Ch 15 Nursing Care during Pregnancy

StudyBlue printing of Ch 15 Nursing Care during Pregnancy html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; 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2 nd = 14-26 wks; 3 rd = 27-40 wks · term – 38-40 wks · Mom & Dad adaptation throughout pregnancy including accepting the pregnancy o Mom § Identifying with the mother role (babysitting, practicing with dolls) § Reordering personal relationships (relation with own mother is significant, also partner, 1 st trimester – decrease d/t nausea and fatigue, 2 nd – increase, 3 rd - decrease § Establishing relationship with fetus (phase 1 “I’m pregnant”, phase 2 “I’m going to have a baby” phase 3 “I’m going to be a mother”) § Preparing for childbirth – reading books, finding a provider, by the end of 3 rd trimester the mom is ready for child birth due to physical discomfort, lack of sleep, etc) o Dad § Couvade syndrome – pregnancy like symptoms (nausea, weight gain) § May’s three phases · Announcement: accept biologic fact of pregnancy · Moratorium: adjust to reality of pregnancy/accept pregnancy · Focusing: last trimester, active involvement in pregnancy and relationship with child, begins to think of himself as a father § Identifying with father role – own father, child care, male and father roles in social group § Reordering personal relationships - nurture partner respond to feelings of vulnerability. May feel rivalry or feel uneasy about mom’s preoccupation with child. § Establishing relationship with fetus - father’s relationship can be as strong. Begins during pregnancy, call child by name, daydreaming. Have father identify concerns. § Preparing for child - surge of creative energy in last 2 mos. Need to alter the environment. Rehearse getting to the facility. Childbirth prep classes can help dad learn ways to be involved in labor and birth. · Signs of Potential Complications p. 342 o 1 st trimester § severe vomiting, chills, fever, diarrhea, abdominal cramping; vaginal bleeding o 2 nd and 3 rd trimester § severe vomiting, sudden rupture of fluid before 37 wks, vaginal bleeding, chills, severe back pain, uterine contractions, swelling of face and fingers, severe headaches, glycosuria, visual disturbances · Education for Self Care: o Kegel Exercises – important for labor and to prevent incontinence later o preparation for breastfeeding and contraindications – breast is best – AAP recommends at least 1 yr, contraindications = needed medications, street drugs, HIV infection. Inverted nipples (pinch test), no special nipple preparation needed, purchase a nursing bra during 3 rd trimester o physical activity – promotes well-being and improves circulation, promotes relaxation and rest, counteracts boredom, avoid risky activities, jogger may need to switch to walking in 7 th month, extra calories and fluid are needed during pregnancy. o Travel – ok for low-risk pregnancy, foreign travel not recommended, wear seatbelt, walk every hour, high altitude decreases oxygen levels (may cause fetal hypoxia), air travel ok until 36 wks – walk every hour o use of alcohol/smoking – abstinence is strongly advised as no safe level has been established, don’t smoke and limit 2 nd hand smoke (can cause IUGR, preterm labor, fetal death assoc. with smoking) o use of prescription medications – susceptible to adverse effects from OTC/ prescription drugs and herbal preparations thru 1 st triemester o body mechanics – pelvic rocking, bend with knees, lift with legs, for prolonged standing place one foot on box or footstool, low chairs knees higher then hips, side-lying position o hygiene – nausea during pregnancy may lead to poor oral hygiene lead to cavities, gum disease is linked to preterm labor and LBW, 2 nd trimester is the best time to see a dentist, tub bathing okay if amniotic membranes are intact, wipe perineum front to back · Discomforts related to pregnancy pp.354-5 especially self-management o 1 st trimester (breast changes, urgency, fatigue, n/v, nasal stuffiness, mood swings) o 2 nd trimester ( pigmentation deepens, acne, palpitations, supine hypotension, faintness, food cravings, heartburn, constipation, gas, HA, round ligament pain, joint pain) o 3 rd trimester (SOB, insomnia, urgency, mood swings, perineal discomfort, Braxton hicks, leg cramps, ankle edema) · Changes in sexual desire throughout pregnancy o 1 st – decrease, 2 nd – increase, 3 rd – decrease · Biofeedback: helps w NV and aches · birth plan: plan to explore and choose childbirth options by personal priority, · childbirth and perinatal education: goal is to help families make informed, safe decisions about pregnancy, birth and early parenthood, choose care provider, birth setting, infant feeding, VBAC. · conscious breathing: during discomfort, it can help bring relief and peace, lie down and get comfy, deep breathing, do it every day · control in labor-? · imagery/visualization: can help with pain and/or discomfort · preconception education-idk. · Purpose of childbirth education: families make informed, safe decisions about pregnancy, birth & early parenthood. · Compare the different types of providers + types of deliveries (high risk vs. low risk) o Physicians: 91% of birthers, low and high risk, use hospital, family dr may use obgyn too. o Nurse-midwives: 8%, low risk, most in hospital or birth center o Direct-entry midwives: lay midwives, 1%, home, low? o Doulas: labor support woman. · Different birth settings o LDR: labor delivery and recovery in one room and postpartum/newborn is in another. vs. LDRP: all four in one room, private, more homelike vs. Birth Centers: separate from hospital, cost effective, low risk only, must attend childbirth/parenting classes, discharge w/I 6h of birth, more independent vs. Home births: low risk only, family is in control, care is more support than intervention, less expensive, lower infection risk.