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    Antepartum

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    phoenix180
    This document provides an overview of normal pregnancy, including terminology used to document obstetric history, signs and symptoms of pregnancy, physical changes that occur, hormones involved, assessments at prenatal visits, and nursing management to promote maternal self-care. Key topics covered include calculating estimated due dates, changes to the uterus, breasts, cervix and cardiovascular system during pregnancy, and common concerns in each trimester.

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    Attribution Non-Commercial (BY-NC)
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    Antepartum

    Uploaded by

    phoenix180
    1K views32 pages
    This document provides an overview of normal pregnancy, including terminology used to document obstetric history, signs and symptoms of pregnancy, physical changes that occur, hormones involved, assessments at prenatal visits, and nursing management to promote maternal self-care. Key topics covered include calculating estimated due dates, changes to the uterus, breasts, cervix and cardiovascular system during pregnancy, and common concerns in each trimester.

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    Antepartum; Maternity Nursing

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    This document provides an overview of normal pregnancy, including terminology used to document obstetric history, signs and symptoms of pregnancy, physical changes that occur, hormones involved, assessments at prenatal visits, and nursing management to promote maternal self-care. Key topics covered include calculating estimated due dates, changes to the uterus, breasts, cervix and cardiovascular system during pregnancy, and common concerns in each trimester.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    1K views32 pages

    Antepartum

    Uploaded by

    phoenix180
    This document provides an overview of normal pregnancy, including terminology used to document obstetric history, signs and symptoms of pregnancy, physical changes that occur, hormones involved, assessments at prenatal visits, and nursing management to promote maternal self-care. Key topics covered include calculating estimated due dates, changes to the uterus, breasts, cervix and cardiovascular system during pregnancy, and common concerns in each trimester.

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    Normal Pregnancy

    Professor Burke

    Terminology Used to Document an Obstetric History


    Gravida: a pregnant woman
    Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc. Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more Primapara: one birth after a pregnancy of at least 20 weeks (primip) Multipara: two or more pregnancies resulting in viable offspring (multip) Nullipara: no viable offspring; para 0

    Obstetric History Terms


    G (gravida) the current pregnancy

    T (term births) the number of pregnancies ending > 37 weeks gestation, at term
    P (preterm births) the number of preterm pregnancies ending > 20 weeks or viability but before completion of 37 weeks A (abortions) the number of pregnancies ending before 20 weeks or viability L (living children) number of children currently living

    Calculating the Estimated Date of Birth (EDB) Using Nageles Rule


    Use the first day of LNMP 11/21/99 Subtract 3 months 8/21/99 Add 7 days 8/28/99 Add 1 year 8/28/2000 = EDB

    Signs and Symptoms of Pregnancy


    Presumptive (time of occurrence)
    Fatigue (12 weeks) Breast tenderness (3-4 weeks) Nausea and vomiting (4-14 weeks) Amenorrhea (4 weeks) Urinary frequency (6-12 weeks) Hyperpigmentation of the skin (16 weeks) Fetal movements (quickening) (16-20 weeks)

    Signs and Symptoms of Pregnancy


    Uterine enlargement (7-12 weeks) Breast enlargement (6 weeks)

    Probable (time of occurrence)


    Braxton-Hicks contractions (16 - 28 weeks) Positive pregnancy test (4-12 weeks) Abdominal enlargement (14 weeks) Ballottement (16-28 weeks) Goodells sign (5 weeks) Chadwicks sign (6-8 weeks) Hegars sign (6-12 weeks)

    Physical Changes of the Cervix During Pregnancy


    Chadwicks sign: Estrogen causes the cervix to become congested with blood (hyperemic), resulting in a bluish color that extends to include the vagina Goodells sign: Increased vascularity causes the cervix to soften Mucus plug: Increased mucus forms to seal off the cervix from outside bacteria

    Signs and Symptoms of Pregnancy (cont.)


