Question

discuss the nursing management of the pregnant client in each trimester of pregnancy(visits, warning signs, additional testing, etc)

Answer 1

The nursing management of the pregnant cline include :-

1.Preconception Care -Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy. It involves obtaining a complete health history and physical examination of the woman and her partner. This information provides a foundation for planning health-promotion activities and education. For example, to have a positive impact on the pregnancy.

2.The First Prenatal Visit -Once a pregnancy is suspected and, in some cases, tentatively confirmed by a home pregnancy test, the woman should seek prenatal care to promote a healthy outcome.

The nursing management includes :-

   *Comprehensive Health History : During the initial visit, a comprehensive health history is obtained, including age, menstrual history, prior obstetric history, past medical and surgical history, family history, genetic screening, medication or drug use, and history of exposure to infections (STIs) etc.

*Physical Examination :- it includes Head-to-Toe Assessment

*Laboratory Tests :- Complete blood cell count (CBC) Blood typing Rubella titer Hepatitis B HIV testing Syphilis screening: Venereal Disease Research Laboratory (VDRL) or rapid plasma reagin (RPR) serologic tests Cervical smears.

3.Follow-Up Visits :- Continuous prenatal care is important for a successful pregnancy outcome. The recommended follow-up visit schedule for a healthy pregnant woman is as follows:

                  • Every 4 weeks up to 28 weeks (7 months)

                  • Every 2 weeks from 29 to 36 weeks

                  • Every week from 37 weeks to birth

At each subsequent prenatal visit the following assessments are completed: -

• Weight and blood pressure, which are compared to baseline values

• Urine testing for protein, glucose, ketones, and nitrites

• Fundal height measurement to assess fetal growth

• Assessment for quickening/fetal movement to determine fetal well-being

• Assessment of fetal heart rate (should be 110 to 160 bpm).

4.Teaching About the Danger Signs of Pregnancy -It is important to educate the client about danger signs during pregnancy that require further evaluation. Explain that she should contact her health care provider immediately if she experiences any of the following:

     *• During the first trimester: spotting or bleeding (miscarriage), painful urination (infection), severe persistent vomiting (hyperemesis gravidarum), fever higher than 100°F (infection), and lower abdominal pain with dizziness and accompanied by shoulder pain (ruptured ectopic pregnancy)

• During the second trimester: regular uterine contractions (preterm labor); pain in calf, often increased with foot flexion (blood clot in deep vein); sudden gush or leakage of fluid (premature rupture of membranes); and absence of fetal movement for more than 24 hours (possible fetal distress or demise)

• During the third trimester: sudden weight gain; periorbital or facial edema, severe upper abdominal pain, or headache with visual changes (pregnancy-induced hypertension); and a decrease in fetal daily movement for more than 24 hours (possible demise).

Any of the previous warning signs and symptoms can also be present in this last trimester.

5.Assessment of Fetal Well-Being and additional testing :-

    *Ultrasonography - Ultrasound provides important information about fetal activity, growth, and gestational age, assesses fetal well-being, and determines the need for invasive intrauterine tests.

   *Doppler Flow Studies -Doppler flow studies can detect fetal compromise in high-risk pregnancies.

   *Alpha-Fetoprotein Analysis -Elevated levels of maternal serum AFP are associated with open neural tube defects, ventral wall defects, some renal abnormalities, multiple gestation, certain skin disorders, fetal demise, and placental abnormality .

*Marker Screening Tests - Two additional blood screening tests may be used to determine the risk of open neural tube defects and Down syndrome: the triple-marker screen and the addition of a fourth marker, inhibin A, which is used to enhance the accuracy of screening for Down syndrome.

*Nuchal Translucency Screening -Nuchal translucency screening (ultrasound) is also done in the first trimester between 11 and 14 weeks. This allows for earlier detection and diagnosis of some fetal chromosomal and structural abnormalities.

*Amniocentesis – It involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth.

*Chorionic Villus Sampling - Chorionic villus sampling (CVS) is a procedure for obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and TaySachs disease.

