Ch 8: Nursing care of the family during pregnancy

what are presumptive signs of pregnancy?

subjective signs experienced by the woman

what some examples of presumptive signs?

fatigue, nausea, amenorrhea, breast changes, urinary frequency, quickening

what are probable signs of pregnancy?

objective changes observed by the examiner

what are some examples of probable signs?

Goodell sign, Chadwick sign, Hegar sign, positive pregnancy test (serum or urine), Braxton Hicks contractions, ballottement

what are positive signs of pregnancy?

only attributable to the fetus- confirm pregnancy

what are examples of positive signs?

visualization of the fetus on ultrasound or other radiologic study, fetal heart tones, fetal movement palpated by the provider

What is the most accurate method for estimating date of birth (EDB)?

ultrasound measurement of embryo/fetus in the first trimester

In pregnancies from assisted reproductive technology, how is EDB determined?

based on the date of embryo transfer

What is Naegele’s Rule for calculating EDB?

based on last normal menstrual period; assumes a 28-day cycle and ovulation on day 14

what tool can healthcare providers use to estimate EDB?

gestational wheel

define gravida

a woman who is pregnant

define gravidity

the state of being pregnant

define nullgravida

a woman who has never been pregnant

define primigravida

a woman who is pregnant for the first time

define multigravida

a woman who has been pregnant 2 or more times

define parity

the number of pregnancies reaching greater than or equal to 20 weeks, regress of the outcome

define nullipara

a woman who has not had a pregnancy up to 20 or more weeks

define primipara

a woman who has carried one pregnancy to 20 or more weeks

define multipara

a woman who has carried two or more pregnancies to 20 or more weeks

define preterm pregnancy

pregnancies reaching 20 or more weeks but ending before 37 weeks

define late preterm pregnancy

24 weeks-36 weeks 6 days

define early term pregnancy

37 weeks- 38 weeks 6 days

define full term pregnancy

39 weeks - 40 weeks 6 days

define late term pregnancy

41 weeks - 41 weeks 6 days

define postterm pregnancy

greater than or equal to 42 weeks

define viability

capacity to live outside the uterus

threshold: 22-25 weeks

What does G/P (2-digit system) represent?

G = total pregnancies

P = number of pregnancies reaching 20 or more weeks regardless of the outcome

What does GTPAL (5-digit system) represent?

• G = total pregnancies

• T = term births (≥37 weeks)

• P = preterm births (20–36 weeks)

• A = abortions (spontaneous/elective, <20 weeks or <500 g)

• L = living children

What is included in the initial prenatal interview?

• complete health history (medications, nutrition, social, mental health, IPV risk, ROS)

• family history (parents, siblings, children of both parents)

• genetic disorders (may trigger genetic testing)

What is the purpose of the physical exam at the initial prenatal visit?

provide a baseline for future visits

What measurements and assessments are included in the initial physical exam?

height, weight, BMI, vitals signs, head-to-toe exam, pelvic exam

What blood tests are typically done at the initial prenatal visit?

blood type and Rh status, RBC antibody screening, CBC, rubella & varicella titers

What urine tests are done at the initial prenatal visit?

pregnancy test, protein, glucose, nitrites, leukocytes, culture for UTI if indicated

What infections are screened for at the initial prenatal visit?

HIV, syphilis, chlamydia, gonorrhea, hepatitis B, hepatitis C

What is assessed at follow-up prenatal interviews?

Emotional/physical changes, concerns/questions, family/partner situations.

What physical assessments are done at follow-up prenatal visits?

weight, vital signs, urine protein check, fundal height measurement

What fetal assessments are done at follow-up visits?

gestational age

fetal heart tones

fetal movement

fetal ultrasound

What routine tests are included at follow-up visits?

• Urine (protein, glucose, nitrites, leukocytes)

• Glucose testing (24–28 weeks for gestational diabetes)

• Rh-negative mothers: antibody screen at 28 weeks, Rhogam IM if negative

• Hemoglobin & hematocrit, syphilis screen (RPR), HIV (if at risk) at 28–32 weeks

• Group B strep culture at 36–38 weeks (antibiotics in labor if positive)

what optional testing may be done?

genetic screening (maternal blood or diagnostic testing)

what is the general recommendation for exercise during pregnancy?

