Nursing Care During Pregnancy
Content
21/05/2012
FIK/MaternityNs/Treesia
1
• DIAGNOSIS OF PREGNANCY 1. Sign and symptom 2. Estimating date of birth • ADAPTATION TO PREGNANCY 1. Maternal Adaptation 2. Paternal adaptation 3. Sibling adaptation 4. Grandparent adaptation • CARE MANAGEMENT 1. Variation in prenatal care 2. Childbirth and perinatal education
21/05/2012
FIK/MaternityNs/Treesia
2
Preasumptive Sign and Symptoms : Missed period (amenorhoe) Nausea and vomitting (morning sickness) Breast tenderness and enlargment Fatique Urinate more often than usual, particularly at night Mood changes (unexplained tearness) Craving for foods/otherwise Distaste food Skin pigmentation changes
21/05/2012 FIK/MaternityNs/Treesia 3
Preasumptive sign and symptom
Missed period Sometimes light bleeding = implantation bleed (occurs when the embryo first attach it self to the lining of the uterus/womb) Pregnancy suspected if more than 10 days has elapsed since the time of the expected onset. NOT PREGNANT: Execive exercise, low body weight, stress, hormonal imbalance, breast feeding
21/05/2012 FIK/MaternityNs/Treesia 4
Preasumptive sign and symptom
Nausea and vomiting Begins between 2 and 6 week after conception and subsides at 12 Happens on 7 from 10 pregnant woman NOT PREGNANT : Food poisoning, Gastrointestinal dissorder, some types of infections
21/05/2012
FIK/MaternityNs/Treesia
5
Preasumptive sign and symptom
Breast changes Fuller, swolen and tender Skin around the niple (areola) become darker and the vein become obvious NOT PREGNANT : Effect of hormones before period, oral contraception pills, hormonal imbalance
21/05/2012 FIK/MaternityNs/Treesia 6
Preasumptive sign and symptom
Fatique Cause by the massive increase of the sex hormone progesterone Progesterone is needed to maintain the pregnancy and help the baby to grow, but it also slows metabolism. Energy levels usually rise again by around the fourth month of pregnancy when the placenta is well established.
21/05/2012 FIK/MaternityNs/Treesia 7
Preasumptive sign and symptom
Frequent urination Pregnancy causes an increase in levels of body fluids and greater kidney efficiency. The swelling uterus also presses against the bladder
21/05/2012
FIK/MaternityNs/Treesia
8
Preasumptive sign and symptom
Mood changes • It is thought that the pregnancy hormones influence chemicals in the brain, causing mood changes. Food cravings especially for foods that provide energy and calcium, such as milk and other dairy products. You may also notice a sudden distaste for foods you previously liked. Some women even develop a bizarre taste for non-food items such as soil or paper. This is called ‘pica’.
21/05/2012
FIK/MaternityNs/Treesia
9
Preasumptive sign and symptom
Skin pigmentation changes: Chloasma/melasma gravidarum (the mask of pregnancy-brownish pigmentation appearing on the face of buterfly pattern in 5070% of women. Ussualy symetric and distributed on the forehead, cheeks and nose.
21/05/2012
FIK/MaternityNs/Treesia
10
Preasumptive sign and symptom
Linea nigradark vertical line on the abdomen between the sternum and the symphisis pubis
21/05/2012
FIK/MaternityNs/Treesia
11
Preasumptive sign and symptom
Abdominal striae (striae gravidarum)reddish or purplish linear marks sometimes appearing on the breast, abdomen, buttocks, anfd thighs because of the streching, rupture and athropy of the deep connective tissue of the skin.
