Ch. 4 Prenatal Care and Adaptations to pregnancy

T- number of term infants born (infants born after at least 37 weeks of gestation) P-number of preterm infants born (infants born after 20 weeks or before 37 weeks of gestation) A-number of pregnancies aborted before 20 weeks of gestation (spontaneously or induced) L-number of children now living M-multiple birth number of multiple gestations (optional)

The TPALM system to describe parity (consistency) -Term -Preterm -Abortions -Living -Multiple, what do they stand for?

most are to establish a baseline normal for comparison throughout pregnancy

To prevent unnecessary fears or stress to the pregnant pt, what is important for the nurse to tell her about most tests that are used?

-corn and beans -lentils and rice -peanut butter and bread -plant proteins complimented with animal proteins such as: grilled cheese sandwiches, cereal with milk, chili made of meat and beans -because all the amino acids necessary for building tissues (essential amino acids) must be present at the same time

beans, lentils, and other legumes; breads and cereals; and seeds and nuts in combo with another plant or animal protein can provide all the amino acids (components of protein) needed, what are some examples of complementary plant protein combos?

small muscular, pear-shaped pelvic organ that: -weighs about 60g (2oz) -measures 7.5 cm (3 inches) x 5 cm (2 inches)x2.5cm (1 inch) -has a capacity of about 10 ml (1/3 oz)

before pregnancy, describe the uterus:

-protein -calcium -iron -folic acid

4 nutrients are especially important in pregnancy:

-obstetric hx -mestrual hx -contraceptive hx -medical and surgical hx -family hx of the woman and her partner -health hx of the woman and her partner -psychosocial hx of the woman and her partner

A complete hx and physical examnation will help identify problems that may affect the woman or her fetus, what should the hx include:

addit'l testing is done if the result of this screening test is 135 mg/dl or higher

blood glucos screening between 24 and 28 weeks of gestation, what are the stipulations of this test?

emotional problems or gastrointestinal upsets

by screening the woman for nausea and vomiting during prenatal visits the nurse can offer interventions and supportive care that can increase the quality of the pregnancy experience, what are some other tings that may also cause nausea and vomiting?

during birth

define intrapartum:

after birth

define postpartum:

-distate for certain foods or even their odors may be a complaint -nausea begins about 4 weeks after the LNMP -usually improves by the end of the 20th week

describe "morning sickness"

-a manuever by which the fetal part is displaced by a light tap of the examining finger on the cervix, and then the part rebounds quickly -uterine or cervical polyps (small tumors) may cause the sensation on the examiner's finger

describe Ballottement:

-irregular, painless uterine contractions that begin in the 2nd trimester -gives the sensation of the abdomen being hard and tense -becomes progressively more noticeable as term approaches and are more pronounced in multiparas -may become strong enough to be mistaken for true labor -uterine fibroids (benign tumors) may also cause these contractions

describe Braxton Hicks contractions:

purplish or bluish discoloration of the cervix, vagina, and vulva caused by increased vascular congestion

describe Chadwick's sign:

softening of the cervix and vagina caused by increased vascular congestion

describe Goodell's sign:

softening of the lower uterine segment

describe Hegar's sign:

the easy ability to flex the body of the uterus against the cervix due to Hegar's sign

describe McDonald's sign:

-stretch marks (fine, pinkish white or purplish gray lines -some women develop when the elastic tissue of the skin has been stretched to its capacity -increased amts of estrogen cause a rise in adrenal gland activity -this changes in addition to the stretching is believed to cause breakdown and atrophy of the underlying connective tissue in the skin -are seen on breasts, thighs, abdomen, and buttocks after pregnancy, the marks lose their bright color and become thin, silvery lines

describe abdominal striae:

-although both plasma (fluid) and RBC (erythrocytes) increase during pregnancy they don't increase by the same amt -the fluid part of the blood increases more than the erythrocyte component -this leads to false anemia -as a result the prepregnant Hct level of 36%-48% may fall to 33%-46% -although this isn't true anemia, the Hct count is reevaluated to determine pt status and needs -the leukocyte count (WBC) also increases about 8% (mostly neutrophils) and returns to prepregnant levels by the 6th day postpartum

describe dilutional anemia/pseudoanemia (false anemia):

may be identified by palpation after the 24th week, but its possible to mistake a tumor for a fetus

describe fetal outline:

-increased glomerular filtration rate in the kidneys increases sodium filtration by 50% -but the increase in tubular resorption rate results in 99% reabsorption of the sodium -sodium retention is influenced by many factors, including elevated levels of the hormones of pregnancy -fetus uses much of the sodium, the remainder is in the maternal circulation which will also cause maternal accumulation of water (edema) -this fluid retention may cause a problem if the woman in labor is given IV fluids containing oxytocin (pitocin), which has an antidiuretic effect, can result in water intoxication -possible symptoms of water intoxication: agitation and delirium--> should be recorded, reported, and an accurate intake and output record should be kept during labor and the immediate postpartum phase

describe fluid and electrolyte balance issues that can happen during pregnancy:

-initially corpus luteum produces most hormones -placenta then takes over acting as the endocrine system -placenta produces large amts of progesterone and estrogen -also hCG (human chorionic gonadotropin) & hPL (human placental lactogen aka chorionic somatomammotropin)

describe how the endocrine system works in pregnancy:

-breaths more deeply (changes Resp rate only slightly if at all) -changes with the deep breathing allow mom to get a good gas exchange -oxygen consumption increases by 15% during pregnancy -expanding uterus exerts upward pressure on her diaghragm, causing it to rise about 4 cm (1.6 inches) -to compensate, her rib cage flares, increasing circumfrence of chest about 6cm (2.4 inches) -dyspnea may occur until the fetus descends into pelvis (lightening) -this relieves upward pressure on the diaphragm

describe how the respiratory system works during pregnancy:

-may occur whenever a woman rises from a recumbent position, resulting in faintness or lightheadedness -cardiac output decreases because venous return from the lower body suddenly drops

describe orthostatic hypotension:

-a sudden increase in heart rate -may occur from increases in thoracic pressure, particularly if the woman moves suddenly

describe palpitations:

-uses maternal urine or blood to determine the presence of hCG (human chorionic gonadotropin hormone) produced by the chorionic villi of the placenta -home tests are based on the presnce of hCG in the urine are capable of greater than 97% accuracy -professional tests are based on urine or blood serum levels of hCG, and are more accurate -a highly reliable test is RIA (radioimmunoassay) test, accurately identifies pregnancy as early as 1 week after ovulation

describe pregnancy tests:

-fetal movement felt by mother -1st perceived at 16-20 weeeks of gestation as a faint fluttering in the lower abdomen -women who have been pregnant before report feeling it at an earlier stage, because they know how to identify it -this important event to record marks the approx midpoint of the pregnancy, and is another reference point to verify the gestational age

describe quickening:

-Occurs if woman lies flat on her back -Allows heavy uterus to compress inferior vena cava -Reduces blood returned to her heart -Can lead to fetal hypoxia (cause circulation to the placenta may also be reduced by increased pressure on the woman's aorta) Symptoms: Faintness Lightheadedness Dizziness Agitation -Turning to one side relieves pressure on inferior vena cava, preferably the left side -if woman must lay flat for any reason, a small towel roll placed under one hip will also help to prevent this issue

describe supine hypotension syndrome/aortocaval compression/vena cava syndrome:

-Category A: no risk demonstrated to the fetus in any trimester -Category B: no adverse effects in animals; no human studies available -Category C: Only prescribed after risks to the fetus are considered. Animal studies have shown adverse reaction; no human studies available -Category D: Definite fetal risks, but may be given in spite of risks in life-threatening situations -Category X: Absolute fetal abnormalities. Not to be used anytime during pregnancy

describe the FDA pregnancy risk categories for drugs:

-tingling as hormones from the placenta stimulate growth of the ductal system in preparation for breastfeeding -similar changes also occur premenstrually in many women -striae (pink to brown lines that may develop as the breasts enlarge) also may develop

describe the breast changes that occur during pregnancy:

-the growing uterus displaces the heart upward and to the left -(hypervolemia) Blood volume increases by ~45% -Increase provides for: Exchange of nutrients, oxygen, and waste products within the placenta Needs of expanded maternal tissue Reserve for blood loss at birth -Pulse rate increases by 10 to 15 beats/min -cardiac output increases, because more blood is pumped from the heart with each contraction -basal metabolic rate (BMR) may increase 20% during pregnancy BP does NOT increase with the higher blood volume becaues resistance to the blood flow thru the vessels decreases -a BP of 104/90 mm Hg or a significant elevation above the woman's baseline measurement calls for attention

describe the changes that the cardiovascular system goes thru during pregnancy:

