MATERNAL NEWBORN NURSING

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MATERNAL NEWBORN NURSING

• REVIEW OF REPRODUCTIVE AP, FETAL CONCEPTION AND
  DEVELOPMENT
• ANTEPARTUM TERMINOLOGY
• ANTEPARTUM ASSESSMENT
• PHYSIOLOGICAL CHANGES IN PREGNANCY
• PSYCHO-SOCIAL CHANGES IN PREGNANCY
• MATERNAL NUTRITION
• ASSESSMENT OF FETAL WELL BEING

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MODULE 1 PART 1 REVIEW OF REPRODUCTIVE ANATOMY
AND PHYSIOLOGY
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• REVIEW
• REPRODUCTIVE AP, FETAL CONCEPTION DEVELOPMENT
• THIS WILL NOT BE COVERED IN THIS LECTUREBE
  PREPARED TO ANSWER REVIEW QUESTIONS IN CLASS
• THE QUIZ IN CLASS 1 WILL FOCUS ON CHANGES IN
  PREGNANCY AND TERMINOLOGY

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Review of Reproductive AP

• External Genitals
• Internal Reproductive Organs
• Vagina
• Uterus
• Uterine corpus
• Cervix
• Uterine ligaments
• Fallopian Tubes
• Ovaries

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Figure 22 Female internal reproductive organs.
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Figure 24 Structures of the uterus.
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REVIEW OF REPRODUCTIVE AP

• UTERINE LIGAMENTS
• ROUND LIGAMENTS
• OVARIAN LIGAMENTS
• CARDINAL LIGAMENTS
• INFUNDIBULOPELVIC LIGAMENT
• UTEROSACRAL LIGAMENT

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Figure 26 Uterine ligaments.
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Figure 23b Blood supply to vagina, ovaries,
uterus, and fallopian tube.
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Figure 23a Blood supply to internal
reproductive organs. Pelvic blood supply.
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Figure 25a Uterine muscle layers. Muscle fiber
placement.
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MODULE 1 PART 2 REVIEW OF REPRODUCTIVE A P
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• PELVIC STRUCTURE
• Innominate bones
• ILIUM
• ILIAC CREST
• ISCHIUM
• ISCHIAL TUBEROSITY
• ISCHIAL SPINES
• PUBIS
• SYMPHYSIS PUBIS
• Sacrum
• SACRAL PROMOTORY, SACROILIAC JOINTS
• Coccyx

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REVIEW OF REPRODUCTIVE AP

• PELVIC DIVISION
• TRUE PELVIS
• INLET
• PELVIC CAVITY
• OUTLET

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Figure 28 Pelvic bones with supporting
ligaments.
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Figure 210a Female pelvis. False pelvis is
shallow cavity above the inlet true pelvis is
deeper portion of cavity below the inlet.
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Figure 211 Pelvic planes coronal section and
diameters of the bony pelvis.
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REVIEW OF REPRODUCTIVE AP

• PELVIC DIAPHRAGM
• LEVATOR ANI
• COCCYGEAL MUSCLES
• DEEP FASCIA
• PELVIC FLOOR MUSCLES
• LEVATOR ANI
• ILLIOCOCCYGEUS
• PUBOCOCCYGEUS, COCCYGEUS
• PUBORECTALIS, PUBORECTALIS
• PUBOVAGINALIS

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Figure 29 Muscles of the pelvic floor. (The
puborectalis, pubovaginalis, and coccygeal
muscles cannot be seen from this view.)
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REVIEW OF REPRODUCTIVE AP

• BREASTS
• NIPPLE
• AREOLA
• TUBERCLES OF MONTGOMERY
• LACTIFEROUS DUCTS
• ADIPOSE, GLANDULAR, FIBROUS TISSUE
• COOPERS LIGAMENTS

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Figure 212 Anatomy of the breast sagittal
view of left breast.
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MODULE 1 PART 3 CONCEPTION
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• MATURATION OF OVARIAN FOLLICLE
• OVULATION
• CORPUS LUTEUM
• NEUROHUMORAL RESPONSE
• HYPOTHALMUS RELEASES GONADATROPIN-RELEASING
  HORMONE TO PITUITARY FROM RESPONES FROM CNS
• ANTERIOR PITUITARY THEN SECRETES FSH AND LH

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• FEMALE REPRODUCTIVE CYCLE
• OVARIAN CYCLE
• FOLLICULAR PHASE
• LUTEAL PHASE
• FEMALE HORMONES
• ESTROGEN
• PROGESTERONE
• PROSTAGLANDINS
• UTERINE CYCLE (MENSTRUAL)

