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Antepartal Nursing Care

Antepartal Nursing Care. Lunar month- 4 weeks, 28 days. OB Terminology . Pregnancy – divided into 3 trimesters 13 weeks each EDC - estimated date of confinement EDB - estimated date of birth *same thing Gestation - number of weeks since first day of last menstrual period

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Antepartal Nursing Care

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  1. Antepartal Nursing Care Lunar month- 4 weeks, 28 days

  2. OB Terminology • Pregnancy – divided into 3 trimesters 13 weeks each • EDC - estimated date of confinement • EDB - estimated date of birth *same thing • Gestation - number of weeks since first day of last menstrual period • Abortion - birth that occurs before end of 20 weeks gestation • Preterm 20 - 37 weeks • Term 38 - 40 wks • Postterm after 42 weeks • Gravida -any pregnancy (any: when preg lasts 4, 5, 6wks or to term) • Para - birth after 20 weeks gestation multiples count as one • Stillborn - born dead after 20 weeks • Primigravida - first time pregnancy • Multigravida - second or any subsequent pregnancy

  3. Essential Components of a Prenatal History • Basis of prenatal care- reevaluated and updated throughout the pregnancy. • Obstetric history – pertaining to pregnancy current and past • Gynecologic history- …how long pt has had menses. • Medical history - Current and past • Family medical history including Father’s health history • Religious, spiritual, and cultural history • Occupational history • Personal information about woman • Comprehensive psychosocial assessment

  4. Comprehensive OB History Acronym • TPAL • T - term births, twins or more count as one • 38 weeks • P - birth from 20 - 37 weeks • A - spontaneous or therapeutic abortion • L - living children- multiples count here

  5. Practice • Cindy is currently 34 weeks gestation and in labor with her first baby. • Gravida 1 Para 0 • After delivery - G 1 P 1 • More detail: • Gravida 1 • Term 0 • Preterm 1 • Abortions 0 • Living 1

  6. Practice • Mary is currently 26 weeks gestation and she has a 4 year old daughter that was born at 38 weeks gestation. • G 2 P 1 • More detail: • G 2 • T 1 • PT 0 • AB 0 • L 1

  7. Practice • Ms Johnson is pregnant for the 4th time. She had one abortion at 8 wks gestation. She has a daughter who was born at 40 wks gestation and a son born at 34 weeks gestation. • G 4 P 2 • More detail: • G 4 • T 1 • PT 1 • AB 1 • L 2

  8. More Practice • Ms T, at 27 weeks gestation, comes to the clinic for a routine prenatal visit. This is her 4th pregnancy. She has three children at home. One child was born at 34 wks gestation and the other two were 40 wks gestation. • G 4 P 3 • More Detail: • G 4 • T 2 • PT 1 • AB 0 • L 3

  9. One More Practice • Sharon is 22 wks pregnant. She has a 2 year old and a 4 year old that were born at 39 wks. She lost 4 pregnancies at 12 wks and she has 10 year old twin boys that were born at 33 wks gestation. • G 8 P 3 • More detail: • G 8 • T 2 • PT 1 • AB 4 • L 4

  10. Determination of Due Date • Nagele’s Rule- one method of determining the EDB. Fairly accurate method to use if woman’s cycle is every 28 days. • First day of LMP • Subtract 3 months • Add 7 days • EDB

  11. Nagele’s Rule Example • LMP April 6 • Subtract 3 months - 3 months • Jan 6 • Add 7 days +_7 days • EDB Jan 13

  12. Another Option of Nagele’s Rule • Just change the month to number • December 10 becomes 12-10 • Subtract 3 months -_3___ • 9 -10 • Add 7 days __+_7 • EDB Sept 17

  13. Other Indicators of EDB • Fundal Height – correlates with weeks gestation (top of a pregnant woman's uterus (fundus) to her pubic bone) • Quickening - fetal movement felt be the mom (~16-22wks, not very accurate) • Fetal heartbeat - Doppler 10-12 wks and 17-20 wks with fetoscope. • Ultrasound - most accurate

  14. Initial Physical Assessment • Head to toe physical assessment • 8-12 wks gestation • Starts with VS and ends with pelvic exam.

  15. Pregnancy Physical Assessment • Blood pressure - trimester specific changes (1st tri = BP drops and will rise towards the 3rd) • Weight - sudden wt gain • Skin - pigmentation • ENT - nosebleeds and swollen gums, dental infection preterm labor • Breast – enlarge, colostrum 12 wks • Abdomen - becomes larger, measured each visit (Fundal Height Measurement)

  16. Fundal Height Measurement • Measure in centimeters from the top of the symphysis pubis to the top of the uterine fundus. • 22 - 34 weeks - fundal height correlate with weeks of gestation • Too small or too large - needs to be evaluated.

