube defects.

What immunizations are given at 28 weeks?

Rhogam (if Rh-negative) and Tdap.

When is the Group Beta Strep (GBS) swab done?

At 35-37 weeks.

What are the general immunization guidelines during pregnancy?

Hepatitis B and Flu vaccines are safe; avoid other live virus immunizations.

Foods to Avoid During Pregnancy

Avoid fish (shark, swordfish, tilefish, king mackerel), soft cheeses, uncooked eggs, raw sprouts, unpasteurized milk, unheated hot dogs, deli meats, and all alcohol.