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Chapter 12
Nursing Management During Pregnancy
Objectives
1.
2.
Identify the information typically collected at the initial prenatal
visit.
3.
4.
Discuss the tests used to assess maternal and fetal well-being,
including nursing management for each.
5.
Outline appropriate nursing management to promote maternal
self-care and minimize the common discomforts of pregnancy.
6.
Key Terms
Alpha- Fetoprotein
Aminocentesis
Biophysical Profile
Chorionic Villus Sampling(CVS)
Gravida
Para
High-Risk Pregnancy
Natural Childbirth
Perinatal Education
Preconception Care
Preconception Care
Immunization status
Underlying medical conditions
Reproductive health care practices
Sexuality and sexual practices
Nutrition
Lifestyle practices
Psychosocial issues
Medication and drug use
Support system
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Menstrual History
Menstrual cycle
Age at menarche
Days in cycle
Flow characteristics
Discomforts
Use of contraception
11/21/07
Subtract 3 months
8/21/07
Add 7 days
8/28/07
Add 1 year
8/28/08 = EDB
Pregnancy Wheel
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
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement True or False?
A multipara refers to a woman who is pregnant for the first
time.
Answer
False.
A multipara refers to a woman who has had two or more
pregnancies resulting in viable offspring.
Physical Examination
Vital signs
Head-to-toe assessment
Head and neck
Chest
Abdomen, including fundal height if appropriate
Extremities
Ricci, 2009
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Laboratory Tests
Urinalysis
Complete blood count
Blood typing
Rh factor
Rubella titer
Hepatitis B surface antigen
HIV, VDRL, and RPR testing
Cervical smears
Ultrasound
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Follow-up Visits
Visit schedule:
Every 4 weeks up to 28 weeks
Every 2 weeks from 29 to 36 weeks
Every week from 37 weeks to birth
Fundal Height
Question
Is the following statement True or False?
A woman who is 24 weeks pregnant would arrange
for a follow-up visit every 2 weeks.
Answer
False.
A woman who is 24 weeks pregnant would have follow-up
visits scheduled every 4 weeks until she reaches 29
weeks gestation.
Ultrasound
PUBS
Question
While assessing a woman at 18 weeks gestation, which of
the following would the nurse report as unusual?
A. Urinary frequency
B. Backache
C. Leukorrhea
D. Flatulence with bloating
Answer
A.
During the second trimester, urinary frequency
typically improves when the uterus becomes an
abdominal organ and moves away from the bladder
region. Backache and flatulence with bloating are
common during the second trimester. Leukorrhea
begins in the first trimester and continues
throughout pregnancy.
REVIEW
1. Which of the following biophysical profile findings
indicate poor oxygenation to the fetus?
A. Two pockets of amniotic fluid
B. Well flexed arms and legs
C. Nonreactive fetal heart rate
D. Fetal breathing movements
REVIEW
The correct response is C:
A nonreactive fetal heart rate is one of the biophysical
profile findings that indicates poor oxygenation to the
fetus.
REVIEW
2. The nurse teaches the pregnant client how to perform
Kegal exercises as a way to accomplish which of the
following?
A. Prevent perineal lacerations
B. Stimulate postdates labor
C. Increase pelvic muscle tone
D. Lose pregnancy weight quickly
Review
The correct response is C:
Kegel exercises help to tighten and strengthen pelvic
floor muscles to improve tone. They can help prevent
stress incontinence in women after childbirth. These
exercises dont strengthen the perineal area on the
outside to prevent lacerations, but rather the internal
pelvic floor muscles. Kegel exercises have nothing to do
with the start of labor for postdate infants. A drop in
progesterone levels and an increase in prostaglandins
augment labor, not exercise. Kegel exercises dont burn
calories.
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
REVIEW
3. During a clinic visit, a pregnant client at 30 weeks gestation
tells the nurse, Ive had some mild cramps that are pretty
irregular, What does this mean? the cramps are probably:
A. The beginning of labor in its very early stages
B. An ominous finding that the client is about to have
a miscarriage.
C. Related to over hydration in the client.
D. Braxton-Hicks contractions which occur though out
pregnancy
REVIEW
The correct response is D.
The uterus is constantly contracting throughout
pregnancy, but the contractions are irregular and not
usually felt by the woman, nor do they cause dilation of
the cervix. Braxton Hicks contractions are not the start of
early labor, since there arent any measurable cervical
changes. They are normal throughout the pregnancy, not
an ominous sign of an impending abortion. A womans
hydration status is not related to Braxton Hicks
contractions; they occur regardless of her fluid status.
REVIEW
4. a pregnant clients last normal mesntrual period was on
August 10. Using Nagels rule , the nurse calculates that
her estimated date of birth(EDB) will be which of the
following?
A. June 23
B. July 10
C. July 30
D. May 17
REVIEW
The correct response is D:
Using Nageles rule, 3 months are subtracted and 7 days
are added, plus 1 year from the date of the last
menstrual period
Questions ???
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins