NURSING MANAGEMENT DURING PREGNANCY

Ni Ketut Alit ANursing Faculty Airlangga University

Surabaya East Java

REFERENCES Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care,

The Nurse and The Family 5th ed , St Luis : CV Mosby Company.

Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993) Maternity Nursing, St Luis : CV Mosby Company.

Mattson Susan & Smith Judi E (2000). Core Curriculum for Maternal – Newborn Nursing. 2nd ed. Philadelphia. W.B. Saunders Company.

Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 ) Ilmu Kebidanan , Jakarta Yayasan Bina Pustaka Sarwono Prawiroharjo.

Journals and article related to..

Conception, Fetal Development, Gestational Risk and Fetal Well-being

Factors affecting fetal well-being:Quality of sperm or ovumIntrauterine environmentFirst trimester exposure to hazardous agentsMaternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatorySubstance abuseKnown or unknown infections

Barriers to Prenatal Care

Sociodemographics Insurance/finances Inadequate care providers for low

income Delay in onset of prenatal care Cultural factors Transportation Attitudes

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

KSPR (Kartu Score Pudji Rohjati)Card for risk detection of Pregnacy

1st Prenatal Visit

Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and

laboratory tests

Comprehensive Health History

Reason for seeking careSuspicion of pregnancyDate of last menstrual periodSigns and symptoms of pregnancyUrine or blood test for hCG

Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric, and

gynecologic history

Menstrual History

Menstrual cycleAge at menarcheDays in cycleFlow characteristicsDiscomfortsUse of contraception

Menstrual History

Date of last menstrual period (LMP) Calculation of estimated or expected date of

birth (EDB) or delivery (EDD)Nagele’s rule

○ Use first day of LNMP 11/21/11○ Subtract 3 months 8/21/11○ Add 7 days 8/28/11○ Add 1 year 8/28/12 = EDB

Gestational or birth calculator.

Obstetric History

Gravida: a pregnant womanGravida I (primigravida): first pregnancyGravida II (secundigravida): second pregnancy, etc.

Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or morePrimapara: 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

TerminologyG (gravida): the current pregnancyT (term births): the number of pregnancies ending

>37 weeks’ gestation, at termP (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

Physical Examination

Vital signs Head-to-toe assessment

Head and neckChestAbdomen, including fundal height if appropriateExtremities

Pelvic examinationExamination of external and internal genitaliaBimanual examinationPelvic shape: gynecoid, android, anthropoid, platypelloidPelvic measurements

Laboratory Tests

Urinalysis Complete blood count Rh factor TORCH test Hepatitis B surface antigen HIV test Ultrasound

Follow-up Visits

Visit schedule: Every 4 weeks up to 28 weeksEvery 2 weeks from 29 to 36 weeksEvery week from 37 weeks to birth

Follow-up Visits

AssessmentsWeight & BP compared to baseline valuesUrine testing for protein, glucose, ketones, and nitritesFundal height Quickening/fetal movement Fetal heart rate

Teaching: danger signs

1st Trimester Discomforts

Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea

2nd Trimester Discomforts

Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating

3rd Trimester Discomforts

Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions

Nursing Management To Promote Self-Care

Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise

Nursing Management To Promote Self-Care

Sleep and rest Sexual activity and sexuality Employment Travel Immunizations and medications

Danger Signs Of Pregnancy !!! Assess and report immediately:

Vaginal bleeding in any amount - May indicate placenta previa

Premature rupture of membranes - Predisposes mom and baby to infection

Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia

Severe, persistent headaches and visual disturbances - Consider preeclampsia

Danger Signs in PregnancyReport any of the following immediately:

Fever and/or chills Painful urination Persistent nausea & vomiting Change in, or absence of fetal movement

for 6-8 hrs.

Preparation for Labor, Birth, and Parenthood

Perinatal education Childbirth education

Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques

Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing

Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

Preparation for Labor, Birth, and Parenthood

Options for birth setting Hospitals: delivery room, birthing suiteBirth centersHome birth

Options for care providersObstetricianMidwifeHealth provider

Preparation for Labor, Birth, and Parenthood

Feeding choicesBreastfeeding: advantages and disadvantagesBottle feeding: advantages and disadvantagesTeaching

Final preparation for labor and birth

Care For Better Health