  17. Figure 8–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundal height.

  18. Fundal Height Assessment • 10-12 wks - fundus slightly above symphysis pubis • 16 wks - fundus halfway between symphysis and umbilicus • 20-22 wks - fundus at umbilicus • 28 weeks - fundus three finger breadths above umbilicus • 36 wks - fundus just below ensiform cartilage

  19. Abdominal Assessment • Fetal movement felt by examiner -18 weeks • Ballotment - Fetus floating in amniotic fluid • Fetal heart tones - 110-160 BPM • Doppler 10-12wks • Fetoscope 17-20 wks

  20. Physical Assessment cont • Extremities - edema of hands and feet in later pregnancy • Reflexes - hyperactivity or clonus associated with preeclampsia • Pelvic - Pelvic measurement assessed for shape and size; dilatation and effacement • Rectum - hemorrhoids (if already present, give advice about incr fiber and fluids)

  21. Initial Laboratory Evaluation and Screening • CBC (Anemia  give more iron) • ABO and Rh typing, Antibody Screen, Blood type • Serolgy (RPR  tests for syphilis) • Rubella • Hepatitis • HIV • PAP smear • STD screen • Urinalysis – C&S; drug screen, can have a UTI that is asymptomatic • Thyroid panel- because of chance of cretinism

  22. Subsequent Prenatal Visit Routines • Every 4 weeks until 28 wks • Every 2 wks until 36 wks • Every wk until delivery • Visits include teaching and assessment of maternal/fetal well-being.

  23. Subsequent Prenatal Assessments • Vital signs • Weight - 1st trimester > 3.5 – 5lbs • 2nd and 3rd trimester > 12 -15lbs, then a lb per wk • Monitor for Edema • Uterine size and uterine activity • FHT’s and fetal movement • Urine screen for protein, glucose and ketones • Lab • CBC at 7 months • AFP at 15-20 wks • Indirect coombs for Rh negative moms at 28 wks • Glucose screen 28 wks • GBS vag culture 36 wks, “Group B Strept”- Carriers must understand the dangers for the baby. • Define: AFP- Alpha Fetal Protein, measurements in amniotic fluid are used for early diagnosis of fetal neural tube defects • High = Neural Tube defect (ex: spina bifida) • Low = Down’s Syndrome

  24. Danger Signs in Pregnancy • Vaginal bleeding (Any bright red bleeding  call phys) • Nausea and vomiting that last over 24hrs • Dehydration leads to preterm labor • Fever -100.4 • Dizziness - sudden and extreme, associated with pelvic or uterine pain • True Labor- Lower back pain to the front • False labor- Abd pain only • Preterm labor symptoms • Leaking of fluid from vagina • Preeclampsia symptoms - edema, rapid wt gain, headaches, visual disturbances, vomiting, epigastric pain, irritability, scanty urine output (usually won’t see till after 20wks) • Decreased fetal movement • Symptoms of UTI - dysuria, severe backache, fever

  25. 1st Trimester Discomforts and Measures to Alleviate • Nausea (due to HcG levels) and vomiting - avoid odors, eat small frequent meals, crackers, avoid spicy or greasy foods • HcG- a hormone produced by the placenta about 10 days after fertilization. Its detection is the basis for most pregnancy tests. • Urinary frequency - void when needed; increase fluids in day and slow down at night • Fatigue - plan rest periods, get help from support system • Breast tenderness - wear good supportive bra • Increased vaginal discharge - frequent bathing, cotton underwear • Nasal stuffiness & epistaxis - cool mist, avoid nasal decongestants and sprays • Ptyalism – “excessive saliva/bad taste in mouth” treat w/ mouthwash, chewing gum, candy

  26. 2nd and 3rd Trimester Discomforts and Measures to Alleviate • Pyrosis – “hrt burn” treat w/ small frequent meals, avoid spicy or greasy meals, sit or stand after meal • Ankle edema - rest frequently, elevate legs when resting, avoid garters • Varicose veins - elevate legs, wear support hose, avoid crossing legs, avoid constrictive bands • Flatulence - avoid constipation and gas producing foods • Hemorrhoids - avoid constipation • Constipation - increase fluids and fiber in diet, exercise, stool softeners as ordered by physician • Make sure softeners are okay’d by phys first.

  27. 2nd and 3rd Trimester Discomforts and Measures to Alleviate cont • Backache - proper body mechanics; avoid high heels, practice pelvic tilt exercise • Leg cramps - dorsiflexing foot • Faintness - rise slowly from sitting or lying, evaluate hematocrit and hemoglobin • Shortness of breath - eat small frequent meals • Difficulty sleeping - prop with pillows, use side-lying position • Lt Side is better for baby • Round ligament pain - position change, heating pad • Carpal tunnel syndrome - avoid repetitive movements of hands

  28. Promotion of Self Care During Pregnancy • Fetal activity monitoring - after 28 wks • Breast care and preparation for breastfeeding • Prenatal classes and exercises • Clothing • Bathing • Employment • Travel- wear safety belts, travel only if you have no problems, stop every 2 hrs, stay hydrated • Activity

  29. Promotion of Self Care During Pregnancycont • Dental Care • Immunizations • Complementary and alternative therapy • Before anything over the counter they need to talk to their phys • Tertatogens • Medications • Categories A – X, pg. 247 – 249; Cat. A is safe during Preg. No to Accutane!! • Tobacco- IUGR  Growth retardation, Tobacco vasocontricts! • Alcohol • Caffeine- limit intake • Street drugs • Flu Vaccine is okay, just not live ones. • Dental care > important, poor dental hygiene associated with preterm labor

  30. Concerns About Sexual Activity • Safety for fetus • Contraindications • PROM “Premature rupture of membranes” (water-break), preterm labor, vag bleeding Changes in sexual desire and response • pregnant woman • partner

  31. Nursing Care of the Pregnant Woman’s Family • Father – involved, participation • Siblings – regression, rivalry • Grandparents – involvement, conflicts

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