Nursing Care During the Antenatal Period

A & P of Pregnancy

• Terms to know

• Gravida

• Parity

• Nulliparous

• Multiparous

• Term

• TPAL

Signs of Pregnancy

• Presumptive Signs/Symptoms

• Probable

• Positive

Uterine Growth

• Stimulated by hormones in the 1st trimester

• Larger as it rises out of the pelvis

• Hegar’s

• Chadwick’s

Contractility

• Braxton Hicks

Cervical Changes

• Goodell’s Sign

• Friability

Fundal Height Changes

• Changes from week to week

Vaginal Changes

• Vaginal mucosa thickens

• Chadwick’s sign

• Vaginal discharge

• Mucous plug

• Varicosities

Breast Changes

• Fullness

• Areolar pigmentation

• Colostrum

Circulatory Changes

• CV- blood volume, cardiac hypertrophy

• Cardiac output increases

• Blood pressure changes

Circulatory changes

• Supine hypotension syndrome

Renal Changes

• Renal pelvis and ureters dilate

• Urine rate is slowed

• Bladder frequency

GI Changes

• Appetite• Gastric emptying• Absorption• Bowel sounds• Blood flow to the pelvis• Morning sickness• Pyrosis• Constipation

Gallbladder and Liver

• Gallbladder with decreased tone

• PUPPS

Skin Changes

• Increased subdermal fat• Hyperpigmentation• Striae• Linea nigra• Chloasma• Angiomas• Pruritis• Palmar erythema• Increased perspiration

Endocrine Changes

• Amenorrhea

• Progesterone

• Estrogen

• Ant pituitary suppresses the FSH and LH causing to rise

• Post pituitary produces oxytocin

Neurological Changes

• Carpal Tunnel Syndrome

• Numbness/Tingling

• HA’s

• Lightheadedness

• Muscle Cramps

Musculoskeletal Changes

• Change in posture

• Waddling

• Back Pain

Nutrition Needs

• Folic Acid

• Calories increased to 300/day

• Increased protein

• Iron requirements increased

• Increased fluid intake

• Limit caffeine

Exercise

• Will produce benefits

• Must consume fluid

• Watching heart rate

• No new activities

Weight Gain in Pregnancy

• 25-35 pounds total weight gain

With singleton pregnancy

35-45 pound total weight gain with multiples

Nagele’s Rule

• LMP minus 3 calendar days

• Add 7 days and 1 year

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

• N/V

• Small frequent meals

• Avoid spicy foods

• Antiemetics

1st Trimester

• Hyperemesis

• No menses

• N/V

• Fatigue

• Breast Tenderness

20 Weeks

• Quickening

• Pelvic Pressure

• Constipation

• Round ligament pain

CVS

• Screening to detect fetal genetic abnormalities

• Risks of miscarriage 1 in 100

Nuchal Fold Thickness

• Ultrasound and 9-13 weeks

• Increased with down syndrome

• Screening only!!

AFP

• Triple marker test/screening

• 16-20 weeks gestation

• If abnormal refer to specialist

Amniocentesis

• Performed between 16-20 weeks

• Done with AMA, FH, +AFP

• Risks of miscarriage 1 in 200-300

Testing in 3rd Trimester

• 1 hour post glucola

• CBC

• UA

• Antibody screen

• Rhogam

• TSH

32-36 Weeks

• Fetal position

• Descending into pelvis

• Placental location

• GBS

• FKC’s

36-42 Weeks

• Vaginal Exams

• Labor precautions

• PIH precautions

Childbirth Education

• Natural

• Lamaze

• Bradley

Birth Plan

• Hospital• Birthing Center• Home• Bath• Pain Meds• Epidural• Natural• Lighting

• Ambulating• Doulas• Hypnosis