WEEK 3: Ch 12 Nursing Management During Pregnancy

information collected at the initial prenatal visit

complete health history, reproductive history

how is estimated date of delivery established?

gestational/birth calendar wheel, ultrasound, or Nagele’s rule “minus 3 months plus one week since last menstrual cycle”

GTPAL stands for

gravida, term, preterm, abortion, living

gravida

number of pregnancies

para

number of times a woman has given birth at or beyond 20 weeks

initial prenatal exam normal changes

nasal edema, hypertrophic gums, slight thyroid enlargement, HR inc 10-15, RR inc, visible blood vessels and stretch marks on enlarged breasts, linea nigra

initial prenatal exam exams/tests

vitals height weight, Pap smear, manual estimation of uterus size, assess regularity of posterior vaginal wall

initial prenatal lab tests

CBC + urinalysis, blood type, glucose screening, rubella, Hep B, HIV, STIs, venereal disease research laboratory (VDRL), rapid plasma reagin (RPR), PAP

fundal height landmarks

12 wk symphysis pubis (pubic bone), 16 wk halfway to umbilicus, 20 weeks umbilicus, 1 cm every week after, 36 weeks just below xiphoid process, then fetus drops. fundal height should grow exponentially, flat curve → growth restriction

circulatory risks during pregnancy

vena cava pressure → lay on left side. increased dependent edema and risk for DVT

Goodell sign

softened cervix

Hegar sign

softened uterine isthmus (the thing right above the cervix)

Chadwick sign

bluish coloration of cervix and vaginal mucosa

when are fetuses most sensitive to their environment

17-56 days

when are follow up visits completed

q4 until 28 week, q2 until 36 week, weekly from 37 to birth. 14 total for average pregnancy.

1 step test for gestational diabetes

take 75 g glucose and test in 2 hours

2 step test for gestational diabetes

nonfasting patient consumes 50 g glucose, draw blood 1 hour later. if it’s high, consume 100 g and test once an hour for 3 hours

prenatal exam 29-36 weeks

edema is common, Rh test, look for preterm labor signs, educate on obtaining a newborn health provider and recommending breastfeeding

prenatal exam 37-40 weeks

group B strep, gonorrhea, chlamydia, fetal presentation and position (via Leopold maneuvers), review S+S of labor

McDonald method

fundal height measurement using measuring tape from top of pubic bone to top of uterus with patient lying on their back with knees slightly flexed

quickening

first perception of fetal movement, described as gentle fluttering. usually begins in 2nd trimester 16-22 weeks. document by having mother lie down and see how long it takes to feel ten kicks around the same time each day.

First trimester danger signs

spotting, painful urination, persistent vomiting, reduced appetite, high fever, dizziness, headache, lower abdominal pain w/ shoulder pain + vaginal bleeding

Second trimester danger signs

regular uterine contractions, back pain, increased discharge, calf pain, sudden fluid gush - prelabor rupture of membranes, absence of movement for more than 12 hours

Third trimester danger signs

sudden weight gain, edema, severe upper abdominal pain, extreme swelling + headache - HTN/preeclampsia, decrease in fetal movement, late pregnancy bleeding

Early contractions vs. Braxton Hicks contractions

BH go away when walking or resting, when PT is asleep. Felt in abdomen rather than lower back. Early contractions are every 10 minutes, menstrual like cramps, discharge change, diarrhea, dull backache.

alpha-fetoprotein (AFP)

yolk sac / fetal gut glycoprotein, rises until 14-15 weeks and falls by 32 weeks, minimally invasive. high indicates neural tube, multiple gestation, omphalocele (organs protrude through belly button), gastroschisis renal abnormalities, threatened miscarriage. low indicates hydatidiform mole, increased maternal weight, down syndrome, trisomy 18 (edward syndrome), overestimated fetal age, fetal death.

amniocentesis

performed in second trimester 15-20 weeks, detects genetic and chromosomal abnormalities

chorionic villus sampling (CVS)

needle takes samples from villi which are hairlike projections from embryo, tests genetics

rhogam

given 28th week of pregnancy if mother is Rh neg

nonstress test (NST)

patient eats to stimulate fetal activity, monitoring device is applied to abdomen to record uterine activity and fetal heart rate.

