Nagele’s Rule
• Begin with the first day of the last menstrual period.• Subtract 3 months• Add 7
days.
Gravity
• Nulligravida
• Primigravida
• Multigravida
Parity
• Nullipara
• Primipara
• Multipara
• GTPAL acronym
• Gravida-number of pregnancies
• Para- number of pg reaching 20 weeks
• Term births 38 weeks – 42 weeks
• Preterm births -reached 20 weeks, ends before completion of 37th week
• Abortion/miscarriage prior to 20 wks
• Living children
“Discomforts of Pregnancy”
First trimester • Breast changes: pain, tingling, tenderness, enlargement
• Urgency and frequency of urination
• Languor and malaise, fatigue
•N&V
• Ptyalism
• Nasal stuffiness
• Leukorrhea
• Emotional lability, mood swings
2nd • Pigmentation deepens
• Spider nevi (angiomas)
• Pruritus (noninflammatory)
• Palpitations
• Faintness
• Food cravings
• Heartburn
• Constipation, flatulence
• Varicose veins
3rd • SOB and dyspnea (60% of
women)
• Insomnia
• Psychosocial responses, mood
swings, mixed feelings, anxiety
• Urinary frequency and urgency
return
, • Perineal discomfort and
Pressure
• Braxton Hicks contraction
• Leg cramps
• Ankle edema (non-pitting) to
lower extremities
Physiologic changes of pregnancy
Cardiac changes during pregnancy
Expected changes Cardiac Alterations or warnings Interventions
HR: increases by 15-20 Increase of BP 20 over baseline Monitor VS
BP: slight to no paired with proteinuria NST
decrease Increase in BP paired with other Fetal monitoring
BV: increases by 1200- signs of cardiovascular issue Assess for signs of
1500 Harsh murmur preeclampsia
CO: increases by 30-50
May experience
palpitations
Soft murmur
Dietary recommendations for pregnancy
Nutrition
Folic Acid Protein
• Folate/folic acid – preconception to 60-70g/day
decrease risk of NTD Needed throughout pregnancy
• 0.4mg po daily antepartum 4 weeks- brainstem dev
• 0.6 mg po daily during pregnancy Inadequate: neurologic damage
Sources: spinach, broccoli, whole grains,
green leafy vegetables, peanuts,organ
meats
Iron Calcium
Last trimester important: fetus must have 3- 1000mg in adults
6mo supply in liver 1300mg if <19yo
Usually a supplement is given, not in first 240ml or 1 cup milk or yogurt= 300mg
trimester tho Especially in 3rd trimester
Lean meats, green leafy veg, eggs, Lactose intolerant moms require a
shellfish, dried fruits, molasses, whole supplement
grains
Vit C increases absorption
, Substance use – alcohol, smoking, opiods, neonatal abstinence
Teratogens: environmental substances/exposures resulting in functional or structural
disability, mental development. Greatest effect: 16-60 days. Drugs. Chemicals, infections,
radiation, maternal conditions such as diabetes, maternal PKU
Alcohol: growth restriction, cognitive impairment, microcephaly, malformation of the face
and trunk
Cocaine: cardiac and CNS anomalies, growth restriction, placental abruption, placental
restriction
Nicotine: LBW, early labor
Opioid: Neonatal absence
Stages of Labor- include physiologic changes, expected patient responses, interventions
medications
Stag Physiologic changes Expected patient Nursing Medications
es response interventions
1 Regular uterine contractions Mild pain Maternal VS Possible
and ends with complete progressing to Uterine activity epidural, nitrous
cervical effacement and very painful FHR oxide can be
dilation towards the end Presence of used.
bloody show Oxytocin.
Vaginal exam Might use
Leopold cervidil
maneuver
Encourage
walking
2 Full cervical dilation, Very painful VS q5 to 30 mins
effacement 100% and ends May feel ring of FHR q5-15 mins
with the birth of infant fire Assess vaginal
Ferguson's show, signs of
reflex - urge to fetal descent and
push changes in
May vomit maternal
Verbalizations of appearance,
being out of mood, affect,
control or not energy level
being able to Assess every
cope contraction and
May “need to bearing down
have a bowel effort
movement” Provide support
Encourage rest
between
contractions
3 Delivery of the placenta Encourage Analgesics
pushing
• Begin with the first day of the last menstrual period.• Subtract 3 months• Add 7
days.
