Nursing Management During Pregnancy

Nursing Management During Pregnancy
presentation from:Los Angeles Valley College

Preconceptual Counseling
* Why is it important?
* Medical- past or current problems
* Sexual- STI
* Reproductive-AB or losses
* Psychosocial-support system
* Counseling- Folic acid, iron, wgt. SA, violence diseases, genetics

Taking History
* Current pregnancy- any problems
* Past pregnancy-problems, type of delivery,newborn info
* Current/past medical hx
* Family-Religion-Culture
* Age-old vs. young
* Identify high risk problems early

Vocabulary
* Nagle’s rule minus three months + 7days
* Ab- before 20 weeks
* Nullipara- no births before 20 weeks
* Primpara -one birth after 20 weeks
* Gravida- pregnancy regardless of duration
* P- after 20 weeks before 37 wks
* Living- number of living children

Head to Toe
* Head and Neck- Evaluate thyroid, dental
* Chest- HR, murmur, SOB, breast exam
* Abdomen- check fundal hgt
* Extremities- varicosities, edema, calfs
* Pelvic exam-Lesions, discharge, hematomas
* Pelvimetry- gynecoid, assess for adequate pelvis
* Labs- CBC, Rh, Rubella, Hepatitis, HIV, VDRL,RPR

Prenatal Care Visits
Fetal Movement
* Used to determine fetal well being
* Cardiff- lie or sit, count 10 fetal movements
* Call healthcare provider if more than 1 hour
* Sadovsky- lie on left after eating.
* Should feel 4 movements in 1 hr
* Count movements second hr.
* Call HCP if criteria not met


Assessment of Fetal Well Being
* UTZ- Low risk assessment tool
* Doppler Flow-Eval for absent or reversed diastolic flow
* AFP-16-18wks Eval for NTD or Down’s
* Marker Screening test- AFP ,unconjugated estriol, hCG and Inhibin A- more accurate
* Amniocentisis—chromosomes and metabolic defect



Assessment of Fetal Well Being
* Nsg-Consent, risk of AB, empty bladder
* Assess for FHT and UC- Rhogam?
* Give labor precautions
* CVS-Tissue sample- Get results sooner
* Nsg- same as amniocentisis
* PUBS- blood collected from fetus
* High Risk- Monitor fetus
* NSG-FKC- S/S of infection, cramping

Assessment of Fetal Well Being
* NST- Fetal Movement = Fetal Well Being
* Reactivity= 2 accelerations above baseline lasting 15 seconds within 20 minutes
* Nsg- Apply monitors, give marker, displace uterus to left lateral
* Need for NST determined by risk factors
* CST- Ability of fetus to tolerate stress and fetal reserve
* Decrease in oxygenation with uc’s
* Initiate 3 ucs in 10 minutes
* Eval. FHR for variations
* Negative results are GOOD
* Positive - 50% of ucs = late decelerations

Biophysical Profile
Promotion of Self-Care

* Treat holistically-promote well being
* Personal Hygiene/Dental Hygiene
* Breast Care- Sears or J.C. Penny
* Clothing- loose comfortable
* Balance exercise with rest
* Pelvic Tilt and Kagel’s
* Sleep- use pillows- limit fluids
* Sexual activity- encourage intimacy
* Employment- evaluate risk factors
* Travel- move q 2 hrs
* Immunizations- no live vaccines
* OTC meds- should consult HCP

Classifications of Drugs
* A- controlled studies- no fetal risks
* B- use frequently- r/t little harm
* C- likely to cause harm risk vs. benefits
* D- fetal risk benefits outweigh risk
* X risks outweigh benefits

Promotion of Self Care
* Urinary frequency-need 2000 cc/day. Limit 2-3 hrs before bed
* Fatigue- feel best 2nd trimester
* N/V- Avoid foods and smell. Crackers, sit up, rise slowly- S/S of dehydration
* Constipation- increase fiber-Do not strain
* Nasal- epitaxis-use air vaporizer
* Cravings- Weight? Avoid sodium/sugar

Promotion of Self Care Second Trimester
* Backache- Good body mechanics
* Leg cramps-increase calcium/magnesium
* Ankle edema- common- legs above heart
* Hemorrhoids- avoid straining
* Constipation- bulk in diet- prune juice
* Flatulence- avoid carbonation, cheese

Promotion of Self Care Third Trimester
* SOB-pressure on diaphragm, sit up, avoid large meals- Lightening
* Constipation- hydration- fruits and vegetables
* Heartburn- sit up, avoid large meals
* Ankle edema- eval for PIH
* Braxton Hicks- Cervix preparing for labor

Diet

* 30 mg ferrous sulphate/600mcg of folic acid
* Normal weight gain 25-35 pounds
* Alterations in weight- thin vs. obese
* Culture variations
* Special Diets- Lactose Intolerant- Vegans
* Use Dieticians
* Evaluate for Pica

Perinatal Education
* Knowledge = Better Birth Experience
* Lamaze- psychophrophylactic- Breathing controls pain
* Bradley-Enjoy process of childbirth-no pain medications
* Dick Read- Break cycle of Fear-Tension-Pain

Birth Options
* Hospital Based Care-Birthing Suites – Family Centered Care
* Birthing Center- No Rush- Midwife
* Home Birth- Must be low risk
* Choosing a health care provider
* Doula- Continuous support during labor and birth

Breast vs. Bottle
* Breast is best
* Bonding
* Less infection
* Promotes involution
* Less allergies
* Less obesity
* More digestible
* Bottle
* Need more to get same nutrition
* Expensive
* Less digestible
* No microwave
* Do not prop bottle
* Father can feed

Danger Signs of Pregnancy
Class activities
GTPAL
Maslow
Diet

Nursing Management During Pregnancy.ppt