-are hormone induced and changes occur early in pregnancy -high levels of estrogen and progesterone prepare breasts for lactation -areolae usually become deeply pigmented -sebaceous glands in the nipples (tubercles of Montgomery) become prominent -tubercles secrete a substance that lubricates the nipples -last few months of pregnancy, a thin yellow colostrum fluid may be expressed from breast -colostrum is premilk-high in protein, fat soluble, vitamins, and minerals -LOW in calories, fat, and sugar -colostrum contains the mother's antibodies to diseases and is secreted for the first 2 to 3 days aftter birth in the breastfeeding woman

describe the changes the breasts undergoes during the progression of pregnancy:

-early symptoms of pregnancy -believed to be caused by increased metabolic needs of the woman and fetus -a significant sign of pregnancy even in healthy pregnant women

describe the fatigue and drowsiness changes that occur during pregnancy:

-common in the early months of pregnancy -the enlarging uterus, along with increased blood supply to the pelvic area exerts pressure on the bladder -the frequency occurs in 1st trimester until the uterus expands and becomes an abdominal organ in the 2nd trimester -also will experience again in the 3rd trimester when the presenting part descends in the pelvis in preparation for birth

describe the frequency and urgency of urination changes that occur during pregnancy:

-Growing uterus displaces stomach and intestines toward the back and sides of the abdomen -Increased salivary secretions sometimes effects taste and smell -Oral mucosa (mouth tissues) may become tender and bleed more easily because of increased blood vessel development caused by high estrogen levels -teeth are not affected by pregnancy -Appetite and thirst may increase (by the demands of the growing fetus) -Gastric acid secretions decrease -Delayed gastric (stomach) emptying and intestinal (motility) movement -Progesterone and estrogen relax muscle tone of gallbladder -Leads to retained bile salts, which can cause pruritus during pregnancy -woman often feel bloated and may experience constipation and hemorrhoids -heartburn (pyrosis) caused by relaxation of the cardiac sphincter of the stomach, which permits reflux (backward flow) of the acid secretions into the lower esophagus -glucose metabolism is altered because of increased insulin resistance during pregnancy -this allows more glucose use by the fetus but also places the woman at risk for the development of gestational diabetes mellitus

describe the gastrointestinal changes during pregnancy:

-high levels of hormones produced during pregnancy can cause a variety of temporary changes -pigment changes -Striae -Spider nevi (small red elevations of skin with lines radiating from the center) -palms may become deeper red -Sweat and sebaceous glands become more active -To dissipate heat from woman and fetus -Posture changes as the child grows in uterus: Low backaches Relaxation of pelvic joints Waddling gait (in the last few weeks of pregnancy because of slight separation of the symphysis pubis) in last few months, rounding of the shoulders may occur along with aching in cervical spine and upper extremeties -Change in center of gravity -Balance may become an issue -most skin changes are reverted shortly after birth

describe the integumentary and skeletal system changes during pregnancy:

-occurs primarily in dark-skinned women -pigmentation of the face (chloasma or "mask of pregnancy") occurs -breasts (darkening of the areolae) -linea nigrea (darkening of a line extending in the midline of the abdomen from just above the umbilicus to the symphysis pubis)

describe the pigmentation that occurs during pregnancy:

-cervix changes in color and consistency -chadwicks and goodells signs appear -glands of the cervical mucosa leads to formation of a mucous plug that seals the cervical canal -mucous plug prevents the ascent of vaginal organsims into the uterus -with the beginning of the cervical thinning (effacement) and opening (dilation) near the onset of labor, the plus is loosened and expelled

describe the process the cervix undergoes during pregnancy progression:

-ovaries do not produce ova (eggs) during pregnancy -the corpus luteum (empty graafian follicle) remains on the ovary and produces progesterone to maintain the decidua (uterine lining) during the first 6 to 7 weeks of pregnancy until the placenta can perform this function

describe the process the ovaries undergoes during the pregnancy progression:

-expands gradually during pregnancy by increasing both the number of myometrial (muscle) cells during the 1st trimester, and the size of individual cells during the 2nd and 3rd trimester -uterus becomes a temporary abdominal organ at the end of the first trimester -at term, the uterus reaches the women's xiphoid process -weighs 1000g (2.2lbs) -capacity is about 5000 ml (5 quarts) -uterus is big enough to house the term fetus, placenta, and amniotic fluid

describe the process the uterus undergoes during pregnancy progression:

-vaginal blood supply increases, causing the bluish color of chadwick's sign -vaginal mucosa thickens and rugae (ridges) become prominent -connective tissue sogtens to prepare for distention as the child is born -secretions of the vagina increase -vaginal pH becomes more acidic to protect the vagina and uterus from pathogenic microorganisms -vaginal secretions also have higher levels of glycogen (substance that promotes growth of Candida albicans-organism that causes yeast)

describe the process the vagina undergoes during the pregnancy progression:

-pregnancy and lactation increase this nutrient's requirements by 50% -dietary reference intake (DRI) of this nutrient for pregnant women is 1200mg -dairy products are the single most plentiful source of this nutrient -other sources: . enriched cereals legumes nuts dried fruits broccoli green leafy vegetables canned salmon and sardines that contain bones -this nutrient supplements is necessary for women who don't drink milk or don't eat a sufficient amt of equivalent products -this nutrient's supplements are also necessary for women younger than 25 yrs of age because their bone density is not complete calcium supplements should be taken separately from iron supplements for best absorption -an adequate intake of vitamin D is required to enhance calcium absorption

describe the significance of calcium during pregnancy:

-edema or swelling of the mucous membranes of the nose, pharynx, mouth, and trachea -woman may have nasal stuffiness, epistaxis (nosebleeds), and changes in her voice -a similar process occurs in the ears, causing a sense of fullness or earaches

describe what estrogen levels during pregnancy can cause to happen:

-ppl of varied cultures believe that specific foods include a dominant trait that affects the "humoral balance" in the body when ingested -classification of food as "hot or cold" has nothing to do with the actual temperature -examples of hot foods: peanuts, mangoes, ice cream, tea, cereal grains, and hard liquour -examples of cold foods include: milk, green leafy vegetables, freshwater fish, chicken, bananas, and citrus fruits -in this belief framework, several health problems are classified as hot or cold, requiring a cold or hot food for balance

discuss the cultural preferences and the pregnant woman:

ultrasonography

fetal movements can be seen by using what device?

prenatal age of the developing fetus calculated from the first day of the woman's LMNP

gestational age:

the number of pregnancies

gravida indicates what?

-any pregnancy, regardless of duration -the number of pregnancies -including the one in progress, if applicable

gravida:

25 to 35 pounds (11.5 to 16 kg)

guidelines for weight gain during pregnancy are based on the woman's prepregnant weight BMI: with women considered normal weight BMI of 18.5-24.9, what is the recommended weight gain during pregnancy?

11 to 15 pounds (5 to 6.8 kg)

guidelines for weight gain during pregnancy are based on the woman's prepregnant weight BMI: with women considered obese BMI greater than 30, what is the recommended weight gain during pregnancy?

11 to 25 pounds (5 to 11.5 kg)

guidelines for weight gain during pregnancy are based on the woman's prepregnant weight BMI: with women considered overweight BMI 25-25.9, what is the recommended weight gain during pregnancy?

28 to 40 lb (12.5 to 18kg)

guidelines for weight gain during pregnancy are based on the woman's prepregnant weight BMI: with women considered underweight BMI less than 18.5, what is the recommended weight gain during pregnancy?

-preterm labor

low matrenal weight gain is associated with complications such as:

a woman who has been pregnant before, regardless of the duration of the pregnancy

multigravida:

-woman who has given birth to two or more children (past point of viability), regardless of whether the children were alive at birth or are presently alive -used informally to describe a woman before the birth of her second child

multipara:

Fatigue Nasal stuffiness Nausea Heartburn Constipation Hemorrhoids Vaginal discharge Backache Varicose veins Leg cramps Edema of the lower extremities

name some common discomforts of pregnancy:

-obstetricians -family practice physicians -CNMs (certified nurse midwives) -nurse practitioners

name the titles that provide prenatal care:

a woman who has never been pregnant

nulligravida:

woman who has not given birth to a child who reached the piont of viability

nullipara:

- demonstration of fetal heart activity -fetal movements felt by an examiner -visualization of the fetus with ultrasound

only a developing fetus causes positive signs of pregnancy, what are some ways this is done?

the outcome of the pregnancies

para indicates what?

