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1. Misamis University
Ozamiz City
Graduate School
MASTER IN NURSING (MN)
FINAL EXAMINATION
Major in Maternal and Child Nursing
Name: Reynel Dan L. Galicinao Date: April 30, 2011
I. Psychological and Physiological Changes of Pregnancy
The psychological changes occur in response to the
physiologic changes. Though the physiological changes of
pregnancy are dynamic and extensive they are considered an
extension of normal physiology. The nurse uses this concept
when preparing teaching plans and developing care plans.
Complete the following:
A. What is the significant health care goal that the nurse
promotes when teaching a pregnant woman from any culture?
Providing care to childbearing families is aimed at the ideal of having every pregnancy
result in a healthy mother, baby, and family unit. Consider cultural practices because they have
important implications for the provision of nursing care. The primary goal is to provide
comprehensive family-centered care to the pregnant client, the family and the baby throughout
pregnancy
Safe, effective care environment
 Provide education and counselling regarding environmental safety for the expectant
woman and a safe intrauterine environment for the fetus.
 Provide opportunities for expectant couple to tour birthing facilities.
 Discuss progress of couple in childbirth education program.
Physiological integrity
 Promote maternal-fetal well-being.
 Discuss changes in third trimester and during birth process.
 Demonstrate methods of assessing fetal activity.
Psychosocial integrity
 Promote psychosocial adaptation.
 Provide opportunities for counselling and discussion of psychosocial aspects.
Health promotion and maintenance
 Promote, encourage, and review self-care activities.
 Provide opportunities to discuss parenting activities that will promote infant health.
B. You are caring for a pregnant client in the third
trimester. What are two physiological reasons why you
would advise her in the lateral recumbent position while
sleeping?
With the progression of pregnancy, the fetal weight increases with the compression of the
major blood vessels, especially the inferior vena cava. With this compression comes return of
insufficient blood to the heart and subsequent onset of symptoms such as pain, dizziness,
cramping, and shortness of breath. Because of the anatomy of the IVC in relation to the aorta

2. and the vertebral column, lying on the left side relieves the pressure and symptoms associated
with this condition. To promote placental perfusion, the woman should not lie flat on her back:
left lateral position provides the best placental perfusion; however, either side is acceptable.
C. Explain why it is important that pregnancy be diagnosed as
early as possible and how this diagnosis may impact upon
the woman’s physiological and psychological health status.
When a woman misses her menstrual period, she must visit the physician to check for
pregnancy. The earlier the client begins prenatal care, the better. This includes assessing the
patient, performing prenatal testing, providing nutritional care, and minimizing the discomforts of
pregnancy. Prenatal education should focus on nutrition, sexuality, stress reduction, lifestyle
behaviors, and hazards at home or work.
II. The Growing Fetus
The development of the fetus is a complex phenomenon
which originates form the union of an ovum and a sperm. When
united, the ovum and the sperm form a single cell which is
called zygote. This concept enables the nurse to explore
these stages of development with the childbearing family to
help them understand some of the changes taking place in the
woman’s body.
Complete the following:
A. Explain how the nutrients are exchanged from the mother to
the fetus during pregnancy.
The placenta is a large, flat organ that is attached to the inside of the uterus of a pregnant
woman. It is attached to the fetus through the umbilical cord. The placenta has many important
functions during pregnancy, including nutrient exchange between mother and baby through their
blood streams. This transfer is vital in enabling nutrition be transported from the mother through
the placenta to the fetus and expelling waste produced by the fetus back through the placenta
and into the maternal blood stream, which is then released by the mother.
The placenta is composed of numerous blood vessels. These blood vessels are filled with
fetal blood, while the placenta is rich in maternal blood. As these blood vessels carry fetal blood
through the placenta, they come into contact with the mother's blood, which transfers nutrients
into and removes waste from the fetal blood through the walls of the blood vessels. It is
important to note that during this interaction, the blood does not mix. Separation is maintained
by the blood vessel walls.
