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Understanding Gestation and Due Dates

• 40 Weeks Gestation:

  • Marks the due date for a pregnant woman.

  • Example: A due date of February 26th indicates 40 weeks gestation.

  • Term pregnancy is categorized as greater than 37 weeks.

  • Women may deliver a little before or after their due date.

Calculating Due Dates

• Nagel's Rule:

  • Used to calculate the estimated due date (EDD).

  • Calculation:

    • Start with the first day of the last menstrual period (LMP).

    • Subtract 3 calendar months.

    • Add 7 days.

  • Familiarity with this rule is important for exams, particularly NCLEX.

Phases of Pregnancy

• Phase 1: Acceptance of pregnancy.

  • Women begin accepting they are pregnant after a positive pregnancy test.

• Phase 2: Acceptance of the fetus.

  • Women start recognizing the baby as distinct from themselves, often feeling fetal movements.

• Phase 3: Preparation for birth (Nesting).

  • Involves practical preparations like cleaning, packing bags, and arranging nurseries.

  • Discussions about nursery readiness can foster rapport between nurses and patients.

Patient Education and Communication

• Critical to inform patients about potential events during labor, including emergency cesarean sections (C-sections).

• Provide explanations for interventions during labor to reduce anxiety.

• Effective communication can help assuage patient fears and improve the overall experience.

Addressing High Anxiety in Patients

• Recognize varying anxiety levels; tailor communication accordingly.

• Some patients may benefit from receiving information piece by piece rather than all at once.

Special Considerations in Pregnancy

• Clinicians must be attentive to whether pregnancy was planned or unplanned.

• Adverse factors like intimate partner violence should be screened.

  • Ask patients, "Do you feel safe at home?" to gauge their safety.

Managing Unexpected Pregnancies

• Address care for women unaware of their pregnancies, including appropriate supportive interventions.

  • Example: College students may present unexpectedly in labor with no prenatal care.

Inclusivity in Pregnancy

• Be aware of diverse family structures, including same-sex couples and transgender individuals.

• Recognize the role of gestational carriers and the specific needs of these families.

Comprehensive Care Management

• Initial visits include gathering medical history and conducting essential screenings.

• Mandatory labs include screening for STIs, blood type, and hemoglobin levels, among others.

• Continue monitoring for substance use; all patients are subjected to routine drug screenings.

Important Pregnancy Complications

• Supine Hypotension:

  • Occurs when a woman lies flat, causing pressure on major blood vessels.

  • Symptoms include dizziness or nausea; first intervention is to reposition the patient onto their left side.

Laboratory Testing During Pregnancy

• Essential tests include but are not limited to:

  • Blood type and Rh factor screening.

  • CBC to assess for anemia and overall maternal health.

  • Testing for bloodborne pathogens (HIV, hepatitis).

  • GBS testing at around 36 weeks.

Informed Consent and Patient Interaction

• When testing positive for substances (e.g., cocaine), engage the patient empathetically, providing non-judgmental support.

• Collecting detailed patient histories supports better care for the mother and fetus.

Nutrition and Health During Pregnancy

• Encourage proper nutrition, exercise, and the importance of prenatal vitamins, specifically folic acid.

• Monitor maternal health, including dental hygiene and exercise habits.

Immunizations and Health Precautions

• Confirm Tdap, flu, and RSV vaccines for expectant mothers.

• Avoid live vaccines, such as varicella, during pregnancy.

Mental Health Awareness

• Assess for and respond to the psychosocial needs of the patient.

  • Provide reassurance, support, and information on resources available for new parents.

Conclusion

• Holistic care includes understanding biological, psychological, and social factors affecting pregnancy.

• Continuous education and communication from initial visits to delivery are crucial for maternal and fetal health.