Chapter - 014 - Care of Family During Pregnancy

Chapter 14
NURSING CARE OF THE

FAMILY
DURING PREGNANCY
Copyright 2016 by Elsevier Inc. All rights reserved.
Learning Objectives
Describe strategies for confirming pregnancy and

estimating the date of birth.
Summarize the physical, psychosocial, and behavioral

changes that usually occur as the expectant mother and
other family members adapt to pregnancy.
Evaluate the benefits of prenatal care and problems of

accessibility for some women.
Outline the patterns of health care used to assess

maternal and fetal health status at initial and follow-up
visits during pregnancy.
Learning Objectives
(Cont.)
Select the typical nursing assessments, diagnoses,
interventions, and methods of evaluation in
providing care for the pregnant woman.
Plan education needed by pregnant women to

understand and manage physical discomforts
related to pregnancy and to recognize signs and
symptoms of potential complications.
Evaluate the effect of culture, age, parity, and

number of fetuses on the response of the family to
the pregnancy and on the prenatal care provided.
Compare the options for health care providers and

birth setting choices that are available.
Definitions *
Prenatal period: A time of physical and

psychologic preparation for birth and
parenthood
Duration of pregnancy: Gestation
Spans 9 calendar months, 10 lunar months
40 weeks or 280 days
Trimesters
First: weeks 1-13
Second: weeks 14-26
Third: weeks 27-40 (pg. 309)
Diagnosis of Pregnancy *
Signs and symptoms
Presumptive indicators
Reported by woman
Amenorrhea, nausea and vomiting, breast

tenderness, urinary frequency, fatigue
Quickening
Diagnosis of Pregnancy
(Cont.)
Signs and symptoms (Cont.)
Probable indicators
Detected by examiner
Uterine enlargement
Braxton Hicks contractions
Placental souffle
Ballottement
Positive pregnancy test
Diagnosis of Pregnancy
(Cont.)
Signs and symptoms (Cont.)
Positive indicators
Attributed to the fetus
Fetal heartbeat distinct from mothers
Fetal movement felt by someone other than mother
Visualization of the fetus
Estimating Date of Birth
Estimated date of birth (EDB)

Older terms
Estimated date of delivery (EDD)
Estimated date of confinement (EDC)
Ultrasound
Standard procedure for determining the

gestational age of the fetus
Naegeles rule to calculate EDB

Assumes that the woman has a 28-day cycle
and that fertilization occurs on the 14th day
After determining the first day of the LMP,
subtract 3 calendar months and add 7 days
Adaptation to Pregnancy
Maternal adaptation
Accepting the pregnancy
Identifying with the mother role
Reordering personal relationships
Establishing relationship with fetus: attachment

process of the mother
Phase 1: She accepts the biologic fact of pregnancy
Phase 2: She accepts the growing fetus as distinct

from herself
Phase 3: She prepares realistically for the birth and

parenting of the child
Preparing for childbirth

10
(Cont.)
Paternal adaptation
Accepting the pregnancy
Couvade syndrome
Developmental tasks experienced by the

expectant father
Announcement phase
Moratorium phase
Focusing phase
Identifying with the father role
Reordering personal relationships
Establishing relationship with the fetus
Preparing for birth

11
(Cont.)
Adaptation to parenthood
for the nonpregnant
partner
Sibling adaptation
Depends on age and

dependency needs
Grandparent adaptation
12
Care Management
Initial visit
Prenatal interview
Reason for seeking

care
Current pregnancy
Childbearing and
female reproductive
history
Health history
Nutritional history
History of drug and
herbal preparation use
Family history
Social, experiential,
occupational history
Pg. 309-312
13
Care Management
(Cont.)
Initial visit (Cont.)
Prenatal interview (Cont.)
History or risk of intimate partner violence
Review of systems
Physical examination
Supine hypotension*
Laboratory tests
Urine, cervical, and blood samples
Screening and diagnostic tests for infectious

diseases and metabolic conditions
14
Care Management (Cont.)
Follow-up visits
Interview
Physical examination
Fetal assessment
Gestational age
Fetal heart tones
Health status
Fundal height
Laboratory/other tests
15
Detecting Fetal Heartbeat
16
Nursing Interventions:
Education for Self-Management
Expected maternal and fetal changes
Nutrition
Personal hygiene
Prevention of urinary tract infections
Kegel exercises
Preparation for breastfeeding-Pinch test and breast

shell pg. 318
Dental health
Physical activity
Nursing Intervention p. 316
Pg. 316-320
17
(Cont.)
Posture and body

mechanics
Rest and relaxation
Employment
Clothing
Travel
Medications and
herbal preparations
Immunizations
Pg. 320-327.
18
(Cont.)
Alcohol, cigarette smoking, caffeine, drugs
Normal discomforts
Recognizing potential complications
Recognizing preterm labor*
Sexual counseling
Using the history
Countering misinformation
Safety and comfort during sexual activity
Psychosocial support
19
20
Variations in Prenatal
Care
Cultural influences
Many cultural variations are found in prenatal care
Cultural barriers to prenatal care: lack of money,

lack of transportation, language barriers, modesty
Cultural prescriptions vs. cultural proscriptions
Emotional response
Physical activity and rest
Clothing
Sexual activity
Diet
Pg. 330-332
21
Care (Cont.)*
Age differences
Adolescents
Less likely than older women to receive adequate

prenatal care
Women older than 35 years
Multiparous women
Primiparous women
Pg. 334.
22
Care (Cont.)
Multifetal pregnancy
Puts the mother and fetuses at increased risk for

