C1 BAPTIST HEALTH SCHOOLS LITTLE ROCK SCHOOL OF NURSING NSG 3207: WOMEN’S HEALTH Lecture : Nursing Process and the Teaching and Learning Needs of the Antepartal Patient. Assigned Reading in Textbooks: Pilliterri, A.(2007). Maternal and child health nursing: Care of the childbearing and child rearing family. 5th ed. Lippincott, Williams & Wilkins. Philadelphia, PA. Chapter 8, p.197; Chapter 9, p. 215-225, 231-237; Chapter 10, p. 252-3, 264-6; Chapter 11, p.274-286, 296. Lecture Objectives: 1. Define the terms listed in the box on the following page. 2. Demonstrate the 2-digit, 4-digit, and 5-digit systems used to describe a history of pregnancy 3. Tell the substance that is measured in a pregnancy test and what factors can produce false results 4. Define the terms: Presumptive, Probable, and Positive in relation to the signs of pregnancy 5. List 5 positive signs of pregnancy as related to the appropriate weeks of pregnancy 6. Explain the weeks of pregnancy that are associated with the 3 trimesters of pregnancy 7.Compare and contrast the length of pregnancy as opposed to the length of gestation 8.Apply Nagele’s Rule to determine EDB and explain why it may not be exact 9. Describe the stages of maternal and paternal adaptation and expected behaviors for each stage 10. List the common lab tests that are done in a routine initial visit for prenatal care and explain why each is needed 11.Explain the normal variations in blood pressures in the 3 trimesters of pregnancy and how serial pressures can be interpreted to determine abnormalities 12. Name 5 symptoms of problems that require medical intervention in pregnancy 13. Tell the reason for drawing maternal blood for Alpha Fetal Protein levels and Multiple Marker test during pregnancy 14. Apply suggested nursing diagnoses to the care of an antepartal patient to form a problem list 15. Describe the nursing interventions associated with the following topics for teaching in pregnancy: Nutrition, Hygiene, Urinary tract infections, Kegel Exercises, Preparation for breast feeding, Physical activities, Body mechanics , Medications, Substance use, and Sexual counseling 16. Discuss the Discomforts of pregnancy in relation to each trimester and the nursing interventions to cope with these discomforts

C2 Reference for studying objectives: Chapters in Pilliterri

Objectives Covered

Page Numbers for Study

Chapter 8

#8

p.197

Chapter 9

#3,4,5,9,10,11

p. 215-225, p. 231-237

Chapter 10

#2,13

p. 252-253, p.264-266

Chapter 11

#12,15,16

p.296, p. 274-286

1. OBJECTIVE : Fill in definitions of key terms in chart below: Key Terms Gravida Gravity Para (parity) Nullipara Nulligravida Primipara Primagravida Multipara Multigravida Term Preterm Postterm Age of Viability EDC EDB

Definitions

C2 1. OBJECTIVE : Define the following terms: 1.1

Gravida

1.2

Para

1.3

Nullipara

1.4

Nulligravida

1.5

Primipara

1.6

Primigravida

1.7

Multipara

1.8

Term

1.9

Preterm

1.10

Post-term

1.11

Abortion

1.12

Age of Viability

1.13

EDC

1.14

EDB

2. OBJECTIVE : Demonstrate the 5 Digit System used to describe a history of pregnancy. 2.1

2.2

5 Digit System: G T P A L Examples:

C3 3.4.5. OBJECTIVE : List the 3 signs of pregnancy and give an example of each. Tell the substance that is measured in a pregnancy test and what factors can produce false results? Identify 5 positive signs of pregnancy and the weeks of pregnancy associated with each. 3.1

Presumptive

3.2

Probable 3.2.1 HCG

3.3

Positive 3.3.1. 3.3.2 3.3.3 3.3.4 3.3.5

5&6. OBJECTIVE : Relate the weeks of pregnancy associated with the 3 trimesters of pregnancy. Compare and contrast the length of pregnancy with the length of gestation. 5.1.

