Transcript discomforts of pregnancy

MATERNAL NEWBORN NURSING
• REVIEW OF REPRODUCTIVE A&P, FETAL
CONCEPTION AND DEVELOPMENT
• ANTEPARTUM TERMINOLOGY
• ANTEPARTUM ASSESSMENT
• PHYSIOLOGICAL CHANGES IN PREGNANCY
• PSYCHO-SOCIAL CHANGES IN PREGNANCY
• MATERNAL NUTRITION
• ASSESSMENT OF FETAL WELL BEING
MODULE 1 PART 1 REVIEW OF
REPRODUCTIVE ANATOMY AND
PHYSIOLOGY
• REVIEW
• REPRODUCTIVE A&P, FETAL
CONCEPTION & DEVELOPMENT
THIS WILL NOT BE COVERED IN THIS
LECTURE—BE PREPARED TO ANSWER
REVIEW QUESTIONS IN CLASS
THE QUIZ IN CLASS 1 WILL FOCUS ON
CHANGES IN PREGNANCY AND
TERMINOLOGY
Review of Reproductive A&P
External Genitals
Internal Reproductive Organs
Vagina
Uterus
Uterine corpus
Cervix
Uterine ligaments
Fallopian Tubes
Ovaries
Figure 2–2 Female internal reproductive organs.
Figure 2–4 Structures of the uterus.
REVIEW OF REPRODUCTIVE A&P
• UTERINE LIGAMENTS
– ROUND LIGAMENTS
– OVARIAN LIGAMENTS
– CARDINAL LIGAMENTS
– INFUNDIBULOPELVIC LIGAMENT
– UTEROSACRAL LIGAMENT
Figure 2–6 Uterine ligaments.
Figure 2–3b Blood supply to vagina, ovaries, uterus, and fallopian tube.
Figure 2–3a Blood supply to internal reproductive organs. Pelvic blood supply.
Figure 2–5a Uterine muscle layers. Muscle fiber placement.
MODULE 1 PART 2
REVIEW OF REPRODUCTIVE
A&P
• PELVIC STRUCTURE
–Innominate bones
• ILIUM
–ILIAC CREST
• ISCHIUM
–ISCHIAL TUBEROSITY
–ISCHIAL SPINES
• PUBIS
–SYMPHYSIS PUBIS
– Sacrum
• SACRAL PROMOTORY, SACROILIAC JOINTS
– Coccyx
REVIEW OF REPRODUCTIVE A&P
• PELVIC DIVISION
– TRUE PELVIS
• INLET
• PELVIC CAVITY
• OUTLET
Figure 2–8 Pelvic bones with supporting ligaments.
Figure 2–10a Female pelvis. False pelvis is shallow cavity above the inlet; true pelvis is deeper portion of cavity below the inlet.
Figure 2–11 Pelvic planes: coronal section and diameters of the bony pelvis.
REVIEW OF REPRODUCTIVE A&P
• PELVIC DIAPHRAGM
– LEVATOR ANI
– COCCYGEAL MUSCLES
– DEEP FASCIA
• PELVIC FLOOR MUSCLES
– LEVATOR ANI
– ILLIOCOCCYGEUS
– PUBOCOCCYGEUS, COCCYGEUS
– PUBORECTALIS, PUBORECTALIS
– PUBOVAGINALIS
Figure 2–9 Muscles of the pelvic floor. (The puborectalis, pubovaginalis, and coccygeal muscles cannot be seen from this view.)
REVIEW OF REPRODUCTIVE A&P
–BREASTS
• NIPPLE
• AREOLA
• TUBERCLES OF MONTGOMERY
• LACTIFEROUS DUCTS
• ADIPOSE, GLANDULAR, FIBROUS TISSUE
• COOPER’S LIGAMENTS
Figure 2–12 Anatomy of the breast: sagittal view of left breast.