adverse outcomes
Multifetal pregnancies are more likely to end in

prematurity.
Spontaneous rupture of membranes before term

is more common.
Congenital malformations twice as common in

monozygotic twins as in singletons
Pg. 335
23
Care (Cont.)
Multifetal pregnancy (Cont.)
Counseling needs to be provided for
Risk of preterm labor
Modification of weight gain and nutritional intake
Selective reproduction
Lifestyle changes
Can place a strain on finances, space, workload, and the womans

and familys coping capabilities
24
Perinatal Education
Goal is to help individuals and family members

to make informed and safe decisions about
pregnancy, birth, infant care, and early
parenthood
Classes for expectant parents
Education programs consist of a menu of class

series and activities from preconception through
the early months of parenting.
25
26
Perinatal Care Choices*
Physicians
Midwives
Certified nurse-midwives (CNMs)
Direct entry midwives or certified midwives (CMs)
Traditional or lay midwives
Doulas
Birth plans
27
Birth Setting Choices
Hospital
Labor, delivery, recovery rooms (LDRs)
Labor, delivery, recovery, postpartum rooms

(LDRPs)
Birth centers
Home birth
Remains a controversial topic in American health

care
28
Key Points
The prenatal period is a preparatory one both

physically, in terms of fetal growth and parental
adaptations, and psychologically, in terms of
anticipation of parenthood.
Pregnancy affects parent-child, sibling-child,

and grandparent-child relationships.
Discomforts and changes of pregnancy can

cause anxiety for the woman and her family
and require sensitive attention and a plan for
teaching self-management measures.
29
Key Points (Cont.)
Education about safety during activity and

exercise is essential, given maternal
anatomic and physiologic responses to
pregnancy.
Important components of the initial prenatal

visit include detailed and carefully
documented findings from the interview, a
comprehensive physical examination, and
selected laboratory tests.
Follow-up visits are shorter than the initial

visit and are important for monitoring the
health of the mother and fetus and providing
anticipatory guidance as needed.
30
Key Points (Cont.)
Even in normal pregnancy the nurse must

remain alert to hazards such as supine
hypotension, signs and symptoms of potential
complications, and signs of family
maladaptations.
Blood pressure is evaluated on the basis of

absolute values and length of gestation and is
interpreted in light of modifying factors.
Each pregnant woman needs to know how to

recognize and report signs of potential
complications such as preterm labor.
31
Key Points (Cont.)
There is an increased incidence of physical,

mental, and verbal abuse during pregnancy.
Culture, age, parity, and multifetal pregnancy

can have a significant effect on the course and
outcome of the pregnancy.
Nurses must ask pregnant women and their

families about preferences, practices, and
customs related to childbearing to provide
culturally sensitive care.
32
Key Points (Cont.)
Childbirth education teaches tuning in to the

bodys inner wisdom and coping strategies that
enhance womens ability to cope effectively
with labor and birth.
Perinatal education strives to promote healthier

pregnancies and family lifestyles.
Nurses can help pregnant women and their

families to make informed decisions about care
providers, birth settings, and labor support.
33
Question
1.
What should the RN be aware during follow-up visits and the

physical examination for women receiving prenatal care?
a. The interview portions become more intensive

as the visits become more frequent over the
course of the pregnancy.
b. Monthly visits are scheduled for the first
trimester, every 2 weeks for the second
trimester, and weekly for the third trimester.
c. During the abdominal examination, the nurse
should be alert for supine hypotension.
d. For pregnant women, a systolic blood pressure
(BP) of 130 mm Hg and a diastolic BP of 80 mm
Hg is sufficient to be considered hypertensive
34

Chapter - 014 - Care of Family During Pregnancy

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Chapter 14

NURSING CARE OF THE

Copyright 2016 by Elsevier Inc. All rights reserved.

Describe strategies for confirming pregnancy and

Summarize the physical, psychosocial, and behavioral

Evaluate the benefits of prenatal care and problems of

Outline the patterns of health care used to assess

Copyright 2016 by Elsevier Inc. All rights reserved.

Plan education needed by pregnant women to

Evaluate the effect of culture, age, parity, and

Compare the options for health care providers and

Prenatal period: A time of physical and

Duration of pregnancy: Gestation

Spans 9 calendar months, 10 lunar months

40 weeks or 280 days

First: weeks 1-13

Second: weeks 14-26

Third: weeks 27-40 (pg. 309)

Copyright 2016 by Elsevier Inc. All rights reserved.

Signs and symptoms

Amenorrhea, nausea and vomiting, breast

Copyright 2016 by Elsevier Inc. All rights reserved.

Signs and symptoms (Cont.)

Braxton Hicks contractions

Positive pregnancy test

Copyright 2016 by Elsevier Inc. All rights reserved.

Signs and symptoms (Cont.)

Attributed to the fetus

Fetal heartbeat distinct from mothers

Fetal movement felt by someone other than mother

Visualization of the fetus

Copyright 2016 by Elsevier Inc. All rights reserved.

Estimating Date of Birth

Estimated date of birth (EDB)

Estimated date of delivery (EDD)

Estimated date of confinement (EDC)

Standard procedure for determining the

Naegeles rule to calculate EDB

Accepting the pregnancy

Identifying with the mother role

Reordering personal relationships

Establishing relationship with fetus: attachment

Phase 1: She accepts the biologic fact of pregnancy

Phase 2: She accepts the growing fetus as distinct

Phase 3: She prepares realistically for the birth and

Preparing for childbirth

Copyright 2016 by Elsevier Inc. All rights reserved.

Accepting the pregnancy

Developmental tasks experienced by the

Identifying with the father role

Reordering personal relationships

Establishing relationship with the fetus

Preparing for birth

Depends on age and

Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

Reason for seeking

Initial visit (Cont.)

Prenatal interview (Cont.)

History or risk of intimate partner violence

Urine, cervical, and blood samples

Screening and diagnostic tests for infectious

Copyright 2016 by Elsevier Inc. All rights reserved.