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Essentials of Maternity and
Pediatric Nursing
Chapter 12
Nursing Care During Pregnancy
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<insert Box 12-1>
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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
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1st 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
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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
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Menstrual History
• Menstrual cycle
– Age at menarche
– Days in cycle
– Flow characteristics
– Discomforts
– Use of contraception
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Menstrual History (cont’d)
• 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
11/21/07
• Subtract 3 months
8/21/07
• Add 7 days
8/28/07
• Add 1 year
8/28/08 = EDB
– Gestational or birth calculator or wheel (see Fig. 123)
– Ultrasound
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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
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Obstetric History (cont’d)
• 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
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Question
Is the following statement True or False?
A multipara refers to a woman who is pregnant for the first
time.
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Answer
False.
A multipara refers to woman who has had two or more
pregnancies resulting in viable offspring.
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Physical Examination
• Vital signs
• Head-to-toe assessment
– Head and neck
– Chest
– Abdomen, including fundal height if appropriate
– Extremities
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Physical Examination (cont’d)
• Pelvic examination
– Examination of external and internal genitalia
– Bimanual examination
– Pelvic shape: gynecoid, android, anthropoid,
platypelloid
– Pelvic measurements: diagonal conjugate, true
(obstetric) conjugate and ischial tuberosity
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Laboratory Tests
• Urinalysis
• Complete blood count
• Blood typing
• Rh factor
• Rubella titer
• Hepatitis B surface antigen
• HIV, VDRL, and RPR testing
• Cervical smears
• Ultrasound
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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
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Follow-up Visits (cont’d)
• Assessments
– Weight & BP compared to baseline values
– Urine testing for protein, glucose, ketones, and
nitrites
– Fundal height (see Fig. 12-5)
– Quickening/fetal movement (see Box 12-3)
– Fetal heart rate (see Nursing Procedure 12-1)
• Teaching: danger signs
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Question
Is the following statement True or False?
A woman who is 24 weeks pregnant would arrange for
a follow-up visit every 2 weeks.
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Answer
False.
A woman who is 24 weeks pregnant would have follow-up
visits scheduled every 4 weeks until she reaches 29
weeks’ gestation.
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Assessment of Fetal Well-Being
• Ultrasonography (see Fig. 12-6)
• Doppler flow studies
• Alpha-fetoprotein analysis
• Marker screening tests
• Amniocentesis (see Figs. 12-7 and 12-8)
• Chorionic villus sampling (CVS)
• Percutaneous umbilical blood sampling (PUBS)
• Nonstress test; contraction stress test
• Biophysical profile
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First-Trimester Discomforts
• Urinary frequency or incontinence (see Teaching
Guidelines 12-1)
• Fatigue
• Nausea and vomiting
• Breast tenderness
• Constipation
• Nasal stuffiness, bleeding gums, epistaxis
• Cravings
• Leukorrhea
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Second-Trimester Discomforts
• Backache
• Varicosities of the vulva and legs
• Hemorrhoids
• Flatulence with bloating
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Third-Trimester Discomforts
• Return of first-trimester discomforts
• Shortness of breath and dyspnea
• Heartburn and indigestion
• Dependent edema
• Braxton Hicks contractions
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Nursing Management to Promote SelfCare
• Personal hygiene
• Avoidance of saunas and hot tubs
• Perineal care
• Dental care
• Breast care
• Clothing
• Exercise (see Teaching Guidelines 12-2)
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Nursing Management to Promote SelfCare (cont’d)
• Sleep and rest
• Sexual activity and sexuality
• Employment (see Teaching Guidelines 12-3)
• Travel (see Teaching Guidelines 12-4)
• Immunizations and medications
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Question
While assessing a woman at 18 weeks’ gestation, which of
the following would the nurse report as unusual?
A. Urinary frequency
B. Backache
C. Leukorrhea
D. Flatulence with bloating
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Answer
A.
During the second trimester, urinary frequency
typically improves when the uterus becomes an
abdominal organ and moves away from the bladder
region. Backache and flatulence with bloating are
common during the second trimester. Leukorrhea
begins in the first trimester and continues
throughout pregnancy.
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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
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Preparation for Labor, Birth, and
Parenthood (cont’d)
• Options for birth setting
– Hospitals: delivery room, birthing suite
– Birth centers
– Home birth
• Options for care providers
– Obstetrician
– Midwife
– Doula
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Preparation for Labor, Birth, and
Parenthood (cont’d)
• Feeding choices
– Breastfeeding: advantages and disadvantages
– Bottle feeding: advantages and disadvantages
– Teaching
• Final preparation for labor and birth
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End of Presentation
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