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7/17/2019 Chapter_014 _care of Family During Pregnancy
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Chapter 14
NURSING CARE OF THEFAMILY
DURING PREGNANCY
Copyright 2016 by Elsevier Inc. All rights reserved.
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2Copyright 2016 by Elsevier Inc. All rights reserved.
Learning Obe!ti"e#
De#!ribe #trategie# $%r !%n&r'ing pregnan!( an)e#ti'ating the )ate %$ birth*
S+''ari,e the ph(#i!a-. p#(!h%#%!ia-. an) beha"i%ra-!hange# that +#+a--( %!!+r a# the e/pe!tant '%ther an)
%ther $a'i-( 'e'ber# a)apt t% pregnan!(* E"a-+ate the bene&t# %$ prenata- !are an) pr%b-e'# %$
a!!e##ibi-it( $%r #%'e 0%'en*
O+t-ine the pattern# %$ hea-th !are +#e) t% a##e##'aterna- an) $eta- hea-th #tat+# at initia- an) $%--%0+p
"i#it# )+ring pregnan!(*
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3Copyright 2016 by Elsevier Inc. All rights reserved.
Learning Obe!ti"e#
2C%nt*3 Se-e!t the t(pi!a- n+r#ing a##e##'ent#. )iagn%#e#.inter"enti%n#. an) 'eth%)# %$ e"a-+ati%n inpr%"i)ing !are $%r the pregnant 0%'an*
P-an e)+!ati%n nee)e) b( pregnant 0%'en t%
+n)er#tan) an) 'anage ph(#i!a- )i#!%'$%rt#re-ate) t% pregnan!( an) t% re!%gni,e #ign# an)#('pt%'# %$ p%tentia- !%'p-i!ati%n#*
E"a-+ate the ee!t %$ !+-t+re. age. parit(. an)
n+'ber %$ $et+#e# %n the re#p%n#e %$ the $a'i-( t%the pregnan!( an) %n the prenata- !are pr%"i)e)*
C%'pare the %pti%n# $%r hea-th !are pr%"i)er# an)birth #etting !h%i!e# that are a"ai-ab-e*
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4Copyright 2016 by Elsevier Inc. All rights reserved.
De&niti%n#55
Prenatal period: A ti'e %$ ph(#i!a- an)p#(!h%-%gi! preparati%n $%r birth an)parenth%%)
D+rati%n %$ pregnan!(6 Gestation
Span# 7 !a-en)ar '%nth#. 18 -+nar '%nth#
48 0ee9# %r :;8 )a(#
Tri'e#ter#
Fir#t6 0ee9# 1148 2pg*
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5Copyright 2016 by Elsevier Inc. All rights reserved.
Diagn%#i# %$ Pregnan!( 5
Sign# an) #('pt%'#
Pre#+'pti"e in)i!at%r#
Rep%rte) b( 0%'an
A'en%rrhea. na+#ea an) "%'iting. brea#tten)erne##. +rinar( $re?+en!(. $atig+e
@+i!9ening
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6Copyright 2016 by Elsevier Inc. All rights reserved.
Diagn%#i# %$ Pregnan!(
2C%nt*3 Sign# an) #('pt%'# 2C%nt*3
Pr%bab-e in)i!at%r#
Dete!te) b( e/a'iner
Uterine en-arge'ent
ra/t%n Hi!9# !%ntra!ti%n#
P-a!enta- #%+Be
a--%tte'ent
P%#iti"e pregnan!( te#t
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7Copyright 2016 by Elsevier Inc. All rights reserved.
Diagn%#i# %$ Pregnan!(
2C%nt*3 Sign# an) #('pt%'# 2C%nt*3
P%#iti"e in)i!at%r#
Attrib+te) t% the $et+#
Feta- heartbeat )i#tin!t $r%' '%ther#
Feta- '%"e'ent $e-t b( #%'e%ne %ther than '%ther
i#+a-i,ati%n %$ the $et+#
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Copyright 2016 by Elsevier Inc. All rights reserved.
E#ti'ating Date %$ irth
E#ti'ate) )ate %$ birth 2ED3
O-)er ter'#
E#ti'ate) )ate %$ )e-i"er( 2EDD3
E#ti'ate) )ate %$ !%n&ne'ent 2EDC3
U-tra#%+n)
Stan)ar) pr%!e)+re $%r )eter'ining thege#tati%na- age %$ the $et+#
Naege-e# r+-e t% !a-!+-ate ED
A##+'e# that the 0%'an ha# a :;)a( !(!-ean) that $erti-i,ati%n %!!+r# %n the 14th )a(
A$ter )eter'ining the &r#t )a( %$ the LMP.#+btra!t < !a-en)ar '%nth# an) a)) > )a(#
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!Copyright 2016 by Elsevier Inc. All rights reserved.