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Figure 213 Female reproductive cycle
interrelationships of hormones with the four
phases of the uterine cycle and the two phases of
the ovarian cycle in an ideal 28-day cycle.
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Figure 214 Various stages of development of
the ovarian follicles.
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REVIEW OF CONCEPTION AND FETAL DEVELOPMENT

• CELLULAR DIVISION
• MITOSIS
• MEIOSIS
• OOGENESIS
• SPERMATOGENESIS
• PRE-FERTILIZATION
• CAPACIATION
• ACROSOMAL REACTION
• FERTILIZATION

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• PREEMBRYONIC STAGE
• CELLULAR MULTIPLICATION
• CLEAVAGE
• MORULA
• BLASTOCYST
• TROPHOBLAST
• IMPLANTATION
• CHANGES IN ENDOMETRIUM
• DECIDUA CAPSULARIS
• DECIDUA BASALIS
• DICIDUA VERA

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Figure 32a Sperm penetration of an ovum. The
sequential steps of oocyte penetration by a sperm
are depicted moving from top to bottom. Source
Scanning electron micrograph from Nilsson, L.
(1990). A child is born. New York Dell
Publishing.
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Figure 31b Each spermatogonium produces four
haploid spermatozoa.
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Figure 35 Formation of primary germ layers. A,
Implantation of a 71/2-day blastocyst in which
the cells of the embryonic disc are separated
from the amnion by a fluid-filled space. The
erosion of the endometrium by the
syncytiotrophoblast is ongoing. B, Implantation
is completed by day 9, and extraembryonic
mesoderm is beginning to form a discrete layer
beneath the cytotrophoblast. C, By day 16 the
embryo shows all three germ layers, a yolk sac,
and an allantois (an outpouching of the yolk sac
that forms the structural basis of the body
stalk, or umbilical cord). The cytotrophoblast
and associated mesoderm have become the chorion,
and chorionic villi are developing. Source
Adapted from Marieb, E. N. (1998).
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Figure 34 During ovulation, the ovum leaves
the ovary and enters the fallopian tube.
Fertilization generally occurs in the outer third
of the fallopian tube. Subsequent changes in the
fertilized ovum from conception to implantation
are depicted.
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MODULE 1 PART 4 REVIEW OF CONCEPTION AND FETAL
DEVELOPMENT
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• CELLULAR DIFFERENTIATION
• THREE PRIMARY GERM LAYERS
• ECTODERM
• MESODERM
• ENDODERM
• EMBRYONIC MEMBRANES
• AMNION
• CHORION
• AMNIOTIC SAC

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REVIEW FETAL DEVELOPMENT

• AMNIOTIC FLUID
• UMBILICAL CORD
• PLACENTA

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REVIEW OF FETAL DEVELOPMENT

• EMBRYONIC AND FETAL DEVELOPMENT
• EMBRYONIC STAGEDAY 15 T0 8TH WEEK
• FETAL STAGE8TH WEEK TO BIRTH

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Figure 310 Vascular arrangement of the
placenta. Arrows indicate the direction of blood
flow. Maternal blood flows through the uterine
arteries to the intervillous spaces of the
placenta and returns through the uterine veins to
maternal circulation. Fetal blood flows through
the umbilical arteries into the villous
capillaries of the placenta and returns through
the umbilical vein to the fetal circulation.
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Figure 37 Early development of primary
embryonic membranes. At 41/2 weeks, the decidua
capsularis (placental portion enclosing the
embryo on the uterine surface) and decidua
basalis (placental portion encompassing the
elaborate chorionic villi and maternal
endometrium) are well formed. The chorionic villi
lie in blood-filled intervillous spaces within
the endometrium. The amnion and yolk sac are well
developed. Source Adapted from Marieb, E. N.
(1998).
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Figure 310 Vascular arrangement of the
placenta. Arrows indicate the direction of blood
flow. Maternal blood flows through the uterine
arteries to the intervillous spaces of the
placenta and returns through the uterine veins to
maternal circulation. Fetal blood flows through
the umbilical arteries into the villous
capillaries of the placenta and returns through
the umbilical vein to the fetal circulation.
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Figure 37 Early development of primary
embryonic membranes. At 41/2 weeks, the decidua
capsularis (placental portion enclosing the
embryo on the uterine surface) and decidua
basalis (placental portion encompassing the
elaborate chorionic villi and maternal
endometrium) are well formed. The chorionic villi
lie in blood-filled intervillous spaces within
the endometrium. The amnion and yolk sac are well
developed. Source Adapted from Marieb, E. N.
(1998).
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Figure 36 Endoderm differentiates to form the
epithelial lining of the digestive and
respiratory tracts and associated glands. Source
Adapted from Marieb, E. N. (1998).
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Figure 312 The actual size of a human
conceptus from fertilization to the early fetal
stage. The embryonic stage begins in the third
week after fertilization the fetal stage begins
in the ninth week. Source Adapted from Marieb,
E. N. (1998).
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MODULE 1 PART 5 REVIEW QUESTIONS
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REVIEW QUESTIONS

