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Nursing Care During the Antenatal Period. Maria Rubolino, MSN, FNPc September 6 th , 2005. A & P of Pregnancy. Terms to know Gravida Parity Nulliparous Multiparous Term TPAL. Signs of Pregnancy. Presumptive Signs/Symptoms Probable Positive. Uterine Growth.

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nursing care during the antenatal period

Nursing Care During the Antenatal Period

Maria Rubolino, MSN, FNPc

September 6th, 2005

a p of pregnancy
A & P of Pregnancy
  • Terms to know
  • Gravida
  • Parity
  • Nulliparous
  • Multiparous
  • Term
  • TPAL
signs of pregnancy
Signs of Pregnancy
  • Presumptive Signs/Symptoms
  • Probable
  • Positive
uterine growth
Uterine Growth
  • Stimulated by hormones in the 1st trimester
  • Larger as it rises out of the pelvis
  • Hegar’s
  • Chadwick’s
contractility
Contractility
  • Braxton Hicks
cervical changes
Cervical Changes
  • Goodell’s Sign
  • Friability
fundal height changes
Fundal Height Changes
  • Changes from week to week
vaginal changes
Vaginal Changes
  • Vaginal mucosa thickens
  • Chadwick’s sign
  • Vaginal discharge
  • Mucous plug
  • Varicosities
breast changes
Breast Changes
  • Fullness
  • Areolar pigmentation
  • Colostrum
circulatory changes
Circulatory Changes
  • CV- blood volume, cardiac hypertrophy
  • Cardiac output increases
  • Blood pressure changes
circulatory changes11
Circulatory changes
  • Supine hypotension syndrome
renal changes
Renal Changes
  • Renal pelvis and ureters dilate
  • Urine rate is slowed
  • Bladder frequency
gi changes
GI Changes
  • Appetite
  • Gastric emptying
  • Absorption
  • Bowel sounds
  • Blood flow to the pelvis
  • Morning sickness
  • Pyrosis
  • Constipation
gallbladder and liver
Gallbladder and Liver
  • Gallbladder with decreased tone
  • PUPPS
skin changes
Skin Changes
  • Increased subdermal fat
  • Hyperpigmentation
  • Striae
  • Linea nigra
  • Chloasma
  • Angiomas
  • Pruritis
  • Palmar erythema
  • Increased perspiration
endocrine changes
Endocrine Changes
  • Amenorrhea
  • Progesterone
  • Estrogen
  • Ant pituitary suppresses the FSH and LH causing to rise
  • Post pituitary produces oxytocin
neurological changes
Neurological Changes
  • Carpal Tunnel Syndrome
  • Numbness/Tingling
  • HA’s
  • Lightheadedness
  • Muscle Cramps
musculoskeletal changes
Musculoskeletal Changes
  • Change in posture
  • Waddling
  • Back Pain
nutrition needs
Nutrition Needs
  • Folic Acid
  • Calories increased to 300/day
  • Increased protein
  • Iron requirements increased
  • Increased fluid intake
  • Limit caffeine
exercise
Exercise
  • Will produce benefits
  • Must consume fluid
  • Watching heart rate
  • No new activities
weight gain in pregnancy
Weight Gain in Pregnancy
  • 25-35 pounds total weight gain

With singleton pregnancy

35-45 pound total weight gain with multiples

nagele s rule
Nagele’s Rule
  • LMP minus 3 calendar days
  • Add 7 days and 1 year
tests in 1 st trimester
Tests in 1st Trimester
  • 1 hour post glucola if indicated
  • Blood type
  • Antibody screen
  • CBC
  • UA C/S
  • Hepatitis
  • HIV
  • RPR
  • TSH
  • Toxoplasmosis if indicated
  • CVS if desired
hyperemesis
Hyperemesis
  • N/V
  • Small frequent meals
  • Avoid spicy foods
  • Antiemetics
1 st trimester
1st Trimester
  • Hyperemesis
  • No menses
  • N/V
  • Fatigue
  • Breast Tenderness
20 weeks
20 Weeks
  • Quickening
  • Pelvic Pressure
  • Constipation
  • Round ligament pain
slide27
CVS
  • Screening to detect fetal genetic abnormalities
  • Risks of miscarriage 1 in 100
nuchal fold thickness
Nuchal Fold Thickness
  • Ultrasound and 9-13 weeks
  • Increased with down syndrome
  • Screening only!!
slide29
AFP
  • Triple marker test/screening
  • 16-20 weeks gestation
  • If abnormal refer to specialist
amniocentesis
Amniocentesis
  • Performed between 16-20 weeks
  • Done with AMA, FH, +AFP
  • Risks of miscarriage 1 in 200-300
testing in 3 rd trimester
Testing in 3rd Trimester
  • 1 hour post glucola
  • CBC
  • UA
  • Antibody screen
  • Rhogam
  • TSH
32 36 weeks
32-36 Weeks
  • Fetal position
  • Descending into pelvis
  • Placental location
  • GBS
  • FKC’s
36 42 weeks
36-42 Weeks
  • Vaginal Exams
  • Labor precautions
  • PIH precautions
childbirth education
Childbirth Education
  • Natural
  • Lamaze
  • Bradley
birth plan
Hospital

Birthing Center

Home

Bath

Pain Meds

Epidural

Natural

Lighting

Ambulating

Doulas

Hypnosis

Birth Plan
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