Nursing Care of the Family during Pregnancy
What is Nagele’s rule and what is it used for?
Method for calculating due date.
First day of LMP – 3 months + 7 days + 1 year
or
LMP + 7 days + 9 months
Not helpful if the woman has irregular cycles. Only about 5% deliver on exact day.
Calculate the due date for the following woman: Her last menstrual period was on April 5, 2011.
April 5th – 3 months = Jan 5th + 7 days = Jan 12th + 1 year = Jan 12, 2012
What are important psychological considerations for the woman when adapting to pregnancy? For the man?
Woman:
Accepting the pregnancy – cognitive restructuring, ambivalence is normal, biological fulfillment of life plan.
Identifying with the mother role – helps them in accepting the pregnancy.
Reorder personal relationships – relationship with own mother is significant in transition, needs to feel loved and valued by partner and feel that partner accepts child. Increased sex drive during first trimester which will decrease as pregnancy progresses.
Establishing a relationship with fetus – emotional attachment begins while pregnant, phase 1 women accepts being pregnant, phase 2 accepts fetus growing as part of herself, phase 3 the women prepares for birth.
Preparing for birth – reading books and watching films helps with this process, education by the nurse can aid in this process.
Man:
Accepting the pregnancy – some men experience couvade syndrome (weight gain, N/V, other physical symptoms). Announcement phase joy and dismay, if unwanted abuse and extramarital affairs may increase. Moratorium phase – adjusts to the reality of pregnancy, Focusins phase – last trimester, takes an involved role.
Identifying with the father role – recalls memories and experience of fathers in his past and begins to identify with fatherhood.
Reordering personal relationships – as they begin to nurture and respond to pregnant women they will begin to change external relationships.
Establishing a relationship with the fetus – daydream about being a father, call the fetus by name.
Preparing for childbirth – think about actual birth and how they will get the woman to the hospital, attend classes etc.
What are the normal labs tests in the prenatal period?
Laboratory Test Purpose
Hmg, Hct, WBC anemia, infection
Hemoglobin electrophoresis sickle cell, thalassemia
Blood type, Rh, irregular antibody identify fetus at risk for erythroblastosis fetalis or hyperbiliruinemia
Rubella titer determine immunity to rubella
tuberculin skin test screen for Tb
Urinalysis diabetes, renal disease, infection, occult hematuria
Urine culture asymptomatic bacteriuria
BUN, creatinine renal compromise for women with hx of DM, renal disease, HTN
Pap test cervical intraepithelial neoplasia, herpes simplex 2, HPV
Vaginal and rectal smear asymptomatic infection
RPR, VDRL, FTA-ABS syphilis
HIV, Hep B screen for infection
1-hr glucose gestational diabetes(initial visit for at risk women, 24-28 wks for all women)
3-hr glucose diabetes for women with elevated 1-hr
ECG, CXR, echo cardiac function in women iwth hx of HTN or cardiac disease
What is a normal prenatal visit schedule?
Monthly visits during the first and second trimester. Starting at week 28 visits are every two weeks until week 36, when they become every week until birth.
What are the potential complications in each of the trimesters and what are the possible causes?
First Trimester
| Signs and Symptoms | Possible Causes |
|---|---|
| severe vomiting | hyperemesis gravidarum |
| chills, fever | infection |
| burning on urination | infection |
| diarrhea | infection |
| abdominal cramping; vaginal bleeding | miscarriage, ectopic pregnancy |
Second and Third Trimester
| Signs and Symptoms | Possible Causes |
|---|---|
| persistent vomiting | hyperemesis gravidarum, hypertension, preeclampsia |
| sudden discharge of fluid from vagina before 37 wk | premature rupture of membrane (PROM) |
| vaginal bleeding, severe abdominal pain | miscarriage, placenta previa, abruptio placentae |
| chill, fever, burning on urination, diarrhea | infection |
| severe backache or flank pain | kidney infection or stones; preterm labor |
| change in fetal movements: absence of fetal movements after quickening, any unusual change in pattern or amount | fetal jeopardy or intrauterine fetal death |
| uterine contractions; pressure; cramping before 37 wk | preterm labor |
| visual disturbances: blurring, double vision, or spots | hypertensive conditions, preeclampsia |
| swelling of face or fingers and over sacrum | hypertensive conditions, preeclampsia |
| headaches: severe, frequent, or continuous | hypertensive conditions, preeclampsia |
| muscular irritability or convulsions | hypertensive conditions, preeclampsia |
| epigastric or abdominal pain (perceived as severe stomach ache) | hypertensive conditions, preeclampsia, abruptio placentae |
| glycosuria, positive glucose tolerance test reaction | gestational diabetes mellitus |
What education is the most pertinent for each of the following for the women during the antenatal period?
- Fetal changes
- Nutrition
- foods high in iron, prenatal vitamin, limit caffeine intake
- Hygiene
- sebaceous glands are more active, baths and warm showers can be relaxing, tub bathing may be contraindicated late in pregnancy due to balance issues
- Preparation for breastfeeding
- women with HIV should not breastfeed, if woman has Hep B infant should receive vaccine, women with inverted nipple should wear breast shell, breast stimulation is contraindicated
- Dental care
- very important because N/V can lead to poor oral care, dental work is permitted
- Physical activity/posture
- exercises that relieve lower back pain are especially important, can help alleviate boredom, proper posture and body mechanics can relieve low back pain
- Clothing
- comfortable, loose clothing is recommended, tight clothing should be avoided, maternity bras can alleviate back and neck pain, high heels are not recommended, shoes should promote comfort and back support
- Medications and herbal preparations
- the use of all drugs should be limited, fetal drug toxicity is possible, any medication should be discussed with your provider, the greatest risk is during the first trimester
- Smoking, alcohol, caffeine and drugs
- small amounts of alcohol may be safe, but total abstinence is recommended, alcoholism is associated with high levels of miscarriage and FAS, pattern is more predictive of damage than amount, smoking can cause low birth rate, increased morbidity and mortality, preterm labor, PROM, abruptio placentae, placenta previa, and fetal death, increased risk for miscarriage with caffeine intake over 300mg/day, should limit caffeine intake to 3 cups of coffee or cola per day, all drugs should be stopped