Normal Antepartum
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Transcript of Normal Antepartum
Student will summarize the care of the Normal Antepartum client by :
identifying maternal hormones produced during pregnancy, their target organs and their major effects on pregnancy.
discussing common discomforts in pregnancy with nursing interventions.
describing danger signals in pregnancy. identifying community resources for the childbearing
family.
describing the components of initial and subsequent prenatal visits.
calculating the estimated date of delivery. describing gravidity and parity with the four-and-
five-digit system. analyzing the effects of different life situations on
nutritional patterns and ways nutritional health can be improved
Pregnancy- Period between conception through complete birth of the products of conception.
Pregnancy is divided into three trimesters
The nurse must be aware of :Physical, emotional, and, psychological changes
Discomforts that accompany each trimester
Danger or warning signs that need medical referral.
Gestation
Term
Preterm
Postterm
Antepartum
Intrapartum
Postpartum
Nulligravida
Primigravida
Multigravida
Abortion
Stillbirth
Gravida refers to the number of times a woman has been pregnant
Para refers to the number of births 20 weeks gestation or greater
FPAL or TPAL
The nurse is interviewing a client at the initial PNV. The client has had seven pregnancies prior to this one. She had two babies at 38 weeks each, one at 35 weeks, one at 41 weeks and 3 abortions at 6, 8 and 12 weeks gestation. She has four living children. What is her gravida/Para?
Jane Doe is pregnant for the fourth time. At home she has a child who was born at 39 weeks. Her second pregnancy ended at 10 weeks gestation. She then gave birth to twins at 35 weeks but one of the twins died soon after birth. She has 2 living children. What is her gravidity and FPAL?
A pregnant woman needs an additional 300 kcal/day
Protein
Carbohydrate
Dairy
Fruit & Vegetable
Prenatal vitamins - High levels of Folic Acid, Calcium and Iron
Folic Acid – 400 mcg/day. Calcium – 1000mg/day.
RDA for iron is 27mg/dl
Iron supplements must be given to most women (ferrous sulfate or ferrous sequels)
Take with orange juice
Normal Value: HCT = 37-47% Hemoglobin = 12-16
What are some food sources of iron???
PICA – eating substances that have no nutritional value
Normal weight gain based on BMI is 25-35 lbs
If the woman is overweight before pregnancy:Gain 15 to 25 pounds during pregnancy.
If the woman are underweight before pregnancy:Gain 28 to 40 pounds during pregnancy
The goal of prenatal care is to monitor the progress of a pregnancy and to identify potential problems
Weeks 4 to 28: 1 visit per month (every 4 weeks) Weeks 28 to 36: 2 visits per month (every 2 to 3
weeks) Weeks 36 to birth: 1 visit per week
Progesterone Estrogen HCG - Human Chorionic Gonadotropin HPL - Human Placental Lactogen Relaxin Prostaglandins
CARDIOVASCULAR SYSTEM
RESPIRATORY SYSTEM
RENAL SYSTEM
GASTROINTESTINAL SYSTEM
INTEGUMENTARY SYSTEM
MUSCULOSKELETAL SYSTEM
ENDOCRINE SYSTEM
REPRODUCTIVE SYTEM
Cardiovascular System Physiologic anemia Supine hypotension/venocaval syndrome/ aortocaval
compression Increase cardiac load and pulse Blood pressure decreases in second trimester Decreased blood flow causes edema and varicosities.