A)aptati%n t% Pregnan!(
Materna- a)aptati%n
A!!epting the pregnan!(
I)enti$(ing 0ith the '%ther r%-e
Re%r)ering per#%na- re-ati%n#hip#
E#tab-i#hing re-ati%n#hip 0ith $et+#6 atta!h'entpr%!e## %$ the '%ther
Pha#e 16 She a!!ept# the bi%-%gi! $a!t %$ pregnan!(
Pha#e :6 She a!!ept# the gr%0ing $et+# a# )i#tin!t$r%' her#e-$
Pha#e
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10Copyright 2016 by Elsevier Inc. All rights reserved.
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11Copyright 2016 by Elsevier Inc. All rights reserved.
A)aptati%n t% Pregnan!(
2C%nt*3 Paterna- a)aptati%n
A!!epting the pregnan!(
C%+"a)e #(n)r%'e
De"e-%p'enta- ta#9# e/perien!e) b( thee/pe!tant $ather
Ann%+n!e'ent pha#e
M%rat%ri+' pha#e
F%!+#ing pha#e
I)enti$(ing 0ith the $ather r%-e Re%r)ering per#%na- re-ati%n#hip#
E#tab-i#hing re-ati%n#hip 0ith the $et+#
Preparing $%r birth
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12Copyright 2016 by Elsevier Inc. All rights reserved.
A)aptati%n t% Pregnan!(2C%nt*3 A)aptati%n t% parenth%%)
$%r the n%npregnantpartner
Sib-ing a)aptati%n
Depen)# %n age an))epen)en!( nee)#
Gran)parent a)aptati%n
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13Copyright 2016 by Elsevier Inc. All rights reserved.
Care Manage'ent
Initia- "i#it Prenata- inter"ie0
Rea#%n $%r #ee9ing!are
C+rrent pregnan!(
Chi-)bearing an)$e'a-e repr%)+!ti"ehi#t%r(
Hea-th hi#t%r(
N+triti%na- hi#t%r(
Hi#t%r( %$ )r+g an)
herba- preparati%n +#e Fa'i-( hi#t%r(
S%!ia-. e/perientia-.%!!+pati%na- hi#t%r(
Pg*
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14Copyright 2016 by Elsevier Inc. All rights reserved.
Care Manage'ent
2C%nt*3 Initia- "i#it 2C%nt*3
Prenata- inter"ie0 2C%nt*3
Hi#t%r( %r ri#9 %$ inti'ate partner "i%-en!e
Re"ie0 %$ #(#te'#
Ph(#i!a- e/a'inati%n
S+pine h(p%ten#i%n5
Lab%rat%r( te#t#
Urine. !er"i!a-. an) b-%%) #a'p-e#
S!reening an) )iagn%#ti! te#t# $%r in$e!ti%+#)i#ea#e# an) 'etab%-i! !%n)iti%n#
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15Copyright 2016 by Elsevier Inc. All rights reserved.
Care Manage'ent 2C%nt*3
F%--%0+p "i#it#
Inter"ie0
Ph(#i!a- e/a'inati%n
Feta- a##e##'ent
Ge#tati%na- age
Feta- heart t%ne#
Hea-th #tat+#
F+n)a- height
Lab%rat%r(%ther te#t#
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16Copyright 2016 by Elsevier Inc. All rights reserved.
Dete!ting Feta- Heartbeat
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17Copyright 2016 by Elsevier Inc. All rights reserved.
N+r#ing Inter"enti%n#6E)+!ati%n $%r Se-$Manage'ent
E/pe!te) 'aterna- an) $eta- !hange#
N+triti%n
Per#%na- h(giene
Pre"enti%n %$ +rinar( tra!t in$e!ti%n#
ege- e/er!i#e#
Preparati%n $%r brea#t$ee)ingPin!h te#t an) brea#t#he-- pg*
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1Copyright 2016 by Elsevier Inc. All rights reserved.
N+r#ing Inter"enti%n#6E)+!ati%n $%r Se-$Manage'ent
2C%nt*3 P%#t+re an) b%)('e!hani!#
Re#t an) re-a/ati%n
E'p-%('ent
C-%thing
Tra"e-
Me)i!ati%n# an)
herba- preparati%n# I''+ni,ati%n#
Pg*
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1!Copyright 2016 by Elsevier Inc. All rights reserved.