21/05/2012
FIK/MaternityNs/Treesia
12
PROBABLE SIGNS OF SIGNS AND SYMPTOMS Objective findings detected by 12 to 16 weeks of gestation
Enlargment of abdomen (felt through di abdominal wall just above symphysis pubis) Changes the shape, size and consistency the uterus (pear shape to globe shape, Hegar’s sign=lower uterine segment soften 6-8weeks after the onset of last menstrual period) Changes in cervix a. Chadwick’s sign-bluish or purplish discoloration of cervix and vaginal wall b. Goodell’s sign-softening of the cervix; may occur as early as 4 weeks
21/05/2012 FIK/MaternityNs/Treesia 13
Hegar’s sign on pregnancy
21/05/2012 FIK/MaternityNs/Treesia 14
Chadwick’s sign on pregnancy
21/05/2012 FIK/MaternityNs/Treesia 15
PROBABLE SIGNS OF SIGNS AND SYMPTOMS Objective findings detected by 12 to 16 weeks of gestation
Interminttent contractions of the uterus (Braxton Hick contractions)painless, palpable contractions occuring at irregular intervals, more frequently felt after 28 weeks. Ussualy disappear with walking or exercise. Ballottement – sinking and rebounding of the fetus in its surrounding amniotic fluid in responce to sudden tap on the uterus (occurs near midpregnancy) Changes in levels of human chorionic gonadotropin (hCG) in maternal plasma and uterine Leukorrhea- increase in vaginal discharge Quickening (sensations of fetal movement in the abdomen)-occurs between the 16th and 20th week after the onset of the last menses Positive hCG
21/05/2012
FIK/MaternityNs/Treesia
16
POSITIVE SIGN AND SYMPTOMS Diagnostic Of Pregnancy
Fetal Heart tones (FHTs)ussually heard between 16th and 20th week of gestation with fetoscope or the 10th and 12th week of gestation with a Doppler stethoscope. Fetal movements felt by the examiner (after about 20 weeks gestation) Outlining of the fetal body through the maternal abdomen in the second half of pregnancy Sonographic evidence (after 4 weeks gestation) using vaginal ultrasound. Fetal cardiac motion can be detected by 6 weeks gestation.
21/05/2012 FIK/MaternityNs/Treesia 17
Nagele’s Rule is a method of obtaining an EDD (Estimated Date of Delivery) 1. Determine first day of last normal menstrual period 2. Count back 3 months 3. Add 7 days 4. Corect year if needed +7-3+1 (day/month/year)
21/05/2012 FIK/MaternityNs/Treesia 18
Practice : First day of LNMP : November 18 Date of Birth?
21/05/2012
FIK/MaternityNs/Treesia
19
The average duration of pregnancy is app 280 days/ 40 weeks (lunar months=28 days/months) same as 9 calendar months. Trimester = 1st trimester (14 weeks), 2nd trimester (1528 weeks) and 3rd trimester (29 weeks to delivery)
21/05/2012
FIK/MaternityNs/Treesia
20
GOALS 1. Ensuring a safe birth for mother and child promoting a good health habits and reducing risk factors 2. Teaching health habits that may be continued after pregnancy 3. Educating about self care during pregnancy 4. Providing physical assessment and care 5. Preparing parents for adaptation to parenthood
21/05/2012 FIK/MaternityNs/Treesia 21
PRENATAL VISIT
Initial health and social history personal information, medical and obstetric history, family and cultural history. Physical examination head to toe assessments, patient’s weight and BP Subsequent visits month 0-7 : 1/month month 8-9 : 1/week antenatal care
21/05/2012 FIK/MaternityNs/Treesia 22
PRENATAL HIGH RISK FACTORS INDICATING FOR SPECIAL PRENATAL TESTING
• Maternal condition that increases risk for uteroplacental insuffuciency such as DM or hypertension • History of previous stillbirth • Mother’s age less than 16 or more than 35 years • Multifetal pregnancy • Post term pregnancy • Decreased fetal movement • Oligohydramnios • Intrauterine growth restriction (IUGR) • History of congenital abnormalities
21/05/2012 FIK/MaternityNs/Treesia 23
21/05/2012
FIK/MaternityNs/Treesia
24
21/05/2012
FIK/MaternityNs/Treesia
25
PERINATAL EDUCATION • BATHING • PHYSICAL ACTIVITY AND EXERCISE DURING PREGNANCY • SEXUAL ACTIVITY DURING PREGNANCY • DOUCHING • CHLOTHING • BREAST AND NIPPLE CARE • DENTAL CARE • IMMUNIZATIONS DURING PREGNANCY • EMPLOYMENT DURING PREGNANCY • TRAVEL DURING PREGNANCY • MEDICATIONS • DANGER SIGNS • WEIGHT GAIN AND FETAL GROWTH • NUTRITION
21/05/2012 FIK/MaternityNs/Treesia 26
PERINATAL EDUCATION
BATHING Consider safety measures such as rubber mats and hand rails
≠ sauna, tub baths
Maternal body temp < 38⁰C
21/05/2012
FIK/MaternityNs/Treesia
27
PHYSICAL ACTIVITY AND EXERCISE DURING PREGNANCY
Mild to moderate exercise ≠ supine, twist, bounce, jerky movements, HR 140bpm Exercises for muscle strengthening and relaxation : Pelvic tilt (back and abdominal muscles) Tailor sitting (thigh and pelvic muscles) Kegel exercises (pubococcygeal muscles) Relaxation
21/05/2012 FIK/MaternityNs/Treesia 28
21/05/2012
FIK/MaternityNs/Treesia
29
SEXUAL ACTIVITY DURING PREGNANCY
No valid reason to avoid sexual activity Increased uterine activity: Breast stimulation, female orgasm, prostaglandin in male ejaculate.
