Health Care Settings and the Health Care Team

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Adaptations to Pregnancy Part II
Susan Sienkiewicz

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Presumptive Signs of Pregnancy

• Amenorrhea
• Nausea and vomiting
• Fatigue
• Urinary frequency
• Changes in the breast
• Quickening

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Probable Signs of Pregnancy

• Cervical Changes
• Chadwicks sign
• Goodells sign (soft like earlobe)
• Hegars sign
• Uterine Changes
• ballottement
• uterine souffle
• contractions
• palpation of fetal outline?
• enlargement
• Positive pregnancy test

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Positive Signs of Pregnancy

• Fetal heart sounds
• Fetal movement noted by the examiner
• Visualization of fetus by ultrasound

Chapter 15
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MATERNAL PSYCHOLOGICAL ADAPTATIONS TO PREGNANCY

• 1st TRIMESTER (focus on self)
• I am pregnant!
• 2nd TRIMESTER (focus on baby)
• I am going to have a baby!
• 3rd TRIMESTER
• I going to be a Mom!

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OBSTETRIC HISTORY

• gravida, para, abortions, living children
• previous labor experiences
• types of deliveries
• maternal/infant complications
• method of feeding

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MENSTRUAL HISTORY

• onset of menses
• regularity
• LMP
• length of cycle

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CONTRACEPTIVE HISTORY

• Type/s used
• when, how long, recent use
• OCPs contraindicated 3 mos prior to pregnancy
• IUD?? spont abortion

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MEDICAL/SURGICAL HISTORY

• PMH
• PSH
• meds
• substance use/abuse
• allergies
• nutrition history

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FAMILY HISTORY

• health status of parents, sibs
• h/o multiple births
• h/o C-sections
• congenital anomalies
• PG complications

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PARTNERS HEALTH HISTORY

• genetic disorders
• chronic dz/infection
• substance use/abuse
• blood type

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VITAL SIGN NORMS DURING PREGNANCY

• Baseline B/P
• evaluate elevations for PIH
• ? 30 mm Hg over systolic baseline
• ? 15 mm Hg over diastolic baseline
• Pulse - 60 to 90
• RR - 16 to 24
• Temp - 98 to 99.6

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PREGNANCY RISK FACTORS

• age lt 18 or gt 35
• ? socioeconomic status
• ? or ? weight
• substance use/abuse
• pre-existing conditions
• negative Rh factor
• previous OB problems

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GROUP ACTIVITY
Break into clinical groups, select a facilitator,
reporter, recorder. Facilitator must ensure
that all participate. Task - determine
interventions for the following NIC 1. (SS)
Nutrition Management, Constipation Management 2.
(CD) Management of Common Discomforts of
Pregnancy (backache urinary frequency) 3.
(LR) Management of Common Discomforts of
Pregnancy (varicosities, hemorrhoids, leg
cramps) 4. (AS) Prenatal Health Education
Substance Use/Abuse, Hygiene 5. (JD) Prenatal
Health Education Lifestyle Considerations
(rest/exercise, work, travel), Reportable SS
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NUTRITION MANAGEMENT

• Ascertain food preferences
• ? wt weekly under same conditions
• Teaching re NVP
• 6 small nutrient dense meals
• dry crackers Q2H
• no fried foods no food with strong odors
• Teaching re Heartburn
• sit upright after meals X 30 min, sleep with
  extra pillow
• low sodium antacids
• fluid intake throughout the day
• relaxation technique

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CONSTIPATION MANAGEMENT

• ? fiber (25g/day)
• 2 L noncaffeinated fluids/day
• ? activity
• ? cheese

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BACKACHE MANAGEMENT

• correct posture
• squat to p/u obj
• bend _at_ knees
• foot supports

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URINARY FREQUENCY MANAGEMENT

• Kegel exercises
• 1st trimester lie on back
• sit or stand after 3rd month
• hold perivag muscles X 5 sec, then slowly release
• 25 - 30 X/day

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VARICOSITY MANAGEMENT

• support hose, no constricting socks
• avoid crossing legs _at_ knees
• freq rest periods, legs ?
• short walks

