106 unit 5 pregnancy
nurtitional teaching for the adolescent
*nursing considerations: keep suggestions to a minimum, *focus on the most important changes and ask the adolescent for input *when changes are necessary explain the reasons *give exmples for alternatives to fast food and healthy food swaps DO not skip meals (thy are self conscious) -do not gain too much weight -take your supplements REGULARLY -
trimesters of pregnancy
- 1st trimester: week 1-13 - 2nd trimester: week 14-27 - 3rd trimester: week 28-42
Breast changes during pregnancy
- Breast size increases, and breasts may be tender. -areolae become darker in color. -Colostrum may leak from the breast: starts at 12-16 weeks and can be squeezed out by the 3rd trimester
what should be assessed during each visit?
-BP -Weight 1st: 2-5 lbs slow and steady 1lbs per week! -Fundal height: make sure empty bladder -Fetal heart tones / activity -Urine/Edema : protein Preeclampsia, -Q & A -Prenatal Tests*****
describe the PATERNAL adaptations
-Grappling with reality: often experience the same ambivalence as mothers -finding a new role: may seek closer ties with fathers, observe and "try" fathering behaviors, some change their image/appearance -couvade: pregnancy related symptoms and behavior in expectant fathers
Cardiovascular changes during pregnancy
-Heart enlarged/displaced to the L -Murmurs may be heard and may last till the 4th week increased: -blood volume 45%: hemorrhoid's, RBCs, increased plasma fluid, WBC (higher is normal during/PP) - increased clotting factors -increased cardiac output: high pulse -BP shouldn't change! supine hypotension -increase in plasma volume: causes pseudoanemia -increased fluid oveload: edema
what women might have a calcium deficiency and what are sources of calcium?
-Lactose intolerant/ vegans lactose free calcium sources: -legumes fortified juice, broccoli -dairy products, salmon, sardines w/ bones
how do siblilings (TODDLERS) adapt to childbirth?
-MAY FEEL JELOUS & DISPLACED -parents must offer reassurance to toddler -start sleeping arrangements early
Food precautions during pregnancy
-nothing UNPAZTURIZED (milk, eggs, etc) -Nothing Raw/ undercooked: sushi, luncheon meats, sunny sideup eggs unless pasturized -unwashed fruits or veggies
Endocrine changes in pregnancy
-prolactin prepares breasts to produce milk? -oxytocin: stimulates milk, contractions and keeps uterus contracted in PP to prevent bleeding -increased BMR GLUCOSE 1st tri: 20-30% lower= hypogylecemia 2nd&3rd: more glucose available for fetus which produces more insulin (HPL) -inadequate insulin production=GDM Aldosterone increases: water retention/edema and carpel tunnel syndrome Cortisol increases: stimulates glucose--> hyper
dietary iron and considerations for taking iron pills
-MEATS & FISH -LEGUMES (TOFU, CHICKPEAS, ETC) -GRAIS (WHEAT,BREAD RICE, RAISIN BRAND) -FRUITS (DRIED FRUITS, PRUNE JUICE) -VEG: POTATOES, TOMATOES, PEAS teaching: -take @ bedtime or with juice/water -do not take with coffee, milk, tea -spinach & coffee prevents absorption
what are some contraindications for CNST?
-PRETERM LABOR -PROM -HX OF C CECTION -PLACENTA PREVIA
Phycological responses of the 2nd trimester
-Physical evidence of pregnancy: feels better creates bond -FETUS AS PRIMARY FOCUS Focusing on physical changes and discomforts INTROVERSION: The woman focuses more on herself and in her body, or becomes fearful of world events that threaten them and their fetus, wonders what the baby looks like and looks at pictures of herself, concerns about how the child will be accepted by siblings. -body image: positive or negative*** -Bonding with fetus -sexual changes: invcreased or decreased desires
important teaching topics during pregnancy
-Safety/Hygiene practices: no douching, no heavy lifting -Fetal growth and development: -Normal changes and discomforts -Ways to reduce discomforts: nausea/vomiting (ginger & saltines), GERD (avoid caffiene, irritants and hotsauce, big meals beofre bed) -nutrition and weight control: avoid raw meats, excess calories -Warning signs for each trimester:
WHAT IS DONE IF AN NST IS NONCREACTIVE?
-US FOR BPP -CONTACTION ST
Phycological responses of the 1st trimester
-Uncertainty:unsure of pregnancy and tries to confirm it. -Ambivalence: conflicting feelings -SELF AS PRIMARY FOCUS: mood swings because of hormones
Phycological responses of the 3rd trimester
-VULVERABILITY; concered about harm to fetus -increased DEPENDANCE -Preparation for birth: May become increasingly concerned with signs and symptoms of Labor or her due date and the experience of Labor -NESTING: Increased interest in preparing for arrival of newborn
what are the DANGER signs during pregnancy and teachings?