21/05/2012
FIK/MaternityNs/Treesia
30
BREAST AND NIPLE CARE
Wear a supportive bra No soap on the niple Collostrum at the last semester Niple cups for correcting inverted niple (2 months before labour)
21/05/2012
FIK/MaternityNs/Treesia
31
IMMUNIZATIONS DURING PREGNANCY
Tetanus Diphteria (Td) vacc if didnt receive Td vacc in the past 10 years 2nd trimester Tetanus Diphteria and Pertusis (Tdap) vacc C after delivery C Woman with high risk HBV infection C HBsAG C vacc ≠ hepatitis A, polio and MMR vacc (at least 28 d)
21/05/2012
FIK/MaternityNs/Treesia
32
DANGER SIGNS
Headaches, visual disturbance or dizziness Increase in systolic BP > 30mmHg Increase in dyastolic BP > 15mmHg BP > 140/80 mmHg Epigastric, abdominal or severe flank pain Burning on urination or severe pain Abnormal fatigue and nervousness Anginal pain and shortness of breath noted with activity Muscular irritability, confusion or seizure Vaginal bleeding or fluid leaking from the vagina Decrease in fetal movement/kick out Fever greater than 38⁰C
21/05/2012 FIK/MaternityNs/Treesia 33
WEIGHT GAIN AND FETAL GROWTH
Normal Total Weight gain 11,5 – 16 kg 1st trimester 1,3 kg After 1st trimester 0,45 kg/week
21/05/2012
FIK/MaternityNs/Treesia
34
21/05/2012
FIK/MaternityNs/Treesia
35
CHILDBIRTH EDUCATION
• BREATHING PATTERNS paced breathing is a method in which the woman paces herself by breathing rhytmically and by self regulation, is able to conserve energy • NATURAL CHILDBIRTH process of giving birth with minimum medical and pharmacologic intervention birth process, pain management, and provider choices
21/05/2012 FIK/MaternityNs/Treesia 36
1st stage breathing
Slow paced breathing cleansing breath-slowly-cleansing breath (like sleeping) Modified paced breathing cleansing breath-rapid and slow-cleansing breath Patterned paced breathing used during the later part of cervical dilation to counteract the desire to push before the cervix fully dilated cleansing breath-more rapid (“hee-hoo”)
21/05/2012 FIK/MaternityNs/Treesia 37
Paced breath rythm according to the contraction
21/05/2012 FIK/MaternityNs/Treesia 38
2nd stage breathing/expulsion breathing
Fully dilated + has the urge tu push Cleansing breath – another deep breath – push down when exhaling (open glottis technique)
21/05/2012
FIK/MaternityNs/Treesia
39
Leifer, Gloria (2008). Maternity Nursing: an introductory text, tenth edition. Canada : Elsevier ; page 83-87
21/05/2012
FIK/MaternityNs/Treesia
40
21/05/2012
FIK/MaternityNs/Treesia
41
FIK/MaternityNs/Treesia
1
• DIAGNOSIS OF PREGNANCY 1. Sign and symptom 2. Estimating date of birth • ADAPTATION TO PREGNANCY 1. Maternal Adaptation 2. Paternal adaptation 3. Sibling adaptation 4. Grandparent adaptation • CARE MANAGEMENT 1. Variation in prenatal care 2. Childbirth and perinatal education
21/05/2012
FIK/MaternityNs/Treesia
2
