Transcript Antepartal Nursing Care

Antepartal Nursing Care
Lunar month- 4 weeks, 28 days
OB Terminology
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Pregnancy – divided into 3 trimesters 13 weeks each
EDC - estimated date of confinement
EDB - estimated date of birth *same thing
Gestation - number of weeks since first day of last menstrual
period
• Abortion - birth that occurs before end of 20 weeks gestation
• Preterm 20 - 37 weeks
• Term 38 - 40 wks
• Postterm after 42 weeks
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Gravida -any pregnancy (any: when preg lasts 4, 5, 6wks or to term)
Para - birth after 20 weeks gestation multiples count as one
Stillborn - born dead after 20 weeks
Primigravida - first time pregnancy
Multigravida - second or any subsequent pregnancy
Essential Components of a Prenatal
History
• Basis of prenatal care- reevaluated and updated throughout
the pregnancy.
• Obstetric history – pertaining to pregnancy current and past
• Gynecologic history- …how long pt has had menses.
• Medical history - Current and past
• Family medical history including Father’s health history
• Religious, spiritual, and cultural history
• Occupational history
• Personal information about woman
• Comprehensive psychosocial assessment
Comprehensive OB History Acronym
• TPAL
– T - term births, twins or more count as one
• 38 weeks
– P - birth from 20 - 37 weeks
– A - spontaneous or therapeutic abortion
– L - living children- multiples count here
Practice
• Cindy is currently 34 weeks gestation and in labor
with her first baby.
• Gravida 1 Para 0
• After delivery - G 1 P 1
• More detail:
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Gravida 1
Term 0
Preterm 1
Abortions 0
Living 1
Practice
• Mary is currently 26 weeks gestation and she has a 4
year old daughter that was born at 38 weeks
gestation.
• G 2 P1
• More detail:
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G2
T 1
PT 0
AB 0
L 1
Practice
• Ms Johnson is pregnant for the 4th time. She had one
abortion at 8 wks gestation. She has a daughter who was
born at 40 wks gestation and a son born at 34 weeks
gestation.
• G 4
P 2
• More detail:
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G 4
T 1
PT 1
AB 1
L 2
More Practice
• Ms T, at 27 weeks gestation, comes to the clinic for a routine
prenatal visit. This is her 4th pregnancy. She has three
children at home. One child was born at 34 wks gestation and
the other two were 40 wks gestation.
• G 4 P3
• More Detail:
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G 4
T 2
PT 1
AB 0
L 3
One More Practice
• Sharon is 22 wks pregnant. She has a 2 year old and a 4 year
old that were born at 39 wks. She lost 4 pregnancies at 12
wks and she has 10 year old twin boys that were born at 33
wks gestation.
• G 8 P 3
• More detail:
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G 8
T 2
PT 1
AB 4
L 4
Determination of Due Date
• Nagele’s Rule- one method of determining the EDB.
Fairly accurate method to use if woman’s cycle is every 28
days.
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First day of LMP
Subtract 3 months
Add 7 days
EDB
Nagele’s Rule Example
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LMP
Subtract 3 months
Add 7 days
EDB
April 6
- 3 months
Jan 6
+_7 days
Jan 13
Another Option of Nagele’s Rule
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Just change the month to number
December 10 becomes 12-10
Subtract 3 months
-_3___
9 -10
Add 7 days
__+_7
EDB
Sept 17
Other Indicators of EDB
• Fundal Height – correlates with weeks
gestation (top of a pregnant woman's uterus (fundus) to
her pubic bone)
• Quickening - fetal movement felt be the mom
(~16-22wks, not very accurate)
• Fetal heartbeat - Doppler 10-12 wks and 1720 wks with fetoscope.
• Ultrasound - most accurate
Initial Physical Assessment
• Head to toe physical assessment
• 8-12 wks gestation
• Starts with VS and ends with pelvic exam.
Pregnancy Physical Assessment
• Blood pressure - trimester specific changes (1st tri
= BP drops and will rise towards the 3rd)
• Weight - sudden wt gain
• Skin - pigmentation
• ENT - nosebleeds and swollen gums, dental
infection preterm labor
• Breast – enlarge, colostrum 12 wks
• Abdomen - becomes larger, measured each visit
(Fundal Height Measurement)
Fundal Height Measurement
• Measure in centimeters from the top of the
symphysis pubis to the top of the uterine
fundus.
• 22 - 34 weeks - fundal height correlate with
weeks of gestation
• Too small or too large - needs to be evaluated.
Figure 8–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundal height.
Fundal Height Assessment
• 10-12 wks - fundus slightly above symphysis pubis
• 16 wks - fundus halfway between symphysis and
umbilicus
• 20-22 wks - fundus at umbilicus
• 28 weeks - fundus three finger breadths above
umbilicus
• 36 wks - fundus just below ensiform cartilage
Abdominal Assessment
• Fetal movement felt by examiner -18 weeks
• Ballotment - Fetus floating in amniotic fluid
• Fetal heart tones - 110-160 BPM
– Doppler 10-12wks
– Fetoscope 17-20 wks
Physical Assessment cont
• Extremities - edema of hands and feet in later
pregnancy
• Reflexes - hyperactivity or clonus associated
with preeclampsia
• Pelvic - Pelvic measurement assessed for
shape and size; dilatation and effacement
• Rectum - hemorrhoids (if already present,
give advice about incr fiber and fluids)
Initial Laboratory Evaluation and
Screening
CBC (Anemia  give more iron)
ABO and Rh typing, Antibody Screen, Blood type
Serolgy (RPR  tests for syphilis)
Rubella
Hepatitis
HIV
PAP smear
STD screen
Urinalysis – C&S; drug screen, can have a UTI that is
asymptomatic
• Thyroid panel- because of chance of cretinism
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Subsequent Prenatal Visit Routines
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Every 4 weeks until 28 wks
Every 2 wks until 36 wks
Every wk until delivery
Visits include teaching and assessment of
maternal/fetal well-being.