    Positive (time of occurrence)
    Ultrasound verification of embryo or fetus (4-6 weeks) Fetal movement felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via Doppler (10-12 weeks)

    Physical Changes of the Uterus During Pregnancy


    Size increases to 20 times that of nonpregnant size
    Weight increases from 2 ounces to approximately 2 pounds at term Walls thin to 1.5 cm or less from a solid globe to a hollow vessel Volume capacity increases from 2 teaspoons to 1 gallon 1/6 of total maternal blood volume is contained within the vascular system of the uterus by term

    Hormones of Pregnancy
    HCG
    HPL Progesterone Estrogen

    Relaxin

    Physical Changes of the Breasts During Pregnancy


    Breasts increase in size and nodularity to prepare for lactation Nipples increase in size, become more erect, and more pigmented Colostrum is produced
    an antibody-rich, yellow fluid that can be expressed after the 12th week converts to mature milk after delivery

    Cardiovascular Changes
    Cardiac output increases Increase in plasma volume & RBC Increase in fibrin & plasma fibrinogen Decrease in Hb & HCT Increase in WBC

    Physical Changes of the GI Tract During Pregnancy


    Reflux of gastric contents common due to relaxation of smooth muscles by progesterone Ptyalism (excessive salivation) is a common condition of pregnant women Decrease in intestinal motility causes constipation Nausea and vomiting (morning sickness) is due to high hCG levels from 6 to 12 weeks

    Psychological Response to Pregnancy


    Ambivalence: initial response; no visible body change yet Acceptance: triggered by quickening in 2nd trimester Introversion: turning in on oneself Mood swings: from great joy to despair Body image change: the picture you have of your body and of yourself

    Maternal Roles
    Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant Learning to give of oneself 1st trimester: identifying what must be given up to assume new role 2nd trimester: identifying with infant, learning how to delay own desires 3rd trimester: questioning ability to become a good mother to infant (Rubin, 1984)

    Focus of Preconception Care


    Immunization status Underlying medical conditions Reproductive healthcare practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system

    Characteristics of the Initial Health History


    Includes questions about three major areas: reason for seeking care past medical, surgical, and personal history patients reproductive history Establishes a trusting relationship Focuses on education for overall wellness Attempts to detect and prevent potential problems

    Components of a Physical Examination of a Pregnant Woman


    Head-to-toe assessment
    head and neck chest abdomen Extremities

    Pelvic examination
    examination of external and internal genitalia
    bimanual examination

    pelvic shape pelvic measurements

    Pelvic Shapes

    Assessments Taken at Subsequent Prenatal Visits


    Weight and blood pressure measurements; compared to the baseline values Urine testing for presence of protein, glucose, ketones, and nitrites Fundal height measurement to assess fetal growth Assessment for quickening/fetal movement to determine well-being Assessment of fetal heart rate; should range between 120160 bp

    Fundal Height
    Indicates uterine size by measuring from the top of the symphysis pubis to the top of the fundus

    Correlates with weeks of gestation between 2030 weeks


    20 weeks = 20 cm 24 weeks = 24 cm 30 weeks = 30 cm

    Measuring fundal height

    Nursing Management to Promote SelfCare of the Pregnant Woman


    Personal hygiene Clothing Exercise Sleep and rest

    Sexual activity and sexuality Employment Travel Immunizations and medications

    First Trimester
    Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness

    Constipation Nasal stuffiness, bleeding gums and epistaxis Cravings Leukorrhea

    Second Trimester
    Blood volume continues to increase B/P drops slightly Oxygen consumption up 15-20% Pelvic ligaments relax May have gall bladder & urinary problems GFR increases up 50% Chloasma, striae gravidarum, linea nigra.

    Postural Changes

    Third Trimester
    Change in balance Backache B/P drops slightly Slowing of peristalsis Fundus = Xiphoid = SOB Edema of LE Hemorrhoids & varicosities

    Natural Childbirth Education Classes


    Lamaze (psychoprophylactic) method
    promotes the use of specific breathing and relaxation techniques

    Bradley (partner-coached) method


    uses various exercises and slow, controlled abdominal breathing to accomplish relaxation

    Dick-Read method
    is based on relaxation and breathing techniques

    Sibling Class

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