PRN1831 : Maternal-Child Health Nursing Module

PRN1831 : Maternal-Child Health Nursing Module 02 Blueprint 1. Diagnosing Pregnancy a. Presumptive Signs Nausea, vomiting, fatigue, urinary frequency, breast enlargement & tenderness, amenorrhea—absence of menstrual period, quickening— fetal movement felt by the mother after 18-20 weeks b. Probable Signs Goodell’s sign, Chadwick’s sign, Hegar’s sign, ballottement, positive pregnancy test—hCG hormone detected in urine by day 11 of gestation (morning urine is optimal). c. Positive Signs Fetal heart auscultation on doppler, fetal movement experience by practitioner, ultrasound 2. Major Physical and Psychological Changes during Pregnancy Physical: Shortness of breath, supine hypotension, nausea & vomiting, hemorrhoids increased mucous production (stuffy nose), swollen breasts, urinary frequency, stretch marks (striae gravidarum). Psychological: maternal crises: worries about pregnancy, impending parenthood, the maternal role (seeking safe passage for herself and fetus, securing acceptance of herself as mother and for her fetus, learning to give up self and to accept herself as mother to infant, committing herself to the child as she progresses through pregnancy) 3. Antepartum Nursing Care The period between conception and labor. Answer questions and provide support. We are focused on her health history and prenatal care as LPN’s. Helping her navigate some changes to her daily life, assisting with exams, or diagnostic testing. Terms to understand: a. Gravida: number of pregnancies b. Para: production of a viable infant regardless of whether fetus is alive at birth c. Viability: newborn weighing at least 500g or more than 20 weeks gestation d. GTPAL G: Gravida- number of pregnancies regardless of the outcome or number of fetuses T: Term- the number of term infants born at 37 weeks gestation and beyond P: Preterm- the number of preterm infants born after 20 weeks gestation and before 37 weeks gestation A: Abortions- the number of pregnancies that ended in a spontaneous or therapeutic abortion L: Living- the number of living children e. How to determine EDD (Estimated Date of Delivery) Naegele’s Rule: Subtract 3 months from the first day of the last menstrual period and then add seven days, which will indicate approximate date of delivery Pregnancy Wheel f. Prenatal Screenings - STI exams, pelvic exam, CBC lab test, mother’s blood type, - Chorionic Villi Sampling (CVS), Nuchal Translucency testing (NTT) done between 11-13 weeks - Quadruple screen: done using the mother’s serum between 15-20 weeks to detect specific serum markers: AFP- high levels risk for fetal neural tube defect, low risk Down syndrome or trisomy 18 hCG- high levels risk for Down syndrome UE- low levels risk for Down syndrome g. How often should women see their provider during pregnancy? Monthly for first 28 weeks, every 2 weeks until 36 weeks, weekly after 36 weeks until childbirth 4. Common Physical Exams for Women Menarche to Menopause Basic physical, STI test, pap exam, pelvic exam, bimanual exam to determine size of uterus and exam cervix, lab tests (CBC, blood type and Rh, urinalysis, TB). 5. Common Discomforts during Pregnancy Nausea & vomiting, nasal congestion & epistaxis, urinary frequency, urinary urgency, nocturia, increased vaginal discharge, increased fatigue, heartburn, constipation, hemorrhoids, backache, leg cramps, shortness of breath, ankle edema, round ligament pain a. Nursing Interventions to Assist don’t take decongestant medications—contraindicated for fetus (vessels constricted), crackers/dry carbs before risings, small, frequent meals, use a humidifier, hydration, but decrease fluid intake 2 hrs before HS, wear cotton underwear, daily perineal hygiene, adequate rest, avoid spicy foods and dairy, increase fiber, maintain exercise routine, side sleep, elevate HOB and feet, avoid stand for long periods 6. Viral Infections of Concern during Pregnancy Viral infection during pregnancy: transmission through mother’s bloodstream through placenta to fetus. -Can cause congenital defects, major concern are TORCH infections T/O: toxoplasmosis- eating raw meat or exposed to cat litter R: rubella C: Cytomegalovirus- bodily fluid contact, can cause microcephaly or hydrocephalus H: HIV a. How to Avoid good hand washing techniques, avoid young children with colds/infections, avoid raw or undercooked meat, avoid cleaning cat litter box, avoid yard work that may cause exposure to cat feces, avoid sharing drinks and eating utensils with small children, make sure vaccinations are current before becoming pregnant again, yearly flu vaccine. 