The substances that are transported from the mother to the fetus include glucose, amino
acids, maternal antibodies, oxygen and waste products such as carbon dioxide and bilirubin
from the liver. Glucose acts as the energy powerhouse for fetal development. Amino acids are
the building blocks of the developing baby. Maternal antibodies provide immunity to the fetus
before it is able to produce its own antibodies as its immune system matures.
B. Why should a pregnant woman avoid lying in the supine
position?
Lying on the right side does not give as much relief as lying on the left.
Lying on your back would understandably give you symptoms. Lying on the back especially as
the pregnancy progresses causes Vena Cava Sydrome and renders the woman extremely
hypotensive and prone to dizzy spells having compressed her major arteries and veins with the
bulging fetus against the spine. To promote placental perfusion, the woman should not lie flat on
her back: left lateral position provides the best placental perfusion; however, either side is
acceptable.
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3. C. Explain why the continued assessment of the eyes is
important when administering oxygen to premature infant.
Oxygen relieves neonatal respiratory distress which can be caused by cyanosis,
tachypnea, nasal flaring, bradycardia, retractions, hypotonia, hyporeflexia, or expiratory grunting.
No matter how it’s administered, oxygen therapy can be hazardous to a neonate. Whan given
for prolonged periods, it can cause retrolental fibroplasia, which may result in blindness in
preterm neonates, and can contribute to bronchopulmonary dysplasia. Because of the
neonate’s size and special respiratory requirements, oxygen administration commonly requires
special techniques and equipment.
III. Assessing Fetal and Maternal Health: The First Prenatal
Visit
When a woman visits a healthcare facility for the
first prenatal visit, an assertive effort should be made by
the healthcare providers to validate the pregnancy,
determine the woman’s health status and initiate the
strategies that will encourage the woman and her family to
establish positive behavior patterns of health promotion
during the pregnancy and throughout their lives. This
concept will allow the nurses to review the anatomical
structures of the female’s body and demonstrate knowledge of
how to appropriately intervene to provide nursing care,
education, and guidance during the mother’s pregnancy.
A. Identify the four types of pelvis and illustrate how the
anatomy of the pelvis may accommodate or hamper the fetus
as it progresses the birthing process.
There are four main types of pelvic shapes.
Gynecoid
 typical female pelvis in which inlet is round instead of
oval
 normal female pelvis
 optimal diameters in all three planes
 50% of all women
Android
 male-type pelvis
 normal male pelvis
 posterior segments are decreased in all three planes
 deep transverse arrest of descent of the fetus and
failure of rotation of the fetus are common
 20% of all women
Anthropoid
 pelvis in which anteroposterior diameter is equal to or
greater than the transverse diameter
 apelike pelvis with long anteroposterior diameter
 may allow for easy delivery of an occiput-posterior
presentation of the fetus
 25% of all women
Platypelloid
 broad pelvis with shortened anteroposterior diameter
and flattened, oval, transverse shape
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4.  flat female pelvis with wide transverse diameter
 arrest of fetal descent at the pelvic inlet is common
 labor progress can be poor
 5% of all women
B. Ms. X had delayed her first pre-natal visit. She visited
the prenatal clinic after she experienced edema of the
feet and hands. As a nurse, you take the history and
physical assessment to begin Ms. X’s care. Explain history
taking of a pregnant woman, assessment and planning of
care.
HEALTH HISTORY
Age
 Adolescents (younger than age 19) have an increased incidence of anemia, gestational
hypertension, preterm labor (PTL), small-for-gestational-age (SGA) infants, intrauterine-
growth-restricted infants, cephalopelvic disproportion, and dystocia.
 Women of advanced maternal age (over age 35) have an increased incidence of
hypertension, pregnancies complicated by underlying medical problems such as
diabetes, multiple gestation, and infants with genetic abnormalities.