Preasumptive Sign and Symptoms : Missed period (amenorhoe) Nausea and vomitting (morning sickness) Breast tenderness and enlargment Fatique Urinate more often than usual, particularly at night Mood changes (unexplained tearness) Craving for foods/otherwise Distaste food Skin pigmentation changes
21/05/2012 FIK/MaternityNs/Treesia 3
Preasumptive sign and symptom
Missed period Sometimes light bleeding = implantation bleed (occurs when the embryo first attach it self to the lining of the uterus/womb) Pregnancy suspected if more than 10 days has elapsed since the time of the expected onset. NOT PREGNANT: Execive exercise, low body weight, stress, hormonal imbalance, breast feeding
21/05/2012 FIK/MaternityNs/Treesia 4
Preasumptive sign and symptom
Nausea and vomiting Begins between 2 and 6 week after conception and subsides at 12 Happens on 7 from 10 pregnant woman NOT PREGNANT : Food poisoning, Gastrointestinal dissorder, some types of infections
21/05/2012
FIK/MaternityNs/Treesia
5
Preasumptive sign and symptom
Breast changes Fuller, swolen and tender Skin around the niple (areola) become darker and the vein become obvious NOT PREGNANT : Effect of hormones before period, oral contraception pills, hormonal imbalance
21/05/2012 FIK/MaternityNs/Treesia 6
Preasumptive sign and symptom
Fatique Cause by the massive increase of the sex hormone progesterone Progesterone is needed to maintain the pregnancy and help the baby to grow, but it also slows metabolism. Energy levels usually rise again by around the fourth month of pregnancy when the placenta is well established.
21/05/2012 FIK/MaternityNs/Treesia 7
Preasumptive sign and symptom
Frequent urination Pregnancy causes an increase in levels of body fluids and greater kidney efficiency. The swelling uterus also presses against the bladder
21/05/2012
FIK/MaternityNs/Treesia
8
Preasumptive sign and symptom
Mood changes • It is thought that the pregnancy hormones influence chemicals in the brain, causing mood changes. Food cravings especially for foods that provide energy and calcium, such as milk and other dairy products. You may also notice a sudden distaste for foods you previously liked. Some women even develop a bizarre taste for non-food items such as soil or paper. This is called ‘pica’.
21/05/2012
FIK/MaternityNs/Treesia
9
Preasumptive sign and symptom
Skin pigmentation changes: Chloasma/melasma gravidarum (the mask of pregnancy-brownish pigmentation appearing on the face of buterfly pattern in 5070% of women. Ussualy symetric and distributed on the forehead, cheeks and nose.
21/05/2012
FIK/MaternityNs/Treesia
10
Preasumptive sign and symptom
Linea nigradark vertical line on the abdomen between the sternum and the symphisis pubis
21/05/2012
FIK/MaternityNs/Treesia
11
Preasumptive sign and symptom
Abdominal striae (striae gravidarum)reddish or purplish linear marks sometimes appearing on the breast, abdomen, buttocks, anfd thighs because of the streching, rupture and athropy of the deep connective tissue of the skin.
