Promoting Fetal And Maternal Health

Promoting Fetal and Maternal Health

Promoting Fetal and Maternal Health  The health of the fetus and mother are directly linked.  A woman who eats well and takes care of her own health provides a healthy environment for fetal growth and development.  Education is a major role in nursing care.  Providing empathetic and accurate advice.  Alert for danger signs of pregnancy and current teratogens.

Health Promotion  The nurse will help the family maintain a state of wellness throughout the pregnancy and into early parenthood.  Nursing Process:  Assessment begins before pregnancy  Plan- goals and outcomes(realistic).  Implementation- teaching is one of the major interventions.  Evaluation- ongoing process aided by regular prenatal health care visits.

Self-Care Needs  Pregnancy is not an illness so common sense about health care is all that is required.  Nurse must be alert to misunderstandings, separate fact from fiction and prevent unnecessary restrictions.  Bathing:  sweating increases  increased vaginal discharge  encourage daily bathing, shower is best  restrict tub bath if cervix dilated ruptured membranes or vaginal bleeding.

 Breast Care:  wear a firm supportive bra with wide straps to spread the weight across the shoulders.  week 16 colostrum secretions begin; wash daily with clear tap water (no soap) and dry.  May need gauze squares or breast pads inside bra.  Dental Care:  see dentist regularly  good tooth brushing (gingival tissue tends to hypertrophy during pregnancy).

 Perineal Hygiene:  increased vaginal discharge  douching is contraindicated due to risk for infection and lowers pH.  Dressing:  common sense and comfort.  avoid garters, firm girdles with panty legs, knee-high stockings, anything extremely restricting.  Wear shoes with a moderate to low heel.

 Sexual Activity:  ask if she has any questions  dispel the myths  intercourse is not harmful to the child  if she has a history of miscarriage she may avoid coitus during this time in the pregnancy when a previous miscarriage occurred.  membranes ruptured or vaginal spotting may lead to infection  caution about male oral-female genital contact  decreased sexual desire due to increased estrogen levels  breast tenderness  increased clitoral sensation  new positions for intercourse  caution about STD’s

 Exercise:  prevents circulatory stasis in lower extremities  extreme exercise is associated with lower birth rate.  daily exercise is recommended for 30 minutes; walking is best.  woman can continue any sport she participated in before pregnancy except contact sports.  Avoid aerobics, jogging, hot tubs or saunas.

 Sleep:  needed for building new body cells and increased metabolic demand  may need rest periods during the afternoon  modified Sims’ position is best. This puts the weight of the fetus on the bed and allows good circulation in the lower extremities  avoid supine position due to supine hypotension syndrome  avoid sitting or lying with knees sharply bent due to increased risk of venous stasis below the knee.

 Employment:  There are few reasons women cannot continue to work throughout pregnancy.  Some reasons involve exposure to toxic substances, lifting heavy objects, excessive physical strain, long periods of standing, or having to maintain body balance.  Public Law 95-555 in 1978  Family Leave Act passed in 1993

 Travel:  early in normal pregnancy - no restrictions  late in pregnancy; possibility of early labor  know the nearest health care facility  if extended period of time, medical records need to be copied and prenatal visits continued and adequate prescriptions.  frequent rests q 1-2 hours.  wear seat belt under abdominal bulge  check air travel restrictions and immunizations needed for destination.

Discomforts of Early Pregnancy  These symptoms may not seem minor to the pregnant woman.  They may lead to more serious problems if not monitored adequately.  Listening, observing and developing a nursing diagnosis based on assessment data.

 Breast Tenderness:  one of the first symptoms noticed  wear proper bra  avoid cold drafts

 Palmar Erythema:  constant redness or itching of the palms  caused by increased estrogen levels, will disappear once her body adjusts.  Calamine lotion may help

 Constipation:  weight of the growing fetus presses against the bowel and slows peristalsis.  encourage regular BM’s  increase roughage and water  Avoid OTC drugs (Colace or glycerin suppositories may be prescribed).  Nausea, Vomiting and Pyrosis:

 Fatigue:  common in early pregnancy  due to increased metabolic requirements  increase rest and sleep  short rest period during the day  Muscle Cramps:  decreased serum calcium levels, increased serum phosphorus levels and circulatory interference cause cramps to legs.  relieved by woman lying on back, and extending involved leg while keeping knee straight dorsiflex foot until pain is gone  may need Rx. for aluminum hydroxide gel (Amphojel) which binds to phosphorus in intestinal tract and lowers levels  lower milk intake to 1 pint /day and add calcium lactate will reduce phosphorus levels  elevate legs frequently

 Hypotension:  supine hypotension  blood pooling in the pelvic area or lower extremities  raise slowly and avoid standing for long periods of time.