-a woman who has given birth to one or more children who reached the age of viability (20 weeks), regardless of the number of fetuses deliverd and regardless of whether those children are now living

para:

trimesters

pregnancy is divided into three 13 week parts called:

-medications such as antianxiety or anticonvulsant drugs -blood in the urine -malignant tumors -premature menopause

pregnancy tests of all types are probable indicators of results, but what are several factors that may interfere with their accuracy?

-Assess the history and cultural needs -Diagnose the knowledge deficit -Plan the goals and priorities -Outcomes identification clarifies expected outcomes -Teach (intervene) the facts and rationales -Evaluate knowledge gained and goals achieved

prenatal education should progress according to the nursing process as follows:

-a woman who has given birth to two or more children (past the point of viability), regardless of whether the children were alive at birth or are presently alive -used informally to describe a woman before the birth of her first child

primipara:

-review of known risk factors and assessment for new ones -vital signs -weight -urinalysis -blood glucose screening -fundal height -leopold's manuevers -fetal heart rate -review of nutrition -ask about any discomforts or problems that have arisen since last visit

routine assessments made at each prenatal visit includes the following:

presence of various risk factors

several tests are done for all pregnant women; other tests are based on what?

-Pregnant adolescent -Sodium intake -Vegetarian -Pica -Lactose intolerance -Cultural preferences -Gestational diabetes mellitus

special nutrition considerations during pregnancy would be for pts with:

-risks of smoking and alcohol use -illicit drug use -advantage of breastfeeding and good nutrition during pregnancy

teaching for the prenatal pt should include:

vaginal and rectal swab be done to detect Group B streptococcus (GBS) at 35 to 37 weeks to protect mother and infant from infection during labor and birth

the 2011 ACOG guidelines recommend what?

electronic calculator designed for this purpose, a physical examination, an ultrasound, or a combination of these methods

the EDD may also be determined with a gestation wheel, what is that?

the detailed outcomes of a woman's pregnancies on her prenatal record

the TPALM system is a standardized way to describe what?

urine culture should be done 12 to 16 weeks to screen for asymptomatic bacteruria

the USPSTF (U.S. Preventive Services Task Force) has recommendations concerning what?

because venous pressure may increase in the femoral veins as the size of weight of the uterus increase, resulting in varicose veins in the legs of some women

the effects on exercise on the cardiovasular system that already has an: -increased blood volume -increased cardiac output -increased coagulability during pregnancy. Why must things be reviewed before the pregnant women implements an exercise plan?

10 weeks

the fetal heartbeat may be detected as early as how many weeks of pregnancy by using a doppler device?

each time a woman is pregnant

the gravida number increases by 1 _____

a woman delivers a fetus of at least 20 weeks of gestation

the para number increases only when ______

for teaching good heatlh habits and list to concersn and answer queestions from the expectant family. most women are highly motivated to improve their health

the prenatal visit is a prime time for the nurse to do what?

-conception to 28 weeks--every 4 weeks -29 to 36 weeks--every 2 weeks -37 weeks to birth--weekly

the recommended schedule for prenatal visits in an uncomplicated pregnancy is as follows:

-presumptive -probable -positive depending on how likely they are to be caused by factors other than pregnancy

the signs of pregnancy are divided into 3 general groups:

-uterine souffles -funic souffles

what are addt'l sounds that may be heard while assessing the fetal heartbeat?

-pressure of uterus on blood vessels that impairs circulation to legs, causing muscle strain and fatigue -imbalance in the calcium/phosphorus ratio

what are influencing factor for leg cramps in 2nd and 3rd trimester?

-abdominal ligaments stretched by enlarging uterus, causing pain in lower abdomen after sudden movements

what are influencing factors for round ligament pain in 2nd and 3rd trimester?

-maintain correct posture with head up and shoulders back use good body mechanics -avoid exaggerating lumbar curve -squat rather than bending over when picking up objects (bend at the knees, not waist) -wear low-heeled shoes to help maintain better posture. -do exercises such as tailor sitting (cross-legged), shoulder circling, and pelvic rocking -rest; applying localized heat may help

what are self care measures for backaches in 2nd and 3rd trimester?

-dorsiflex foot and straighten leg with downward pressure on knee or stand with fee flat on floor when cramps occur evaluate diet and calcium intake

what are self care measures for leg cramps in 2nd and 3rd trimester?

-avoid jerky or quick movements -use pillow support for abdomen -use good body mechanics

what are self care measures for round ligament pain in 2nd and 3rd trimester?

-illness -stress -sudden changes in lifestyle

what are some other causes of fatigue, besides being pregnant?

-abdominal gas -bowel activity -false pregnancy (pseudocyesis)

what are some other things that can cause quickening (fluttering in the lower abdomen) feeling besides pregnancy?

hormonal imbalance or infection

what are some other things that may cause Goodell's or Chadwick's signs besides pregnancy?

-nausea, vomiting, and some transient (temporary) food dislikes, but weight is regained when the GI upsets subside

what are some reasons the weight gain is limited or weight loss can happen during the 1st trimester?

-strenuous exercise -changes in metabolism -endocrine dysfunction -chronic disease -certain medications -anorexia nervosa -early menopause -serious psychological disturbances

what are some things that can cause amenorrhea, besides being pregnant?

-BCG (bacille calmette-guerin -HPV (human papillomavirus) -LAIV (live attenuated influenza vaccine) in nasal spray form cause it is a live virus -MMR (measles, mumps, and rubella)

what are some vaccines contraindicated for pregnant women?

-heme (found in red and organ meats) -nonheme (found in plant products) -body absorbs heme iron the best -nonheme plant foods that are high in iron include: molasses whole grains iron-fortified cereals and breads dried fruits dark green, leafy vegetables

what are the 2 forms that iron comes in?

-Orthostatic hypotension -Palpitations -Dilutional anemia (a.k.a. pseudoanemia) -Increased clotting factors in second and third trimesters -Increases risk of thrombophlebitis

what are the Effects of Pregnancy on the Cardiovascular System?

-heartburn (pyrosis) -constipation and flatulence (gas) -hemorrhoids -backaches -round ligament pain -leg cramps -headache -varicose veins -edema of feet and ankles -faintness and dizziness -fatigue -dyspnea

what are the common discomforts for the pregnant woman in the 2nd and 3rd trimester?

-nausea with or without vomiting -breast tenderness -urinary frequency -vaginal discharge (leukorrhea)

what are the common discomforts for the pregnant women in the 1st trimester?

-estrogen -progesterone -thyroxine -hCG (human chorionic gonadotropin -hPL (human placental lactogen/jchorionic somatomammotropin) -MSH (melanocyte-stimulating hormone -relaxin -prolactin -oxytocin

what are the hormones that are essential to pregnancy?

-increased producation of progesterone, causing relaxation of eophageal sphincter -regurgitation or backflow of gastric contents into the esophagus, causing burning sensation behind the sternum, burping, and sour tastes in mouth

what are the influencing factor for heartburn in the 2nd and 3rd trimester?

-increased vascular supply and hypertrophy of breast tissue caused by estrogen and progesterone -results in tingling, fullness, and tenderness

what are the influencing factors for breast tenderness in the 1st trimester?

-vasomotor instability or postural hypotension -standing for long periods with venous stasis in lower extremities

what are the influencing factors for faintness and dizziness in 2nd and 3rd trimester?

-hormonal changes in early pregnancy and periodic hypoglycemia as glucose is used by embryo for rapid growth -more prominent in early moths of pregnancy

what are the influencing factors for fatigue in the 2nd and 3rd trimester?

-elevation in hormones -decrease in gastric motility -fatigue -emotional factors -usually does not last beyond 16 weeks -if vomiting persists, may lead to hyperemesis gravidarum

what are the influencing factors for nausea and vomiting in the 1st trimester?

-pressure of growing uterus on bladder in both 1st and 3rd trimesters -progesterone relaxes smooth muscles of bladder

what are the influencing factors for urinary frequency in the 1st trimester?

-promote the health of the mother, fetus, newborn, and family -ensure a safe birth for mother and child by promoting good health habits and reducing risk factors -teach health habits that may be continued after pregnancy -educate in self-care for pregnancy -develop a partnership with parents and family to provide continuous and coordinated health care -provide physical care -prepare parents for the responsibilities of parenthood

what are the major goals of prenatal care?