Gravity
• Nulligravida
• Primigravida
• Multigravida
Parity
• Nullipara
• Primipara
• Multipara
• GTPAL acronym
• Gravida-number of pregnancies
• Para- number of pg reaching 20 weeks
• Term births 38 weeks – 42 weeks
• Preterm births -reached 20 weeks, ends before completion of 37th week
• Abortion/miscarriage prior to 20 wks
• Living children
“Discomforts of Pregnancy”
First trimester • Breast changes: pain, tingling, tenderness, enlargement
• Urgency and frequency of urination
• Languor and malaise, fatigue
•N&V
• Ptyalism
• Nasal stuffiness
• Leukorrhea
• Emotional lability, mood swings
2nd • Pigmentation deepens
• Spider nevi (angiomas)
• Pruritus (noninflammatory)
• Palpitations
• Faintness
• Food cravings
• Heartburn
• Constipation, flatulence
• Varicose veins
3rd • SOB and dyspnea (60% of
women)
• Insomnia
• Psychosocial responses, mood
swings, mixed feelings, anxiety
• Urinary frequency and urgency
return
, • Perineal discomfort and
Pressure
• Braxton Hicks contraction
• Leg cramps
• Ankle edema (non-pitting) to
lower extremities
Physiologic changes of pregnancy
Cardiac changes during pregnancy
Expected changes Cardiac Alterations or warnings Interventions
HR: increases by 15-20 Increase of BP 20 over baseline Monitor VS
BP: slight to no paired with proteinuria NST
decrease Increase in BP paired with other Fetal monitoring
BV: increases by 1200- signs of cardiovascular issue Assess for signs of
1500 Harsh murmur preeclampsia
CO: increases by 30-50
May experience
palpitations
Soft murmur
Dietary recommendations for pregnancy
Nutrition
Folic Acid Protein
• Folate/folic acid – preconception to 60-70g/day
decrease risk of NTD Needed throughout pregnancy
• 0.4mg po daily antepartum 4 weeks- brainstem dev
• 0.6 mg po daily during pregnancy Inadequate: neurologic damage
Sources: spinach, broccoli, whole grains,
green leafy vegetables, peanuts,organ
meats
Iron Calcium
Last trimester important: fetus must have 3- 1000mg in adults
6mo supply in liver 1300mg if <19yo
Usually a supplement is given, not in first 240ml or 1 cup milk or yogurt= 300mg
trimester tho Especially in 3rd trimester
Lean meats, green leafy veg, eggs, Lactose intolerant moms require a
shellfish, dried fruits, molasses, whole supplement
grains
Vit C increases absorption
, Substance use – alcohol, smoking, opiods, neonatal abstinence
Teratogens: environmental substances/exposures resulting in functional or structural
disability, mental development. Greatest effect: 16-60 days. Drugs. Chemicals, infections,
radiation, maternal conditions such as diabetes, maternal PKU
Alcohol: growth restriction, cognitive impairment, microcephaly, malformation of the face
and trunk
Cocaine: cardiac and CNS anomalies, growth restriction, placental abruption, placental
restriction
Nicotine: LBW, early labor
Opioid: Neonatal absence
Stages of Labor- include physiologic changes, expected patient responses, interventions
medications
Stag Physiologic changes Expected patient Nursing Medications
es response interventions
1 Regular uterine contractions Mild pain Maternal VS Possible
and ends with complete progressing to Uterine activity epidural, nitrous
cervical effacement and very painful FHR oxide can be
dilation towards the end Presence of used.
bloody show Oxytocin.
Vaginal exam Might use
Leopold cervidil
maneuver
Encourage
walking
2 Full cervical dilation, Very painful VS q5 to 30 mins
effacement 100% and ends May feel ring of FHR q5-15 mins
with the birth of infant fire Assess vaginal
Ferguson's show, signs of
reflex - urge to fetal descent and
push changes in
May vomit maternal
Verbalizations of appearance,
being out of mood, affect,
control or not energy level
being able to Assess every
cope contraction and
May “need to bearing down
have a bowel effort
movement” Provide support
Encourage rest
between
contractions
3 Delivery of the placenta Encourage Analgesics
pushing
