nursing management during pregnancy ni ketut alit a nursing faculty airlangga university surabaya...
Post on 19-Dec-2015
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NURSING MANAGEMENT DURING PREGNANCY
Ni Ketut Alit ANursing Faculty Airlangga University
Surabaya East Java
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REFERENCES Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care,
The Nurse and The Family 5th ed , St Luis : CV Mosby Company.
Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993) Maternity Nursing, St Luis : CV Mosby Company.
Mattson Susan & Smith Judi E (2000). Core Curriculum for Maternal – Newborn Nursing. 2nd ed. Philadelphia. W.B. Saunders Company.
Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 ) Ilmu Kebidanan , Jakarta Yayasan Bina Pustaka Sarwono Prawiroharjo.
Journals and article related to..
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Conception, Fetal Development, Gestational Risk and Fetal Well-being
Factors affecting fetal well-being:Quality of sperm or ovumIntrauterine environmentFirst trimester exposure to hazardous agentsMaternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatorySubstance abuseKnown or unknown infections
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Barriers to Prenatal Care
Sociodemographics Insurance/finances Inadequate care providers for low
income Delay in onset of prenatal care Cultural factors Transportation Attitudes
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Preconception Care
Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system
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KSPR (Kartu Score Pudji Rohjati)Card for risk detection of Pregnacy
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1st Prenatal Visit
Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and
laboratory tests
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Comprehensive Health History
Reason for seeking careSuspicion of pregnancyDate of last menstrual periodSigns and symptoms of pregnancyUrine or blood test for hCG
Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric, and
gynecologic history
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Menstrual History
Menstrual cycleAge at menarcheDays in cycleFlow characteristicsDiscomfortsUse of contraception
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Menstrual History
Date of last menstrual period (LMP) Calculation of estimated or expected date of
birth (EDB) or delivery (EDD)Nagele’s rule
○ Use first day of LNMP 11/21/11○ Subtract 3 months 8/21/11○ Add 7 days 8/28/11○ Add 1 year 8/28/12 = EDB
Gestational or birth calculator.
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Obstetric History
Gravida: a pregnant womanGravida I (primigravida): first pregnancyGravida II (secundigravida): second pregnancy, etc.
Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or morePrimapara: one birth after a pregnancy of at least 20
weeks (“primip”)Multipara: two or more pregnancies resulting in viable
offspring (“multip”) Nullipara: no viable offspring; para 0
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Obstetric History
TerminologyG (gravida): the current pregnancyT (term births): the number of pregnancies ending
>37 weeks’ gestation, at termP (preterm births): the number of preterm
pregnancies ending >20 weeks or viability but before completion of 37 weeks
A (abortions): the number of pregnancies ending before 20 weeks or viability
L (living children): number of children currently living
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Physical Examination
Vital signs Head-to-toe assessment
Head and neckChestAbdomen, including fundal height if appropriateExtremities
Pelvic examinationExamination of external and internal genitaliaBimanual examinationPelvic shape: gynecoid, android, anthropoid, platypelloidPelvic measurements
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Laboratory Tests
Urinalysis Complete blood count Rh factor TORCH test Hepatitis B surface antigen HIV test Ultrasound
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Follow-up Visits
Visit schedule: Every 4 weeks up to 28 weeksEvery 2 weeks from 29 to 36 weeksEvery week from 37 weeks to birth
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Follow-up Visits
AssessmentsWeight & BP compared to baseline valuesUrine testing for protein, glucose, ketones, and nitritesFundal height Quickening/fetal movement Fetal heart rate
Teaching: danger signs
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1st Trimester Discomforts
Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea
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2nd Trimester Discomforts
Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating
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3rd Trimester Discomforts
Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions
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Nursing Management To Promote Self-Care
Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise
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Nursing Management To Promote Self-Care
Sleep and rest Sexual activity and sexuality Employment Travel Immunizations and medications
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Danger Signs Of Pregnancy !!! Assess and report immediately:
Vaginal bleeding in any amount - May indicate placenta previa
Premature rupture of membranes - Predisposes mom and baby to infection
Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia
Severe, persistent headaches and visual disturbances - Consider preeclampsia
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Danger Signs in PregnancyReport any of the following immediately:
Fever and/or chills Painful urination Persistent nausea & vomiting Change in, or absence of fetal movement
for 6-8 hrs.
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Preparation for Labor, Birth, and Parenthood
Perinatal education Childbirth education
Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques
Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing
Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques
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Preparation for Labor, Birth, and Parenthood
Options for birth setting Hospitals: delivery room, birthing suiteBirth centersHome birth
Options for care providersObstetricianMidwifeHealth provider
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Preparation for Labor, Birth, and Parenthood
Feeding choicesBreastfeeding: advantages and disadvantagesBottle feeding: advantages and disadvantagesTeaching
Final preparation for labor and birth
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Care For Better Health