Family History
 Includes maternal and paternal history
 Congenital disorders, hereditary diseases, multiple pregnancies, diabetes, heart disease,
hypertension, mental retardation, renal disease, use of diethylstilbestrol
Woman's Medical History
 Childhood diseases, especially rubella, measles and chickenpox
 Major illnesses, surgery (especially of the reproductive tract, spinal surgery or
appendectomy), blood transfusions
 Chronic medical conditions, such as epilepsy, diabetes mellitus
 Drug, food, and environmental sensitivities
 Urinary tract infections (UTIs), heart disease, hypertension, endocrine disorders,
anemias
 Menstrual history (onset of menarche, length, amount, regularity, and pain
[dysmenorrhea] of menstrual cycle). Also, assess bleeding between periods
 Gynecologic history (sexually transmitted diseases, contraceptive use, sexual history)
 Use of medications (prescription and over-the-counter [OTC]), recreational drugs,
alcohol, nicotine, tobacco, and caffeine
 History of tuberculosis, hepatitis, group B beta-hemolytic streptococcus, or human
immunodeficiency virus (HIV)
Woman's Nutritional History
 Adherence to special dietary practices (religious, social or cultural preferences)
 Eating disorders (obesity, bulimia, anorexia nervosa)
Woman's Past Obstetric History
 Problems of infertility, date of previous pregnancies, and deliveries’ dates; infant weights;
length of labors; types of deliveries; multiple births; abortions; and maternal, fetal, and
neonatal complications
 Woman's perception of past pregnancy, labor, and delivery for herself and effect on her
family
Woman's Present Obstetric History
 Gravidity, parity
 Date of last menstrual period
 Estimated date of birth/expected date of confinement
 Signs and symptoms of pregnancy: amenorrhea, breast changes, nausea and vomiting,
fetal movement, fatigue, urinary frequency, skin pigment changes. Expectations for her
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5. present pregnancy, labor, and delivery. Expectations for her health care providers and
her perception of her relationship between herself and her nurse
 Rest and sleep patterns: length, quality, and regularity of rest and sleep
 Activity and employment: exercise patterns, type and hours of employment, exposure to
hazardous material (occupational hazards), plans for continued employment
 Sexual activity: sexual satisfaction, frequency and positions during intercourse,
alternative practices used to achieve sexual satisfaction
 Diet history: weight gain, eating patterns (times and frequency of eating daily), number of
servings of food from the five food groups, calories, protein, vitamins, and minerals
consumed daily
 Psychosocial status: emotional changes she is experiencing, woman's and family's
reactions to present pregnancy, support system - family's and friends' willingness to
provide support, woman's present coping with lifestyle changes caused by the
pregnancy
LABORATORY DATA
Urinalysis
 Urine is tested for glucose, ketones, and protein. Urine is usually collected by way of
clean catch midstream
 Glucose (glucosuria) may be present in small amounts because the glomerular filtration
rate is increased without the same increase in kidney tubular reabsorption. Glucosuria
should be investigated to rule out diabetes
 Protein in the urine that exceeds 250 mg/dL should be reported because it may be a
sign of preeclampsia, renal problems, or UTI
 Ketones in the urine should be reported because ketonuria may be a sign of excessive
weight loss, dehydration, or electrolyte imbalance. Ketonuria is commonly secondary to
nausea and vomiting of pregnancy
 If the urine is cloudy and bacteria or leukocytes are present (> 4 leukocytes per high-
powered field), a urine culture is performed
 The presence of bilirubin is indicative of liver or gallbladder disease or breakdown of
RBCs
 The presence of blood in the urine (hematuria) is suggestive of UTI, kidney disease, or
vaginal contamination
Blood
 Determination of hematocrit and hemoglobin levels and description of the morphology of
the RBCs are done to find evidence of anemias, such as sickle cell or Mediterranean
anemia
 Hemoglobin levels average 12 to 16 g/dL
 Blood type, Rh factor, and antibody screen: if the woman is found to be Rh negative or
to have a positive antibody screen, her partner is screened and a maternal antibody titer
is drawn as indicated
o Coombs' test - retested at 28 weeks in the Rh-negative woman for detection of
antibodies.
