1. Chapter 4 Physiological Aspects of Antepartum

2. Goals of Prenatal Care Regular assessment of health of pregnancy
Regular assessment and screening of risk factors for potential complications
Implementation of appropriate interventions based on risk status or actual complications
Inclusion of significant others/family in care and education to promote pregnancy adaptation
Education on health promotion and disease prevention of complication

3. Preconception Health Care
Defined as a set of interventions aiming to identify medical, behavioral, and social risks to a woman’s health. Two components of preconception health care include
Routine physical exam
Health screening

4. Anticipatory Guidance
Anticipatory guidance and teaching include information on
Nutrition
Medication
Self-care
Contraception
Timing of conception
Modifying behaviors to reduce risks

5. Diagnosis of Pregnancy
Based on combination of the following
Presumptive signs
Probable signs
Positive signs

6. Formula for Naegele’s Rule
Calculating Due Date
Formula for Naegele’s Rule
LMP
April 27
4 – 27
Subtract 3 months
–3 months
January 27
1 – 27
Add 7 days
+7 days
EDD:
February 3
2 – 3

7. Physiological Changes of Pregnancy
Breast
Uterus
Vagina
Ovaries
Cardiovascular system
Respiratory system
Renal system

8. Physiological Changes of Pregnancy (Cont.)
Gastrointestinal system
Musculoskeletal system
Integumentary
Endocrine system
Immune system

10. Antepartal Nursing Care
Components of prenatal care
Family-centered maternity care

11. Intimate Partner Violence
How do you recognize a pregnant woman who has been abused?
What strategies would you utilize to approach her?
What is the nurse’s role?

12. Prenatal Assessment Terminology
Gravida
Parity
GTPAL
Nulligravida
Primigravida
Multigravida

13. First Trimester Initial assessment includes
History of current pregnancy
Physical and pelvic exam
Assessment of uterine growth
Assessment of fetal heart tones
Laboratory and diagnostic studies
Patient education and anticipatory guidance

14. Second Trimester Includes components of initial assessment
Confirm established due date
Laboratory and diagnostic studies
Administer Rhogam (if indicated)
Patient education and anticipatory guidance

15. Third trimester Focused assessment Assessment of fetal well-being
Pelvic examination
Leopold’s maneuver
Nutritional follow-up
Screening for group B streptococcus
Laboratory tests
Patient education and anticipatory guidance

16. Review Questions
Goals of prenatal care include all of the following except
Regular assessment of health of pregnancy and screening of risk factors
Implementation of appropriate interventions based on risk status or actual complications
Exclusion of significant others/family in care an education to promote pregnancy adaptation
Education on health promotion and disease prevention of complication

17. Answer 3

18. Diagnosis of pregnancy is based on a combination
of the following
1. Presumptive, definitive and positive signs
2. Presumptive, probable signs and positive signs
3. Presumptive, assumed and positive signs
4. Presumptive, physiological and positive signs

19. Answer 2

20. Chapter 5 Psychosocial Cultural Aspects Of Antepartal Period

21. Maternal Adaptation to Pregnancy
Factors affecting adaptation
Psychological
Physical
Social

22. Maternal Tasks of Pregnancy (Rubin)
Ensuring safe passage for herself and her child
Ensuring social acceptance of the child by significant others
Attaching or “binding-in” to the child refers to the development of maternal — fetal attachment
Giving of oneself to the demands of being a mother

23. Seven Dimensions of Maternal Role Development (Lederman)
Acceptance of pregnancy
Identification with the motherhood role
Relationship to her mother
Reordering relationship with her husband or partner
Preparation for labor
Prenatal fear of control in labor
Prenatal fear of loss of self-esteem in labor

24. Factors That Influence Maternal Adaptation
Parity
Maternal age
Sexual orientation
Single parenting
Multiple pregnancies
Socioeconomic factor
Abuse

26. Paternal Adaptation During Pregnancy
Effect of pregnancy on fathers

27. Developmental Tasks of Fathers: Three Phases (May)
Announcement phase
Moratorium phase
Focusing phase

28. Couvade Syndrome Ritual couvade
Couvade syndrome is a condition in which men may experience pregnancy symptoms and discomforts similar to their pregnant partner.
Ritual couvade

29. Sexuality in Pregnancy
Physical, emotional, and interactional factors
The desire for sex depends on the trimester
Sexual desire decreases during third trimester
Body image changes
Concerns related to pregnancy

30. Family Adaptation During Pregnancy
Changing structures of the family
Eight stages in the life cycle of a family
Grandparent adaptation
Sibling adaptation
Maternal adaptation to pregnancy
Psychosocial adaptation to pregnancy complications

31. Social Support During Pregnancy
Types of support include
Material support assistance with chores, meals, managing finances
Emotional support — affection, approval, encouragement, and feelings of togetherness
Informational support — sharing information, and helping women investigate new sources of information
Comparison support

32. Childbearing and Culture
Statistics of U.S. population
Behavioral practices
Barriers to culturally competent care
Ethnocentrism

33. Culturally Competent Nursing
When practices, beliefs, and culture conflict, nurses must consider the following questions
Is the practice safe?
Is it feasible?
Is it important to the woman?