-Vaginal bleeding, with or without discomfort: placenta previa/ abruptio -Rupture of membranes: chorioamnionitis, PROM Swelling, pounding headache or visual changes: preeclampsia/ PIH -Persistent or severe abdominal pain Chills or fever--> infections Painful urination: UTI can lead to PROM Persistent vomiting: hyepermemesis Changes in frequency or strength of fetal movements
how do OLDER SIBLINGS (3-12YRS) adapt to childbirth?
-alot of question on how birth happens -enjoy listening/feeling baby move -need preparation for mom to be gone for days -parents should include them in the plans/preparations -encourage touching/talking to tummy -adress childrens concerns and reassure they are still important -books about children experiences after birth
what is the primary focus/ teaching for backache?
-correct posture and body meachanics -shoulder circling, pelvic tilt/ rocking, tailor sitting
how do ADOLESCENTS adapt to childbirth?
-depends on DL -may feel embarrassed that mom and dad 'get it on' -indifference because they only care about themselves, unless it affects them -some become very involved
Respiratory changes
-increases oxygen consumption 20-30% -increased tidal volume/ slight hyperventilation s/s: -SOB -nose bleeds, nasal congestion, hoarseness (sore throat), deeper voice
EAQ which symtoms would the nurse tell the pt of 29 weeks to report immediately? -lower back pain -white vaginal discharge -irregular strong contractions -leakage of fluid from the vagina
-leakage this could mean SPROM and could cause an infection if birth doesnt occur in 24hrs or if early treatment isint given
EAQ i client thats 7 WEEKS gestation tells a nurse at the clinic that shes been bothered by episodes of nausea throughout the day. which interventions would the nurse recommend? -Focus on and repeat a rhythmic chant -sit upright for 30 minutes -take low sodium antacids -drink carbonated beverages -eat small frequent meals
-rythmic chant: focusing may help migitate odors, tastes and thoughts that may cause nausea -avoiding an empty stomach may decrease the occurace of nausea -low sodium antacids should be given IN BETWEEN meals
what are some high risk factors for pregnancy?
-teennage -multiparity -low income: preterm/ LBW -low weight/obesity: lbw/ GDM, vascular probs -short: cesarean due to disproportions -smoking: PPr/PAB, PROM,SAB,LBW,SIDS -alcohol/drugs -hx of big babies (over 8lbs) -preterm births/fetal neonatal death -Rh factor -DM -hypo/hyperthyroidism -cardiac disease/ renal failure -infections stds
what is the purpose of increased blood volume?
-transports nutrients & O2 to the placenta for growing fetus -to meet demands of expanded maternal tissue (breasts/uterus) -provides reserve against blood loss
how can these STDs affect the neonate, pregnancy and the birthing process? what are the interventions? 1. HSV 2. HIV 3. Syphilis edit
1. 2. 3.
1. pre-embryo stage: 2. embryo 3. fetus
1. 0-2 weeks 2. 3-8 weeks 3. 9+ weeks
1. fetal membranes role 2. amniotic fluid role
1. Amnion—inner membrane that forms fluid-filled sac Chorion—outer membrane that forms fetal side of placenta -AT RISK FOR INFECTIONS: chorioamnionitis 2. cushions, maintains temp, buoyancy/movement, can tell fetal kidney function because they urinate in there & aides with development
1. chadwicks! 2. Hegars 3. Goodels sign
1. CHAD IS BLUE --BLUISH DISCOLORATION of the cervix, vagina, and vulva -due to increased vascularity to the vagina, uterus 2. ELONGATION & SOFTENING of the isthmus, usually seen at 10-12 3. SOFTENING OF THE CERVIX 6-8 WEEKS
1. role of the placenta 2. umbilical cord
1. Exchanges gases, nutrients, antibodies and waste removal between fetus and woman; produces hormones--Progesterone maintains the pregnancy -Helps to provide passive immunity for first few months of infancy -Filters large particles out only—more of a "sieve" than a "barrier" -Glucose CROSSES ; insulin doesn't 2. AVA Lifeline b/t fetus and placenta Arteries—carries DEOXYGENATED blood and waste products from the fetus Vein—carries OXYGENATED blood and nutrients to fetus