o RhO(D) immune globulin (RhoGAM) given at 28 weeks as indicated. Also
administered following chorionic villus sampling (CVS), percutaneous umbilical
sampling (PUBS), amniocentesis, trauma or placental separation (abruptio
placentae or placenta previa)
o Given within 72 hours of birth of RhO(D) mom or Du- and without antibodies and
neonate is Rh1(D) or Du+ with a negative Coombs' test
 Glucose- diabetic screening for women who are at average risk conducted at 24 to 28
weeks using a 1-hour 50-g glucose load test. According to the American Diabetes
Association, average risk includes: age 25 or older; obese women of any age; family
history of diabetes mellitus in a first-degree relative; member of an ethnic group with a
high prevalence of diabetes (Hispanic, Black, Native American, Asian-American); history
of abnormal glucose tolerance; history of poor obstetric outcome
 Alpha-fetoprotein (AFP) - done at 15 to 18 weeks. High maternal levels may indicate an
open neural tube defect in the fetus; low levels have been associated with Down
syndrome. Inaccurate pregnancy dating is the most common cause for an abnormal AFP
Infection
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6.  Venereal Disease Research Lab (VDRL) test or Fluorescent Treponemal Antibody
Absorption Test for syphilis is done on the initial visit; repeat VDRL at 32 weeks as
indicated
 Gonorrhea - cervical cultures are usually done at the initial visit and when symptoms are
present
 Herpes - all visible lesions are cultured, and the cervix is cultured weekly beginning 4 to
8 weeks before delivery
 Chlamydia - done at the initial visit and when symptoms are present
 Rubella titer - if nonimmune, less than 1:8, immunize postpartum
 Hepatitis B surface antigen
 HIV - screen is done on high-risk women
Other Tests
 Toxoplasmosis - done as indicated for women at risk
 Tuberculin skin tests - done as indicated
 Papanicolaou (Pap) smear - done unless recent results available
 Maternal serum alpha-fetoprotein (MS-AFP) - done to detect open neural tube defects or
open abdominal wall defects; offered to all women and usually drawn between 16 and
18 weeks' gestation
 Sickle cell screen - done to detect presence of sickle hemoglobin in at-risk women.
 Group B beta streptococcus (cervical and pharyngeal swabs) - done to detect carriers or
active group B beta streptococcus
PHYSICAL ASSESSMENT
General Examination
 The woman is asked to empty her bladder before the examination to enhance her
comfort and to facilitate palpation of her uterus and pelvic organs during the vaginal
examination
 Evaluation of the woman's weight and blood pressure.
 Examination of the eyes, ears, and nose - nasal congestion during pregnancy may occur
as a result of peripheral vasodilatation
 Examination of the mouth, teeth, throat, and thyroid - the gums may be hyperemic and
softened because of increased progesterone
 Inspection of breasts and nipples - the breasts may be enlarged and tender; nipple and
areolar pigment may be darkened
 Auscultation of the heart
 Auscultation and percussion of the lungs
Abdominal Examination
 Examination for scars or striations, diastasis (separation of the rectus muscle), or
umbilical hernia
 Palpation of the abdomen for height of the fundus (palpable after 13 weeks of
pregnancy); measurement recorded and used as guideline for subsequent calculations
 Palpation of the abdomen for fetal outline and position (Leopold's maneuvers) - third
trimester
 Check of FHTs - FHTs are audible with a Doppler after 10 to 12 weeks and at 18 to 20
weeks with a fetoscope
 Record fetal position, presentation, and FHTs
Pelvic Examination
 The woman is placed in lithotomy position
 Inspection of external genitalia
 Vaginal examination - done to rule out abnormalities of the birth canal and to obtain
cytologic smear (Pap and, if indicated, smears for gonorrhea, vaginal trichomoniasis,
candidiasis, herpes, group B beta streptococcus, and chlamydia)
 Examination of the cervix for position, size, mobility, and consistency. Cervix is softened
and bluish (increased vascularity) during pregnancy
 Identification of the ovaries (size, shape, and position)
 Rectovaginal exploration to identify hemorrhoids, fissures, herniation, or masses
 Evaluation of pelvic inlet - anteroposterior diameter by measuring the diagonal conjugate
 Evaluation of midpelvis - prominence of the ischial spines
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7.  Evaluation of pelvic outlet - distance between ischial tuberosities and mobility of coccyx
