Nursing care during the prenatal period

Prepared by: Marwah, Wjdan,Sharefa, Saleha & Amal.Supervised by: Mrs.Hadeer AL-Morbaty.

outlines:

1. Introduction. 2. Nursing process for prenatal care. 3. Common discomforts of pregnancy. 4. Major family teaching topics to cover during prenatal care. 5. Balanced nutritional intake for pregnant woman. 6. References.

 At the end of this lecture you will:

1 .outline the nursing care and implication after prenatal assessment. 2 Identify common nursing diagnosis for a pregnant woman

 3 .Choose appropriate nursing interventions for the pregnant woman. discomforts of pregnancy .

4 .Teach the pregnant woman how to deal with the common discomfort.5 .Discuss the importance of balanced nutritional intake for pregnant

woman .6 .Assist the woman to assess her own diet for adequacy by using the

food pyramid .7 .Evaluate the effectiveness of care given during pregnancy.

Objectives:

What is the meaning of prenatal ?

Relating to pregnant women and their unborn babies.

Nurses are in a unique position to influence behaviors of the pregnant woman and to increase the chance she and her baby will stay healthy. Through consistent use of the nursing process, we can detect problems early in order to intervene, or assist ,and support the woman through her pregnancy.

What is the primary nursing

intervention throughout

pregnancy ?

Teaching

pregnent.mp4

Don't make unfounded assumptions .Don't assume that just because this is not the woman's first baby, or because she is educated, or even that she is a nurse, that she has the information she needs to maintain a healthy pregnancy.

Assess her knowledge level by asking questions .

Essential components of prenatal visits:

1-Ongoing assessment and 2-data collection .

During the 1st prenatal visit, pay close attention to cues the woman may give regarding her feelings toward the pregnancy. ( Ambivalence is normal ).

E.g.: The woman may express feelings of doubt about the

pregnancy or her ability to be a good parent. These are normal reactions when a woman 1st finds out she is

pregnant, and she needs reassurance that her responses are normal.

1st prenatal visit

A) Medical history:1 -mensteral cycle.

2-use of birth controle3 -post pregnency.

4 -personal medical history.5 -family medical history.

6-medication use.

1st prenatal visit

B) Lab test:

1 -check blood type ( Rh ),2 -check ( Hgb ).

3 -check immunity to certain infections ( rubella & chickenpox )

4 -detect exposue to other infections.5 -screening test for fetal abnormalities

At every visit, inquire 1- Medications, OTC 2- Food supple. (Pay close attention to signs that might indicate poor nutritional status - Weight is an obvious clue).

warning signs of poor nutritional status include (dull, brittle hair, poor condition of skin and nails or a low hemoglobin level. *If the woman is overweight or underweight, she will need special assistance with nutritional concerns throughout the pregnancy.

Cont. at every visit, inquire

 3 -Note if she experiencing nausea and vomiting.

  4 -Determine her education level and knowledge

of pregnancy and prenatal care.

*During subsequent visits, you may assist with assessing for signs of fetal wellbeing.1- Obtaining fetal heart tones with an ultrasound Doppler device which beginning in week 10, and soliciting reports of active fetal. - Pay close attention to V/S, particularly the BP.

  Inquire regarding these warning signals at every visit .

Instruct the woman to report any of these signs to health care provider right Away:

1 Fever or severe vomiting unrelieved by Tylenol or other relief

2 -Headache ,3 -Blurred vision or spots

4 -Pain in the epigastria region 5 -Sudden weight gain or sudden onset of

Cont,

6 -Vaginal bleeding7 -Painful urination

8-uncontrollable leaking of fluid from the vagina 9 -Decreased fetal movement (is Signs of

preterm labor )10 -lower Uterine contractions

11 -Menstrual-like Increase in vaginal discharge 12-A feeling that something is not right

• Bleeding gums • Nasal stuffiness• Nosebleeds• Breast tenderness• Nausea and nausea• with vomiting• Feeling faint• Fatigue• Shortness of breath• Heartburn• Low back pain

COMMON DISCOMFORTS OF PREGNANCY

• Round ligament• pain• Leg cramps• Varicose veins• Ankle edema• Flatulence• Constipation and• hemorrhoids• Trouble sleeping

COMMON DISCOMFORTS OF PREGNANCY

Maintaining balanced nutritional intake

With in first trimester ,the fetus’ demands on maternal stores are less than at other times during the pregnancy.

Some times it is difficult to maintain a well- balanced diet when she is coping with nausea.

Maintaining balanced nutritional intake

1 -In the first visit focus on assessing the adequacy of her diet and answer questions.

2 -Emphasize the important of taking

the prenatal vitamins.

3 -My pyramid can assist the pregnant woman achieve balanced die.

Maintaining balanced nutritional intake

4 -Monitor weight gain throughout pregnancy .there should be steady in crease in weight throughout pregnancy, for total in crease of to 25 to 35 Ib.

5 -Sudden weight gain often is associated with fluid retention and may be sign of developing preeclampsia.

Maintaining balanced nutritional intake

6 -Encourage the woman to take her iron and folic acid supplement.

7 -Monitor the hemoglobin and hematocrit at the 28-week check up for any decreases.

If you were... -Underweight before pregnancy: 28-40 pounds

-Normal weight before pregnancy: 25-35pounds

-Overweight before pregnancy: 15-25 pounds -Obese before pregnancy: 15

-Carrying twins: 35-45

Total Weight Gain During Pregnancy

Total Weight Gain During Pregnancy

How Much Weight Should You Gain in the 1st

Trimester?

Gain 1 to 1 1/2 pounds per month for a total of 3-5 pounds.Consume an extra 200 calories a day (for example, a glass of skim milk, and two slices of turkey breast).