1. Number of Pregnancies regardless of duration 4. Para
1. Gravida 4. Number of pregnancies delivered at 20 weeks gestation or more - AVLIVE OR STILLBORN
-Guess the hormones based off their roles/ function during pregnancy: 1. High levels in early pregnancy SUPPORTS EMBRYO/FETUS until placenta takes over--> 20 weeks---> causes morning sickness in the first trimester 2. Breast Tissue & ductal growth -Hyperpigmentation-Linea nigra, nipple darkness, etc. gradual increased vascularization (increased clotting factors) 3. Preserves the pregnancy! -relaxes smooth muscle-clues to common discomforts!! bladder (urinary frequency) prevents uterus from contracting, cardiac upset (relaxes cardiac sphincter), varicose veins 4. increases available glucose to fetus-AIDS IN FETAL GROWTH by aiding in breaking down protein-can be a risk factor for GDM, by increases insulin resistance -PREPARES the body to produce MILK 5. takes off in 3rd trimester- SOFTENS CONNECTIVE TISSUE, joints, muscle in preparation to delivery and widening the pelvic passage way
1. HCG 2. ESTROGEN 3. PROGESTERONE 4. HPL 5. Relaxin
1. term 2. Preterm 3. abortion
1.* 37-41 weeks* 2. 20-36 weeks 3. spontaneous or elective termination of pregnancy BEFORE 20 WEEKS
fundal height
12-13 weeks: ABOVE SYMPHISIS PUBIS 16 WEEKS: HALF WAY TO UMBILICUS 20 weeks: AT UMBILICUS **After 20 weeks cm will represent gestational age (+ or - 2 cm)** 26 weeks: 24-28 cm half way between belly button and xiphoid process 36 weeks: at the xiphoid process 37-40 weeks: will drop PP fundus should be @ the belly button and decrease 1 cm/day!
prenatal visit schedule 1st trimester 2n trimester 3rd trimester
1st and 2nd trimester every 4 weeks 3rd trimester (28-36) q 2 weeks 37weeks -birth: weekly
What is the age of viability for a fetus?
23-24 weeks -@ 24 weeks SUFRACANT PRODUCTUON BEGINGS in the lungs -resp is possible but most fetus die if born at this time -@ 28 weeks there is sufficient alveoli, SUFRACANT & CAPILLARY NETWORKS TO ALLOW RESP FUNCTION. -many infants born at this time survive WITH INTENSIVE CARE
GDM screening
24-28 weeks gestation 50 g oral glucose load Random: less than 140 mg/dL--> if higher do fasting and 3 with glucose fasting need to be less than 95 1 hr = less than 180 2 hrs= less than 155 3 hrs less than 140 2 or more abnormals= GDM
what are the nutritional needs during pregnancy?
340 extra calories 2200-2500 calories/day total 7 oz. PROTEIN/day** & 3 dairy servings a day *FOLIC ACID- prevents tube defects , leafy greens, fortified cereal, tabs *IRON- needed for blood, causes constipation -tabs + OJ, egg yolks *CALCIUM- for bones & teeth- especially in the 3rd trimester -tabs+vitD, dairy, non dairy : Dark green vegetables, legumes, fish with bones that you can eat, supplements.
what are some assesment findings that could indicare PIH?
A sudden elevation in BP or sudden excessive weight gain may indicate this
EAQ what information would the nurse include when explaining common body changes in the FIRST trimester of pregnancy? SATA a) sleep needs b) urinary frequency increases c) body temp increases d) calcium requirements increase e) the need for carbs decrease
A,B,D A-FATIGUE INCREASES=INCREASED SLEEP C- BODY TEMP INCREASES DUE TO INCREASED METABOLISM
prenatal test done in the second trimester
Abdominal Us AFPT: done 15 to 18 weeks Glucose Challenge Test: 24 to 28 weeks To screen for gestational diabetes. GCT: NO FASTING, NO DIET RESTRICTIONS- pt drinks 50g of oral glucose and testing labs are drawn 1 hr later. IF levels are higher than 140 a GTT is done GTT: gold standard for dx. DONE FASTING. Levels taken before drinking 100mg of OG and @ 1,2,& 3 hrs
what factors Influence maternal Psychosocial Adaptations during pregnancy? -what could change her maternal metal/phycological/emotional states?
Age: may feel more ready, mature, income establishes Parity: "this nothing new" "im scared" Support System: no one to help, guide, etc. Socioeconomic Status: cant afford this baby Absence of partner:
what is the difference between NV & hyperemesis gravidum?