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HEMORRHOID MANAGEMENT

• sitz or tub bath X 20 min tid
• witch hazel compresses
• prevent constipation (fluids, fiber, exercise)

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LEG CRAMP MANAGEMENT

• extend affected leg, keeping knee straight, flex
  foot
• frequent leg elevation
• aluminum hydroxide

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PRENATAL HEALTH EDUCATION SUBSTANCE USE/ABUSE

• Smoking ? LBW, risk of prematurity, cognitive
  problems
• ETOH ? MR FAS
• Illegal drug use ? abruption, preterm labor, CNS
  dysfunction

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PRENATAL HEALTH EDUCATION HYGIENE

• no hot tubs or tub baths in 3rd trim
• dental care brush with soft toothbrush 2X/day,
  sugar-free gum
• no douching
• use good support bra, no soap on nipples, no
  breast stimulation
• loose, non-constricting clothing low heels

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PRENATAL HEALTH EDUCATION REST EXERCISE

• rest as much as possible
• change position freq, brief walks
• heart rate should not exceed 140 temp not gt
  100.4
• warm up/cool down
• 15 min max of strenuous exercise
• no exercise in supine position
• no Valsalva maneuver

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PRENATAL HEALTH EDUCATION LIFESTYLE
CONSIDERATIONS

• Avoid teratogenic subst _at_ work
• Travel
• lap belt under abdomen
• freq stops to empty bladder, stretch legs
• Immunizations
• no live virus vaccines (rubella)
• inactivated Ags for post-exp prophylaxis

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PRENATAL HEALTH EDUCATION REPORTABLE SIGNS
SYMPTOMS

• vaginal bldg
• ROM
• swelling of fingers/face
• continuous pounding H/A
• visual disturbances
• severe abd pain
• fever, chills
• dysuria
• persistent vomiting
• changes in fetal movement

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INDIVIDUALIZED PATIENT EDUCATION

• assess barriers to learning
• assess previous knowledge
• present most significant info first
• visual aids

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FAMILY INTEGRITY PROMOTION

• involve family members in patient teaching
  sessions
• teach family about impact of PG and birth
• encourage verbalization of feelings
• facilitate communication b/w family members

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ADAPTATIONS TO PREGNANCY CASE STUDY I
A woman is making her first antepartal visit on
August 15. She has a 2-yr old son who was
delivered at 40 wks, a 5-yr old daughter
delivered at 38 wks, and 7-yr old twins delivered
at 35 wks. She had a spontaneous abortion 3
years ago at 10 weeks. Her last menstrual period
was April 5. Fundal height is at the umbilicus.
She denies any major complaints and states her
health has been good. 1. Determine the womans
obstetrical history using the digit
system. G____ P____ T____ P____ A____
L____ 2. Determine EDD using Nageles
Rule. 3. Determine gestation on the day of this
prenatal visit. 4. Compare present fundal height
to gestation. 5. What factors may have influenced
the delay in seeking prenatal care?
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ADAPTATIONS TO PREGNANCY CASE STUDY II
An 18 year old is at 20 weeks gestation in her
first pregnancy. She admits that this was an
unplanned pregnancy and she does not intend to
marry the FOB. She quit school. She has gained
20 lbs and feels unattractive and fat. She is
the oldest of six children and lives with her
parents. 1. What factors may be involved in the
delay in seeking prenatal care? 2. Identify how
this pregnancy has begun to change this
adolescents life. 3. What are the priority
nursing diagnoses? Appropriate outcomes? 4. What
can the nurse do to assist this young woman in
meeting the needs of her newborn?
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All of the following are considered presumptive
signs of pregnancy except
A. nausea vomiting B. urinary
frequency C. fetal heart beat D. fatigue
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Maternal cigarette smoking can be hazardous to
the growing fetus. Which of the following is NOT
a common risk of maternal cigarette
smoking? A. heart defects B. ? incidence of
SIDS C. LBW D. ? incidence of apnea
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When a pregnant woman lies in the supine
position, what potentially harmful physiologic
processes occur?
A. increased edema in the hands
face B. maternal hypotension C. decreased blood
return to the heart D. after a prolonged period,
decreased oxygen to the fetus
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THE END