MODULE 1 PART 3
CONCEPTION
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MATURATION OF OVARIAN FOLLICLE
OVULATION
CORPUS LUTEUM
NEUROHUMORAL RESPONSE
–HYPOTHALMUS RELEASES
GONADATROPIN-RELEASING
HORMONE TO PITUITARY FROM
RESPONES FROM CNS
–ANTERIOR PITUITARY THEN SECRETES
FSH AND LH
• FEMALE REPRODUCTIVE CYCLE
–OVARIAN CYCLE
• FOLLICULAR PHASE
• LUTEAL PHASE
• FEMALE HORMONES
–ESTROGEN
–PROGESTERONE
–PROSTAGLANDINS
• UTERINE CYCLE (MENSTRUAL)
Figure 2–13 Female reproductive cycle: interrelationships of hormones with the four phases of the uterine cycle and the two phases
of the ovarian cycle in an ideal 28-day cycle.
Figure 2–14 Various stages of development of the ovarian follicles.
REVIEW OF CONCEPTION AND FETAL
DEVELOPMENT
• CELLULAR DIVISION
– MITOSIS
– MEIOSIS
• OOGENESIS
• SPERMATOGENESIS
• PRE-FERTILIZATION
– CAPACIATION
– ACROSOMAL REACTION
– FERTILIZATION
 PREEMBRYONIC STAGE
CELLULAR MULTIPLICATION
CLEAVAGE
MORULA
BLASTOCYST
TROPHOBLAST
IMPLANTATION
CHANGES IN ENDOMETRIUM
DECIDUA CAPSULARIS
DECIDUA BASALIS
DICIDUA VERA
Figure 3–2a Sperm penetration of an ovum. The sequential steps of oocyte penetration by a sperm are depicted moving from top to
bottom. Source: Scanning electron micrograph from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
Figure 3–1b Each spermatogonium produces four haploid spermatozoa.
Figure 3–5 Formation of primary germ layers. A, Implantation of a 71⁄2-day blastocyst in which the cells of the embryonic disc are separated from the amnion
by a fluid-filled space. The erosion of the endometrium by the syncytiotrophoblast is ongoing. B, Implantation is completed by day 9, and extraembryonic
mesoderm is beginning to form a discrete layer beneath the cytotrophoblast. C, By day 16 the embryo shows all three germ layers, a yolk sac, and an allantois
(an outpouching of the yolk sac that forms the structural basis of the body stalk, or umbilical cord). The cytotrophoblast and associated mesoderm have become
the chorion, and chorionic villi are developing. Source: Adapted from Marieb, E. N. (1998).
Figure 3–4 During ovulation, the ovum leaves the ovary and enters the fallopian tube. Fertilization generally occurs in the outer
third of the fallopian tube. Subsequent changes in the fertilized ovum from conception to implantation are depicted.
MODULE 1 PART 4
REVIEW OF CONCEPTION AND
FETAL DEVELOPMENT
• CELLULAR DIFFERENTIATION
–THREE PRIMARY GERM LAYERS
• ECTODERM
• MESODERM
• ENDODERM
• EMBRYONIC MEMBRANES
–AMNION
–CHORION
–AMNIOTIC SAC
REVIEW FETAL DEVELOPMENT
• AMNIOTIC FLUID
• UMBILICAL CORD
• PLACENTA
REVIEW OF FETAL DEVELOPMENT
• EMBRYONIC AND FETAL DEVELOPMENT
–EMBRYONIC STAGE—DAY 15 T0 8TH
WEEK
–FETAL STAGE—8TH WEEK TO BIRTH
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the
uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood
flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal
circulation.
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing
the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal
endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and
yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the
uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood
flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal
circulation.
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing
the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal
endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and
yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
Figure 3–6 Endoderm differentiates to form the epithelial lining of the digestive and respiratory tracts and associated glands. Source:
Adapted from Marieb, E. N. (1998).
Figure 3–12 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage begins in the third
week after fertilization; the fetal stage begins in the ninth week. Source: Adapted from Marieb, E. N. (1998).
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MODULE 1 PART 5
REVIEW QUESTIONS
REVIEW QUESTIONS
• WHAT IS THE SIGNIFICANCE OF THE
ENDOMETRIAL (MUCOSAL) LAYER OF THE
UTERUS?
• THE UTERUS IS MADE UP OF WHAT TYPE OF
MUSCLE?
• ESTROGEN IS SECRETED BY THE_______?
• PROGESTERONE IS SECRETED BY THE_______?
• WHAT IS THE FUNCTION OF LSH AND FH?
• DESCRIBE MEIOSIS.
REVIEW QUESTIONS
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WHERE DOES FERTILIZATION OCCUR?
