Nursing Care to Promote Fetal and Maternal Health
Self-Care Needs During Pregnancy
Bathing
- Daily tub baths or showers are encouraged.
- Avoid long soaks in extremely hot water; switch to showers if indicated.
Breast Care
- As breast size increases, wear a firm, supportive bra.
- Clean breasts with clear water and dry when colostrum begins.
Dental Care
- Maintain good oral hygiene.
Perineal Hygiene
- Maintain good hygiene, douching is contraindicated.
Clothing
- Avoid clothing that restricts circulation to lower extremities; moderate-to-low heeled shoes are recommended.
Sexual Activity
- May continue if comfortable.
Exercise
- Continue exercise based on baseline fitness level.
- Avoid contact sports.
Sleep
- For sleep issues, drink warm milk or practice relaxation exercises.
- Sleep in a left-sided Sims position.
Employment
- Can continue unless exposed to toxic substances, heavy lifting, or prolonged standing/sitting.
- Federal law protects from loss of employment benefits if unable to work due to pregnancy.
Travel
- Generally unrestricted but consider nearby health facilities.
- Take frequent breaks for rest and hydration during long travel.
Healthy People 2030 Goals
Prenatal Care
- Increase early and adequate prenatal care from 76.4% to 80.5%.
Substance Abstinence
- Increase abstention from illicit drugs during pregnancy from 93.0% to 95.3%.
- Increase abstention from alcohol from 89.3% to 92.2%.
- Increase abstention from cigarette smoking from 93.5% to 95.7%.
Assessing First Trimester Discomforts
- Common discomforts include:
- Nasal congestion
- Nausea and vomiting
- Palpitations
- Breast tenderness
- Backache
- Abdominal discomfort
- Increased urinary frequency
- Braxton Hicks contractions
- Constipation
- Leukorrhea (increased discharge)
- Hemorrhoids
- Muscle cramps
- Varicosities
- Ankle edema
Assessing Second and Third Trimester Discomforts
- Common discomforts include:
- Musculoskeletal pain (backache)
- Headaches
- Dyspnea (shortness of breath)
- Ankle edema
- Braxton Hicks contractions
Preliminary Signs of Labor
- Signs and Symptoms include:
- Lightening: Fetal head descends into pelvis.
- Slight weight loss: Due to hormonal changes.
- Increased energy: Due to adrenaline.
- Backache: From early contractions.
- Cervical ripening: Softening due to prostaglandins.
- Rupture of membranes: Release of amniotic fluid.
- Show: Internal mucus plug released.
Exposure to Teratogens
Maternal infections that can affect fetus:
- Malaria, Rubella, Toxoplasmosis, Herpes simplex, Cytomegalovirus, Syphilis
Infections at birth that can affect the neonate:
- Gonorrhea, Candidiasis, Chlamydia, Streptococcus B, Hepatitis B
Other teratogenic factors include:
- Live virus vaccines, certain herbs, alcohol, and tobacco exposure
FDA Pregnancy Risk Categories of Drugs
- Category A: No risk to fetus (e.g., Thyroid hormone)
- Category B: No risk in animal studies; well-controlled studies in pregnant individuals lacking.
- Category C: Risk in animal studies; requires risk-benefit assessment.
- Category D: Proven risk to fetus; benefits must outweigh risks.
- Category X: Proven risk; avoid use during pregnancy (e.g., Thalidomide).
Nursing Diagnoses for Healthy Pregnancy
- Health-seeking behaviors related to maintaining optimal health
- Anxiety related to body changes during pregnancy
- Risk for deficient fluid volume due to nausea and vomiting
- Disturbed body image related to appearance changes
- Risk for altered sexuality patterns owing to fear of harming fetus
Kegel Exercises
Strengthen pubococcygeal muscles.
Perform 3 times daily:
- Squeeze as if stopping urine flow; hold for 3 seconds; relax.
- Rapid contractions and relaxations for 10 to 25 times.
- Imagine sucking water into the vagina; hold for 3 seconds; relax.
Avoid starting/stopping urine flow during urination to promote proper bladder emptying.