HG is severe nv with WEIGHT LOSS AND KETONES treatment: vit B6 & antihistamines, HYPNOSIS & ACCUPRESSURE
EAQ which info would the nurse include in a teaching session for a couple on fetal growth and development? SATA a) all major organs are developed and function before birth B) development occurs in a 'head-to-toe & central-to-peripheral' pattern C) the fetal stage of development is the most vulnerable to teratogenic effects D) pregnancy includes the pre embryonic, embryonic and fetal stages of development E) during pregnancy the embryo grows from a single cell to a complex physiologic being
B,D,E -the EMBRYONIC stage (2-8 weeks) is the most vulnerable to teratogenics NOT the fetal stage
positive signs of pregnancy
FETUS Fetal movements felt by examiner-starts to move at 16-20 Electronic device detecs Heart tones @ 10 weeks w/ doppler Transvaginal /ultrasound ultrasound detecs baby see fetal movement
how can Rubella affect the fetus/ neonate and what can be done? EDIT
First 8 weeks carries highest risk to embryo—serious defects Vaccinate after delivery wait 4 weeks after to have sex
what is the normal weight gain during pregnancy?
First trimester-Approximately 2-5 pounds [first 13 weeks] first trimester 2nd & 3rd trimesters: 1 lbs. per week. 25-23 lbs TOTAL
can decrease the incidence of spina bifida and anencephaly (born w/o parts of brain or the skull)
Folic acid
GTPAL
Gravida: COUNT THE CURRENT PREGNANCY! Term (37+) Preterm, Abortions, Living -twins are counted as one pregnancy, if they live they are counted separatley
EAQ which pregnancy hormone causes N/V the client experiences in the FIRST trimester?
HCG -estrogen makes the reproductive tract receptive to the embryo -progesterone protects/maintains the pregnancy from SAB -HPL screreted by the placenta aides in milk production and stimulates maternal metabolism to supply nutrients for maternal growth
-pregnancy complications- RH factor
Moms body makes antibodies after first pregnancy is a problem when mom and dad are opposites (RH-/RH+) -Causes severe anemia(breakdown of fetus' blood) in baby & future pregnancies -Rhogam deep IM weekly -GIVEN: whenever bleeding starts in pregnancy, at 28 weeks, and after delivery -even if there was n SAB given within 72 hrs to prevent reoccurrence in the next pregnancy
primary means for fetal surveillance in pregnancies that are increased risk for UTEROPLACENTAL INSUFFICIENCY
NST
BPP (biophysical profile)
NST & Ultrasound to assess fetal wellbeing based on 5 criteria each worth 2 pts or 0 if absent. Five fetal variables: NST-detecs FHR Fetal breathing- THESE FOUR REQUIRE US movements Muscle tone (fine body movements) Amniotic fluid volume (index) -10/10; good -6/8 requires OBSERVATION - 4/8 results in C-CECTION
what is the difference in results for NST and CNST
NST- REACTIVE (GOOD) NONREACTIVE (NOT GOOD) CNST- USES OXYTOCIN POSITIVE (NOT GOOD) NEGATIVE (GOOD)
NST vs contraction NST
NST: Observing for FHR ACCELERATONS W/ MOVEMENT •Reactive (reassuring) we should se an increase in FHR Nonreactive (non-reassuring) -done throughout pregnancy (toco goes on lower ab) if non reassuring--> CNST CNST: Observing the RESPONSE of the FHR to STRESS of CONTRACTIONS Negative (reassuring) Positive (non-reassuring) -Uses especially when oxytocin is given : can cause hypercontraction's-> deadly -used during labor
EAQ A client at 42 weeks gestation is admitted for an NST. The nurse concludes that this test is being done due to which complication that is related to PROLONGED PREGNANCY?
PLACENTAL ISSUFICIENCY -PLACENTAL FUNCTION PEAKS AT 37 WEEKS AND DECLINES AFTER, therefore pasterm pregnancy (over 40 weeks) is a risk for the above.
Probable signs of pregnancy
PROBABLE POSITIVE PREGNANCY TEST REBOUND-BALLOTMENT OUTLINE OF OF FETUS PALPABLE BRAXTON HICKS A SOFTENING OF THE CERVIX- GOODELS 6-8 WEEKS BLUE VULVA/VERXIX- CHADWICKS LOWER UTERINE SOFTENING 10-12 WEEKS- Hegars ENLARGED UTERUS -Uterine Souffle: muffling sounds of fetal vs maternal vena cava/ blood flow
Findings NOTED (seen) BY HEALTHCARE PROVIDER that suggest a pregnancy
Probable signs of pregnancy
what are the PRENANTAL TESTS that should be done during first trimester pregnancy?