N+r#ing Inter"enti%n#6E)+!ati%n $%r Se-$Manage'ent
2C%nt*3 A-!%h%-. !igarette #'%9ing. !aeine. )r+g#
N%r'a- )i#!%'$%rt#
Re!%gni,ing p%tentia- !%'p-i!ati%n#
Re!%gni,ing preter' -ab%r5
Se/+a- !%+n#e-ing
U#ing the hi#t%r(
C%+ntering 'i#in$%r'ati%n
Sa$et( an) !%'$%rt )+ring #e/+a- a!ti"it(
P#(!h%#%!ia- #+pp%rt
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20Copyright 2016 by Elsevier Inc. All rights reserved.
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21Copyright 2016 by Elsevier Inc. All rights reserved.
ariati%n# in Prenata-
Care C+-t+ra- in+en!e#
Man( !+-t+ra- "ariati%n# are $%+n) in prenata- !are
C+-t+ra- barrier# t% prenata- !are6 -a!9 %$ '%ne(.
-a!9 %$ tran#p%rtati%n. -ang+age barrier#. '%)e#t( C+-t+ra- pre#!ripti%n# "#* !+-t+ra- pr%#!ripti%n#
E'%ti%na- re#p%n#e
Ph(#i!a- a!ti"it( an) re#t
C-%thing
Se/+a- a!ti"it(
Diet
Pg*
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22Copyright 2016 by Elsevier Inc. All rights reserved.
ariati%n# in Prenata-
Care 2C%nt*35 Age )ieren!e#
A)%-e#!ent#
Le## -i9e-( than %-)er 0%'en t% re!ei"e a)e?+ate
prenata- !are
%'en %-)er than
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23Copyright 2016 by Elsevier Inc. All rights reserved.
ariati%n# in Prenata-
Care 2C%nt*3 M+-ti$eta- pregnan!(
P+t# the '%ther an) $et+#e# at in!rea#e) ri#9 $%ra)"er#e %+t!%'e#
M+-ti$eta- pregnan!ie# are '%re -i9e-( t% en) inpre'at+rit(*
Sp%ntane%+# r+pt+re %$ 'e'brane# be$%re ter'i# '%re !%''%n*
C%ngenita- 'a-$%r'ati%n# t0i!e a# !%''%n in'%n%,(g%ti! t0in# a# in #ing-et%n#
Pg*
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24Copyright 2016 by Elsevier Inc. All rights reserved.
ariati%n# in Prenata-
Care 2C%nt*3 M+-ti$eta- pregnan!( 2C%nt*3
C%+n#e-ing nee)# t% be pr%"i)e) $%r
Ri#9 %$ preter' -ab%r
M%)i&!ati%n %$ 0eight gain an) n+triti%na- inta9e
Se-e!ti"e repr%)+!ti%n
Li$e#t(-e !hange#
Can p-a!e a #train %n &nan!e#. #pa!e. 0%r9-%a). an) the 0%'an#an) $a'i-(# !%ping !apabi-itie#
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25Copyright 2016 by Elsevier Inc. All rights reserved.
Perinata- E)+!ati%n
G%a- i# t% he-p in)i"i)+a-# an) $a'i-( 'e'ber#t% 'a9e in$%r'e) an) #a$e )e!i#i%n# ab%+tpregnan!(. birth. in$ant !are. an) ear-(
parenth%%) C-a##e# $%r e/pe!tant parent#
E)+!ati%n pr%gra'# !%n#i#t %$ a 'en+ %$ !-a###erie# an) a!ti"itie# $r%' pre!%n!epti%n thr%+ghthe ear-( '%nth# %$ parenting*
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26Copyright 2016 by Elsevier Inc. All rights reserved.
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27Copyright 2016 by Elsevier Inc. All rights reserved.
Perinata- Care Ch%i!e#5
Ph(#i!ian#
Mi)0i"e#
Certi&e) n+r#e'i)0i"e# 2CNM#3
Dire!t entr( 'i)0i"e# %r !erti&e) 'i)0i"e# 2CM#3
Tra)iti%na- %r -a( 'i)0i"e#
D%+-a#
irth p-an#
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irth Setting Ch%i!e#
H%#pita-
Lab%r. )e-i"er(. re!%"er( r%%'# 2LDR#3
Lab%r. )e-i"er(. re!%"er(. p%#tpart+' r%%'#2LDRP#3
irth !enter#
H%'e birth
Re'ain# a !%ntr%"er#ia- t%pi! in A'eri!an hea-th
!are
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e( P%int#
The prenata- peri%) i# a preparat%r( %ne b%thph(#i!a--(. in ter'# %$ $eta- gr%0th an) parenta-a)aptati%n#. an) p#(!h%-%gi!a--(. in ter'# %$anti!ipati%n %$ parenth%%)*
Pregnan!( ae!t# parent!hi-). #ib-ing!hi-).an) gran)parent!hi-) re-ati%n#hip#*
Di#!%'$%rt# an) !hange# %$ pregnan!( !an!a+#e an/iet( $%r the 0%'an an) her $a'i-(an) re?+ire #en#iti"e attenti%n an) a p-an $%rtea!hing #e-$'anage'ent 'ea#+re#*
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30Copyright 2016 by Elsevier Inc. All rights reserved.