• WHAT IS THE SIGNIFICANCE OF THE ENDOMETRIAL
  (MUCOSAL) LAYER OF THE UTERUS?
• THE UTERUS IS MADE UP OF WHAT TYPE OF MUSCLE?
• ESTROGEN IS SECRETED BY THE_______?
• PROGESTERONE IS SECRETED BY THE_______?
• WHAT IS THE FUNCTION OF FSH AND LH?
• DESCRIBE MEIOSIS.

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REVIEW QUESTIONS

• WHERE DOES FERTILIZATION OCCUR?
• THE BLASTOCYST DEVELOPS INTO THE ______.
• THE TROPHOBLAST DEVELOPS INTO THE ____.
• THE PLACENTA DEVELOPS FROM THE ______.
• WHICH SYSTEMS/STRUCTURES DEVELOP FROM THE
  MESODERM LAYER?

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• NAME THREE FACTORS THAT AFFECT FETAL DEVELOPMENT.
• WHAT IS THE ROLE OF THE BROAD AND ROUND
  LIGAMENTS?
• WHAT IS THE UPPER PORTION OF THE UTERUS CALLED?
• WHATS CHANGES OCCUR IN THE FUNCTION OF THE
  OVARIES AT ABOUT THE 12- 14TH WEEK OF PREGNANCY?

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MODULE 1 PART 6A PHYSIOLOGICAL CHANGES IN
PREGNANCY
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PHYSIOLOGICAL CHANGES IN PREGNANCY
GROWTH OF PLACENTA
INTEGUMENTARY
RESPIRATORY
ENDOCRINE
RENAL
CARDIOVASCULAR
GI GU
REPRODUCTIVE
MUSCULOSKELETEL
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• REPRODUCTIVE SYSTEM
• PLACENTA
• AMNION
• CHORION
• UMBILICAL CORD
• AMNIOTIC FLUID

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• REPRODUCTIVE SYSTEM
• PLACENTAL FUNCTION
• METABOLIC
• TRANSPORT
• ENDOCRINE

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REPRODUCTIVE SYSTEM

• OVARIES
• STOP PRODUCING OVA. CORPUS LUTEUM IS ACTIVE
  10-12 WEEKS INTO PREGNANCY TO PRODUCE ESTROGEN
  AND PROGESTERONE. THEN WHAT HAPPENS?
• BREASTS
• INCREASED VASCULARITY AND SIZE
• HYPERTROPHY OF MAMMARY AVEOLI
• BECOME MORE NODULAR NIPPLES ENLARGE
• PIGMENTATION OF AREOLA COLUSTRUM

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• REPRODUCTIVE SYSTEM
• UTERUS
• INCREASE IN SIZE, WEIGHT, AND VOLUME CAPACITY
• FIBROUS TISSUE INCREASES
• INCREASE IN BLOOD FLOW
• CERVIX
• GOODALLS SIGN, CHADWICKS SIGN
• DEVELOPMENT OF MUCOS PLUG

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• REPRODUCTIVE SYSTEM
• VAGINA
• MUCOSA THICKENS
• INCREASE IN SECRETIONS
• LOOSENING OF CONNECTIVE TISSUEWHY?

