Nursing Care During Nursing Care During the Antenatal Periodthe Antenatal Period

Maria Rubolino, MSN, FNPcMaria Rubolino, MSN, FNPc

September 6September 6thth, 2005, 2005

A & P of PregnancyA & P of Pregnancy

Terms to knowTerms to know GravidaGravida ParityParity NulliparousNulliparous MultiparousMultiparous TermTerm TPALTPAL

Signs of PregnancySigns of Pregnancy

Presumptive Signs/SymptomsPresumptive Signs/Symptoms

ProbableProbable

PositivePositive

Uterine GrowthUterine Growth

Stimulated by hormones in the 1Stimulated by hormones in the 1stst trimestertrimester

Larger as it rises out of the pelvisLarger as it rises out of the pelvis Hegar’sHegar’s Chadwick’sChadwick’s

ContractilityContractility

Braxton HicksBraxton Hicks

Cervical ChangesCervical Changes

Goodell’s SignGoodell’s Sign FriabilityFriability

Fundal Height ChangesFundal Height Changes

Changes from week to weekChanges from week to week

Vaginal ChangesVaginal Changes

Vaginal mucosa thickensVaginal mucosa thickens Chadwick’s signChadwick’s sign Vaginal dischargeVaginal discharge Mucous plugMucous plug VaricositiesVaricosities

Breast ChangesBreast Changes

FullnessFullness Areolar pigmentationAreolar pigmentation ColostrumColostrum

Circulatory ChangesCirculatory Changes

CV- blood volume, cardiac CV- blood volume, cardiac hypertrophyhypertrophy

Cardiac output increasesCardiac output increases

Blood pressure changesBlood pressure changes

Circulatory changesCirculatory changes

Supine hypotension syndromeSupine hypotension syndrome

Renal ChangesRenal Changes

Renal pelvis and ureters dilateRenal pelvis and ureters dilate Urine rate is slowedUrine rate is slowed Bladder frequencyBladder frequency

GI ChangesGI Changes

AppetiteAppetite Gastric emptyingGastric emptying AbsorptionAbsorption Bowel soundsBowel sounds Blood flow to the pelvisBlood flow to the pelvis Morning sicknessMorning sickness PyrosisPyrosis ConstipationConstipation

Gallbladder and LiverGallbladder and Liver

Gallbladder with decreased toneGallbladder with decreased tone PUPPSPUPPS

Skin ChangesSkin Changes

Increased subdermal fatIncreased subdermal fat HyperpigmentationHyperpigmentation StriaeStriae Linea nigraLinea nigra ChloasmaChloasma AngiomasAngiomas PruritisPruritis Palmar erythemaPalmar erythema Increased perspirationIncreased perspiration

Endocrine ChangesEndocrine Changes

AmenorrheaAmenorrhea ProgesteroneProgesterone EstrogenEstrogen Ant pituitary suppresses the FSH and Ant pituitary suppresses the FSH and

LH causing to riseLH causing to rise Post pituitary produces oxytocinPost pituitary produces oxytocin

Neurological ChangesNeurological Changes

Carpal Tunnel SyndromeCarpal Tunnel Syndrome Numbness/TinglingNumbness/Tingling HA’sHA’s LightheadednessLightheadedness Muscle CrampsMuscle Cramps

Musculoskeletal ChangesMusculoskeletal Changes

Change in postureChange in posture WaddlingWaddling Back PainBack Pain

Nutrition NeedsNutrition Needs

Folic AcidFolic Acid Calories increased to 300/dayCalories increased to 300/day Increased proteinIncreased protein Iron requirements increasedIron requirements increased Increased fluid intakeIncreased fluid intake Limit caffeineLimit caffeine

ExerciseExercise

Will produce benefitsWill produce benefits Must consume fluidMust consume fluid Watching heart rateWatching heart rate No new activitiesNo new activities

Weight Gain in PregnancyWeight Gain in Pregnancy

25-35 pounds total weight gain25-35 pounds total weight gain

With singleton pregnancyWith singleton pregnancy

35-45 pound total weight gain with 35-45 pound total weight gain with multiplesmultiples

Nagele’s RuleNagele’s Rule

LMP minus 3 calendar daysLMP minus 3 calendar days Add 7 days and 1 yearAdd 7 days and 1 year

Tests in 1Tests in 1stst Trimester Trimester 1 hour post glucola if indicated1 hour post glucola if indicated Blood typeBlood type Antibody screenAntibody screen CBCCBC UA C/SUA C/S HepatitisHepatitis HIVHIV RPRRPR TSHTSH Toxoplasmosis if indicatedToxoplasmosis if indicated CVS if desiredCVS if desired

HyperemesisHyperemesis

N/VN/V Small frequent mealsSmall frequent meals Avoid spicy foodsAvoid spicy foods AntiemeticsAntiemetics

11stst Trimester Trimester

HyperemesisHyperemesis No mensesNo menses N/VN/V FatigueFatigue Breast TendernessBreast Tenderness

20 Weeks20 Weeks

QuickeningQuickening Pelvic PressurePelvic Pressure ConstipationConstipation Round ligament painRound ligament pain

CVSCVS

Screening to detect fetal genetic Screening to detect fetal genetic abnormalitiesabnormalities

Risks of miscarriage 1 in 100Risks of miscarriage 1 in 100

Nuchal Fold ThicknessNuchal Fold Thickness

Ultrasound and 9-13 weeksUltrasound and 9-13 weeks Increased with down syndromeIncreased with down syndrome Screening only!!Screening only!!

AFPAFP

Triple marker test/screeningTriple marker test/screening 16-20 weeks gestation16-20 weeks gestation If abnormal refer to specialistIf abnormal refer to specialist

AmniocentesisAmniocentesis

Performed between 16-20 weeksPerformed between 16-20 weeks Done with AMA, FH, +AFPDone with AMA, FH, +AFP Risks of miscarriage 1 in 200-300Risks of miscarriage 1 in 200-300

Testing in 3Testing in 3rdrd Trimester Trimester

1 hour post glucola1 hour post glucola CBCCBC UAUA Antibody screenAntibody screen RhogamRhogam TSHTSH

32-36 Weeks32-36 Weeks

Fetal positionFetal position Descending into pelvisDescending into pelvis Placental locationPlacental location GBSGBS FKC’sFKC’s

36-42 Weeks36-42 Weeks

Vaginal ExamsVaginal Exams Labor precautionsLabor precautions PIH precautionsPIH precautions

Childbirth EducationChildbirth Education

NaturalNatural LamazeLamaze BradleyBradley

Birth PlanBirth Plan

HospitalHospital Birthing CenterBirthing Center HomeHome BathBath Pain MedsPain Meds EpiduralEpidural NaturalNatural LightingLighting

AmbulatingAmbulating DoulasDoulas HypnosisHypnosis