30 minutes of moderate physical activity daily (can be broken into segments).

Which exercises should be avoided during pregnancy?

contact sports, scuba diving, high-risk balance/coordination activities, Valsalva maneuvers

What environmental factors should be considered during pregnancy exercise?

exercise in a thermoneutral/air-conditioned environment; avoid overheating, hot tubs, and saunas.

what positioning should be avoided after the 4th month in pregnancy?

exercising flat on the back

What are danger signs that should stop exercise and prompt HCP contact?

SOB, dizziness, headache, numbness/tingling, chest pain, regular painful contractions, decreased fetal activity, vaginal bleeding, dyspnea before exertion, muscle weakness affecting balance, calf pain/swelling

What hydration/nutrition measures should pregnant women take when exercising?

drink fluids during and after exercise, replace calories with healthy snacks

What clothing/equipment is recommended for safe pregnancy exercise?

supportive bra, supportive shoes

what is the medication safety alert for pregnant women?

no prescription, OTC, or herbal meds without consulting HCP

why should CAM modalities be discussed with HCP?

Some vitamins/herbal remedies may be unsafe or harmful in pregnancy.

What is the pertussis (Tdap) recommendation for people in close contact with infants <12 months?

Single Tdap dose ≥2 weeks before contact if not up to date (parents, grandparents, siblings, caregivers, healthcare workers).

Is occasional air travel safe during pregnancy?

yes, if no medical/obestetric complications

Until what gestational age do most airlines allow pregnant women to fly?

up to 36 weeks

What causes breast tenderness and enlargement in pregnancy, and how can it be managed?

Hypertrophy of mammary glands + ↑ vascularization (hormones). Wear supportive bra with pads, wash with warm water, keep dry.

What causes urinary urgency/frequency in early pregnancy, and how can it be managed?

Vascular engorgement + ↓ bladder capacity from enlarging uterus. Empty bladder regularly, Kegels, limit fluids before bed, avoid caffeine, wear pad, report dysuria.

What is the most common symptom in early pregnancy and its management?

Fatigue (from hormones/psychologic changes). Rest as needed; eat balanced diet to prevent anemia.

What causes morning sickness, and how can it be managed?

Likely hormonal (hCG, estrogen, prostaglandins). Small frequent meals, avoid empty stomach/greasy foods, dry carbs on waking, ginger/acupressure bands, vitamin B6 + doxylamine if prescribed.

What causes excessive salivation (ptyalism), and how can it be managed?

Possibly ↑ estrogen. Use astringent mouthwash, chew gum, hard candy.

What causes gingivitis/tender gums, and how can it be managed?

↑ vascularity from estrogen; poor dental care worsens. See dentist early, good oral hygiene, balanced diet.

What causes nasal stuffiness/epistaxis in pregnancy, and how can it be managed?

Hyperemia of mucous membranes (estrogen). Use humidifier, avoid trauma, saline drops.

What causes leukorrhea in pregnancy, and how should it be managed?

Cervical hypertrophy + hyperactivity → ↑ mucus. Use pads, maintain hygiene, avoid douching, call HCP if pruritus, odor, or color change

What causes emotional lability in early pregnancy, and what helps?

Hormones, psychosocial adaptation. Support groups, open communication, referrals if needed.

What causes linea nigra, melasma, and darkening of areolae?

Melanocyte-stimulating hormone. Not preventable, usually fades postpartum.

What causes spider angiomas (nevi) in pregnancy?

↑ estrogen → dilated arterioles. Not preventable, usually fade postpartum.

What causes pruritus in pregnancy and how can it be managed?

Unknown; may be skin stretching or hormones. Cool environment, tepid baths, oatmeal/sodium bicarb, loose clothing, antihistamines/topical creams if prescribed.

What causes palpitations in pregnancy?

Unknown; usually benign unless persistent. Contact HCP if with other cardiac symptoms.

What is supine hypotension (vena cava syndrome), and how is it prevented?

Gravid uterus compresses vena cava → ↓ perfusion. Avoid lying flat; use side-lying or semi-sitting.

What causes faintness/syncope in pregnancy, and how is it managed?

Vasodilation, orthostatic changes, venous stasis. Eat small meals, avoid heat/crowds, rise slowly, wear elastic hose.

What causes food cravings in pregnancy?