THE BLASTOCYST DEVELOPS INTO THE ______.
THE TROPHOBLAST DEVELOPS INTO THE ____.
THE PLACENTA DEVELOPS FROM THE ______.
WHICH SYSTEMS/STRUCTURES DEVELOP
FROM THE MESODERM LAYER?
• NAME THREE FACTORS THAT AFFECT FETAL
DEVELOPMENT.
• WHAT IS THE ROLE OF THE BROAD AND
ROUND LIGAMENTS?
• WHAT IS THE UPPER PORTION OF THE UTERUS
CALLED?
• WHATS CHANGES OCCUR IN THE FUNCTION
OF THE OVARIES AT ABOUT THE 12- 14TH
WEEK OF PREGNANCY?
MODULE 1 PART 6A
PHYSIOLOGICAL CHANGES IN
PREGNANCY
PHYSIOLOGICAL CHANGES IN
PREGNANCY
GROWTH
OF
PLACENTA
RESPIRATORY
INTEGUMENTARY
ENDOCRINE
CARDIOVASCULAR
RENAL
MUSCULOSKELETEL
GI
GU
REPRODUCTIVE
• REPRODUCTIVE SYSTEM
–PLACENTA
–AMNION
–CHORION
–UMBILICAL CORD
–AMNIOTIC FLUID
REPRODUCTIVE SYSTEM
• PLACENTAL FUNCTION
–METABOLIC
–TRANSPORT
–ENDOCRINE
REPRODUCTIVE SYSTEM
• OVARIES
– STOP PRODUCING OVA. CORPUS LUTEUM IS
ACTIVE 10-12 WEEKS INTO PREGNANCY TO
PRODUCE ESTROGEN AND PROGESTERONE. THEN
WHAT HAPPENS?
• BREASTS
• INCREASED VASCULARITY AND SIZE
• HYPERTROPHY OF MAMMARY AVEOLI
• BECOME MORE NODULAR; NIPPLES ENLARGE
• PIGMENTATION OF AREOLA; COLUSTRUM
• REPRODUCTIVE SYSTEM
–UTERUS
• INCREASE IN SIZE, WEIGHT, AND
VOLUME CAPACITY
• FIBROUS TISSUE INCREASES
• INCREASE IN BLOOD FLOW
–CERVIX
• GOODALL’S SIGN, CHADWICK’S SIGN
• DEVELOPMENT OF MUCOS PLUG
REPRODUCTIVE SYSTEM
• VAGINA
– MUCOSA THICKENS
– INCREASE IN SECRETIONS
– LOOSENING OF CONNECTIVE TISSUE—
WHY?
• RESPIRATORY SYSTEM
–O2 CONSUMPTION INCREASES
–SUBCOSTAL ANGLE AND A/P
DIAMETER INCREASE
–BREATHING CHANGES FROM
ABDOMINAL TO THORACIC
–NASAL STUFFINESS AND EPITAXIS
–INCREASED VACULARITY
–DIAPHRAGM ELEVATES
• CARDIOVASCULAR SYSTEM
–BLOOD VOLUME INCREASES 40%-50%
–PHYSIOLOGIC ANEMIA—WHY?
–DECREASE IN SYSTEMIC AND
PULMONARY RESISTANCE IN THIRD
TRIMESTER
–INCREASE IN CARDIAC OUTPUT, PULSE
INCREASE (10-15 BPM)
• MUSCULOSKELETAL SYSTEM
– PELVIC JOINTS RELAX
– CENTER OF GRAVITY CHANGES
– SEPARATION OF RECTUS ABDOMINUS
• METABOLISM
– EXTRA WATER, FAT, AND PROTEIN STORED
– FATS ARE MORE COMPLETELY ABSORBED
– BMR INCREASE (CAN BE UP TO 25%)
MODULE 1 PART 6B
PHYSIOLOGICAL CHANGES IN
PREGNANCY
• GASTRONTESTINAL
–SMOOTH MUSCLE RELAXATION—
RELATED TO PROGESTERONE
INFLUENCE
• WHAT CHANGES WOULD YOU EXPECT TO SEE
RELATED TO RELAXATION OF SMOOTH
MUSCLE IN THE GI TRACT?