Respiratory System Breathing changes from abdominal to thoracic
Hyperventilation Shortness of breathNasal stuffiness and epistaxis
Renal System Bladder- Urinary frequency
Ureter- Urinary stasis and pyelonephritis
Urethra- Poor emptying
Glomerular filtration rate increases
Gastrointestinal system
Heartburn and acid reflux
Constipation and flatulence
Gum tissue soften and bleed
Nausea and vomiting/morning sickness
Hyperptyalism
Integumentary System
- Chloasma/melasma
- Linea negra
- Striae gravidarum
Musculoskeletal
Relaxation of pelvis joints = Waddling gaitChanged center of gravityLordosis Diastasis recti
Endocrine Thyroid - enlargement causes increased BMI
Parathyroid - allows for better use of calcium and vitamin D
Pancreas - in the first trimester decreased insulin production allows for more glucose availability for fetal growth
Endocrine Continued Pituitary - Produce hormones that support pregnancy
such as prolactin, oxytocin, and vasopressin
Adrenals - Increased glandular activity
Uterus Increase in size Lightening Hegar’s sign Braxton Hicks contractions
Are irregular contractions of the uterus “False labor”
Cervical Goodell’s signOperculum/Mucus plug
VaginalChadwick’s signVaginal secretions are increased (leukorrhea)
OvariesOvum production ceasesCorpus luteum persists and secretes hormones until weeks
6-8
Breasts fullness, tingling or tenderness darkened areola prominent blue veins maybe seen secretion of colostrum by last trimester
Acceptance of the Pregnancyoften accompanied by feelings of ambivalence
Acceptance of Baby feelings such as introversionemotionally labile couvade syndrome
Preparation for baby- End of Pregnancy
Subjective Changes (Presumptive) Objective Changes (Probable) Diagnostic Changes (Positive)
Presumptive - Subjective Amenorrhea Nausea/ Vomiting Excessive Fatigue Breast changes Quickening Urinary frequency
Probable- ObjectivePelvic Organ Changes:-
Goodell’s sign, Hegar’s sign, Chadwicks’s signEnlarged abdomenUterine souffle Changes in pigmentationBallottementPregnancy tests
Positive - Diagnostic Fetal heart tones
Fetal movement
Ultrasound
Nausea/ Vomiting (morning sickness)FatigueUrinary frequencyBreast tendernessIncreased vaginal dischargeNasal Stuffiness/NosebleedSalivation/Ptyalism
BackacheShortness of
BreathMuscle cramps Carpel Tunnel
SyndromeConstipationVaricosities &
Hemorrhoids
HeartburnEdemaBraxton Hicks
ContractionsInsomniaHypotensionPalpitationsHeadaches
Vaginal bleeding Increased or decreased fetal movement Headaches or blurred vision Swelling of hands and/or feet Burning on urination Abdominal or chest pains Chills or fever Persistent vomiting Increase in fluid from the vagina
Alcohol Smoking Marijuana Drugs & Herbs Abuse Hazardous Substances Mercury
Stress Rodents Live vaccinations Heat (environmental, hot tubs, saunas) X-rays Kitty Litter or Cat feces
Current PregnancyNagele’s Rule Fundal height measurementPresence of discomfortsAttitude towards pregnancy
Past Obstetrical HistoryGravity/Parity - FPALPregnancy historyPerinatal status
Based on 280 day pregnancy28 day cycle40 weeks (38-42 is normal)Minus three months and plus 7 days to the first
day of the last menstrual period A client LNMP was June 10th. Figure her
EDD.
6 month 10th day -3 +73rd month 17th day or March 17th of the
following year
LMP: February 16, 2007. Due date?
LMP: August 3, 2006. Due date?
LMP: March 26, 2006. Due date?
Fundal Height Measurement
Gynecology History Last pap Prior infections Previous surgery Menarche Contraception Sexual history
Current & Past Medical History
Personal History
Family Medical History
Partner’s Medical & Personal History
Blood Studies Blood type, CBC, VDRL, MSAFP HIV, Hepatitis, Rubella, Sickle Cell, TORCH Glucose testing
Urinalysis & Pap smear Cultures – *GBS* Tuberculosis - PPD Ultrasound- AFI, Placenta
Toxoplasmosis
Other Infections
Rubella
Cytomegalovirus (CMV)
Herpes Simplex
Antigen – antibody reaction Mother is Rh negative and baby is Rh positive Sensitization-maternal body forms antibodies
when baby blood is mixed. Screening
Direct coombs test Indirect coombs test
Prevention Good pre-natal care RhoGAM
Nursing Management Confidentiality
Develop a trusting relationship
Promote self esteem and physical health
Education- regular prenatal visits, STD’s, Substance abuse, signs of complications.
Risk Factors Preterm labor Cephalopelvic disproportion (CPD) Preeclampsia Iron deficiency anemia Low birth weight
At the conclusion of the antepartum lecture you will have an understanding of the foundation necessary to understand Labor and Delivery , Postpartum and Newborn Nursery.