21/05/2012
FIK/MaternityNs/Treesia
12
PROBABLE SIGNS OF SIGNS AND SYMPTOMS Objective findings detected by 12 to 16 weeks of gestation
Enlargment of abdomen (felt through di abdominal wall just above symphysis pubis) Changes the shape, size and consistency the uterus (pear shape to globe shape, Hegar’s sign=lower uterine segment soften 6-8weeks after the onset of last menstrual period) Changes in cervix a. Chadwick’s sign-bluish or purplish discoloration of cervix and vaginal wall b. Goodell’s sign-softening of the cervix; may occur as early as 4 weeks
21/05/2012 FIK/MaternityNs/Treesia 13
Hegar’s sign on pregnancy
21/05/2012 FIK/MaternityNs/Treesia 14
Chadwick’s sign on pregnancy
21/05/2012 FIK/MaternityNs/Treesia 15
PROBABLE SIGNS OF SIGNS AND SYMPTOMS Objective findings detected by 12 to 16 weeks of gestation
Interminttent contractions of the uterus (Braxton Hick contractions)painless, palpable contractions occuring at irregular intervals, more frequently felt after 28 weeks. Ussualy disappear with walking or exercise. Ballottement – sinking and rebounding of the fetus in its surrounding amniotic fluid in responce to sudden tap on the uterus (occurs near midpregnancy) Changes in levels of human chorionic gonadotropin (hCG) in maternal plasma and uterine Leukorrhea- increase in vaginal discharge Quickening (sensations of fetal movement in the abdomen)-occurs between the 16th and 20th week after the onset of the last menses Positive hCG
21/05/2012
FIK/MaternityNs/Treesia
16
POSITIVE SIGN AND SYMPTOMS Diagnostic Of Pregnancy
Fetal Heart tones (FHTs)ussually heard between 16th and 20th week of gestation with fetoscope or the 10th and 12th week of gestation with a Doppler stethoscope. Fetal movements felt by the examiner (after about 20 weeks gestation) Outlining of the fetal body through the maternal abdomen in the second half of pregnancy Sonographic evidence (after 4 weeks gestation) using vaginal ultrasound. Fetal cardiac motion can be detected by 6 weeks gestation.
21/05/2012 FIK/MaternityNs/Treesia 17
Nagele’s Rule is a method of obtaining an EDD (Estimated Date of Delivery) 1. Determine first day of last normal menstrual period 2. Count back 3 months 3. Add 7 days 4. Corect year if needed +7-3+1 (day/month/year)
21/05/2012 FIK/MaternityNs/Treesia 18
Practice : First day of LNMP : November 18 Date of Birth?
21/05/2012
FIK/MaternityNs/Treesia
19
The average duration of pregnancy is app 280 days/ 40 weeks (lunar months=28 days/months) same as 9 calendar months. Trimester = 1st trimester (14 weeks), 2nd trimester (1528 weeks) and 3rd trimester (29 weeks to delivery)
21/05/2012
FIK/MaternityNs/Treesia
20
GOALS 1. Ensuring a safe birth for mother and child promoting a good health habits and reducing risk factors 2. Teaching health habits that may be continued after pregnancy 3. Educating about self care during pregnancy 4. Providing physical assessment and care 5. Preparing parents for adaptation to parenthood
21/05/2012 FIK/MaternityNs/Treesia 21
PRENATAL VISIT
Initial health and social history personal information, medical and obstetric history, family and cultural history. Physical examination head to toe assessments, patient’s weight and BP Subsequent visits month 0-7 : 1/month month 8-9 : 1/week antenatal care
21/05/2012 FIK/MaternityNs/Treesia 22
PRENATAL HIGH RISK FACTORS INDICATING FOR SPECIAL PRENATAL TESTING
• Maternal condition that increases risk for uteroplacental insuffuciency such as DM or hypertension • History of previous stillbirth • Mother’s age less than 16 or more than 35 years • Multifetal pregnancy • Post term pregnancy • Decreased fetal movement • Oligohydramnios • Intrauterine growth restriction (IUGR) • History of congenital abnormalities
21/05/2012 FIK/MaternityNs/Treesia 23
21/05/2012
FIK/MaternityNs/Treesia
24
21/05/2012
FIK/MaternityNs/Treesia
25
PERINATAL EDUCATION • BATHING • PHYSICAL ACTIVITY AND EXERCISE DURING PREGNANCY • SEXUAL ACTIVITY DURING PREGNANCY • DOUCHING • CHLOTHING • BREAST AND NIPPLE CARE • DENTAL CARE • IMMUNIZATIONS DURING PREGNANCY • EMPLOYMENT DURING PREGNANCY • TRAVEL DURING PREGNANCY • MEDICATIONS • DANGER SIGNS • WEIGHT GAIN AND FETAL GROWTH • NUTRITION
21/05/2012 FIK/MaternityNs/Treesia 26
PERINATAL EDUCATION
BATHING Consider safety measures such as rubber mats and hand rails
≠ sauna, tub baths
Maternal body temp < 38⁰C
21/05/2012
FIK/MaternityNs/Treesia
27
PHYSICAL ACTIVITY AND EXERCISE DURING PREGNANCY
Mild to moderate exercise ≠ supine, twist, bounce, jerky movements, HR 140bpm Exercises for muscle strengthening and relaxation : Pelvic tilt (back and abdominal muscles) Tailor sitting (thigh and pelvic muscles) Kegel exercises (pubococcygeal muscles) Relaxation
21/05/2012 FIK/MaternityNs/Treesia 28
21/05/2012
FIK/MaternityNs/Treesia
29
SEXUAL ACTIVITY DURING PREGNANCY
No valid reason to avoid sexual activity Increased uterine activity: Breast stimulation, female orgasm, prostaglandin in male ejaculate.
