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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

Maria Rubolino, MSN, FNPc

September 6th, 2005


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A & P of Pregnancy

  • Terms to know

  • Gravida

  • Parity

  • Nulliparous

  • Multiparous

  • Term

  • TPAL


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Signs of Pregnancy

  • Presumptive Signs/Symptoms

  • Probable

  • Positive


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Uterine Growth

  • Stimulated by hormones in the 1st trimester

  • Larger as it rises out of the pelvis

  • Hegar’s

  • Chadwick’s


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Contractility

  • Braxton Hicks


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Cervical Changes

  • Goodell’s Sign

  • Friability


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Fundal Height Changes

  • Changes from week to week


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Vaginal Changes

  • Vaginal mucosa thickens

  • Chadwick’s sign

  • Vaginal discharge

  • Mucous plug

  • Varicosities


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Breast Changes

  • Fullness

  • Areolar pigmentation

  • Colostrum


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Circulatory Changes

  • CV- blood volume, cardiac hypertrophy

  • Cardiac output increases

  • Blood pressure changes


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Circulatory changes

  • Supine hypotension syndrome


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Renal Changes

  • Renal pelvis and ureters dilate

  • Urine rate is slowed

  • Bladder frequency


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GI Changes

  • Appetite

  • Gastric emptying

  • Absorption

  • Bowel sounds

  • Blood flow to the pelvis

  • Morning sickness

  • Pyrosis

  • Constipation


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Gallbladder and Liver

  • Gallbladder with decreased tone

  • PUPPS


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Skin Changes

  • Increased subdermal fat

  • Hyperpigmentation

  • Striae

  • Linea nigra

  • Chloasma

  • Angiomas

  • Pruritis

  • Palmar erythema

  • Increased perspiration


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Endocrine Changes

  • Amenorrhea

  • Progesterone

  • Estrogen

  • Ant pituitary suppresses the FSH and LH causing to rise

  • Post pituitary produces oxytocin


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Neurological Changes

  • Carpal Tunnel Syndrome

  • Numbness/Tingling

  • HA’s

  • Lightheadedness

  • Muscle Cramps


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Musculoskeletal Changes

  • Change in posture

  • Waddling

  • Back Pain


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Nutrition Needs

  • Folic Acid

  • Calories increased to 300/day

  • Increased protein

  • Iron requirements increased

  • Increased fluid intake

  • Limit caffeine


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Exercise

  • Will produce benefits

  • Must consume fluid

  • Watching heart rate

  • No new activities


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Weight Gain in Pregnancy

  • 25-35 pounds total weight gain

    With singleton pregnancy

    35-45 pound total weight gain with multiples


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Nagele’s Rule

  • LMP minus 3 calendar days

  • Add 7 days and 1 year


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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


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Hyperemesis

  • N/V

  • Small frequent meals

  • Avoid spicy foods

  • Antiemetics


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1st Trimester

  • Hyperemesis

  • No menses

  • N/V

  • Fatigue

  • Breast Tenderness


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20 Weeks

  • Quickening

  • Pelvic Pressure

  • Constipation

  • Round ligament pain


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CVS

  • Screening to detect fetal genetic abnormalities

  • Risks of miscarriage 1 in 100


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Nuchal Fold Thickness

  • Ultrasound and 9-13 weeks

  • Increased with down syndrome

  • Screening only!!


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AFP

  • Triple marker test/screening

  • 16-20 weeks gestation

  • If abnormal refer to specialist


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Amniocentesis

  • Performed between 16-20 weeks

  • Done with AMA, FH, +AFP

  • Risks of miscarriage 1 in 200-300


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Testing in 3rd Trimester

  • 1 hour post glucola

  • CBC

  • UA

  • Antibody screen

  • Rhogam

  • TSH


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32-36 Weeks

  • Fetal position

  • Descending into pelvis

  • Placental location

  • GBS

  • FKC’s


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36-42 Weeks

  • Vaginal Exams

  • Labor precautions

  • PIH precautions


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Childbirth Education

  • Natural

  • Lamaze

  • Bradley


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Hospital

Birthing Center

Home

Bath

Pain Meds

Epidural

Natural

Lighting

Ambulating

Doulas

Hypnosis

Birth Plan


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