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Nursing Care During the Antenatal Period

Nursing Care During the Antenatal Period. Maria Rubolino, MSN, FNPc September 6 th , 2005. A & P of Pregnancy. Terms to know Gravida Parity Nulliparous Multiparous Term TPAL. Signs of Pregnancy. Presumptive Signs/Symptoms Probable Positive. Uterine Growth.

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Nursing Care During the Antenatal Period

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  1. Nursing Care During the Antenatal Period Maria Rubolino, MSN, FNPc September 6th, 2005

  2. A & P of Pregnancy • Terms to know • Gravida • Parity • Nulliparous • Multiparous • Term • TPAL

  3. Signs of Pregnancy • Presumptive Signs/Symptoms • Probable • Positive

  4. Uterine Growth • Stimulated by hormones in the 1st trimester • Larger as it rises out of the pelvis • Hegar’s • Chadwick’s

  5. Contractility • Braxton Hicks

  6. Cervical Changes • Goodell’s Sign • Friability

  7. Fundal Height Changes • Changes from week to week

  8. Vaginal Changes • Vaginal mucosa thickens • Chadwick’s sign • Vaginal discharge • Mucous plug • Varicosities

  9. Breast Changes • Fullness • Areolar pigmentation • Colostrum

  10. Circulatory Changes • CV- blood volume, cardiac hypertrophy • Cardiac output increases • Blood pressure changes

  11. Circulatory changes • Supine hypotension syndrome

  12. Renal Changes • Renal pelvis and ureters dilate • Urine rate is slowed • Bladder frequency

  13. GI Changes • Appetite • Gastric emptying • Absorption • Bowel sounds • Blood flow to the pelvis • Morning sickness • Pyrosis • Constipation

  14. Gallbladder and Liver • Gallbladder with decreased tone • PUPPS

  15. Skin Changes • Increased subdermal fat • Hyperpigmentation • Striae • Linea nigra • Chloasma • Angiomas • Pruritis • Palmar erythema • Increased perspiration

  16. Endocrine Changes • Amenorrhea • Progesterone • Estrogen • Ant pituitary suppresses the FSH and LH causing to rise • Post pituitary produces oxytocin

  17. Neurological Changes • Carpal Tunnel Syndrome • Numbness/Tingling • HA’s • Lightheadedness • Muscle Cramps

  18. Musculoskeletal Changes • Change in posture • Waddling • Back Pain

  19. Nutrition Needs • Folic Acid • Calories increased to 300/day • Increased protein • Iron requirements increased • Increased fluid intake • Limit caffeine

  20. Exercise • Will produce benefits • Must consume fluid • Watching heart rate • No new activities

  21. Weight Gain in Pregnancy • 25-35 pounds total weight gain With singleton pregnancy 35-45 pound total weight gain with multiples

  22. Nagele’s Rule • LMP minus 3 calendar days • Add 7 days and 1 year

  23. Tests in 1st Trimester • 1 hour post glucola if indicated • Blood type • Antibody screen • CBC • UA C/S • Hepatitis • HIV • RPR • TSH • Toxoplasmosis if indicated • CVS if desired

  24. Hyperemesis • N/V • Small frequent meals • Avoid spicy foods • Antiemetics

  25. 1st Trimester • Hyperemesis • No menses • N/V • Fatigue • Breast Tenderness

  26. 20 Weeks • Quickening • Pelvic Pressure • Constipation • Round ligament pain

  27. CVS • Screening to detect fetal genetic abnormalities • Risks of miscarriage 1 in 100

  28. Nuchal Fold Thickness • Ultrasound and 9-13 weeks • Increased with down syndrome • Screening only!!

  29. AFP • Triple marker test/screening • 16-20 weeks gestation • If abnormal refer to specialist

  30. Amniocentesis • Performed between 16-20 weeks • Done with AMA, FH, +AFP • Risks of miscarriage 1 in 200-300

  31. Testing in 3rd Trimester • 1 hour post glucola • CBC • UA • Antibody screen • Rhogam • TSH

  32. 32-36 Weeks • Fetal position • Descending into pelvis • Placental location • GBS • FKC’s

  33. 36-42 Weeks • Vaginal Exams • Labor precautions • PIH precautions

  34. Childbirth Education • Natural • Lamaze • Bradley

  35. Hospital Birthing Center Home Bath Pain Meds Epidural Natural Lighting Ambulating Doulas Hypnosis Birth Plan

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