Subsequent Prenatal Assessments
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Vital signs
Weight - 1st trimester > 3.5 – 5lbs
2nd and 3rd trimester > 12 -15lbs, then a lb per wk
Monitor for Edema
Uterine size and uterine activity
FHT’s and fetal movement
Urine screen for protein, glucose and ketones
Lab
– CBC at 7 months
– AFP at 15-20 wks
– Indirect coombs for Rh negative moms at 28 wks
– Glucose screen 28 wks
– GBS vag culture 36 wks, “Group B Strept”- Carriers must understand the
dangers for the baby.
• Define: AFP- Alpha Fetal Protein, measurements in amniotic fluid are used for early
diagnosis of fetal neural tube defects
– High = Neural Tube defect (ex: spina bifida)
– Low = Down’s Syndrome
Danger Signs in Pregnancy
• Vaginal bleeding (Any bright red bleeding  call phys)
• Nausea and vomiting that last over 24hrs
– Dehydration leads to preterm labor
• Fever -100.4
• Dizziness - sudden and extreme, associated with pelvic or uterine
pain
• True Labor- Lower back pain to the front
• False labor- Abd pain only
• Preterm labor symptoms
• Leaking of fluid from vagina
• Preeclampsia symptoms - edema, rapid wt gain, headaches,
visual disturbances, vomiting, epigastric pain, irritability, scanty
urine output (usually won’t see till after 20wks)
• Decreased fetal movement
• Symptoms of UTI - dysuria, severe backache, fever
1st Trimester Discomforts and Measures
to Alleviate
• Nausea (due to HcG levels) and vomiting - avoid odors, eat small
frequent meals, crackers, avoid spicy or greasy foods
– HcG- a hormone produced by the placenta about 10 days after
fertilization. Its detection is the basis for most pregnancy tests.
• Urinary frequency - void when needed; increase fluids in day and
slow down at night
• Fatigue - plan rest periods, get help from support system
• Breast tenderness - wear good supportive bra
• Increased vaginal discharge - frequent bathing, cotton underwear
• Nasal stuffiness & epistaxis - cool mist, avoid nasal decongestants
and sprays
• Ptyalism – “excessive saliva/bad taste in mouth” treat w/
mouthwash, chewing gum, candy
2nd and 3rd Trimester Discomforts and
Measures to Alleviate
• Pyrosis – “hrt burn” treat w/ small frequent meals, avoid
spicy or greasy meals, sit or stand after meal
• Ankle edema - rest frequently, elevate legs when resting,
avoid garters
• Varicose veins - elevate legs, wear support hose, avoid
crossing legs, avoid constrictive bands
• Flatulence - avoid constipation and gas producing foods
• Hemorrhoids - avoid constipation
• Constipation - increase fluids and fiber in diet, exercise, stool
softeners as ordered by physician
– Make sure softeners are okay’d by phys first.
2nd and 3rd Trimester Discomforts and
Measures to Alleviate cont
• Backache - proper body mechanics; avoid high heels, practice
pelvic tilt exercise
• Leg cramps - dorsiflexing foot
• Faintness - rise slowly from sitting or lying, evaluate hematocrit
and hemoglobin
• Shortness of breath - eat small frequent meals
• Difficulty sleeping - prop with pillows, use side-lying position
– Lt Side is better for baby
• Round ligament pain - position change, heating pad
• Carpal tunnel syndrome - avoid repetitive movements of hands
Promotion of Self Care During
Pregnancy
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Fetal activity monitoring - after 28 wks
Breast care and preparation for breastfeeding
Prenatal classes and exercises
Clothing
Bathing
Employment
Travel- wear safety belts, travel only if you have no
problems, stop every 2 hrs, stay hydrated
• Activity
Promotion of Self Care During Pregnancy
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• Dental Care
• Immunizations
• Complementary and alternative therapy
– Before anything over the counter they need to talk to their phys
• Tertatogens
– Medications
• Categories A – X, pg. 247 – 249; Cat. A is safe during Preg. No to Accutane!!
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Tobacco- IUGR  Growth retardation, Tobacco vasocontricts!
Alcohol
Caffeine- limit intake
Street drugs
Flu Vaccine is okay, just not live ones.
Dental care > important, poor dental hygiene associated with
preterm labor
Concerns About Sexual Activity
• Safety for fetus
• Contraindications
– PROM “Premature rupture of membranes”
(water-break), preterm labor, vag bleeding
Changes in sexual desire and response
– pregnant woman
– partner
Nursing Care of the Pregnant Woman’s
Family
• Father – involved, participation
• Siblings – regression, rivalry
• Grandparents – involvement, conflicts