biophysical profile

real time ultrasound + NST to assess various parameters of fetal well-being that are sensitive to hypoxia.

preconception care

promotion of health and well-being of a person and their partner before pregnancy. identify health risks that could affect pregnancy, use prevention and management interventions. immunization, medical conditions, reproductive health and sexual practices, nutrition, lifestyle, psychosocial, medications/drugs, support system.

interconception care

period of time between pregnancies, a person can improve health especially if prior pregnancy had complications.

pain management during pregnancy

take acetaminophen (not ibuprofen → kidney issues and heart complications after 20-30 weeks)

how to decrease urinary frequency

decrease fluid intake 2-3 hr before bed, limit caffeine, pelvic floor exercises. seen in 1st trim due to hormonal changes and 3rd trim due to uterus pressure on bladder

how to decrease nausea + vomiting

avoid empty stomach, dry crackers/toast before getting out of bed, 5-6 small meals, drink fluids between meals, avoid triggering food, avoid brushing teeth immediately after eating (triggers gag reflex), acupressure wristbands

how to decrease constipation

increase fiber, prune juice, warm liquids, exercise, reduce cheese

how to relieve braxton hicks contractions

change position, walk, mild exercise, drink water

how to reduce leukorrhea

wash perineum with mild soap and water, avoid douching and tampons, let area breathe, cotton underwear

how to reduce leg cramps

elevate legs, straighten both legs and flex foot up, ask doctor about calcium supplements

how to reduce hemorrhoids

establish regular time for daily bowel elimination, avoid constipation, warm sitz baths, witch hazel compress

sexual activity changes in pregnancy

symptoms and discomforts may reduce desire for intimacy, others report enhanced desire due to high estrogen levels. vaginal penetration will not injure the fetus

adult immunizations needed to be around baby

MMR, varicella, tetanus, diphtheria, Tdap, flu, COVID, pneumonia, meningitis, Hep A + B

lamaze method

breathing and relaxation techniques to ease pain during natural childbirth

bradley method

partner coaching method of natural childbirth

dick-read method

prenatal instruction to reduce fear in natural childbirth

how long should we breastfeed for according to the WHO?

6 months

risk factors for adverse pregnancy outcomes

isotretinoins (accutane), alcohol misuse/smoking, antiepileptics, preconceptive diabetes, folic acid deficiency, HIV/AIDS (introduce azt early to prevent baby from being positive), hypothyroidism, PKU, rubella seronegativity (can’t give vaccine during pregnancy - live virus), obesity, oral anticoagulants (aspirin, ibuprofen), STIs

first trimester discomforts

frequency, fatigue, n+v, breast tenderness, constipation, nasal stuffiness, bleeding gums, epistaxis (nosebleed), cravings, leukorrhea

second trimester discomforts

backache, vulva + leg varicosities, hemorrhoids, flatulence with bloating

third trimester discomforts

first trimester stuff, SOB + dyspnea, heartburn and indigestion, dependent edema, braxton-hicks

nursing management to promote self care

personal hygiene, avoid saunas and hot temps (temperature changes are bad), perineal care, dental care, breast care, comfortable loose clothing, exercise unless contraindicated (keep doing whatever you were doing, significant change can be bad), seep and rest, sexual activity does not harm baby, employment factors, travel immunizations and medications

breastfeeding advantages and disadvantages

pros - free and digestible, promoted bonding, suppressed ovulation, reduce reproductive cancer, reduce CV and type 2 diabetes, oxytocin release, sucking helps infant jaw development, immunologic properties, reduce otitis media, improved mineral and lactose absorption, adapts to meet infant’s changing needs, analgesic effect. cons - breast discomfort, milk blisters, mastitis, engorgement, abscess, candida infection.

bottle feeding advantages and disadvantages

pros - convenience and flexibility for mothers who cannot be with baby constantly, allow other caregivers to bond more. cons - lacks immunologic and enzymatic factors, preparation and sterilization require careful attention to hygiene, can incur additional costs.