Unknown; may be cultural/psychologic. Usually safe unless interfering with diet (report unusual cravings)

What causes heartburn (pyrosis), and how can it be managed?

Progesterone slows GI motility + relaxes sphincter; uterus compresses stomach. Small meals, avoid fatty/spicy foods, sip milk/herbal tea, antacids if prescribed

What causes constipation in pregnancy, and how is it managed?

Progesterone slows motility, uterus compression, iron supplements. High-fiber diet, fluids, exercise, schedule BMs, avoid laxatives/enemas unless prescribed.

What causes flatulence/bloating in pregnancy, and how is it managed?

Slowed GI motility, air swallowing. Chew slowly, avoid gas-producing foods, exercise.

What causes varicose veins/hemorrhoids in pregnancy, and how are they managed?

Hormones relax vein walls + uterine pressure. Avoid standing long, wear support hose, elevate legs, sitz baths, avoid constipation.

What causes headaches in pregnancy, and what should be reported?

Sinus congestion, stress, eye strain, caffeine withdrawal, or preeclampsia. Rest, fluids, relaxation; report constant/severe headache with vision changes or vomiting.

What causes carpal tunnel syndrome in pregnancy?

Compression of median nerve (↑ blood volume). Elevate, splint, usually resolves postpartum.

What causes numbness/tingling of fingers in pregnancy?

brachial plexus traction (drooping shoulders). Good posture, supportive bra

What causes round ligament pain in pregnancy, and how can it be managed?

Uterine growth stretching ligaments. Rest, good posture, knee-to-chest position, sometimes heat.

What causes backache/joint pain in pregnancy?

Hormone-induced joint relaxation + posture changes. Good body mechanics, firm mattress, pelvic tilts, abdominal support.

What causes shortness of breath in late pregnancy, and how is it managed?

Uterus elevates diaphragm (~4 cm). Good posture, extra pillows, avoid large meals/smoking.

What causes insomnia in pregnancy, and how can it be managed?

Fetal movement, cramps, urinary frequency, SOB. Relaxation, massage, pillows, warm milk/bath, avoid screens before bed.

What causes psychosocial changes in late pregnancy?

hormonal and role changes before labor/parenthood. Support, reassurance, communication

What causes Braxton Hicks contractions, and how should they be managed?

Uterus prepares for labor. Rest, position change, breathing techniques, reassurance.

What causes leg cramps in pregnancy, and how can they be managed?

Nerve compression, low calcium, high phosphorus, fatigue. Dorsiflex foot, stand on cold floor, calcium supplements, HCP if severe

What causes ankle edema in pregnancy, and how can it be managed?

Venous stasis + pressure of uterus, worse with standing/heat. Fluids, elevate legs, support stockings, moderate exercise. Report generalized edema.

What maternal age is considered adolescent pregnancy, and what is AMA?

less than 20 years = adolescent pregnancy;

what risks are increased with multifetal pregnancy?

Miscarriage, hyperemesis, anemia, gestational hypertension, preeclampsia, postpartum hemorrhage, maternal death, preterm birth, IUGR, LBW, VLBW, congenital anomalies, neonatal death, cerebral palsy.

How does prenatal care differ for multifetal pregnancies?

More frequent prenatal visits, ultrasounds, nonstress tests, FHR monitoring, nutrition counseling, management of discomforts, education on preterm labor warning signs.

What are the three primary birth setting options?

hospital, free-standing birth center, and home birth

What are the features of hospital LDR/LDRP units?

Comfortable, private, homelike rooms; family bonding time; emergency equipment available; LDRP allows same staff from admission to discharge.

Who usually staffs free-standing birth centers, and who qualifies?

Certified midwives; only women at low risk for complications.

What is the typical postpartum discharge time at free-standing birth centers?

within 6 hours of birth

What are the benefits of doula support during labor?

↓ pain medication, ↓ epidural use, shorter labor, ↑ satisfaction, ↑ spontaneous vaginal birth, ↓ cesarean/instrumental birth, ↓ low APGAR risk.

What is a birth plan?

a tentative preference list where expectant parents outline birth setting, partner participation, interventions, and postpartum care preferences

When should birth plans be introduced and discussed?

prenatally, with modifications as couples learn more; nurses initiate discussion and provide resources