21/05/2012
FIK/MaternityNs/Treesia
30
BREAST AND NIPLE CARE
Wear a supportive bra No soap on the niple Collostrum at the last semester Niple cups for correcting inverted niple (2 months before labour)
21/05/2012
FIK/MaternityNs/Treesia
31
IMMUNIZATIONS DURING PREGNANCY
Tetanus Diphteria (Td) vacc if didnt receive Td vacc in the past 10 years 2nd trimester Tetanus Diphteria and Pertusis (Tdap) vacc C after delivery C Woman with high risk HBV infection C HBsAG C vacc ≠ hepatitis A, polio and MMR vacc (at least 28 d)
21/05/2012
FIK/MaternityNs/Treesia
32
DANGER SIGNS
Headaches, visual disturbance or dizziness Increase in systolic BP > 30mmHg Increase in dyastolic BP > 15mmHg BP > 140/80 mmHg Epigastric, abdominal or severe flank pain Burning on urination or severe pain Abnormal fatigue and nervousness Anginal pain and shortness of breath noted with activity Muscular irritability, confusion or seizure Vaginal bleeding or fluid leaking from the vagina Decrease in fetal movement/kick out Fever greater than 38⁰C
21/05/2012 FIK/MaternityNs/Treesia 33
WEIGHT GAIN AND FETAL GROWTH
Normal Total Weight gain 11,5 – 16 kg 1st trimester 1,3 kg After 1st trimester 0,45 kg/week
21/05/2012
FIK/MaternityNs/Treesia
34
21/05/2012
FIK/MaternityNs/Treesia
35
CHILDBIRTH EDUCATION
• BREATHING PATTERNS paced breathing is a method in which the woman paces herself by breathing rhytmically and by self regulation, is able to conserve energy • NATURAL CHILDBIRTH process of giving birth with minimum medical and pharmacologic intervention birth process, pain management, and provider choices
21/05/2012 FIK/MaternityNs/Treesia 36
1st stage breathing
Slow paced breathing cleansing breath-slowly-cleansing breath (like sleeping) Modified paced breathing cleansing breath-rapid and slow-cleansing breath Patterned paced breathing used during the later part of cervical dilation to counteract the desire to push before the cervix fully dilated cleansing breath-more rapid (“hee-hoo”)
21/05/2012 FIK/MaternityNs/Treesia 37
Paced breath rythm according to the contraction
21/05/2012 FIK/MaternityNs/Treesia 38
2nd stage breathing/expulsion breathing
Fully dilated + has the urge tu push Cleansing breath – another deep breath – push down when exhaling (open glottis technique)
21/05/2012
FIK/MaternityNs/Treesia
39
Leifer, Gloria (2008). Maternity Nursing: an introductory text, tenth edition. Canada : Elsevier ; page 83-87
21/05/2012
FIK/MaternityNs/Treesia
40
21/05/2012
FIK/MaternityNs/Treesia
41