Rh factor & Antibody Screen: To determine blood type & screen for possible maternal-fetal blood incompatibility. CBC: To identify infection, anemia, cell abnormalities. Hg & Hct: detect anemia, often check several times during pregnancy VDRL/ RPR: to screen for syphilis & venereal diseases TB: to screen for tuberculin Rubella, Varicella titer Hepatitis B & C: To detect present of antigen in maternal blood. (HIV): Voluntary test encouraged at first visit to detect HIV antibodies. Urinalysis: Protein, glucose, ketones,bacteria, nitrates Nitrates may indicate infection/culture may be done PapTest: To screen for cervical anomalies STD testing: chlamydia & gonorrhea
what are some of the normal changes and discomforts during pregnancy and how can the be helped?
Urinary frequency Nausea and vomiting Heartburn / Indigestion Backache Fatigue Constipation and hemorrhoids Edema of lower extremities/leg cramps
how do you calculate the EDD using nageles rule?
Use FIRST DAY!! of last menstrual cycle (LMP) Minus 3 months Add 7 days Ex. Sept. 14 minus 3 months = June 14, then add 7 days = June 21
VEAL CHOP
V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placental insufficiency/FETAL HYPOXIA
Describe late decels
a dip in FHR (U shaped) AFTER THE contraction caused by UteroPlacental inssuficiency -last letter in V.E.A.L- C.H.O.P interventions: repo, give o2,
complete vs imcomplete protein
complete: animal, soy products incomplete: plant protein this may be an issue for venags -combine both incomplete plant proteins with other plant food can help
EAQ what changes would the nurse include in a childbirth class focusing in the maternal physiologic and psychologic changes that occur near the end of pregnancy? a) food cravings increase b) nesting needs increase c) dependency needs decrease d) anxiety about childbirth increases e) GI motility increases
d
Taxoplasmosis
disease from parasitic microorganisms -carried in dirt, cat feces, raw meat; dangerous to unborn children
Fetal Kick Counts
done 2-3 times/day: 10 movements in 12 hrs or 3 movements in 60 minutes done
examples of teratogens
drugs: OTC! alcohol, cigarettes, - bacteria: infections (clamydia, gonh,) -viruses: RUBELLA less than 1;8 -chemicals & pollutants
PICA
eating NONFOODS or food COMPONENTS not considered part of the diet -ICE, CLAY DIRT, LAUNDRY STARCH, CORN STARCH -CHALK ,BACKING SODA, TOOTHPASTE, FREEZER, FROST, COFFEE GROUNDS & ANTACID TABS -ASSOCIATED WITH IRON DEFFICIENCY -CAN BE HARMFUL/CAUSE NUT DEFFICIENCIES
Vaginal changes during pregnancy
increased vaginal discharge- this is normal! as long as its not a wierd color or odor or accompanied by other symtoms (UTI) -elevated PH- risk for recurring yeast infections (candida)
Alpha feto-protein test
is a Plasma protein produced by fetus. Maternal blood sample at 16-18 WEEKS** High: spina bifida Low: Down syndrome
caused by Abnormal implantation of the placenta in the lower uterus, at or near the cervical os.
placenta Previa previa=painless no oxy, no stress test tx: cesarean, or bed rest
Premature separation of a normally implanted placenta. Painful bleeding during late pregnancy or during labor/birth
placenta abruptio tx:
GI/GU changes in pregnancy
progestin may slow down smooth muscle -nausea, vomiting, GERD, constipation, altered smell and taste -increases kidney filtration rate-- urinary frequency, stasis- decreased bladder tone (increased risk for UTI) -Gingivitis -ptyalism (excess salivation) tx: small frequent meals, stand up after meals, gum chewing, cough drops -itchiness (thicker bile/retention of bile salts)
integumentary system
straea: stetch marks cholasma: dark pactches on the face increased temp and sweating (especially in last trimester) hair grows raplidly-can fall out PP, this is temp
nervous/muscoloskeletal changes
sciatica pain: due to increased abdominal pressure Relaxin: creates instability--Falls! Lordosis: lower back pain! -increase calcium in 3rd trimester
Presumptive signs of pregnancy
symtoms SHE EXPRIENCES c/o PRESUME P: PERIOD ABSECENT Amenorrhea REALLY TIRED: FATIFUE ENLARGED BREAST SORE BREAST URINARY FREQUENCY MOVEMENT- QUIKENING 16-20 WEEKS EMESIS/ NAUSEA
GBS
•Vaginal / rectal culture obtained between 35-37 weeks* •Associated with preterm rupture of membranes (PROM) and preterm births -if positive treated w/ antibiotics right before birth