7. Recommended Weight Gain during Pregnancy • BMI 18.5: gain 28-40 pounds • BMI between 18.5 and 24.9: gain 25-35 pounds • BMI between 25 and 29.9: gain 15-25 pounds’ • BMI 30: gain 11-20 pounds -Nutrition: Multivitamin with iron Folate, calcium, vitamin D Protein Extra 200 calories/day (avoid empty calories) 8. Fetal Kick Counts directly assess fetal well-being. 9. Determining Fetal Well-Being 4 fetal kicks/hr = reassuring, if they are decreased, encourage mom to eat. If they are decreased for the second hr report to provider. a. Non-Stress Test Monitors fetal heart rate, fluctuations in fetal heart tones, done after 28 weeks to monitor for any fetal heart distress Fetal heart 110-160 normal b. Biophysical Profile Done in 3rd trimester, abdominal ultrasound and non-stress test c. Group B Strep Done on mother at 35-37 weeks, swab in genital area of vagina and anus, if it is positive she needs IV antibiotics while in labor. 10. Hyperemesis Gravidarum Nausea and vomiting persisting past 20 weeks gestation S/SX: vomiting multiple times throughout the day, poor appetite, weight loss (5% of pregnancy weight), dehydration a. Nursing Interventions Care at home or hospitalized for fluids or antiemetics, prescribe lab studies, administer IV fluids, monitor weight loss, psychosocial support, patient teaching 11. Ectopic Pregnancy -Egg fertilizes outside of uterus -S/SX: vaginal bleeding/ abdominal pain -risk of fallopian tube rupture a. Nursing Interventions monitor for signs of hypovolemic shock, postop care if indicated, control pain, psychosocial support, patient teaching 12. Placenta Previa -Placenta implants near opening of cervix (covers all or part of cervix) -Painless, bright red bleeding a. Nursing Interventions Avoid vaginal cervical exam, fetal monitoring, emergency support, patient teaching 13. Placenta Abruptio -Premature separation of the placenta from the wall of the uterus -Life threatening emergency, bleeding and fetus is not receiving oxygen -Risk factors: abdominal trauma, hypertension, drug use, alcohol use, cigarette smoking, diabetes -S/SX: vaginal bleeding, severe uterine tenderness, firm board-like abdomen a. Nursing Interventions Report any bleeding to provider, report any abdominal pain, C-Section may be required, be clear and honest 14. Hypertensive Disorders during Pregnancy - Chronic hypertension: BP 140/90 or higher BEFORE pregnancy or that occurs before 20 weeks gestation - Gestation hypertension: BP of 140/90 or greater for the first time during pregnancy. *BP returns to normal or less than 12 weeks postpartum *No proteinuria -Pre-eclampsia: hypertension and proteinuria after 20 weeks gestation -Eclampsia: onset of a seizure with the diagnosis of pre-eclampsia (baby needs to be delivered) a. Warning Signs b. Nursing Interventions Pre-eclampsia: monitor BP, urine output & daily weights. Administer antihypertensive meds. Monitor for nervous system irritability. Monitor fetal status. Emotional support, continue to monitor postdelivery and patient teaching. 15. Gestational Diabetes -High blood glucose levels when pregnant -S/SX: increased thirst, hunger, increased urination a. Risk Factors -Age -Previous history of gestational diabetes -Family history of Type 2 Diabetes -History of LGA (large for gestational age) infant b. Nursing Interventions Medical management: tests to monitor for complications, monitor for ketoacidosis, LGA fetus, assess for fetal complications Therapies: blood glucose measurements, dietary management, medication Nursing care: dietician referral, monitor blood sugar levels, administer meds, monitor for complications, monitor fetal status, patient teaching