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• RESPIRATORY SYSTEM
• O2 CONSUMPTION INCREASES
• BREATHING CHANGES FROM ABDOMINAL TO THORACIC
• INCREASED VACULARITY
• DIAPHRAGM ELEVATES

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• CARDIOVASCULAR SYSTEM
• BLOOD VOLUME INCREASES
• DECREASE IN SYSTEMIC AND PULMONARY RESISTANCE IN
  THIRD TRIMESTER
• INCREASE IN CARDIAC OUTPUT, PULSE INCREASE (10-15
  BPM) Why?
• SVR DECREASE IN THIRD TRIMESTER

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• MUSCULOSKELETAL SYSTEM
• PELVIC JOINTS RELAX
• CENTER OF GRAVITY CHANGES
• METABOLISM
• EXTRA WATER, FAT, AND PROTEIN STORED
• FATS ARE MORE COMPLETELY ABSORBED
• BMR INCREASE (CAN BE UP TO 25)

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MODULE 1 PART 6B PHYSIOLOGICAL CHANGES IN
PREGNANCY
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• GASTRONTESTINAL
• SMOOTH MUSCLE RELAXATIONRELATED TO PROGESTERONE
  INFLUENCE

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• RENAL
• FREQUENCY
• DILATATION OF KIDNEYS, URETERS ELONGATE
• INCREASED GFR, CREATININE CLEARANCE AND RENAL
  PLASMAFLOW-WHY?
• GLYCOSURIA MAY OCCUR

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• INTEGUMENTARY
• HYPERPIGMENTATION
• STRIAE
• CHLOASMA (MELASMA)
• VASCULAR SPIDER NEVI
• DECREASED HAIR GROWTH
• HYPERACTIVE SWEAT AND SEBACEOUS GLANDS

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• ENDOCRINE SYSTEM
• THYROIDT4 AND BMR INCREASE (25 BY TERM), TSH
  DECREASES THYROIDGLAND ENLARGES, INCREASED
  IODINE METABOLISM, INCREASED VASCULARITY
• PITUITARYFSH AND LH SUPPRESSED, SECRETION OF
  PROLACTIN, OXYTOCIN, AND VASOPRESSION
• PANCREASINSULIN PRODUCTION INCREASE
• TO COMPENSATE FOR PLACENTAL HORMONE INSULIN
  ANTAGONISTS

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• ENDOCRINE SYSTEM
• CONCENTRATION OF PARATHYROID HORMONE
  INCREASESWHY IS THIS SIGNIFICANT?
• INCREASED ALDOSTERONE
• ADRENALSLITTLE CHANGE

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• ENDOCRINE SYSTEM
• ESTROGEN
• LIST THREE ACTION OF ESTROGEN DURING PREGNANCY
• ESTROGEN IS PRIMARILY EXCRETED BY THE ______
  DURING PREGNANCY

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• ENDOCRINE SYSTEM
• PROGESTERONE
• LIST THREE ACTIONS OF PROGESTERONE DURING
  PREGNANCY

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• ENDOCRINE SYSTEM
• hCG--(HUMAN CHORIOGONADATROPIC HORMONE)--STIMULATE
  S PROGERTERONE AND ESTROGEN TO MAINTAIN PREGNANCY
• hPL(HUMAN PLACENTAL LACTOGEN)DECREASES MATERNAL
  METABOLISM FOR GLUCOSE (INSULIN ANTAGONIST)
• PROSTGLANDINS

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• ENDOCRINE SYSTEM
• RELAXIN
• DECREASES UTERINE CONTRACTILITY
• SOFTENS CERVIX
• SOFTENS JOINTS
• REMODELS COLLAGEN

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MODULE 1 PART 7 PSYCHOLOGICAL CHANGES IN
PREGNANCY
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MOTHERS RESPONSE TO PREGNANCY

• AMBIVALENCE
• ACCEPTANCE
• INTROVERSION
• MOOD SWINGS
• FEAR
• CHANGES IN BODY IMAGE
• ANTEPARTUM DEPRESSION?

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FATHERS RESPONSE TO PREGNANCY

• CONFUSED BY PARTNERS MOOD SWINGS
• FEELS LEFT OUT
• RESENTS ATTENTION GIVEN YO THE WOMAN
• RESENTS CHANGES IN THEIR RELATIONSHIP
• NEEDS TO RESOLVE CONFLICTS ABOUT FATHERING

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MODULE 1 PART 8 ANTEPARTUM TERMINOLOGY
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• GESTATION
• ANTEPARTUM
• INTRAPARTUM
• POSTPARTUM
• PRETERM LABOR
• POSTTERM LABOR

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• GRAVIDA
• NULLIGRAVIDA
• PRIMIGRAVIDA
• MULTIGRAVIDA

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• PARA
• NULLIPARA
• PRIMIPARA
• MULTIPARA

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• ABORTION 4-20 WEEKS
• PRE-TERM 21-39 WEEKS
• TERM 39 WEEKS, 1 DAY- 42 WEEKS

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• TPAL
• T--NUMBER OF TERM PREGNANCIES
• P--NUMBER OF BIRTHS AFTER 20 WEEKS
• ANUMBER OF ABORTIONS
• LNUMBER OF LIVING CHILDREN