1ST trimester

5.2

2nd Trimester

5.3

3rd trimester

5.4

Length of pregnancy

5.5

Length of gestation

5.6

Difference between pregnancy and gestation

7. OBJECTIVE : Apply Nagel’s Rule to determine EDB and explain why it may not be exact. 7.1

EDC

7.2

EDB

7.3

Nagel’s Rule Step 1 Step 2 Step 3 Step 4

7.4

Why it may not be exact?

C4 7.5

Examples of Nagel’s Rule :

8 . OBJECTIVE: Describe the stages of Maternal, Paternal, and Sibling adaptation and expected behaviors for each. 8.1

Maternal 8.1.1 8.1.2 8.1.3 8.1.4. 8.1.5

8.2

Paternal 8.2.1 8.2.2. 8.2.3 8.2.4

8.3

Sibling 8.3.1

9. OBJECTIVE : List the 2 goals for nursing management of the antepartal patient. 9.1. 9.2. 10. OBJECTIVE : Describe the various aspects of the initial prenatal visit. And subsequent visits. 10.1 10.2 10.2.1 UA 10.2.2 H&H 10.2.3 CBC C5

10.3

Type and X match

10.4.

Rubella Titre

10.5

Glucose tolerance

10.6

PAP

10.7

Cervical cultural

10.8 10.9

Skin AFP

10.10. Multiple Marker Test 10.11

Subsequent visits : a. Monthly b. Biweekly c. Weekly

11 & 12. OBJECTIVE : Name 5 symptoms of problems that may occur in pregnancy that require a physician’s attention. Explain the variations in blood pressure during the 3 trimesters. 11.1 Symptoms of Complications : a.. b. c. d. e.. 11.2

Blood Pressure variations : a.. b. c.

C6

13. OBJECTIVE : List the methods of fetal assessment and how each applies clinically. 13.1

Fetal Heart Tones (FHT) -

13.2

Fetal Movement

13.3

Fundal height

13.4

Ultrsonography

13.5

Amniocentesis

14. OBJECTIVE: Write the important points in antepartal teaching the is necessary to be taught for the mother to cope effectively during pregnancy. 14.1

Nutrition

14.2

Hygiene

14.3

Urinary Tract health

14.4

Kegal Exercises

14.5

Dental health

14.6

Physical activity

14.7

Posture and Body mechanics

14.8

Rest

14.9

Employment

14.10

Clothing

14.11 Travel 14.12

Car and Air travel

14.13

Medications

14.14 Substance abuse 14.15

Sex C7

15. OBJECTIVE : Apply the nursing process to the care of an antepartal patient to create an

appropriate care plan. 15.1 Assessment 15.2

Diagnosis

15.3

Outcomes

15.4

Interventations

16. OBJECTIVES: Describe the discomforts of pregnancy associated with each trimester of pregnancy and how to incorporate the appropriate interventions into a care plan. 16.1

1st Trimester 16.1.1. Breast engorgement 16.1.2

Urinary frequency

16.1.3

Fatigue

16.1.4 Nausea and vomiting ( morning sickness)

16.1.5

Nasal stuffiness

16.1.6 Leukorrhea 16.1.7

16.2

Mood swings

2nd Trimester 16.2.1 Skin Pigment 16.2.2

Palpitations

16.2.3

Supine Hypotension

16.2.4

Orthostatic Hypotension

16.2.5

Food cravings

16.2.6 Heartburn 16.2.7

Constipation

16.2.8

Flatulence

C8

16.3

16.2.9

Varicose veins

16.2.10

Headaches

16.2.11

Carpal Tunnel Syndrome

16.2.12

Round ligament pain

16.2.13.

Backache and joint pain

3rd Trimester 16.3.1 Dyspnea 16.3.2

Insomnia

16.3.3

Mood swings

16.3.4

Gingivitis

16.3.5

Perineal discomfort

16.3.6

Braxton Hicks contractions

16.3.7

Leg cramps

16.3.8

Ankle edema

17. OBJECTIVE : Identify the signs of preterm labor. 17.1 17.2 17.3