• RENAL
– PRESSURE ON BLADDER CAUSES
FREQUENCY—IN WHICH TRIMESTER AND
WHY?
– DILATATION OF KIDNEYS, URETERS
ELONGATE
– INCREASED GFR, CREATININE CLEARANCE
AND RENAL PLASMA FLOW—WHY?
– GLYCOSURIA MAY OCCUR
• INTEGUMENTARY
–HYPERPIGMENTATION
–STRIAE
–CHLOASMA (MELASMA)
–VASCULAR SPIDER NEVI
–DECREASED HAIR GROWTH
–HYPERACTIVE SWEAT AND SEBACEOUS
GLANDS
• ENDOCRINE SYSTEM
– THYROID—T4 AND BMR INCREASE (25% BY
TERM), TSH DECREASES THYROID—GLAND
ENLARGES, INCREASED IODINE
METABOLISM, INCREASED VASCULARITY
– PITUITARY—FSH AND LH SUPPRESSED,
SECRETION OF PROLACTIN, OXYTOCIN, AND
VASOPRESSION
– PANCREAS—INSULIN PRODUCTION
INCREASE
– TO COMPENSATE FOR PLACENTAL
HORMONE INSULIN ANTAGONISTS
• ENDOCRINE SYSTEM
• CONCENTRATION OF PARATHYROID
HORMONE INCREASES—WHY IS THIS
SIGNIFICANT?
• INCREASED ALDOSTERONE
• ADRENALS—LITTLE CHANGE
ENDOCRINE SYSTEM
ESTROGEN
LIST FIVE ACTION OF ESTROGEN DURING
PREGNANCY
ESTROGEN IS PRIMARILY EXCRETED BY
THE ______ DURING PREGNANCY
 ENDOCRINE SYSTEM
hCG--(HUMAN CHORIOGONADATROPIC
HORMONE)--STIMULATES PROGERTERONE
AND ESTROGEN TO MAINTAIN PREGNANCY
hPL—(HUMAN PLACENTAL LACTOGEN)—
DECREASES MATERNAL METABOLISM FOR
GLUCOSE (INSULIN ANTAGONIST)
PROSTGLANDINS
• ENDOCRINE SYSTEM
• PROGESTERONE
–LIST FIVE ACTIONS OF PROGESTERONE
DURING PREGNANCY
• ENDOCRINE SYSTEM
–RELAXIN
• DECREASES UTERINE CONTRACTILITY
• SOFTENS CERVIX
• SOFTENS JOINTS
• REMODELS COLLAGEN
MODULE 1 PART 7
PSYCHOLOGICAL CHANGES IN
PREGNANCY
MOTHER’S RESPONSE TO PREGNANCY
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AMBIVALENCE
ACCEPTANCE
INTROVERSION
MOOD SWINGS
FEAR
CHANGES IN BODY IMAGE
ANTEPARTUM DEPRESSION?
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FATHER’S RESPONSE TO PREGNANCY
CONFUSED BY PARTNER’S MOOD SWINGS
FEELS LEFT OUT
RESENTS ATTENTION GIVEN YO THE WOMAN
RESENTS CHANGES IN THEIR RELATIONSHIP
NEEDS TO RESOLVE CONFLICTS ABOUT
FATHERING
MODULE 1 PART 8
ANTEPARTUM TERMINOLOGY
GESTATION
ANTEPARTUM
INTRAPARTUM
POSTPARTUM
PRETERM LABOR
POSTTERM LABOR
• GRAVIDA
–NULLIGRAVIDA
–PRIMIGRAVIDA
–MULTIGRAVIDA
• PARA
–NULLIPARA
–PRIMIPARA
–MULTIPARA
• TPAL
• T--NUMBER OF TERM PREGNANCIES
• P--NUMBER OF BIRTHS AFTER 20
WEEKS
• A—NUMBER OF ABORTIONS
• L—NUMBER OF LIVING CHILDREN
G/TPAL EXERCISES
• G
T
P
A
L
• G3
1
2
0
1
• G2
0
3
1
3
• G5
2
1
3
3
• G2
0
5
0
3
MODULE 1 PART 9A
ANTEPARTUM PHYSICAL AND