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G/TPAL EXERCISES

• G T P A L
• G3 1 2 0 1
• G2 0 3 1 3
• G5 2 1 3 3
• G2 0 5 0 3

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MODULE 1 PART 9AANTEPARTUM PHYSICAL AND
PSYCHO-SOCIAL ASSESSMENT
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ANTEPARTUM PHYSICAL AND PSYCHO-SOCIAL ASSESSMENT
CULTURE
FINDINGS RELATED TO PREGNANCY
PHYSICAL ASSESSMENT
RISK FACTORS
CLIENT PROFILE
ECONOMICS ENVIRONMENT SUPPORT SYSTEM
FAMILY FUNCTION
EDUCATIONAL NEEDS
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CULTURAL BELIEFS AND PRACTICE ASSESSMENT IN
ANTEPARTUM PERIOD

• HOME REMEDIES
• NUTRITION
• ALTERNATIVE HEALTH CARE PROVIDERS
• FAMILY SUPPORT
• EXERCISE
• SPIRITUALITY

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CULTURAL CONSIDERATIONS/ASSESSMENT IN ANTEPARTUM
PERIOD

• VIEW OF PREGNANCY
• SELF CARE PRACTICES
• PAIN
• CHILDBIRTH PRACTICES
• CARE OF THE NEWBORN
• POST PARTUM

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SIGNS OF PREGNANCY

• SUBJECTIVE (PRESUMPTIVE)
• OBJECTIVE (PROBABLE)
• DIAGNOSTIC (POSITIVE)

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DUE DATE

• EDD, EDC, EDB
• NAEGLES RULESUBTRACT 3 MONTHS FROM FIRST DAY OF
  LAST MENSTRUAL PERIOD AND ADD 7 DAYS
• EXAMPLE LMP OCT. 12EDB---JULY 19

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CLIENT PROFILE

• CURRENT PREGNANCY
• PAST PREGNANCY
• CURRENT MEDICAL/SUGICAL HISTORY
• GYN HISTORY
• FAMILY MEDICAL HISTORY
• RELIGIOUS, SPIRITUAL, CULTURAL HISTORY
• OCCUPATIONAL HISTORY
• PERSONAL INFORMATION(PSYCHOSOCIAL)

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ANTEPARTUM RISK FACTORS

• FACTORS RELATED TO
• ECONOMICS
• ENVIRONMENT
• CURRENT HEALTH STATUS/PRACTICES
• AGE
• NUTRITION
• CHILDBIRTH HISTORY
• SOCIAL ISSUES
• PYSCHOLOGICAL STATUS

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MODULE 1 PART 9B ANTEPARTUM PHYSICAL AND
PSYCHOSOCIAL ASSESSMENT
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ANTEPARTUM PHYSICAL ASSESSMENT

• VS UTERUS
• SKIN EXTERNAL GENITALS
• MOUTH, EARS, NECK CERVIX, VAGINA
• CHEST AND LUNGS ANUS AND RECTUM
• BREASTS LAB EVALUATION
• HEART
• ABDOMEN
• EXTREMITIES
• REFLEXES
• SPINE

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LAB EVALUATIONS INITIAL ANTEPARTUM VISIT

• SCREENING TESTS
• CBC
• ABO AND Rh TYPING
• WBC WITH DIFFERENTIAL
• FIRST TRIMESTER ANEUPLOIDY
• STD SCREENING, HIV
• GLUCOSE
• RUBELLA TITER
• HEPATITS B
• SICKLE CELL
• PAP SMEAR

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PSYCHO-SOCIAL ANTEPARTUM ASSESSMENT

• CULTURE
• PSYCHOLOGIC STATUS
• EDUCATIONAL NEEDS
• SUPPORT SYSTEMS
• FUNCTIONING OF FAMILY
• ECONOMIC STATUS
• ENVIRONMENT

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MATERNAL NUTRITION

• AVERAGE WEIGHT GAIN
• PATTERN OF WEIGHT GAIN
• NUTRITIONAL REQUIREMENTS
• CALORIES
• PROTEIN

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MATERNAL NUTRITION

• FAT
• CARBS
• VITAMINS
• MINERALS
• CULTURAL CONSIDERATIONS

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MATERNAL NUTRITION

• VEGETARIANISM
• LACTOSE DEFICIENCY
• EATING DISORDERS
• PICA
• ADOLESCENT
• WHAT TEACHING WOULD YOU DO FOR THESE ALTERATIONS/
  CHANGES IN NUTRITION?

