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 1 st 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 pounds total weight gain With singleton pregnancy pound total weight gain with multiples

Nagele’s Rule LMP minus 3 calendar days Add 7 days and 1 year

Tests in 1 st 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

1 st 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 weeks gestation If abnormal refer to specialist

Amniocentesis Performed between weeks Done with AMA, FH, +AFP Risks of miscarriage 1 in

Testing in 3 rd 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