e( P%int# 2C%nt*3
E)+!ati%n ab%+t #a$et( )+ring a!ti"it( an)e/er!i#e i# e##entia-. gi"en 'aterna-anat%'i! an) ph(#i%-%gi! re#p%n#e# t%
pregnan!(* I'p%rtant !%'p%nent# %$ the initia- prenata-
"i#it in!-+)e )etai-e) an) !are$+--()%!+'ente) &n)ing# $r%' the inter"ie0. a!%'prehen#i"e ph(#i!a- e/a'inati%n. an)
#e-e!te) -ab%rat%r( te#t#* F%--%0+p "i#it# are #h%rter than the initia-
"i#it an) are i'p%rtant $%r '%nit%ring thehea-th %$ the '%ther an) $et+# an) pr%"i)inganti!ipat%r( g+i)an!e a# nee)e)*
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31Copyright 2016 by Elsevier Inc. All rights reserved.
e( P%int# 2C%nt*3
E"en in n%r'a- pregnan!( the n+r#e '+#tre'ain a-ert t% ha,ar)# #+!h a# #+pineh(p%ten#i%n. #ign# an) #('pt%'# %$ p%tentia-!%'p-i!ati%n#. an) #ign# %$ $a'i-('a-a)aptati%n#*
-%%) pre##+re i# e"a-+ate) %n the ba#i# %$ab#%-+te "a-+e# an) -ength %$ ge#tati%n an) i#interprete) in -ight %$ '%)i$(ing $a!t%r#*
Ea!h pregnant 0%'an nee)# t% 9n%0 h%0 t%re!%gni,e an) rep%rt #ign# %$ p%tentia-!%'p-i!ati%n# #+!h a# preter' -ab%r*
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32Copyright 2016 by Elsevier Inc. All rights reserved.
e( P%int# 2C%nt*3
There i# an in!rea#e) in!i)en!e %$ ph(#i!a-.'enta-. an) "erba- ab+#e )+ring pregnan!(*
C+-t+re. age. parit(. an) '+-ti$eta- pregnan!(
!an ha"e a #igni&!ant ee!t %n the !%+r#e an)%+t!%'e %$ the pregnan!(*
N+r#e# '+#t a#9 pregnant 0%'en an) their$a'i-ie# ab%+t pre$eren!e#. pra!ti!e#. an)!+#t%'# re-ate) t% !hi-)bearing t% pr%"i)e
!+-t+ra--( #en#iti"e !are*
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33Copyright 2016 by Elsevier Inc. All rights reserved.
e( P%int# 2C%nt*3
Chi-)birth e)+!ati%n tea!he# t+ning in t% theb%)(# inner 0i#)%' an) !%ping #trategie# thatenhan!e 0%'en# abi-it( t% !%pe ee!ti"e-(0ith -ab%r an) birth*
Perinata- e)+!ati%n #tri"e# t% pr%'%te hea-thierpregnan!ie# an) $a'i-( -i$e#t(-e#*
N+r#e# !an he-p pregnant 0%'en an) their$a'i-ie# t% 'a9e in$%r'e) )e!i#i%n# ab%+t !arepr%"i)er#. birth #etting#. an) -ab%r #+pp%rt*
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34C i ht 2016 b El i I All i ht d
@+e#ti%n
1* hat #h%+-) the RN be a0are )+ring $%--%0+p "i#it# an) theph(#i!a- e/a'inati%n $%r 0%'en re!ei"ing prenata- !areK
a* The inter"ie0 p%rti%n# be!%'e '%re inten#i"ea# the "i#it# be!%'e '%re $re?+ent %"er the
!%+r#e %$ the pregnan!(*b* M%nth-( "i#it# are #!he)+-e) $%r the &r#t
tri'e#ter. e"er( : 0ee9# $%r the #e!%n)tri'e#ter. an) 0ee9-( $%r the thir) tri'e#ter*
!* D+ring the ab)%'ina- e/a'inati%n. the n+r#e#h%+-) be a-ert $%r #+pine h(p%ten#i%n*
)* F%r pregnant 0%'en. a #(#t%-i! b-%%) pre##+re2P3 %$ 1