NURSING MANAGEMENT DURING PREGNANCY

Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java

REFERENCES

 Bobak LM & Jensen MD (1993

) Maternity & Gynecologyc Care, The Nurse and The Family

5 th ed , St Luis : CV Mosby Company.

 Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993)

Maternity Nursing,

St Luis : CV Mosby Company.

 Mattson Susan & Smith Judi E (2000).

Core Curriculum for Maternal – Newborn Nursing

. 2 nd ed. Philadelphia. W.B. Saunders Company.

 Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 )

Ilmu Kebidanan

, Jakarta Yayasan Bina Pustaka Sarwono Prawiroharjo.

 Journals and article related to..

Conception, Fetal Development, Gestational Risk and Fetal Well-being Factors affecting fetal well-being: 

Quality of sperm or ovum



Intrauterine environment



First trimester exposure to hazardous agents



Maternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatory



Substance abuse



Known or unknown infections

Barriers to Prenatal Care

 Sociodemographics  Insurance/finances  Inadequate care providers for low income  Delay in onset of prenatal care  Cultural factors  Transportation  Attitudes

Preconception Care

         Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system

KSPR (Kartu Score Pudji Rohjati) Card for risk detection of Pregnacy

1

st

Prenatal Visit

    Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests

Comprehensive Health History

   Reason for seeking care  Suspicion of pregnancy  Date of last menstrual period  Signs and symptoms of pregnancy  Urine or blood test for hCG Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric, and gynecologic history

Menstrual History

 Menstrual cycle  Age at menarche  Days in cycle  Flow characteristics  Discomforts  Use of contraception

Menstrual History

  Date of last menstrual period (LMP) Calculation of estimated or expected date of birth (EDB) or delivery (EDD)  Nagele’s rule ○ Use first day of LNMP 11/21/11 ○ Subtract 3 months 8/21/11 ○ ○ Add 7 days Add 1 year 8/28/11 8/28/12 = EDB  Gestational or birth calculator.

Obstetric History



Gravida:

a pregnant woman   Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc.



Para:

a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more  Primapara: one birth after a pregnancy of at least 20 weeks (“primip”)  Multipara: two or more pregnancies resulting in viable offspring (“multip”)  Nullipara: no viable offspring; para 0

Obstetric History

 Terminology 

G

(gravida): the current pregnancy 

T

(term births): the number of pregnancies ending >37 weeks’ gestation, at term 

P

(preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks 

A

(abortions): the number of pregnancies ending before 20 weeks or viability 

L

(living children): number of children currently living

Physical Examination

  Vital signs Head-to-toe assessment   Head and neck Chest  Abdomen, including fundal height if appropriate  Extremities  Pelvic examination  Examination of external and internal genitalia  Bimanual examination   Pelvic shape: gynecoid, android, anthropoid, platypelloid Pelvic measurements

Laboratory Tests

       Urinalysis Complete blood count Rh factor TORCH test Hepatitis B surface antigen HIV test Ultrasound

Follow-up Visits

 Visit schedule:  Every 4 weeks up to 28 weeks  Every 2 weeks from 29 to 36 weeks  Every week from 37 weeks to birth

Follow-up Visits

 Assessments  Weight & BP compared to baseline values  Urine testing for protein, glucose, ketones, and nitrites  Fundal height  Quickening/fetal movement  Fetal heart rate  Teaching: danger signs

1

st

Trimester Discomforts

 Urinary frequency or incontinence        Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea

2

nd

Trimester Discomforts

 Backache  Varicosities of the vulva and legs  Hemorrhoids  Flatulence with bloating

3

rd

Trimester Discomforts

 Return of 1 st trimester discomforts  Shortness of breath and dyspnea  Heartburn and indigestion  Dependent edema  Braxton Hicks contractions

Nursing Management To Promote Self-Care

 Personal hygiene  Avoidance of saunas and hot tubs  Perineal care  Dental care  Breast care  Clothing  Exercise

Nursing Management To Promote Self-Care

 Sleep and rest  Sexual activity and sexuality  Employment  Travel  Immunizations and medications

Danger Signs Of Pregnancy !!!

Assess and report immediately:  Vaginal bleeding in any amount - May indicate placenta previa  Premature rupture of membranes - Predisposes mom and baby to infection  Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia  Severe, persistent headaches and visual disturbances - Consider preeclampsia

Danger Signs in Pregnancy

Report any of the following immediately:  Fever and/or chills  Painful urination  Persistent nausea & vomiting  Change in, or absence of fetal movement for 6-8 hrs.

Preparation for Labor, Birth, and Parenthood

 Perinatal education  Childbirth education  Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques  Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing  Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

Preparation for Labor, Birth, and Parenthood

  Options for birth setting    Hospitals: delivery room, birthing suite Birth centers Home birth Options for care providers    Obstetrician Midwife Health provider

Preparation for Labor, Birth, and Parenthood

  Feeding choices  Breastfeeding: advantages and disadvantages  Bottle feeding: advantages and disadvantages  Teaching Final preparation for labor and birth