Subsequent Prenatal Assessments
 Uterine growth and estimated fetal growth
o Fundus at symphysis pubis indicates 12 weeks' gestation
o Fundus at umbilicus indicates 20 weeks' gestation
o Fundal height corresponds with gestational age between 22 and 34 weeks
o Fundus at lower border of rib cage indicates 36 weeks' gestation
o Uterus becomes globular, and drop indicates 40 weeks' gestation
 A greater fundal height suggests:
o Multiple pregnancy
o Miscalculated due date
o Polyhydramnios (excessive amniotic fluid)
o Hydatidiform mole (degeneration of villi into grapelike clusters; fetus does not
usually develop)
o Uterine fibroids
 A lesser fundal height suggests:
o Intrauterine fetal growth restriction
o Error in estimating gestation
o Fetal or amniotic fluid abnormalities
o Intrauterine fetal death
o SGA
 FHTs - palpate abdomen for fetal position
o Normal - 110 to 160 beats per minute (bpm)
 Weight - major increase in weight occurs during second half of pregnancy; usually
between 0.5 lb (0.2 kg)/week and 1 lb (0.5 kg)/week. Greater weight gain may indicate
fluid retention and hypertensive disorder
 Blood pressure - should remain near woman's prepregnant baseline
 Complete blood count at 28 and 32 weeks' gestation; VDRL - rechecked at 36 to 40
weeks' gestation
 Antibody serology screen if Rh negative at 36 weeks' gestation
 Culture smears for gonorrhea, chlamydia, group B beta-hemolytic streptococcus, and
herpes, as indicated; usually at 36 and 40 weeks' gestation
 Urinalysis - for protein, glucose, blood, and nitrates
 AFP - done at 15 to 20 weeks
 Diabetic screening - done as indicated at 24 to 28 weeks
 Administer RhoGAM as indicated at 28 weeks
 Edema - check the lower legs, face, and hands
 Evaluate discomforts of pregnancy - fatigue, heartburn, hemorrhoids, constipation, and
backache
 Evaluate eating and sleeping patterns, general adjustment and coping with the
pregnancy
 Evaluate concerns of the woman and her family
 Evaluate preparation for labor, delivery, and parenting
IV. Promoting Fetal and Maternal Health
A. Describe health practices important for a positive
pregnancy outcome.
PATIENT EDUCATION GUIDELINES
Prenatal Care
 It is important to keep scheduled prenatal care appointments:
o Weeks 1-28: Every month
o Weeks 28-36: Every 2 weeks
o Weeks 36-delivery: Every week
 Expect the following discomforts of pregnancy, and speak with your nurse or health care
provider about strategies for relief:
o Back pain, leg cramps, breast tenderness
o Morning sickness, heartburn
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8. o Frequent urination
o Constipation
o Swelling of legs, varicose veins
o Fatigue
 Follow a healthy, balanced diet with three meals per day, and take prenatal vitamin as
directed by your health care provider
 Get regular exercise, and use proper body mechanics to avoid injury
 Be aware of danger symptoms of pregnancy; these must be reported to your health care
provider promptly:
o Vision disturbances - blurring, spots, or double vision
o Vaginal bleeding, new or old blood
o Edema of the face, fingers, and sacrum
o Headaches - frequent, severe, or continuous
o Fluid discharge from vagina; unusual or severe abdominal pain
o Chills, fever, or burning on urination
o Epigastric pain (severe stomach ache)
o Muscular irritability or convulsions
o Inability to tolerate food or liquids, leading to severe nausea and hyperemesis
B. Utilize the nursing process to address the concerns and
potentially harmful health practices of a woman during
pregnancy.
HEALTH EDUCATION AND INTERVENTION
Nursing Diagnoses
 Acute Pain (backache, leg cramps, breast tenderness) related to physiologic changes of
pregnancy
 Imbalanced Nutrition: Less Than Body Requirements related to morning sickness and
heartburn and lack of knowledge of requirements in pregnancy
 Impaired Urinary Elimination (frequency) related to increased pressure from the uterus
 Constipation related to physiologic changes of pregnancy and pressure from the uterus
 Impaired Tissue Integrity related to pressure from the uterus and increased blood
volume
 Anxiety or Fear related to the birth process and infant care
 Ineffective Role Performance related to the demands of pregnancy
 Activity Intolerance related to physiologic changes of pregnancy and enlarging uterus
Nursing Interventions
Minimizing Pain
 Teach the woman to use good body mechanics: wear comfortable, low-heeled shoes
with good arch support; try the use of a maternity girdle.