34. Chapter 8 Intrapartum Assessment and Interventions

35. Factors That May Trigger Labor
Maternal factors
Fetal factors

36. Management of Discomfort During Labor and Delivery
Pain may result due to the following factors
Decreased blood supply to uterus
Increased pressure and stretching of the pelvic structures
Cervical dilatation and stretching

37. Factors Affecting Labor (4 Ps)
Powers (the contractions)
Passage (the pelvis)
Passenger (the fetus)
Psyche (the response of woman)

38. Labor Process Premonitory signs of labor are Lightening
Braxton-Hicks contractions
Bloody show
Spontaneous rupture of membranes

39. Mechanism of Labor Engagement Descent Flexion Internal rotation
Extension
External rotation
Expulsion

40. Labor Stage one Stage two Stage three Stage four
Labor is the process in which the fetus, placenta, and membranes are expelled spontaneously
Stages of labor
Stage one
Stage two
Stage three
Stage four

41. First Stage Medical interventions Nursing actions Latent phase
Cervix 0 – 3 cm
Contraction every 5 – 10 min, mild intensity, lasting 30 – 45 sec
Medical interventions
Nursing actions

42. First Stage Average dilation 1.2 cm/hr depending on gravida
Active phase
Average dilation 1.2 cm/hr depending on gravida
Dilation progresses 4 – 7 cm, 40 – 80% effacement
Fetal descent
Intense contraction q 2 – 5 mins, lasting 40 – 60 sec
Increase in pain
Medical interventions
Nursing actions

43. First Stage Dilation from 8 – 10 cm, 100% effacement
Transition phase
Dilation from 8 – 10 cm, 100% effacement
Contractions intense, q 1 – 2 min lasting 60 – 90 sec
Feels exhausted
Bloody show
N/V, backache, diaphoresis, and trembling
Medical interventions
Nursing actions

44. Second Stage Complete dilatation Sudden burst of energy
Shorter duration with multips than primips
Intense contraction every 2 min, lasting 60 – 90 sec
Increase in bloody show
Perineum flattens, with bulging rectum and vagina
Medical interventions
Nursing actions

45. Third Stage of Labor Occurs after delivery of infant
Period involving separation and expulsion of placenta/membranes
Last 5 – 20 min
Medical interventions
Nursing actions

46. Fourth Stage This stage begins the postpartum period
Ends 4 hr after delivery
Mechanism of homeostasis occurs
Medical intervention
Nursing actions

47. Management of Discomfort During Labor
Nonpharmacological management
Pharmacological management
Care of a woman before and after epidural anesthesia

48. Review Questions Latent phase of labor is indicated by
Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of mild intensity, lasting 30 – 45 sec
Cervix 0 – 4 cm dilated with contractions every 5 – 15 min, of mild intensity, lasting 30 – 45 sec
Cervix 0 – 2 cm dilated with contractions every 3 – 10 min, of mild intensity, lasting 45 – 60 sec
Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of strong intensity, lasting 30 – 60 sec

49. Answer 1

50. Active phase of labor is indicated by
Average dilation 1.2 cm/hr, dilation progresses 4 – 7 cm
Average dilation 1.2 cm/hr, dilation progresses 4 – 10 cm
Average dilation 2 cm/hr, dilation progresses 4 – 7 cm
Average dilation 1 cm/hr, dilation progresses 2 – 6 cm

51. Answer 1

52. Transition phase of labor is indicated by
Dilation from 8 to 10 cm, contractions intense, q 1 – 2 min lasting 60 – 90 sec
Dilation from 6 to 10 cm, contractions intense, q 1 – 2 min lasting 60 – 90 sec
Dilation from 7 to 10 cm, contractions intense, q 2 – 4 min lasting 60 – 90 sec
Dilation from 8 to 10 cm, contraction moderate, q 1 – 2 minutes lasting 60 sec

53. Answer 1