nursing management during pregnancy ni ketut alit a nursing faculty airlangga university surabaya...
Post on 19-Dec-2015
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NURSING MANAGEMENT DURING PREGNANCY
Ni Ketut Alit ANursing Faculty Airlangga University
Surabaya East Java
REFERENCES Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care,
The Nurse and The Family 5th ed , 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 ) Ilmu Kebidanan , Jakarta Yayasan Bina Pustaka Sarwono Prawiroharjo.
Journals and article related to..
Conception, Fetal Development, Gestational Risk and Fetal Well-being
Factors affecting fetal well-being:Quality of sperm or ovumIntrauterine environmentFirst trimester exposure to hazardous agentsMaternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatorySubstance abuseKnown or unknown infections
Barriers to Prenatal Care
Sociodemographics Insurance/finances Inadequate care providers for low
income Delay in onset of prenatal care Cultural factors Transportation Attitudes
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
KSPR (Kartu Score Pudji Rohjati)Card for risk detection of Pregnacy
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
Comprehensive Health History
Reason for seeking careSuspicion of pregnancyDate of last menstrual periodSigns and symptoms of pregnancyUrine or blood test for hCG
Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric, and
gynecologic history
Menstrual History
Menstrual cycleAge at menarcheDays in cycleFlow characteristicsDiscomfortsUse of contraception
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.
Obstetric History
Gravida: a pregnant womanGravida I (primigravida): first pregnancyGravida II (secundigravida): second pregnancy, etc.
Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or morePrimapara: 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
Obstetric History
TerminologyG (gravida): the current pregnancyT (term births): the number of pregnancies ending
>37 weeks’ gestation, at termP (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
Physical Examination
Vital signs Head-to-toe assessment
Head and neckChestAbdomen, including fundal height if appropriateExtremities
Pelvic examinationExamination of external and internal genitaliaBimanual examinationPelvic shape: gynecoid, android, anthropoid, platypelloidPelvic measurements
Laboratory Tests
Urinalysis Complete blood count Rh factor TORCH test Hepatitis B surface antigen HIV test Ultrasound
Follow-up Visits
Visit schedule: Every 4 weeks up to 28 weeksEvery 2 weeks from 29 to 36 weeksEvery week from 37 weeks to birth
Follow-up Visits
AssessmentsWeight & BP compared to baseline valuesUrine testing for protein, glucose, ketones, and nitritesFundal height Quickening/fetal movement Fetal heart rate
Teaching: danger signs
1st Trimester Discomforts
Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea
2nd Trimester Discomforts
Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating
3rd Trimester Discomforts
Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions
Nursing Management To Promote Self-Care
Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise
Nursing Management To Promote Self-Care
Sleep and rest Sexual activity and sexuality Employment Travel Immunizations and medications
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
Danger Signs in PregnancyReport 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.
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
Preparation for Labor, Birth, and Parenthood
Options for birth setting Hospitals: delivery room, birthing suiteBirth centersHome birth
Options for care providersObstetricianMidwifeHealth provider
Preparation for Labor, Birth, and Parenthood
Feeding choicesBreastfeeding: advantages and disadvantagesBottle feeding: advantages and disadvantagesTeaching
Final preparation for labor and birth
Care For Better Health