 Instruct the woman in the technique for pelvic rocking exercises.
 Encourage the woman to take rest periods with her legs elevated.
 Inform the woman that adequate calcium intake may decrease leg cramps.
 Instruct the woman to dorsiflex the foot while applying pressure to the knee to straighten
the leg for immediate relief of leg cramps.
 Instruct the woman to wear a fitted, supportive brassiere.
 Instruct the woman to wash her breasts and nipples with water only.
 Instruct the woman to apply vitamin E or lanolin cream to the breast and nipple area.
Lanolin is contraindicated for women with allergies to lamb's wool.
Minimizing Morning Sickness and Heartburn and Maintaining Adequate Nutrition
 Encourage the woman to eat low-fat protein foods and dry carbohydrates, such as toast
and crackers.
 Encourage the woman to eat small, frequent meals.
 Advise the woman to eat slowly.
 Instruct the woman to avoid brushing her teeth soon after eating.
 Instruct the woman to get out of bed slowly.
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9.  Encourage the woman to drink soups and liquids between meals to avoid stomach
distention and dehydration.
 Instruct the woman in the use of antacids; caution against the use of sodium bicarbonate
because it results in the absorption of excess sodium and fluid retention.
 Instruct the woman to avoid offensive foods or cooking odors that may trigger nausea.
 Encourage the woman to eat a few bites of soda cracker or dry toast before getting out
of bed in the morning.
 Teach the woman the importance of good nutrition for herself and her fetus. Review the
basic food groups with appropriate daily servings.
o Seven servings of protein-rich foods, including one serving of a vegetable protein
o Three servings of dairy products or other calcium-rich foods
o Seven servings of grain products
o Two or more servings of vitamin C-rich vegetable or fruit
o Three servings of other fruits and vegetables
o Three servings of unsaturated fats
o Two or more servings of other fruits and vegetables
 If the woman is a vegetarian, inform her of appropriate intake. Assess type of vegetarian
and food intake.
o Partial vegetarians may exclude a specific type of animal food, usually meat, but
may consume fish and poultry.
o Recommend iron and folic acid supplements.
 Inform the woman that average weight gain in pregnancy is 25 to 35 lb (11 to 16 kg).
About 2 to 5 lb (0.9 to 2.3 kg) are gained in the first trimester and about 1 lb (0.5 kg) per
week for the remainder of the gestation.
o Average weight gain for obese women is 15 lb (6.8 kg).
o Adolescent weight gain should be about 5 lb more than for adult women if within
2 years of starting menses.
o Women with a multiple pregnancy should gain between 35 and 45 lb (15.9 and
20.5 kg).
o Average weight gain for underweight women is 28 to 40 lb (12.7 to 18.1 kg).
 Advise the woman to limit the use of caffeine.
 Inform the woman that alcohol should be limited or eliminated during pregnancy; no safe
level of intake has been established.
 Inform the woman that smoking should be eliminated or severely reduced during
pregnancy; risk of spontaneous abortion, fetal death, low birth weight, and neonatal
death increases with increased levels of maternal smoking.
 Inform the woman that ingesting any drug during pregnancy may affect fetal growth and
should be discussed with her health care provider.
Minimizing Urinary Frequency and Promoting Elimination
 Instruct the woman to limit fluid intake in the evening.
 Instruct the woman to void before going to bed.
 Encourage the woman to void after meals.
 Encourage the woman to void when she feels the urge and after sexual intercourse.
 Encourage the woman to wear loose-fitting cotton underwear.
 Cranberry or blueberry juice may be recommended to help prevent UTIs. Caffeine
should be avoided.
Avoiding Constipation
 Instruct the woman to increase fluid intake to at least eight glasses of water per day.
One to two quarts of fluid per day is desirable.
