Chapter 12 Nursing Management During Pregnancy
Maternity and Pediatric Nursing
Objectives
• 1. Define the key terms used in this chapter.
• 2. Identify the information typically collected at the initial prenatal visit.
• . !"plain the assessments completed at follo#$up prenatal visits.
• %. Discuss the tests used to assess maternal and fetal #ell$&eing' including nursing management for each.
• (. )utline appropriate nursing management to promote maternal self$care and minimi*e the common discomforts of pregnancy.
• +. ,ist the key components of perinatal education.
 
Key Terms
• -lpha$ etoprotein
• 4ravida
• Para
 
Preconception Care
1st Prenatal Visit
• ocus on education for overall #ellness
• Detection and prevention of potential pro&lems
• Comprehensive health history' physical e"amination' and la&oratory tests
 
Comprehensive Health History
8 7rine or &lood test for hC4
• Past medical' surgical' and personal history
• 9oman:s reproductive history; menstrual' o&stetric' and gynecologic history
 
Comprehensive Health History
8 7rine or &lood test for hC4
• Past medical' surgical' and personal history
• 9oman:s reproductive history; menstrual' o&stetric' and gynecologic history
 
Comprehensive Health History
8 7rine or &lood test for hC4
• Past medical' surgical' and personal history
• 9oman:s reproductive history; menstrual' o&stetric' and gynecologic history
 
Menstrual History
• Menstrual cycle
Menstrual History cont!d"
• Date of last menstrual period ,MP3
• Calculation of estimated or e"pected date of &irth !D/3 or delivery !DD3
8 Nagele:s rule
• u&tract months ?<21<=>
• -dd 1 year ?<2?<=? @ !D/
8 4estational or &irth calculator or #heel see igure 12$3
8 7ltrasound
Pregnancy #heel
Obstetric History
8 4ravida II secundigravida3; second pregnancy' etc.
• Para% a #oman #ho has produced one or more via&le offspring carrying a pregnancy 2= #eeks or more
8 Primapara; one &irth after a pregnancy of at least 2= #eeks AprimipB3
8 Multipara; t#o or more pregnancies resulting in via&le offspring AmultipB3
8 Nullipara; no via&le offspring para =
 
Obstetric History cont!d"
8 $ gravida3; the current pregnancy
8 T term &irths3; the num&er of pregnancies ending E> #eeks: gestation' at term
8 P preterm &irths3; the num&er of preterm pregnancies ending E2= #eeks or via&ility &ut &efore completion of > #eeks
8 & a&ortions3; the num&er of pregnancies ending &efore 2= #eeks or via&ility
8 ' living children3; num&er of children currently living
 
(uestion
Is the follo#ing statement rue or alseF
 
&ns)er
alse.
 
Physical *+amination
• 0ital signs
• 5ead$to$toe assessment
8 !"tremities
Physical *+amination cont!d"
8 /imanual e"amination
 
 
Obstetric" conjugate, and ischial tuberosity
 
'aboratory Tests
• Cervical smears
-ollo).up Visits
• 0isit schedule;
8 !very 2 #eeks from 2H to + #eeks
8 !very #eek from > #eeks to &irth
 
-ollo).up Visits cont!d"
8 7rine testing for protein' glucose' ketones' and nitrites
8 undal height see igure 12$(3
8 Juickening<fetal movement see /o" 12$3
8 etal heart rate see Nursing Procedure 12$13
• eaching; danger signs
-undal Height
(uestion
Is the follo#ing statement rue or alseF
 
&ns)er
alse.
 
&ssessment o/ -etal #ell.0eing
• Doppler flo# studies
• Percutaneous um&ilical &lood sampling P7/3
• Nonstress test contraction stress test
• /iophysical profile
ltrasound
P02
1st Trimester 3iscom/orts
• atigue
• Cravings
• ,eukorrhea
4nd Trimester 3iscom/orts
• 5emorrhoids
5rd Trimester 3iscom/orts
• 5eart&urn and indigestion
Nursing Management to Promote 2el/. Care
• Personal hygiene
• Perineal care
• Dental care
• /reast care
 
Nursing Management to Promote 2el/. Care cont!d"
• leep and rest
• Immuni*ations and medications
(uestion
9hile assessing a #oman at 1? #eeks: gestation' #hich of the follo#ing #ould the nurse report as unusualF
-. 7rinary freKuency
&ns)er
-.
 
Preparation /or 'abor, 0irth, and Parenthood
• Perinatal education
• Child&irth education
8 ,ama*e psychoprophylactic3 method; focus on &reathing and rela"ation techniKues
8 /radley partner$coached child&irth3 method; focus on e"ercises and slo#' controlled a&dominal &reathing
 
Preparation /or 'abor, 0irth, and Parenthood cont!d"
• )ptions for &irth setting
8 /irth centers
8 5ome &irth
Preparation /or 'abor, 0irth, and Parenthood cont!d"
• eeding choices
8 /ottle feeding; advantages and disadvantages
8 eaching
 
6*V7*#
1. 9hich of the follo#ing &iophysical profile findings indicate poor o"ygenation to the fetusF
  -. #o pockets of amniotic fluid
/. 9ell fle"ed arms and legs
  C. Nonreactive fetal heart rate
  D. etal &reathing movements
6*V7*#
• he correct response is C;
 
6*V7*#
• 2. he nurse teaches the pregnant client ho# to perform Legal e"ercises as a #ay to accomplish #hich of the follo#ingF
  -. Prevent perineal lacerations
 
6evie)
• he correct response is C;
 
6*V7*#
• . During a clinic visit' a pregnant client at = #eeks gestation tells the nurse' A I:ve had some mild cramps that are pretty irregular' 9hat does this meanFB the cramps are pro&a&ly;
  -. he &eginning of la&or in its very early stages
  /. -n ominous finding that the client is a&out to have
a miscarriage.
  D. /ra"ton$5icks contractions #hich occur though out
pregnancy
6*V7*#
• he correct response is D.
 
6*V7*#
• %. a pregnant clients last normal mesntrual period #as on -ugust 1=. 7sing Nagel:s rule ' the nurse calculates that her estimated date of &irth!D/3 #ill &e #hich of the follo#ingF
  -. une 2
  /. uly 1=
  C. uly =
6*V7*#
• he correct response is D;
 
(uestions 888