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ANTEPARTUM ASSESSMENTFETAL DEVELOPMENT

• FUNDAL HEIGHT
• QUICKENING
• FETAL HEART RATE
• ULTRASOUND

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Figure 75 Approximate height of the fundus at
various weeks of pregnancy.
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Figure 83 A cross-sectional view of fetal
position when McDonalds method is used to assess
fundal height.
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MODULE 1 PART 10 ASSESSMENT OF FETAL WELL BEING
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• FETAL ACTIVITY
• ULTRASOUND
• TRANSABDOMINAL
• TRANSVAGINAL
• NUCAL TRANSLUCENCY TESTING (NTT)
• DOPPLER BLOOD FLOW STUDIES

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• AMNIOCENTESIS (AMNIOTIC FLUID ANALYSIS)
• EVALUATION OF FETAL HEALTH
• EVALUATION OF LUNG MATURITY
• CHORIONIC VILLI SAMPLING (CVS)
• WHAT IS THE ADVANTAGE OF THE CVS?

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TERATOGENESIS

• MEDICATIONS MATERNAL NUTRITION VIRUS
• ALCOHOL RADIATION
• COCAINE TOBACCO
• HYPERTHERMIA
• CAFFEINE
• MARIJUANA

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MODULE 1 PART 11 DANGERS/DISCOMFORTS IN PREGNANCY
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DANGER SIGNS OF PREGNANCY

• VAGINAL BLEEDING
• LEAKAGE OF FLUID FROM VAGINA
• ABDOMINAL PAIN
• TEMP gt 101
• DIZZINESS, BLURRING OF VISION
• SEVERE HEADACHE
• EDEMA OF HANDS, FACE, FEET

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DANGER SIGNS OF PREGNANCY

• PERSISTENT VOMITING
• MUSCULAR IRRITABILITY
• EPIGASTRIC PAIN
• OLIGURIA
• DYSURIA
• ABSENCE OF FETAL MOVEMENT

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DISCOMFORTS OF PREGNANCY

• FIRST TRIMESTER
• NAUSEA AND VOMITING
• URINARY FREQUENCY
• FATIGUE
• BREAST TENDERNESS

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DISCOMFORTS OF PREGNANCY

• INCREASED VAGINAL DISCHARGE
• NASAL STUFFINESS EPITAXIS
• PTYALISM

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DISCOMFORTS OF PREGNANCY

• SECOND THIRD TRIMESTER
• HEARTBURN
• ANKLE EDEMA
• VARICOSE VEINS
• HEMORRHOIDS

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DISCOMFORTS OF PREGNANCY

• CONSTIPATION
• BACKACHE
• LEG CRAMPS
• FAINTNESS

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DISCOMFORTS OF PREGNANCY

• DYSPNEA
• FLATULENCE
• CARPAL TUNNEL SYNDROME
• DIFFICULTY SLEEPING
• ROUND LIGAMENT PAIN

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DISCOMFORTS OF PREGNANCY

• DETERMINE WHICH SYSTEM IS RESPONSIBLE FOR EACH OF
  THE DISCOMFORTS OF PREGNANCY.
• EXPLAIN HOW THE PHYSIOLOGICAL CHANGES THAT OCCUR
  IN EACH SYSTEM DURING PREGNANCY CAN BE
  RESPONSIBLE FOR THE DISCOMFORTS.
• WHAT INTERVENTIONS WOULD YOU USE TO TREAT THE
  DISCOMFORTS? (EBP)

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SUBSEQUENT LAB EVALUATION

• HEMOGLOBIN
• QUAD MARKER (15-20 WEEKS)
• INDIRECT COOMBS
• 50 G 1 HOUR GLUCOSE SCREEN
• URINALYSISGYCOSURIA, PROTEINURIA
• GROUP B STREP SCREENING (35-37 WEEKS)

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SELF CARE PROMOTION

• BATHING
• EMPLOYMENT
• TRAVEL
• ACTIVITY, REST
• FETAL ACTIVITY MONITORING
• BREAST CARE
• CLOTHING
• BATHING

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SELF CARE PROMOTION

• DENTAL CARE
• IMMUNIZATIONS
• SEXUAL ACTIVITY
• COMPLEMENTARY ALTERNATIVE THERAPIES
• ABSTINENCE FROM ALCOHOL, TOBACCO, DRUGS
• PSYCHO-SOCIALSUPPORT