 Teach the woman that foods high in fiber should be eaten daily.
 Encourage the woman to establish regular patterns of elimination.
 Encourage daily exercise such as walking.
 Inform the woman that OTC laxatives should be avoided and that bulk-forming agents
may be prescribed if indicated.
Maintaining Tissue Integrity
 Encourage the woman to take frequent rest periods with her legs elevated.
 Instruct the woman to wear support stockings and wear loose-fitting clothing for leg
varicosities.
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10.  Instruct the woman to rest periodically with a small pillow under the buttocks to elevate
the pelvis for vulvar varicosities.
 Instruct the woman to avoid constipation, apply cold compresses, take sitz baths, and
use topical anesthetics, such as Tucks, for the relief of anal varicosities (hemorrhoids).
 Provide reassurance that varicosities will totally or greatly resolve after delivery.
Reducing Anxiety and Fear and Promoting Preparation for Labor, Delivery, and Parenthood
 Encourage the woman or couple to discuss their knowledge, perceptions, cultural values,
and expectations of the labor and delivery process.
 Provide information on childbirth education classes, and encourage them to attend.
 Provide information on sibling and grandparent preparation as indicated.
 Encourage a tour of the birth facility.
 Discuss coping and pain control techniques for labor and birth.
 Inform the woman or couple of common procedures during labor and birth.
 Provide guidelines for coming to the birth facility.
 Encourage the woman or couple to discuss their perceptions and expectations of
parenthood and their “idealized child”.
 Discuss the infant's sleeping, eating, activity, and response patterns for the first month of
life.
 Discuss physical preparations for the infant, such as a sleeping space, clothing, feeding,
changing, and bathing equipment.
 Discuss plans for returning to work and childcare arrangements.
 Discuss the importance of planning time for themselves and each other apart from the
newborn.
 Provide information and encourage attendance at baby care, breast-feeding, and
parenting classes.
 Answer any questions the woman/couple may have.
Enhancing Role Changes
 Encourage discussion of feelings and concerns regarding the new role of mother and
father.
 Provide emotional support to the woman/couple regarding the altered family role.
 Discuss physiologic causes for changes in sexual relationships, such as fatigue, loss of
interest, and discomfort from advancing pregnancy. Some women experience
heightened sexual activity during the second trimester.
 Teach the woman or couple that there are no contraindications to intercourse or
masturbation to orgasm provided the woman's membranes are intact, there is no vaginal
bleeding, and she has no current problems or history of premature labor.
 Teach the woman or couple that female superior or side-lying positions are usually more
comfortable in the latter half of pregnancy.
Minimizing Fatigue
 Teach the woman reasons for fatigue, and have her plan a schedule for adequate rest.
o Fatigue in the first trimester is due to increased progesterone and its effects on
the sleep center.
o Fatigue in the third trimester is due mainly to carrying increased weight of the
pregnancy.
o About 8 hours of rest are needed at night.
o Inability to sleep may be due to excessive fatigue during the day.
o In the latter months of pregnancy, sleeping on the side with a small pillow under
the abdomen may enhance comfort.
o Frequent 15- to 30-minute rest periods during the day are important to avoid
overfatigue.
o Whenever possible, the woman should work while sitting with her legs elevated.
o The woman should avoid standing for prolonged periods, especially during the
third trimester.
 To promote placental perfusion, the woman should not lie flat on her back:
left lateral position provides the best placental perfusion; however, either
side is acceptable.
 Help the woman plan for adequate exercise.
o In general, exercise during pregnancy should be in keeping with the woman's
prepregnancy pattern and type of exercise.
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11. o Activities or sports that have a risk of bodily harm (skiing, snowmobiling, ice-
skating, inline skating, horseback riding) should be avoided.
o During pregnancy, endurance during exercise may be decreased.
o Exercise classes for pregnant women that concentrate on toning and stretching
have resulted in enhanced physical condition, increased self-esteem, and greater
social support as a result of being in the exercise group.
