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FIK/MaternityNs/Treesia
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
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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
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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
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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
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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
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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.
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Frequent urination Pregnancy causes an increase in levels of body fluids and greater kidney efficiency. The swelling uterus also presses against the bladder
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Linea nigradark vertical line on the abdomen between the sternum and the symphisis pubis
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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, Hegars sign=lower uterine segment soften 6-8weeks after the onset of last menstrual period) Changes in cervix a. Chadwicks sign-bluish or purplish discoloration of cervix and vaginal wall b. Goodells sign-softening of the cervix; may occur as early as 4 weeks
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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
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Nageles 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)
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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)
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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
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PRENATAL VISIT
Initial health and social history personal information, medical and obstetric history, family and cultural history. Physical examination head to toe assessments, patients weight and BP Subsequent visits month 0-7 : 1/month month 8-9 : 1/week antenatal care
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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
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PERINATAL EDUCATION
BATHING Consider safety measures such as rubber mats and hand rails
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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
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No valid reason to avoid sexual activity Increased uterine activity: Breast stimulation, female orgasm, prostaglandin in male ejaculate.
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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)
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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 38C
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Normal Total Weight gain 11,5 16 kg 1st trimester 1,3 kg After 1st trimester 0,45 kg/week
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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
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Fully dilated + has the urge tu push Cleansing breath another deep breath push down when exhaling (open glottis technique)
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Leifer, Gloria (2008). Maternity Nursing: an introductory text, tenth edition. Canada : Elsevier ; page 83-87
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