PSYCHO-SOCIAL ASSESSMENT
ANTEPARTUM PHYSICAL AND PSYCHOSOCIAL
ASSESSMENT
PHYSICAL
ASSESSMENT
CULTURE
FINDINGS
RELATED
TO
PREGNANCY
RISK
FACTORS
CLIENT
PROFILE
EDUCATIONAL
NEEDS
FAMILY
FUNCTION
ECONOMICS
ENVIRONMENT
SUPPORT
SYSTEM
CULTURAL BELIEFS AND PRACTICE
ASSESSMENT IN ANTEPARTUM PERIOD
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HOME REMEDIES
NUTRITION
ALTERNATIVE HEALTH CARE PROVIDERS
FAMILY SUPPORT
EXERCISE
SPIRITUALITY
CULTURAL CONSIDERATIONS/ASSESSMENT
IN ANTEPARTUM PERIOD
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VIEW OF PREGNANCY
SELF CARE PRACTICES
PAIN
CHILDBIRTH PRACTICES
CARE OF THE NEWBORN
POST PARTUM
SIGNS OF PREGNANCY
• SUBJECTIVE (PRESUMPTIVE)
• OBJECTIVE (PROBABLE)
• DIAGNOSTIC (POSITIVE)
DUE DATE
• EDD, EDC, EDB
• NAEGLE’S RULE—SUBTRACT 3 MONTHS
FROM FIRST DAY OF LAST MENSTRUAL
PERIOD AND ADD 7 DAYS
• EXAMPLE: LMP OCT. 12—EDB---JULY 19
CLIENT PROFILE
CURRENT PREGNANCY
PAST PREGNANCY
CURRENT MEDICAL/SUGICAL HISTORY
GYN HISTORY
FAMILY MEDICAL HISTORY
RELIGIOUS, SPIRITUAL, CULTURAL HISTORY
OCCUPATIONAL HISTORY
PERSONAL INFORMATION—(PSYCHOSOCIAL)
ANTEPARTUM RISK FACTORS
• FACTORS RELATED TO:
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ECONOMICS
ENVIRONMENT
CURRENT HEALTH STATUS/PRACTICES
AGE
NUTRITION
CHILDBIRTH HISTORY
SOCIAL ISSUES
PYSCHOLOGICAL STATUS
PSYCHO-SOCIAL ANTEPARTUM ASSESSMENT
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CULTURE
PSYCHOLOGIC STATUS
EDUCATIONAL NEEDS
SUPPORT SYSTEMS
FUNCTIONING OF FAMILY
ECONOMIC STATUS
ENVIRONMENT
CRITICAL THINKING
• IN WHAT SYSTEMS/AREAS WOULD
YOU EXPECT TO SEE
DEVIATIONSAND/OR ALTERATIONS
FROM EXPECTED FINDINGS IN THE
PHYSICAL ASSESSMENT?
• WHAT DEVIATIONS/ALTERATIONS
MIGHT YOU OBSERVE?
MODULE 1 PART 9B
ANTEPARTUM PHYSICAL AND
PSYCHOSOCIAL ASSESSMENT
ANTEPARTUM PHYSICAL ASSESSMENT
VS
SKIN
MOUTH, EARS, NECK
CHEST AND LUNGS
BREASTS
HEART
ABDOMEN
EXTREMITIES
REFLEXES
SPINE
UTERUS
EXTERNAL GENITALS
CERVIX, VAGINA
ANUS AND RECTUM
LAB EVALUATION
MATERNAL NUTRITION
• AVERAGE WEIGHT GAIN
• PATTERN OF WEIGHT GAIN
• NUTRITIONAL REQUIREMENTS
– CALORIES
– PROTEIN
MATERNAL NUTRITION
– FAT
– CARBS
– VITAMINS
– MINERALS
CULTURAL CONSIDERATIONS
MATERNAL NUTRITION
– VEGETARIANISM
– LACTOSE DEFICIENCY
– EATING DISORDERS
– PICA
– ADOLESCENT
WHAT TEACHING WOULD YOU DO FOR THESE
ALTERATIONS/ CHANGES IN NUTRITION?