-hemoglobin electrophoresis -endovaginal ultrasound

what are the prenatal laboratory tests that are done first trimester only if indicated?

-blood glucose screen: sample drawn 1 hour after 50g of liquid glucose is ingested -serum alpha-fetoprotein -ultrasonography

what are the prenatal laboratory tests that are done second trimester routinely?

-Goodell's sign -Chadwick's sign -Hegar's sign -McDonald's sign -Braxton Hicks contractions -Ballottement -Striae -positive pregnancy test

what are the probable indications of pregnancy, which provide stronger evidence of pregnancy but still may be caused by other conditions?

-blood type and Rh factor and antibody screen -complete blood count (CBC) -hemoglobin or hematocrit -VDRL or rapid plasma reagin (RPR) -rubella titer -tuberculosis screening/PPD skin test or serum blood test (QuantiFERON-TB Gold) -Hepatitis B screen -HIV screen -urinalysis and culture -papanicolaou (PaP test -vaginal culture

what are the routine prenatal laboratory tests that are done in the first trimester?

-elevate legs when sitting -increase rest periods -avoid constrictive clothing and prolonged standing or sitting

what are the self care measure for edema of feet and ankles in 2nd and 3rd rimester?

-increase fluid intake (a minimum of 8 glasses/day, not including carbonated or caffeinated drinks cause of their diuretic effect), roughage of diet, and exercise -exercise to stimulate peristalsis -establish regular schedule for bowel movement -do not take mineral oil or enemas. consult health care provider about taking a stool softener (docusate)

what are the self care measures for constipation and flatulence in 2nd and 3rd trimester?

-sit up for 30 minutes after eating a meal -avoid gas-forming and greasy foods -avoid overeating -use low-sodium liquid antacids like Gelusil or Maalox (liquid will coat lining better than tablets) -avoid sodium bicarbonate and alka seltzer

what are the self care measures for heartburn in the 2nd and 3rd trimester?

-use anesthetic ointment, cool witch hazel pads, or rectal suppositories -may disappear after birth, when pressure is relieved -take sitz baths -increase fiber in diet -have regular bowel habits to avoid constipation

what are the self care measures for hemorrhoids in the 2nd and 3rd trimester?

-avoid an empty stomach -eat dry crackers or toast 1/2 to 1 hr before rising in the morning -eat small, frequent meals -drink fluids between meals -avoid greasy, odorous, spicy, or gas-forming foods -increase vitamin B6

what are the self care measures for nausea with or without vomiting in the 1st trimester?

-void when urge is felt (to prevent urinary stasis) -increase fluid intake during the day -decrease fluid in late evening to lessen nocturia; limit caffeine -practice kegel exercises

what are the self care measures for urinary frequency in the 1st trimester?

-wear a supportive bra (to alleviate tingling and tenderness) -avoid soap to the nipples (to prevent cracking)

what are the self care measures to avoid breast tenderness in the 1st trimester?

-has greater nutritional needs than one who is more sexually mature -nurse must consider the characteristics of resistance, ambivalence, and inconsistency when planning nutritional interventions -nurse must remember that the girl's peer group is of the utmost importance -find nutritional needs that allows her to fit in with her friends -inadequate weight gain and nutrient deficits are more likely to occur in the pregnant adolescent -the girls continuing growth plus the growth of the fetus make it difficult for her to meet her nutritional needs -peer pressure to eat junk foods put her at special risk -nurse should give the girl positive reinforcement for her efforts to make even the smallest changes to her diet -the younger and smaller teen adolescent may need an addt'l 200 kcal/day in addition to the recommended increase of about 300 kcal/day for a normal pregnancy to meet her own growth needs and those of the developing fetus -nurse often refers these young women to programs, WIC and food stamps program

what are the special nutrition considerations for the pregnant adolescent:

antepartum, intrapartum, and postpartum

what are the three phases of pregnancy?

-woman should gain 4 to 6 pounds in first trimester - 1½ pounds per week in second and third trimesters -for a total of 37 to 54 pounds (16.5 to 24.5 kg) -normal weight women: 37-54lbs (16.5 to 24.5kg) -overweight women: 31-50 lbs (14-23 kg) -obese women: 25-42lbs (11.5-19kg)

what are the weight gain guidelines for multifetal women/twins with how much weight they should gain during pregnancy?

water aerobics, because hydrostatic pressure forces fluid into the circulation, stimulating glomerular filtration and excretion of water, avoid excessive water temps during water aerobics

what can relieve edema?

blood entering the dilated arteries of the uterus

what causes the uterine souffle sound?

a woman be covered (hair, body, arms, and legs) when in the presence of an unrelated male, so a female health care provider is often preferred

what do Muslim beliefs dictate?

a brief period of conversation during which pleasantries are exchanged before "getting to the point" of the visit

what do latino families expect at a prenatal visit?

risk factors that may be changed before conception to reduce their negative impact on the outcome of pregnancy

what does preconception care identify?

-20 mg of DHA /kg/day sources include fish such as: -macherel -atlantic and sockeye salmon -halibut -tuna -flounder -egg yolk -red meat -poultry -canola oil -soybean oil -2-3 servings per week are recommended -frying these foods depletes the DHA content

what does the WHO (world health organization) recommend that a full term infant receive of DHA (docosahexaenoic acid-omega 2 fatty acid)?

increases maternal insulin resistance during pregnancy, providing the fetus with glucose needed for growth

what does the hPL (human placental lactogen/chorionioc somatomammotropin) hormone do?

the expectant family's physical, psychological, and social needs and teaches the woman self-care

what does the nurse assist the physician in evaluating?

raw meat and raw eggs, they can be contaminated

what food should be avoided during pregnancy and lactation?

fish containing high mercury levels like albacore tuna and mackerel

what food should be eaten with caution?

has expanded the prenatal detection of genetic disorders and provides the basis for future therapeutic interventions

what has the development of human genome mapping done?

be sure to document abnormal data such as high blood pressure MUST be followed by documentation of intervention or referral for follow up care

what is a legal and ethical consideration when documenting?

prenatal care

what is a primary example of preventitive medicin?

preexisting diabetes

what is a risk factor during pregnancy that can't be eliminated?

saline drops or room humidifiers

what is a way to relieve nasal stuffiness that can be caused by edema of nasal tissues as a result of high levels of estrogen?

cessation of menses

what is amenorrhea

-banana, carrot, piece of whole wheat bread, glass of low-fat milk -half of roast beef sandwich on whole wheat bread and a fresh green salad -caloric intake must be nutritious to have beneficial effects on pregnancy

what is an example of a meal meeting the 300 cal requirement?

any cause that stretches the skin, like weight gain

what is another cause of striae, besides pregnancy

hormones

what is essential to maintain pregnancy?

should be taken in the same arm in the same position each time for accurate comparison with her baseline value

what is important to know when taking pregnant pt vital signs at a prenatal appt?

-emotional tension and fatigue -increased circulatory blood volume and heart rate causing dilation and distenstion of cerebral vessels

what is influencing factor of headache in 2nd and 3rd trimester?

the presentation and position of the fetus by abdominal palpation (usually at about 36 weeks gestation)

what is leopold's maneuvers done to assess for during a prenatal appt?

Vitamin B6 and ginger

what is often recommended to relieve the common discomfort of nausea during pregnancy?

amenorrhea (cessation of menses)

what is often the 1st sign of pregnancy?

a definite diagnosis of pregnancy can't be made

what is presumptive indications of pregnancy?

-for metabolism and to support the growth and repair of maternal and fetal tissues -best sources: meat, fish, poultry, dairy products

what is protein do for the pregnant pt?

if the pattern of gain is normal: - low prepregnancy weight or inadequate gains are risk factors for preterm birth, low birth weight infant, and other problems -a sudden, rapid weight gain is often associated with gestational hypertension

what is taking the weight of the pt at the prenatal visit used to determine?

40 weeks (280 days)

what is the average duration of a term pregnancy?

an ultrasound photography of the gestational sac as early as 4 to 5 weeks of gestation

what is the earliest positive sign of pregnancy?

150 to 160 bpm

what is the fetal heart rate at term when its high?

110-120 bpm

what is the fetal heart rate at term when its low?

fetoscope, it provides another marker of the approx. midpoint of gestatioin

what is the fetal heartbeat is heard with, and what is the significance of this?

to teach the mother how to maintain good health, or if there is an at risk for mother and fetus: to improve her health as much as possible to promote a healthy outcome for both mother and fetus

what is the focus of nursing care during pregnancy?

