Maternal-Newborn Nursing

The
The Critical
Critical Components
Components of
of Nursing
Nursing Care
Care

Chapter 4
Physiological Aspects of
Antepartum

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

Preconception Health Care

Defined as a set of interventions aiming to

identify medical, behavioral, and social
risks to a womans health. Two
components of preconception health care
include

Routine physical exam

Health screening

Anticipatory Guidance
Anticipatory guidance and teaching include information on

Nutrition
Medication
Self-care
Contraception
Timing of conception
Modifying behaviors to reduce risks

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

Calculating Due Date

Formula for Naegeles Rule
LMP
Subtract 3 months

April 27
3 months
January 27

Add 7 days
EDD:

4 27

1 27

+7 days
February 3

23

Physiological Changes of Pregnancy

Breast
Uterus
Vagina
Ovaries
Cardiovascular system
Respiratory system
Renal system

Physiological Changes of Pregnancy

(Cont.)
Gastrointestinal system
Musculoskeletal system
Integumentary
Endocrine system
Immune system

Antepartal Nursing Care

Components of prenatal care

Family-centered maternity care

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 nurses role?

Prenatal Assessment Terminology

Gravida
Parity
GTPAL
Nulligravida
Primigravida
Multigravida

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

Second Trimester

Includes components of initial assessment

Confirm established due date
Laboratory and diagnostic studies
Administer Rhogam (if indicated)
Patient education and anticipatory
guidance

Third trimester

Focused assessment
Assessment of fetal well-being
Pelvic examination
Leopolds maneuver
Nutritional follow-up
Screening for group B streptococcus
Laboratory tests
Patient education and anticipatory guidance

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

Answer

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

Answer

Maternal-Newborn Nursing
The
The Critical
Critical Components
Components of
of Nursing
Nursing Care
Care

Chapter 5
Psychosocial Cultural Aspects
Of Antepartal Period

Maternal Adaptation to Pregnancy

Factors affecting adaptation
Psychological
Physical
Social

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

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

Factors That Influence Maternal

Adaptation

Parity
Maternal age
Sexual orientation
Single parenting
Multiple pregnancies
Socioeconomic factor
Abuse

Paternal Adaptation During Pregnancy

Effect of pregnancy on fathers

Developmental Tasks of Fathers: Three

Phases (May)

Announcement phase
Moratorium phase
Focusing phase

Couvade Syndrome

Couvade syndrome is a condition in which

men may experience pregnancy symptoms
and discomforts similar to their pregnant
partner.

Ritual couvade

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

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

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

Childbearing and Culture

Statistics of U.S. population
Behavioral practices
Barriers to culturally competent care
Ethnocentrism

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?

Maternal-Newborn Nursing
The
The Critical
Critical Components
Components of
of Nursing
Nursing Care
Care

Chapter 8
Intrapartum Assessment and
Interventions

Factors That May Trigger Labor

Maternal factors
Fetal factors

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

Factors Affecting Labor (4 Ps)

Powers (the contractions)

Passage (the pelvis)
Passenger (the fetus)
Psyche (the response of woman)

Labor Process

Premonitory signs of labor are

Lightening
Braxton-Hicks contractions
Bloody show
Spontaneous rupture of membranes

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

Labor
Labor is the process in which the fetus,
placenta, and membranes are expelled
spontaneously
Stages of labor

Stage
Stage
Stage
Stage

one
two
three
four

First Stage

Latent phase
Cervix 0 3 cm
Contraction every 5 10 min, mild intensity,
lasting 30 45 sec

Medical interventions
Nursing actions

First Stage

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

First Stage

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

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

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

Fourth Stage

This stage begins the postpartum period

Ends 4 hr after delivery
Mechanism of homeostasis occurs
Medical intervention
Nursing actions

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

Review Questions

Latent phase of labor is indicated by

1. Cervix 0 3 cm dilated with contractions every
5 10 min, of mild intensity, lasting 30 45 sec
2. Cervix 0 4 cm dilated with contractions every
5 15 min, of mild intensity, lasting 30 45 sec
3. Cervix 0 2 cm dilated with contractions every
3 10 min, of mild intensity, lasting 45 60 sec
4. Cervix 0 3 cm dilated with contractions every
5 10 min, of strong intensity, lasting 30 60 sec

Answer

Active phase of labor is indicated by

1. Average dilation 1.2 cm/hr, dilation progresses
4 7 cm
2. Average dilation 1.2 cm/hr, dilation progresses
4 10 cm
3. Average dilation 2 cm/hr, dilation progresses
4 7 cm
4. Average dilation 1 cm/hr, dilation progresses
2 6 cm

Answer

Transition phase of labor is indicated by

1. Dilation from 8 to 10 cm, contractions intense,
q 1 2 min lasting 60 90 sec
2. Dilation from 6 to 10 cm, contractions intense,
q 1 2 min lasting 60 90 sec
3. Dilation from 7 to 10 cm, contractions intense,
q 2 4 min lasting 60 90 sec
4. Dilation from 8 to 10 cm, contraction moderate,
q 1 2 minutes lasting 60 sec

Answer