LAB EVALUATIONS INITIAL ANTEPARTUM VISIT
• SCREENING TESTS
– CBC
– ABO AND Rh TYPING
– WBC WITH DIFFERENTIAL
– FIRST TRIMESTER ANEUPLOIDY
– STD SCREENING, HIV
– GLUCOSE
– RUBELLA TITER
– HEPATITS B
– SICKLE CELL
– PAP SMEAR
ANTEPARTUM ASSESSMENT
FETAL DEVELOPMENT
• FUNDAL HEIGHT
• QUICKENING
• FETAL HEART RATE
• ULTRASOUND
Figure 7–5 Approximate height of the fundus at various weeks of pregnancy.
Figure 8–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundal height.
MODULE 1 PART 10 ASSESSMENT
OF FETAL WELL BEING
• FETAL ACTIVITY
• ULTRASOUND
–TRANSABDOMINAL
–TRANSVAGINAL
• NUCAL TRANSLUCENCY TESTING (NTT)
• DOPPLER BLOOD FLOW STUDIES
• AMNIOCENTESIS (AMNIOTIC FLUID
ANALYSIS)
–EVALUATION OF FETAL HEALTH
–EVALUATION OF LUNG MATURITY
• CHORIONIC VILLI SAMPLING (CVS)
• WHAT IS THE ADVANTAGE OF THE
CVS?
TERATOGENESIS
• MEDICATIONS
NUTRITION
• ALCOHOL
• COCAINE
• HYPERTHERMIA
• CAFFEINE
• MARIJUANA
MATERNAL:
VIRUS
RADIATION
TOBACCO
MODULE 1 PART 11
DANGERS/DISCOMFORTS IN
PREGNANCY
DANGER SIGNS OF PREGNANCY
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VAGINAL BLEEDING
LEAKAGE OF FLUID FROM VAGINA
ABDOMINAL PAIN
TEMP > 101
DIZZINESS, BLURRING OF VISION
SEVERE HEADACHE
EDEMA OF HANDS, FACE, FEET
DANGER SIGNS OF PREGNANCY
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PERSISTENT VOMITING
MUSCULAR IRRITABILITY
EPIGASTRIC PAIN
OLIGURIA
DYSURIA
ABSENCE OF FETAL MOVEMENT
DISCOMFORTS OF PREGNANCY
• FIRST TRIMESTER
–NAUSEA AND VOMITING
–URINARY FREQUENCY
–FATIGUE
–BREAST TENDERNESS
DISCOMFORTS OF PREGNANCY
–INCREASED VAGINAL DISCHARGE
–NASAL STUFFINESS & EPITAXIS
–PTYALISM
DISCOMFORTS OF PREGNANCY
• SECOND & THIRD TRIMESTER
–HEARTBURN
–ANKLE EDEMA
–VARICOSE VEINS
–HEMORRHOIDS
DISCOMFORTS OF PREGNANCY
– CONSTIPATION
– BACKACHE
– LEG CRAMPS
– FAINTNESS
DISCOMFORTS OF PREGNANCY
– DYSPNEA
– FLATULENCE
– CARPAL TUNNEL SYNDROME
– DIFFICULTY SLEEPING
– ROUND LIGAMENT PAIN
DISCOMFORTS OF PREGNANCY
• DETERMINE WHICH SYSTEM IS RESPONSIBLE
FOR EACH OF THE DISCOMFORTS OF
PREGNANCY.
• EXPLAIN HOW THE PHYSIOLOGICAL CHANGES
THAT OCCUR IN EACH SYSTEM DURING
PREGNANCY CAN BE RESPONSIBLE FOR THE
DISCOMFORTS.
SUBSEQUENT LAB EVALUATION
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HEMOGLOBIN
QUAD MARKER (15-20 WEEKS)
INDIRECT COOMBS
50 G 1 HOUR GLUCOSE SCREEN
URINALYSIS—GYCOSURIA, PROTEINURIA
GROUP B STREP SCREENING (35-37
WEEKS)
SELF CARE PROMOTION
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BATHING
EMPLOYMENT
TRAVEL
ACTIVITY, REST
FETAL ACTIVITY MONITORING
BREAST CARE
CLOTHING
BATHING
SELF CARE PROMOTION
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DENTAL CARE
IMMUNIZATIONS
SEXUAL ACTIVITY
COMPLEMENTARY & ALTERNATIVE THERAPIES
ABSTINENCE FROM ALCOHOL, TOBACCO,
DRUGS
• PSYCHO-SOCIALSUPPORT