Evaluation: Expected Outcomes
 Verbalizes understanding of proper body mechanics and wears low-heeled shoes
 Identifies the basic food groups and describes meals to include needed servings for
pregnancy
 Reports limited fluid intake in the evening
 Describes foods high in fiber
 Wears support stockings and loose-fitting clothing
 Discusses expectations for labor, delivery, and parenthood and attends educational
classes
 Verbalizes an understanding of the physiologic causes that may change the sexual
relationship
 Reports engaging in regular exercise
C. Discuss the categories of potential terratogens.
Terratogens are any drug, virus or irradiation, the exposure to such may cause damage
to the fetus. A wide range of different chemicals and environmental factors are suspected or are
known to be teratogenic in humans.
Drugs and medications:
 Tobacco, caffeine, drinking alcohol (ethanol), coccaine, isotretinoin, temazepam,
nitrazepam, nimetazepam, amino pterin or methotrexate, androgenic hormones,
busulfan, captopril, enalapril, coumadin, cyclosphamide, diethylstilbestrol, phenytoin,
etretinate, lithium, methimazole, penicillamine, tetracyclines, thalidomide, trimethadione,
methoxyethyl esthers, flusilazole, valproic acid, streptomycin, quinine, Vitamin K, iodides,
steroids
Environmental chemicals:
 Polychlorinated biphenyls (PCBs), polychlorinated dibenzodioxins (dioxin),
polychlorinated dibenzofurans (PCDFs), hexachlorobenzene, organic mercury, ethidium
bromide
Ionizing radiation:
 Atomic weapons fallout (Iodine-131, uranium), background radiation, diagnostic x-rays,
radiation therapy
Infections:
 Cytomegalovirus, herpes virus, parvovirus B19, rubella virus (German measles), syphilis,
toxoplasmosis, Venezuelan equine encephalitis virus
 TORCH: Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, Herpes simplex virus.
 Group of infections caused by organisms that can cross the placenta or ascend through
the birth canal and adversely affect fetal growth and development
Metabolic imbalance:
 Alcoholism, endemic cretinism, diabetes, folic acid deficiency, iodine deficiency,
hyperthermia, phenylketonuria, rheumatic disease, congenital heart block, virilising
tumors
D. Make a teaching plan for working women that addresses
their needs and problems.
Nurses specializing in obstetrics understand the importance of ensuring a healthy
mother and a healthy baby. In order to design a tailored pregnancy nursing care plan, it is
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12. necessary to have a baseline of the pregnant or post-partum patient's condition, whether that be
hemorrhage, preeclampsia or ectopic pregnancy, to name a few. An effective nursing care plan
for pregnancy patients should include assessment, promoting autonomy and patient teaching.
Assessment
Assessment, the first element in the nursing process, is what nurses use to establish
baseline information for patients. This begins with a thorough head-to-toe overview. Assess the
patient's head and neck, noting any enlarged lymph nodes, thyroid or other abnormalities.
Moving down, check the patient's heart rate and breathing, and report any signs of shortness of
breath. Also document the patient's fundal height and fetal assessment. Pay special attention to
any edema in the extremities or subjective reports of pain in the calves. Laboratory results are
also reviewed and documented.
Promoting Autonomy
As the pregnant patient watches their body change, she may begin to feel at a loss of
control of her body or well-being. A pregnancy nursing care plan acknowledges and respects
those feelings, while focusing on promoting patient autonomy. Interventions that the patient can
perform for themselves should be included in the nursing care plan. For example, if a particular
goal on the nursing care plan states that the patient will be free of nausea and vomiting by their
third trimester, a patient intervention might include avoiding areas with strong or offensive
smells and eating crackers. This allows the patient to feel proactive and more involved in their
own health care maintenance.
Patient Education
Pregnancy nursing care plans most often include patient education listed as a goal and
as a nursing intervention. Teaching the pregnant patient how to recognize normal and abnormal
symptoms in her body provides an extra line of defense against fetal health risks that might
otherwise go unnoticed or addressed too late. It also helps mothers-to-be feel more comfortable
about the birthing process and post-partum life. This may include information about proper diet,
the risks and benefits of medications and activities that should be avoided during pregnancy and
immediately post-partum. Patient teaching also should include information on birthing options,
breastfeeding and bottle feeding.
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