* Percutaneous Umbilical Blood Sampling (PUBS) – It permits the collection of a blood specimen directly from the fetal circulation. It is done specifically for women at risk for genetic anomalies and those with potential blood disorders, such as blood incompatibility or hemoglobinopathies.

* Nonstress Test -The nonstress test (NST) is an indirect measurement of uteroplacental function.

* Contraction Stress Test -Because blood flow to the uterus and placenta is slowed during uterine contractions, the contraction stress test (CST), formerly called the oxytocin-challenge test, is a diagnostic procedure performed to determine the fetal heart rate response under stress, such as during contractions.

* Biophysical Profile - A biophysical profile uses a real-time ultrasound to allow assessment of various parameters of fetal well-being: fetal tone, breathing, motion, and amniotic fluid volume. These four parameters, together with the NST, constitute the biophysical profile.

6. Teaching to Manage the Discomforts of Pregnancy

*First-Trimester Discomforts - During the first 3 months of pregnancy, the woman’s body is undergoing numerous changes :

       -Urinary Frequency or Incontinence :-

                             • Kegel exercises to increase control over leakage.

                             • Avoid caffeinated drinks, which stimulate voiding.

     -. Fatigue

                           • Eat a healthy balanced diet.

                          . • When you are feeling tired, rest.

- Nausea and Vomiting

                            • Avoid an empty stomach at all times.

                           • Eat several small meals throughout the day.

                           • Drink fluids between meals rather than with meals.

                           • Avoid greasy, fried foods or ones with a strong odor, such as cabbage

-Backache

                         • Avoid standing or sitting in one position for long periods.

                         • Apply heating pad (low setting) to the small of your back.

                         • Support your lower back with pillows when sitting.

-Leg Cramps

                         • Elevate legs above heart level frequently throughout the day.

                         • If you get a cramp, straighten both legs and flex your feet toward your body. -Varicosities

                          • Walk daily to improve circulation to extremities.

                          • Elevate both legs above heart level while resting.

                         • Avoid standing in one position for long periods of time.

-. Hemorrhoids

                        • Establish a regular time for daily bowel elimination.

                        • Prevent straining by drinking plenty of fluids and eating fiber-rich foods and exercising daily

-. Constipation

                          • Increase your intake of foods high in fiber and drink at least eight 8-ounce glasses of fluid daily.

                    • Exercise each day (brisk walking) to promote movement through the intestine. -Heartburn/Indigestion

                     • Avoid spicy or greasy foods and eat small frequent meals.

                     • Sleep on several pillows so that your head is elevated..

-Braxton Hicks Contractions

                      • Keep in mind that these contractions are a normal sensation.

                     • Try changing your position or engaging in mild exercise to help reduce the sensation.

                      • Drink more fluids if possible.

*Second-Trimester Discomforts - A sense of well-being typically characterizes the second trimester for most women. By this time, the fatigue, nausea, and vomiting have subsided and the uncomfortable changes of the third trimester are a few months away. Not every woman experiences the same discomforts during this time, so nursing assessments and interventions must be individualized.

*Third-Trimester Discomforts As women enter their third trimester, many experience a return of the first-trimester discomforts of fatigue, urinary frequency, leukorrhea, and constipation. These discomforts are secondary to the ever-enlarging uterus compressing adjacent structures, increasing hormone levels, and the metabolic demands of the fetus. In addition to these discomforts, many women experience shortness of breath, heartburn and indigestion, swelling, and Braxton Hicks contractions.

7.Nursing Management to Promote Self-Care - Personal Hygiene , Hot Tubs and Saunas , Perineal Care , Dental Care , Clothing , Exercise etc.

8.Nursing Management to Prepare the Woman and Her Partner for Labor, Birth, and Parenthood

     -   Childbirth Education Classes

- Options for Birth Settings and Care Providers

- Preparation for Breastfeeding or Bottle-Feeding

- Final Preparation for Labor and Birth