-identify the first day of the LNMP -count backward 3 months -add 7 days -correct year if necessary

what is the formula for Nagele's rule that is used to determine the EDD?

if the fetus is growing as expected and the volume of amniotic fluid is appropriate

what is the fundal height done to determine during a prenatal appt?

provide early, accurate, noninvasive screening tests

what is the future direction of prenatal testing?

the number of years between the onset of menses and the date of conception

what is the gynecological age ?

-result of the spine's adaptation to posture changes as the uterus enlarges -enlarging uterus altering center of gravity, resulting in lordosis (exaggeration of lumbosacral curve) and muscle pain

what is the influencing factor for backaches in 2nd and 3rd trimester?

-later in pregnancy, caused by uterus rising into abdomen and pressing on diaphragm

what is the influencing factor for dyspnea in the 2nd and 3rd trimester?

-circulatory congestion of lower extremities

what is the influencing factor for edema of feet and ankles in 2nd and 3rd trimester?

-varicosities (distended veins) of rectum caused by vascular enlargement of pelvis -straining from constipation -descent of fetal head into pelvis -may disappear after birth, when pressure is relieved

what is the influencing factor for hemorrhoids during 2nd and 3rd trimester?

-increased production of mucus by endocervical glands in response to elevated estrogen levels and increased blood supply to the pelvic area, causing white, viscid vaginal discharge

what is the influencing factor for vaginal discharge in the 1st trimester?

-relaxation of smooth muscle in walls of veins caused by elevated progesterone -pressure of enlarging uterus causing pressure on veins, resulting in development of varicosities in vulva, rectum, and legs

what is the influencing factor for varicose veins in 2nd and 3rd trimester?

-increaesd levels of progesterone, causing bowel sluggishness with increased water absorption (results in hardened stool) -pressure of enlarging uterus on intestine -diet, lack of exercise, and decreased fluids -iron supplements contributing to hardening of stools

what is the influencing factors for constipation and flatulence in the 2nd and 3rd trimester?

-include collecting data fronm the pregnant woman -identifying and reevaluating risk factors -educating in self-care -providing nutrition counselling -promoting the family's adaptation to pregnancy

what is the major roles of the nurse during prenatal care?

-should drink 8-10 oz glasses of fluid each day -caffeinated and high sugar drinks should be limited -caffeine acts as a diuretic, which counteracts some of the benefit of the fluid intake -should limit daily caffeine consumption to 2 cups of coffee or their equivalent -women at risk for insufficient amniotic fluid (oligohydramnios) have a successful outcome by increasing their daily fluid intake

what is the significance of fluids during pregnancy?

-is the most common cause of vaginal discharge -there is a decrease in normal lactobacilli and an increase in bacteroids and other anaerobic microorgansims -may be a milky-white discharge (often no other symptoms) -treatment with antimicrobials between 12 and 20 weeks is common

Bacterial vaginosis has been associated with preterm labs, and OB's routinely screen pregnant women for this early in pregnancy. Describe BV and its pathophysiology:

urinary tract infections and pelvic masses

what are other causes of frequency and urgency of urination besides being pregnant?

-produced by corpus luteum and placenta -remodels collagen, causing connective tissue of symphysis pubis to be more movable and cervix to soften -inhibits uterine activity

what is the source and significance of relaxin in pregnancy?

higher and slows

The fetal heart rate is ________ in early gestation, and ______ as term approaches

recommended dietary allowances (RDA)

IOM (institute of medicine), USDA, & dept of health and human services developed what that recommends the nutrient intake required to maintain optimal health?

-Protein—60 g/day -Calcium—1200 mg/day -Iron—30 mg/day -Folic acid—400 mcg (0.4mg)/day

Increase kCal by 300 per day is recommended to provide for the growth of the fetus, placenta, amniotic fluid, and maternal tissues; and should include:

before birth/prenatal

define antepartum:

soft swishing sound heard as the blood passes thru the umbilical cord vessels

describe the funic souffle:

soft blowing sound heard over the uterus during auscultation, the sound is sychronized with the mothers pulse

describe the uterine souffle:

prenatal age of the developing fetus calculated from the date of conception; approx. 2 weeks less than the gestational age

fertilization age:

a woman who is pregnant for the first time

primigravida:

ultrasound examination

what is done to confirm the calculated EDD?

nausea and sometimes vomiting

what occurs in at least half of pregnancies and may be the result of an increase of hCG levels (human chorionic gonadotropin) early in pregnancy and isn't associated with any bad foreseeable outcomes for the mother or infant?

corpus luteum

what produces the most hormones INITIALLY during pregnancy?

teach woman how to relieve them, and explain signs of problems that can be confused with normal discomforts of pregnancy, provide written info in woman's primary language

what should the nurse do when talking to pregnant woman about discomforts that happen during pregnancy?

as early as 8 weeks after LNMP (Last normal menstrual period)

when can the fetal heart be seen on ultrasound examination?

by the end of the 12th week

when can the uterine fundus be felt just above the symphysis pubis?

between the 20th and 22nd weeks of gestation, but uterine or abdominal tumors may also cause enlargement

when does the uterine fundus extend to the umbilicus?

-hepatitis A & B -inactivated influenza -meningococcal MCV-4, only in high risk women -pneumococcal polysaccharide vaccine PPV in high risk women -rabies if risk for infection is high -tetanus-diptheria (Td) after 29 weeks of gestation -vaccine for japanese encephalitis and anthrax -if at high risk of infection

when exposure to or high risk of infection is present, which vaccinations are allowable during pregnancy?

have multiple gestations, an eating disorder, or a restricted diet such as vegan or vegetarian

when should a women be referred for guidance from a Registered dietician?

-Seeing safe passage for herself and her fetus (obtaining health care by a professional and adhering to important cultural practices) -Securing acceptance of herself as a mother and for her fetus -Learning to give of self and to receive the care and concern of others (woman will never be same carefree girl, will depend on others in ways she has not experienced before -Committing herself to the child as she progresses through pregnancy (1st accepts fetus as part of herself, gradually moves to acceptance of child as an independent person, goes from being pregnant to mother)

According to Reva Rubin, four maternal tasks the woman accomplishes during pregnancy include:

-general health -determine her baseline weight -vital signs -evaluate her nutritional status -identify current physical or social problems

a woman has a complete physical examination on her first visit to evaluate what things?

termination of pregnancy before viability (20 weeks), either spontaneous or induced

abortion:

-Women must be educated that they are not "eating for two." -The intake must be evaluated for both caloric content and value to the growing fetus -women should read food labels, to be sure they are consuming calories that are nutritient dense, rather than empty -Eat foods that are nutrient-dense -Protein versus sugary foods

according to USDA & Helath and Human Srervices created by MyPlate, which offers dietary guidelines for americans, what are some things pregnant women should know for having a health diet during pregnancy:

fetus that has reached the stage (usually 20 weeks) where its capable of living outside of the uterus

age of viability:

optimal brain development of fetus and infant

an adequate dietary intake of DHA (docosahexaenoic acid-omega 3 fatty acid) is essential for what?

at subsequent visits

an assessment risk factor that may affect the pregnancy is performed during the first visit, when is it updated?

around the 20th week of gestation

an ultrasound is often routinely performed around what week of pregnancy?