Total Weight Gain During Pregnancy

How Much

Weight Should You Gain in the

2nd Trimester?

Gain about 1 pound per week for a total of 12 to 14 pounds.Consume an extra 300 calories a day (for example, a cup of carrot-orange juice and a cup of low-fat fruit-flavored yogurt.

Total Weight Gain During Pregnancy

How Much Weight

Should You Gain in the

3rd Trimester?

Gain 3/4 to 1 pound per week (weight gain often slows during the last month) for a total of 10 to 14 pounds.Consume an extra 300-500 calories a day (for example, a cup of low-sodium tomato juice and a whole-grain bagel spread with low-fat cream cheese).

Major components of prenatal self care

1 -Avoid alcohol - alcohol harms the fetus.

2 -Avoid smoking ,it can lead to lower birth weight and increase the incidence of preterm labor.

3 -Eat a healthy ,well- balanced diet .

Major components of prenatal self care

4 -Consume approximately 300 calories more per day than before pregnancy.

5 -Take an extra 400 mcg of folic acid per day .if the doctor ordered prenatal vitamins, the recommended dose will be met.

Major components of prenatal self care

6 -Avoid dieting during pregnancy .every pregnant women with a normal body mass index should gain 25 to 30 Ib during the pregnancy.

7-Continue to exercise during pregnancy .how ever, do not exercise to the point of exhaustion or start a grueling new work out that you were not doing before pregnancy.

Major components of prenatal self care

8 -Avoid douching during pregnancy because it will increase the risk of

bacterial infection.

9 -Avoid taking any medication (other than acetaminophen) or over the counter herbal remedy unless your primary care provider has approved it.

Dental hygiene

1 -A pregnant woman needs to continue regular dental checkups and practice excellent dental hygiene.

2 -This includes at least twice-daily brushing, once daily flossing ,and a nutritious diet.

3 -If pregnancy gingivitis is a problem, then regular dental checkups are necessary.

4 -Untreated gingivitis can damage the gums and result in bone and tooth loss.

Nursing diagnosis / interventions:

Nursing diagnosis / interventions:

1- Anxiety related to uncertainty regarding pregnancy diagnosis and not knowing what to expect during the office visit.

2 -Health-seeking Behaviors related to maintaining a healthy pregnancy and concerns regarding the common discomforts of pregnancy.

3 -Deficient Knowledge of self-care during

pregnancy.

Nursing diagnosis / interventions:

4 -Risk for injury related to complications of pregnancy.

 5- Fear related to the unknown of childbirth, concerns regarding safe passage of self and infant through the delivery experience, and concerns related to assuming the parenting role.

1-Anxiety related to uncertainty regarding pregnancy diagnosis and not knowing what to expect during the office visit;

Escort women to the examination room and explain the procedures to her and what she can expect during the visit .

Much anxiety can be alleviated when women know what to expect , maintain calm , confident demeanor while giving care and protect women privacy during invasive examinations .

Try to understand women perspective .

1-Anxiety related to uncertainty regarding pregnancy diagnosis and not knowing what to expect during the office visit;

Note if her anxiety level increases.

Anticipate concerns when fetal testing is planned .

Attend to women's questions and misunderstanding .

Provide factual information concerning the treatment plan .

Use active listening .

Encourage positive coping behaviors .

2-Health-seeking Behaviors related to maintaining a healthy pregnancy and concerns regarding the common discomforts of pregnancy.

3-Deficient Knowledge of self-care during pregnancy.

Teaching self-care during pregnancy.* Maintaining a balanced nutritional intake.* Dental hygiene* Exercise* Hygiene* Breast care* Clothing* Sexual activity* Employment* *Travel* Medications and herbal remedies* Teaching about substance use and abuse .

4 -Risk for injury related to complications of

pregnancy.

Your baby is well protected from the outside world while inside your uterus. There is even more protection during the first three months of pregnancy when the uterus is still surrounded by the pelvic bones. For these reasons, it's hard to hurt your baby during normal day-to-day activities.

4 -Risk for injury related to complications of

pregnancy.

To avoid falls, be especially careful when you do things that require a good sense of balance. This includes climbing stairs, carrying packages, or walking where there is ice, snow, sand, or gravel. Be sure to ask for help if you feel unsteady.

Refer to Newborn discharge teaching

5-Fear related to the unknown of childbirth, concerns regarding safe passage of self and infant through the delivery experience, and concerns related to assuming the parenting role.

Preparing women for labor , birth, and parenthood.

Its all deepened in teaching and teaching if women got enough information's about labor and what is expected her fears will be decrease.

Try to speak to someone who have been in labor before and “get the positive things from her “.

Learn relaxation technique to do it whenever you got this fear .

Have support from her parents or friends with children or through attending classes about the role of parents .

5-Fear related to the unknown of childbirth, concerns regarding safe passage of self and infant through the delivery experience, and concerns related to assuming the parenting role.

Evaluation of care giving during pregnancy

Evaluation of care giving during pregnancy

1- The pregnant women anxiety is reduced.

2- The pregnant women manage the symptoms and discomforts associated with pregnancy that she nor the fetus will experience injury from the complication of pregnancy.

Evaluation of care giving during pregnancy

3- The pregnant women is having sufficient knowledge to adequately meet the needs of the growing fetus throughout the pregnancy

4- She express confidence in her ability to go through the labor and birth experience and assume the parenting role.

References :

1 -Essentials of maternity, newborn, and women’s health nursing. 2ed edition. Lippincott williams & wilkins.

2 -Maternity & pediatric nursing.2ed edition. Lippincott williams & wilkins.