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Nursing Management During Pregnancy: Key Factors and Care Methods

Understand the critical factors affecting fetal well-being, barriers to prenatal care, and the importance of preconception care. Learn about the KSPR Card and the essential information needed during the first prenatal visit. Dive into the details of comprehensive health history, menstrual and obstetric histories, physical examinations, and laboratory tests. Gain insights into follow-up visit schedules, discomforts across trimesters, and nursing management strategies to facilitate self-care during pregnancy.

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Nursing Management During Pregnancy: Key Factors and Care Methods

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  1. Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java Nursing Management During Pregnancy

  2. REFERENCES • Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The Nurse and The Family 5thed , St Luis : CV Mosby Company. • Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993) Maternity Nursing, St Luis : CV Mosby Company. • Mattson Susan & Smith Judi E (2000). Core Curriculum for Maternal – Newborn Nursing. 2nd ed. Philadelphia. W.B. Saunders Company. • Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 ) IlmuKebidanan , Jakarta YayasanBinaPustakaSarwonoPrawiroharjo. • Journals and article related to..

  3. Conception, Fetal Development, Gestational Risk and Fetal Well-being Factors affecting fetal well-being: • Quality of sperm or ovum • Intrauterine environment • First trimester exposure to hazardous agents • Maternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatory • Substance abuse • Known or unknown infections

  4. Barriers to Prenatal Care • Sociodemographics • Insurance/finances • Inadequate care providers for low income • Delay in onset of prenatal care • Cultural factors • Transportation • Attitudes

  5. Preconception Care • Immunization status • Underlying medical conditions • Reproductive health care practices • Sexuality and sexual practices • Nutrition • Lifestyle practices • Psychosocial issues • Medication and drug use • Support system

  6. KSPR (Kartu Score PudjiRohjati)Card for risk detection of Pregnacy

  7. 1st Prenatal Visit • Establishment of trusting relationship • Focus on education for overall wellness • Detection and prevention of potential problems • Comprehensive health history, physical examination, and laboratory tests

  8. Comprehensive Health History • Reason for seeking care • Suspicion of pregnancy • Date of last menstrual period • Signs and symptoms of pregnancy • Urine or blood test for hCG • Past medical, surgical, and personal history • Woman’s reproductive history: menstrual, obstetric, and gynecologic history

  9. Menstrual History • Menstrual cycle • Age at menarche • Days in cycle • Flow characteristics • Discomforts • Use of contraception

  10. Menstrual History • Date of last menstrual period (LMP) • Calculation of estimated or expected date of birth (EDB) or delivery (EDD) • Nagele’s rule • Use first day of LNMP 11/21/11 • Subtract 3 months 8/21/11 • Add 7 days 8/28/11 • Add 1 year 8/28/12 = EDB • Gestational or birth calculator.

  11. Obstetric History • Gravida: a pregnant woman • Gravida I (primigravida): first pregnancy • Gravida II (secundigravida): second pregnancy, etc. • Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more • Primapara: one birth after a pregnancy of at least 20 weeks (“primip”) • Multipara: two or more pregnancies resulting in viable offspring (“multip”) • Nullipara: no viable offspring; para 0

  12. Obstetric History • Terminology • G (gravida): the current pregnancy • T (term births): the number of pregnancies ending >37 weeks’ gestation, at term • P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks • A (abortions): the number of pregnancies ending before 20 weeks or viability • L (living children): number of children currently living

  13. Physical Examination • Vital signs • Head-to-toe assessment • Head and neck • Chest • Abdomen, including fundal height if appropriate • Extremities • Pelvic examination • Examination of external and internal genitalia • Bimanual examination • Pelvic shape: gynecoid, android, anthropoid, platypelloid • Pelvic measurements

  14. Laboratory Tests • Urinalysis • Complete blood count • Rhfactor • TORCH test • Hepatitis B surface antigen • HIV test • Ultrasound

  15. Follow-up Visits • Visit schedule: • Every 4 weeks up to 28 weeks • Every 2 weeks from 29 to 36 weeks • Every week from 37 weeks to birth

  16. Follow-up Visits • Assessments • Weight & BP compared to baseline values • Urine testing for protein, glucose, ketones, and nitrites • Fundal height • Quickening/fetal movement • Fetal heart rate • Teaching: danger signs

  17. 1st Trimester Discomforts • Urinary frequency or incontinence • Fatigue • Nausea and vomiting • Breast tenderness • Constipation • Nasal stuffiness, bleeding gums, epistaxis • Cravings • Leukorrhea

  18. 2nd Trimester Discomforts • Backache • Varicosities of the vulva and legs • Hemorrhoids • Flatulence with bloating

  19. 3rd Trimester Discomforts • Return of 1st trimester discomforts • Shortness of breath and dyspnea • Heartburn and indigestion • Dependent edema • Braxton Hicks contractions

  20. Nursing Management To Promote Self-Care • Personal hygiene • Avoidance of saunas and hot tubs • Perineal care • Dental care • Breast care • Clothing • Exercise

  21. Nursing Management To Promote Self-Care • Sleep and rest • Sexual activity and sexuality • Employment • Travel • Immunizations and medications

  22. Danger Signs Of Pregnancy !!! Assess and report immediately: • Vaginal bleeding in any amount - May indicate placenta previa • Premature rupture of membranes - Predisposes mom and baby to infection • Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia • Severe, persistent headaches and visual disturbances - Consider preeclampsia

  23. Danger Signs in Pregnancy Report any of the following immediately: • Fever and/or chills • Painful urination • Persistent nausea & vomiting • Change in, or absence of fetal movement for 6-8 hrs.

  24. Preparation for Labor, Birth, and Parenthood • Perinatal education • Childbirth education • Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques • Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing • Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

  25. Preparation for Labor, Birth, and Parenthood • Options for birth setting • Hospitals: delivery room, birthing suite • Birth centers • Home birth • Options for care providers • Obstetrician • Midwife • Health provider

  26. Preparation for Labor, Birth, and Parenthood • Feeding choices • Breastfeeding: advantages and disadvantages • Bottle feeding: advantages and disadvantages • Teaching • Final preparation for labor and birth

  27. Care For Better Health

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