-Elevated temperature: can decrease the fetal circulation and cardiac function maternal body temp shouldn't exceed 100.4 F/38C no hot tubs or saunas during pregnancy -maternal heat exposure during 1st trimester is associated with neural tube defects and miscarriage -orthostatic Hypotension: can reduce blood flow to the fetus -certain exercise positions may be modified during pregnancy to avoid these problems which can cause fetal hypoxia - pregnancy increases the workload of the heart -the increase in peripheral pooling during pregnancy decreases cardiac output reserves for exercise -when exercise is allowed to exceed the ability of the cardiovascular system to respond, blood may be diverted from the uterus, causing fetal hypoxia -exercise increases catelcholamine levels (placenta may not be able to filter) resulting in fetal bradycardia and hypoxia -strenuous and prolonged exercise causes blood flow to be distributed to the skeletal muscles and skin away from the viscera, uterus, and placenta if blood flow exceeds 50% serious advers effects to the fetus may occur -exercise increases maternal Hct levels and uterine oxygen uptake, so moderate exercise won't cause decreased oxygen supplies to the fetus

discuss elevated temp, hypotension, and cardiac output relating to exercise and the pregnant women:

-theres evidence that mild to moderate exercise during pregnancy is beneficial -vigorous exercise should be avoided -nurse should educate pt thats concerned about exercise during pregnancy that the maternal circulatory system is the lifeline to the fetus, and any alteration can affect the growth and survival of the fetus -the basis for determining exercised levels during all trimesters of pregnancy is the maternal cardiac status and fetoplacental reserve -a hx of the exercise practices of the pt is important, gathering such data is the 1st step in the nursing process -women who have previous training may have a higher tolerance for exercise than women who have led a sedentary lifestyle -goal of exercise during pregnancy is to maintenance of fitness, not improvement of fitness or weight loss

discuss general exercise during pregnancy:

-first diagnosed during pregnanacy rather than being present before pregnancy -calories should be evenly distributed during the day among 3 meals and 3 snacks to maintain adequate and stable blood glucose levels -pregnant diabetic women are susceptible to hypoglycemia (low blood glucose level) during the night, cause the fetus continues to use glucose while the mother sleeps -suggested that the final betime snack be one of protein and a complex carbohydrate to provide more blood glucose stability -RN may supervise dietary management -glycemic control during the 1st and 2nd trimesters is most important in preventing complications such as macrosomia (abnormally large newborn) -women with uncontrolled diabetes and fasting blood glucose levels greater than 500 mg/dL in the last trimester have an increased risk of still births

discuss gestational diabetes mellitus and the pregnant woman:

-exercise can cause changes in Hormones oxygen consumption and epinephrine, glucagon, cortisol, prolactin, and endorphin levels -in early pregnancy these hormonal changes can negatively affect implantation of the zygote and vascularization of the uterus -in late pregnancy the increases in catecholamines during exercise can trigger labor -joing instability caused by hormonal changes can result in injury if the women engages in deep flexion or extension of joints -ROM should not extend beyond prepregnancy abilities -moderate exercise several times a week from the 8th week thru delivery is advised during pregnancy, avoid vigorous activity and competitive sports -Other factors: moderate exercise has many benefits—more positive self-image, a decrease in musculoskeletal discomfort during pregnancy, and a more rapid return to prepregnant weight after delivery

discuss hormone and other factors relating to exercise and the pregnant woman:

-Live virus vaccines are contraindicated during pregnancy -products containing Thimerosal should not be given during pregnancy due to risk of mercury poisoning -Avoid pregnancy for at least 1 month after receiving an MMR vaccine -Select immunizations are allowable during pregnancy, such as influenza vaccine and Tdap vaccine -most vaccines are available in a alternative thimerosal-free form for pregnant women

discuss immunizations during pregnancy:

-fetus becomes real to the woman -weight increases, uterus becomes obvious as it ascends into the abdomen -more stable time of pregnancy during which most women have resolved many of their earlier feelings of ambivalence and begin to take on the role of an expectant mother -becomes totally involved with her developing child and her changing body image (narcissism) -may lose interest in work or other activities as she devotes herself to the project of nurturing her fetus -nurse can take advantage of her hieghtened interest in healthful living to teach good nutrition and other habits that can benefit the woman and her family long after the birth -she wants to hear stories of what her and her mate were like as infants -fantasizes about how her child will look or what sex the child will be -body changes may alter her sexual relationship, her increasing size discomfort in other changes result in disinterest in intercourse -

discuss the changes that happen in 2nd trimester with the pregnant woman and how the nurse can help:

-woman alternates between feeling "absolutely beautiful and productive" and feeling "as big as a house, and totally unloved" -mood swings reflect her sense of increased vulnerability and dependence on her partner -becomes introspective about the challenge of labor that is ahead and its outcome -her moods may again be more labile -begins making concrete decisions with partner about preparations for infant's arrival -may take childbirth classes -thinking gradually shifts from "i am pregnant" to "i am going to be a mother" -minor discomforts of pregnancy become tiresome during the last weeks before delivery

discuss the changes that happen in 3rd trimester with the pregnant woman and how the nurse can help:

-most women have conflicting feelings about being pregnant (ambivalence) during the early weeks -woman often feels that she should not have these conflicting feelings -nurse can help the woman to express these feelings of ambivalence and reassure her that they are normal -woman focuses on herself during this time, feels many new physical sensations that don't seem related to a child -physical changes and higher hormone levels cause her emotions to be more unstable (labile) -nurse can reassure the woman and her partner (whose often confused with her moods) about the cause of these fluctuations, that they are normal, and they will stabilize after pregnancy

discuss the changes that happen in the 1st trimester with the pregnant woman and how the nurse can help:

-avoid lengthy standing or sitting, constrictive clothing, and bearing down during bowel movements -walk frequently -rest with legs elevated -wear support stockings; avoid tight knee-highs -exercise (to stimulate venous return -relieve hemorrhoid swelling with warm sitz baths, local application of astringent compresses, or analgesic ointment

what is the self care measure for varicose veins in 2nd and 3rd trimester?

- physiological changes in Pregnancy affects the metabolism of medications given to mother -May have subtherapeutic levels cause of increased plasma volume, caridac output, and glomerular filtration that occur during pregnancy -Parenteral medications may be absorbed more rapidly due to increased blood flow and may have a fster onset of action than in the nonpregnant state -Drugs can cross the placenta (especially in 1st trimester), and have increased absorption levels in the developing fetus in the 3rd trimester, can be passed through breast milk -decreased gastric emptying time during pregnancy changes absorption of drugs and can delay onset of action -increased levels of estrogen and progesterone may alter hepatic function, resulting in drug accumulation in the body -mother should be instructed to check with doctor before taking OTC meds -taking ibuprofen in the 3rd trimester can cause early closure of the ductus areteriosus, resulting in fetal distress if lactating mother must take medication, it should be administered immediately after the infant breastfeeds to minimize passage to the infant -all women of childbearing age should be counseled about the risk of ingesting drugs during pregnancy and lactation

discuss the effect of pregnancy and lactation on medication metabolism:

-May eagerly anticipate the woman's pregnancy -Some will take a more active role in the care of the grandchild -If grandparents and expectant couple have similar views of their roles, little conflict is likely -The nurse may be able to help the new parents to understand their own parents' reactions and help them to negotiate solutions to conflicts that are satisfactory to both generations

discuss the impact of pregnancy on grandparents:

-The nurse must assess the girl's developmental and educational level, as well as her support system to best provide care for her -Consider her developmental level and the priorities typical of her age -Must cope with two of life's most stress-laden transitions at the same time: adolescence and parenthood -a critical variable is the girl's age -young adolescents have difficulty considering the needs of others, such as the fetus -nurse helps the adolescent girl to complete the developmental task of adolescence while assuming the new role of motherhood -separate prenatal classes tailored to their needs help adolescent girls learn to care for themselves and assume the role of mother -nurse must anticipate resistive behavior, ambivalence, and inconsistency in the adolescent -nurse must consider the girl's developmental level and the priorities typical of her age (importance of peer group, focus on appearance, difficulty considering the needs of others

discuss the impact of pregnancy on the adolescent and the nurse's role:

-"elderly primips" or "advanced maternal age"=woman pregnant for the 1st time after age 35 many factors contribute to the trend to postpone pregnancy until after 35: -Effective birth control alternatives -Increasing career options for women -High cost of living -Development of fertilization techniques to enable later -pregnancy -women greater that 35 yrs of age may have decreased ability to adjust to their uterine blood flow to meet the needs of the fetus -increased in multiple pregnancies if fertility drugs were used, which increases fetal risk -increased risk of a congenital anomaly usually results in the offering of special tests during pregnancy (chorionic villi sampling, amniocentesis, which increases cost factor of prenatal care

discuss the impact of pregnancy on the older couple:

-May take an active interest in and financial responsibility for the child -May want to participate in plans for the child and take part in the care of the infant after it is born -His participation is sometimes rejected by the woman

discuss the impact of pregnancy on the single father:

-May be an adolescent or a mature woman -May have unique emotional needs -Single women who plan pregnancies often prepare for the financial and lifestyle changes -have special emotional needs -their uncertainty in day to day living competes with mastering the emotional tasks of pregnancy -nurse should maintain a nonjudgmental attitgude and assist the single mother to successfully achieve the psychological tasks of pregnancy

discuss the impacts of pregnancy on the single mother, and the nurse's role:

-Cultural values influence the role of fathers because pregnancy and birth are viewed exclusively as women's work in some cultures -The nurse should not assume that a father is uninterested if he takes a less active role in pregnancy and birth -Acceptance of the pregnancy results in strengthening of the family support system and expansion of the social network -pregnancy is considered the beginning of a separate developmental stage called "growth and development of a parent" -1st phase: Announcement phase-->when pregnancy is confirmed -2nd phase: Adjustment phase --> father's response is either to adjust or lack of adjustment -3rd phase: focus phase--> fathers response is either to be active in plans for participation in labor process, birth, and change in lifestyle or naw -nurse's role is to help father achieve positive outcomes in each phase; explore father's feelings and encourage him during the prenatal appt, childbirth preparation class, and labor and birth -father's health hx documentation is important -father's blood type and Rh are important when the mother is Rh negative

discuss the impacts on the father during pregnancy, and the nurse's role:

-caused by a deficiency of lactase, the enzyme that digests the sugar in milk -not being able to digest milk or milk products increases their risk for calcium deficiency -higher risk of lactose intolerance: native americans latinos african middle eastern asian descents more than caucasians -signs and symptoms: -abdominal distention -flatulence -nausea -vomiting -loose stools after ingestion of dairy products -a daily calcium supplement can be taken to help -substitutes for dairy products can be taken instead -may be able to tolerate cultured or fermented mik products like: aged cheese, buttermilk, yogurt -the enzyme lactase (lactaid) is available in tablet form or as a liquid to add to milk -lactase-treated milk is also available commercially and can be used under a doctor's direction

discuss the lactose and tolerant pregnant woman:

-Caloric intake during lactation should be about 500 -calories more than the nonpregnant woman's RDA -Protein intake should be 65 mg/day -Calcium and iron intake is the same as during pregnancy -Vitamin supplements are often continued during lactation -Limit intake of caffeine and alcohol -Drugs should only be taken upon the advice of the health care provider -an indicator of adeqjuate caloric intake is a stable maternal weight and a gradually increasing infant weight -drinking 8-10 glasses of liquids other than those containing caffeine is adequate

discuss the nutritional requirements during lactation:

-Air travel generally safe up to 36 weeks gestation -Avoid sitting for extended periods of time (cause of increased levels of clotting factors and plasma fibrinogen that normally occur during pregnancy) -Avoid locations that pose a high risk of exposure to -infectious diseases -Bring a copy of obstetric records -Obtain information about nearest health care facility -Encourage hand hygiene and dietary precautions to prevent diarrhea are essential -Provide the "recipe" for oral rehydration formula: 1 Liter of water 1 tspn of salt 4 teaspoon of cream of tartar 1/2 tsp of baking soda 4 tblspn of sugar (bottled drinks may provide the fluid, sugar, and electrolytes needed) -wear comfortable shoes, long-sleeved clothing and use mosquito nets around the bed in insectprone areas -inspect repellants that contain DEET are usually safer after the 1st trimester -apply sunblock as appropriate

discuss the pregnant woman traveling during pregnancy:

-the craving for and ingestion of nonfood substances such as: clay, starch, raw flour, and cracked ice -ingestion of small amts of these substances may be harmless, but frequent ingestion in large amts may cause significant health problems -starch can interfere with iron absorption -large amts of clay may cause fecal impaction -any other non food substance ingested in large quantities may be harmful, cause the necessary nutrients for healthy fetal development will not be available -its a difficult habit to break, nurse often becomes aware of the practice when discussing nutrition, food cravings, and myths with the pregnant woman -nurse should educate the pregnant woman in a nonjudgemental way about the importance of good nutrition so the pica habit can be eliminated or at least decreased

discuss the pregnant woman with pica:

-should focus on protein-rich foods such as: soy milk, tofu, tempeh, and beans -should supplement the diet with prenatal vitamins to meet the dietary needs of pregnancy

discuss the pregnant women with vegan or vegetarian diets:

reducing the number of low-birth-weight infants born and for reducing morbidity and mortality for mothers and newborns

early and regular prenatal care is important for what reasons?

-No need to provide nutrients in excess of the upper limits of the recommended dietary allowance (RDA) -The combination of supplements and food fortification must not exceed present upper limits of safety or adverse responses, such as toxicity, can occur -Recommended dietary intake (RDI) is an umbrella term that includes the RDA and upper levels of intake -RDIs focus on specific nutrients -RDA is retained for any nutrient for which revision to the new DRI has not been made -both RDI and RDA will be used until the new research for the DRI (dietary reference intake)

explain RDA/RDI

-Excretes waste products of woman and fetus -Glomerular filtration rate of kidneys increases -renal tubules increase the reabsorption of substances that the body needs to conserve, but the tubules may not be able to keep up with the high load of some substances filtered by the glomeruli -therefore glycosuria and proteinuria are more common -Water is retained cause its needed for increased blood volume an for dissolving nutrients that are provided for fetus -the relaxing effects of Progesterone causes renal pelvis and ureters to lose tone and the diameter of the ureters and the bladder capacity increase, leads to urinary stasis (aka peristalsis to the bladder) -Woman more susceptible to UTIs -99% of sodium is reabsorbed, leads to fluid retention -bladder can hold up to 1500ml of urine, the pressure of the enlarging uterus causes increasing frequency of urination, especially in 1st and 3rd trimesters UTIs can be prevented by drinking 8-10 glasses of water daily -changes in the renal system may take 6 to 12 weeks after delivery to return to the prepregnant state

explain the changes the urinary system goes thru during pregnancy:

-there are increased levels of clotting factors 7, 8, & 9 (VII, VIII, & X) and plasma fibrinogen during the 2nd and 3rd trimesters of pregnancy -this hypercoagulability state helps prevent excessive bleeding after delivery when the placenta separates from the uterine wall -

explain why there is a risk for thrombophlebitis, and why the pregnant pt requires careful assessment for the risk and specific teaching to prevent the venous stasis (slow blood flow in the veins) that can lead to thrombophlebitis:

-conveying interest in their needs -listening to their concerns -directing them to appropriate resources

how does the nurse establish rapport with the expectant family?

-early pregnancy: measured with a doppler transducer -later prenancy, it may also be heard with a fetoscope

how is the fetal heart measured?

based on the LNMP

how is the pregnant pt's EDD (estimated date of delivery) calculated?

ultrasound photography of the gestational sac

identification of the embryo or fetus is possible as early as 4 to 5 weeks of gestation with 100% reliability by using what noninvasive method?

-bathe or shower daily -wear cotton underwear -avoid tight undergarments and pantyhose -keep the perineal area clean and dry -avoid douching and using tampons -wipe the perineal area from front to back after toileting -contact health care provider if there is a change in color, odor, or character of discharge

what is the self care measures for vaginal discharge in the 1st trimester?

-identifying and managing psychosocial problems is essential to positive outcome of pregnancy -identifying barriers to accessing care is a primary nursing repsonsibility -identify problems that can be referred to social worker: inadequate health insurance coverage, financial problems, knowledge deficit concerning community resources, lack of transportation, need for day care for other children or older adult parents -special attention to ensure compliance with regular prenatal care: frequent housing relocation may indicate: domestic violence, legal problems, or financial difficulties -tobacco or substance abuse should be assessed -nutritional needs and patterns relating to age, ethnicity, or financial constraints should be discussed -stress in the life of the mother should be reviewed -appropriate referrals to mental health professionals or educational programs should be made to reduce the levels of stress that can affect pregnancy outcome

what is the nurse role in talking to the pt and assessing psychosocial adaptation to pregnancy?

-even the trained woman should avoid vigorous exercise in hot, humid weather -safety measures are advisable because of the changes in the body's center of gravity as the uterus enlarges -start with a warm-up, end with a cool-down -don't exceed the ACOG recommendations for moderate exercise -women who exercised before pregnancy may be more liberal with it, but no more than 1 hr 3-5 x's a week -exercise combined with a blanced diet thats rich in unprocessed, nonroot vegetables, nuts, fruits, and whole-grain breads are beneficial during pregnancy -eat 2-3 hrs before exercise and again immediately after -avoid scuba diving below a 30 feet or exercising in altitudes above 8000 ft during pregnancy -avoid becoming overheated and drink plenty of water during exercise intensity should be modified using the "talk test" (be able to complete a conversational sentence without taking an extra breath)

what is the nursing guidance for pregnant women interested in exercising?

-size -adequacy -condition of the pelvis and reproductive organs and to assess for signs of pregnancy

what is the pelvic examination performed to evaluate?

-amniocentesis

what is the prenatal laboratory test done second trimester only if indicated?

-real-time ultrasonography -cervical fibronectin assay

what is the prenatal laboratory test that is done third trimester only if indicated?

-up to 4.4lbs (2kg) during the 1st trimester -approx 1 lbs (0.44kg) per week during the rest of pregnancy

what is the proper pattern of weight gain?

the woman's pulse rate must be assessed at the same time to be certain that the fetal heart is what is actually heard

what is the protocol when assessing the fetal heartbeat with a doppler device or fetoscope?

identifies carriers of hepatitis B (recommended by American College of Obstetricians and Gynecologists)

what is the purpose of Hepatitis B screen?

identifies presence of sickle cell trait or disease (in women of African or Mediterranean descent)

what is the purpose of hemoglobin electrophoresis during the first trimester (only if indicated)?

performed at 16-20 weeks of gestation when high-risk problem is suspected

what is the purpose of the amniocentesis given during the second trimester (only if indicated)?

routine test done at 24-28m weeks of gestation to identify gestational diabetes; results above 135 mg/dL necessitate medical follow-up

what is the purpose of the blood glucose screen (which is given 1 hr after 50 g of liquid glucose is ingested) during the second trimester routinely?

performed when high risk of fetal loss is suspected

what is the purpose of the endovaginal ultrasound?

detects anemia, infecction, or cell abnormalities

what is the purpose of the lab test; CBC

syphillis screen mandated by law

what is the purpose of the lab test; VDRL or rapid plasma reagin (RPR)

detects anemia

what is the purpose of the lab test; hemoglobin or hematocrit?

determines immunity to rubella

what is the purpose of the lab test; rubella titer

determines risk for maternal-fetal blood incompatibility

what is the purpose of the lab; test blood type and Rh factor and antibody screen:

screens for cervical cancer (if not done within 6 months before conception)

what is the purpose of the papanicolaou (pap) test

optional routine test to identify neural tube or chromosomal defect in fetus

what is the purpose of the serum alpha-fetoprotein given during the second trimester routinely?

optional noninvasive routine test to identify some anomalies and confirm estimated date of delivery (EDD)

what is the purpose of the ultrasonography given during the second trimester routinely?

detects HIV infection, renal disease, or diabetes recommended to screen for asymptomatic bacteruria

what is the purpose of the urinalysis and culture testing in the first trimester?

detects group B streptococci or sexually transmitted infecctions (STIs) such as gonorrhea, chlamydia

what is the purpose of the vaginal culture

screening test for exposure to tuberculosis

what is the purpose of tuberculosis screening PPD skin test or serum blood test (QuantiFERON-TB Gold)

-sleep with several pillow under head -use deep chest breathing before going to sleep -use proper posture while sitting or standing, avoid exertion

what is the self care measure for dyspnea in 2nd and 3rd trimester?

-try to get 8-10 hrs of sleep -take naps during the day if possible -use relaxation techniques, meditatoin, or change of scenery

what is the self care measure for fatigue in the 2nd and 3rd trimester?

-obtain emotional support -practice relaxation exercises -eat regular meals -if headaches continue, report to caregiver (potential gestational hypertension

what is the self care measure for headache in the 2nd and 3rd trimester?

can reduce the incidence of congenital anomalies

what is the significance of an adequate folic acid intake before conception?

-a water-soluble B vitamin essential for the formation and maturation of both red and white blood cells in bone marrow can reduce the incidence of neural tube defects such as spona bifida and anencephaly when taken at conception supplementation for 3 months before pregnancy may prevent autism -DRI recommendation for a pregnant women is 400mcg/day (0.4mg) -food sources: liver, lean beef, kidney and lima beans, dried beans, potatoes, whole-wheat bread, peanuts, and fresh, dark green leafy vegetables -in non pregnant women, this nutrient has shown to decrease cervical dysplasia and bacterial vaginosis -supplementation beyond 1000 mcg per day is associated with development of insulin resistance, obesity, and allergic asthma -can also negatively interact with drugs like: methotrexate and antimalarial drugs -should be used with care to prevent negative effects in non pregnant women

what is the significance of folic acid during pregnancy?

-pregnancy causes heavy demand for iron, because the fetus must store an adequate supply to meet the needs in the first 3 to 6 months after birth -the pregnant women increases her production of erythrocytes -DRI is 15 mg/day for non pregnant adult women and 30 mg/day for pregnant women -its difficult to obtain this much of this nutrient from diet alone, so doctor prescribes 30mg supplements in the beginning of 2nd trimester, after morning sickness decreases -taking this nutrient on an empty stomach improves absorption, but shouldn't be taken with coffee, tea, or with high calcium foods such as milk -Vitamin C (ascorbic acid) may enhance iron absorption

what is the significance of iron during pregnancy:

-prepares breasts for lactation

what is the significance of prolactin in pregnancy?

-essential for maintaining normal sodium levels in plasma, bone, brain, and muscle because both tissue and fluid expand during the prenatal period -sodium should not be restricted during pregnancy, but foods high in sodium like lunchmeats and chips, should be avoided during pregnancy -diuretics to rid the body of excess fluids are not recommended for the healthy pregnant woman, because they reduce fluids needed for the fetus -added fluid during pregnancy supports the mother's increased blood volume

what is the significance of sodium during pregnancy?

allow for some assessment of risk to the fetus when a drug is prescribed in a pregnant woman

what is the significance of the FDA risk categories that were established for medication administration during pregnancy?

-true vitamin deficiency is rare in North America -DRI has recommendations of specific vitamins -excess intake of some vitamins can result in problems excess vitamin A can cause fetal craniofacial anomalies and cardiac defects -vitamin A should not exceed 3000mcg/day -vitamin B6 (pyridoxine) is prescribed to reduce the nausea of pregnancy, but excess intake can cause numbness and nerve damage -adequate intake of zince is required during pregnancy especially in begetarians and vegan diets because whole grains decrease zinc absorption -copper and zinc are part of the prenatal vitamin formula -folates are essential in early pregnancy to prevent neural tube defects but are prescribed separately from the prenatal vitamin, because the amt needed can't be achieved in the prenatal formula -iron should be taken between meals if possible and with orange juice or a source of vitamin C to enhance absorption -iron and calcium should not be taken together at the same time

what is the significance of vitamins and minerals during pregnancy?

--produced by anterior pituitary gland -causes pigmentation of skin to darken, resulting in brown patches on face (chloasma [melasma gravidarum]) -dark line on abdomen (linea nigra) -darkening of moles and freckles -darkening of nipples and areolae

what is the source and significance of MSH (melanocyte-stimulating hormone) in pregnancy?

-produced by ovaries and placenta -responsible for enlargement of uterus, breasts, and genitals -promotes fat deposit changes -stimulates melanocyte-stimulating hormone in hyperpigmentation of skin -promotes vascular changes -promotes development of striae gravidarum -alters sodium and water retention

what is the source and significance of estrogen in pregnancy?

-produced early in pregnancy by trophoblastic tissue -stimulates progesterone and estrogen by corpus luteum to maintain pregnancy until placenta takes over -used in pregnancy tests to determine pregnancy state

what is the source and significance of hCG (human chorionic gonadotropin) in pregnancy?

-produced by placenta -affects glucose and protein metabolism -has a diabetogenic effect-allows increased glucose to stimulate pancreas and increase insulin level

what is the source and significance of hPL (human placental lactogen/chorionic somatomammotropin) in pregnancy?

-produced by posterior pituitary gland -stimulates uterine contraction -is inhibited by progesterone during pregnancy -after birth, helps keep uterus contracted -stimulates milk ejection reflex during breastfeeding

what is the source and significance of oxytocin during pregnancy?

-influences thyroid gland's size and activity -increases heart rate -increases basal metabolic rate 23% during pregnancy

what is the source and significance of progesterone in pregnancy?

-produced by the corpus luteum and ovary and later by placenta -maintains endometrium for implantation -inhibits uterine contractility, preventing abortion -promotes development of secretory ducts of breasts for lactation -stimulates sodium secretion -reduces smooth muscle tone (causing constipation, heartburn, varicosities)

what is the source and significance of progesterone in pregnancy?

for protein, glucose, and ketone levels

what is urinalysis done at the prenatal appt for?

the softening of the ligaments predispose the pregnant woman to the problems with balance

when it comes to a change in the center of gravity and joint instability, interventions concerning safety should be part of prenatal education, why does the change occur?

a trained examiner

who can feel fetal movements in the second trimester?

for adequacy of calorie intake and specific nutrients

why is the nutrition reviewed

may be showing respect to the nurse rather than agreement with what is taught

why may a nurse think an Asian woman understands what she is teaching when she nods when the nurse is talking to her?