 Varicosities:  due to pressure from the fetus on the veins returning blood from the lower extremities.  causes pooling of blood in the vessels  veins become engorged, inflamed and painful  can extend to the vulva  rest in Sims’ position or on back with legs raised against the wall or on foot stool for 15 to 20 minutes twice a day.  avoid crossing legs or knees bent  avoid knee high hose or garters  may need medical support hose (apply before arising).  exercise and walk 2 times a day  increase vitamin C with fresh fruit

 Hemorrhoids:  due to pressure on veins from the uterus  daily BM’s  Sims’ position or knee chest position for 10 to 15 minutes  stool softeners, witch hazel or cold compresses

 Heart Palpitations:  with sudden movements  due to circulatory adjustments for increased blood supply during pregnancy  encourage slow gradual movements  Frequency of Urination:  due to pressure of uterus on anterior bladder  lasts for 3 months then returns again in late pregnancy  check for symptoms of UTI  decrease caffeine  Kegel exercises

 Abdominal Discomfort:  feeling pressure may be relieved by putting gentle pressure on the fundus  pulling pain in lower abdomen from tension on round ligaments (can be sharp)  rise slowly

 Leukorrhea:  whitish viscous vaginal discharge due to high estrogen levels and increased blood supply to vaginal epithelium and cervix  daily bath or shower  no douching, tampons, tight underpants, pantyhose  wear cotton underwear and sleep without underwear at night

Discomforts of Middle to Late Pregnancy  20th to 24th week a woman is ready for further health teaching.  Inform her of signs and symptoms of beginning labor.  Backache:  lumbar lordosis and postural changes  encourage her to wear shoes with low heals and walk with pelvis tilted forward.  Local heat, squat instead of bending over, firm mattress, monitor for bladder or kidney infections, avoid herbs ask MD about Tx.

 Headache:  from expanding blood volume, which puts pressure on cerebral arteries.  avoid eye strain or tension  rest with cold towels on forehead  Tylenol  intense or continuous notify the doctor.

 Dyspnea:  SOB due to uterus pressing on diaphragm  noticed at night or with exercise

Discomforts of Middle to Late Pregnancy  may need 2 pillows to sleep on at night

 Ankle Edema:  more noticeable by the end of the day  due to reduced blood circulation to the lower extremities due to uterine pressure and general fluid retention.  encourage left side lying position which increases the kidney’s glomerular filtration and allows good venous return.  elevate legs and avoid constricting clothing

 Braxton Hicks Contractions:  can begin at week 8 to 12  become stronger later in pregnancy  a rhythmic pattern can be a beginning sign of labor

 Danger Signs of Pregnancy:  Review with woman and have her report any of the symptoms to her health care provider.

 Vaginal Bleeding:  report to MD no matter how slight  check for hemorrhoids

 Persistent Vomiting:  1 to2 times daily for first trimester is common  persistent vomiting past week 12 is not normal  this depletes nutritional supply available to the fetus

 Chills and Fever:  may indicate intrauterine infection or gastroenteritis

 Sudden Escape of Clear Fluid From The Vagina:  membranes may have ruptured so uterine cavity is no longer sealed against infection  umbilical cord may prolapse  cord could be compressed

 Abdominal or Chest Pain:  report immediately may be ectopic pregnancy, separation of placenta, pre term labor, appendicitis, ulcer or pancreatitis  chest pain may indicate pulmonary embolus or thrombophebitis.

 Pregnancy-Induced Hypertension (PIH)  refers to potentially severe or fatal elevation of blood pressure  Symptoms  rapid weight gain(over 2 lbs/ wk in 2nd trimester and 1 lb/wk in 3rd trimester  swelling of face or fingers  flashes of light or dots before the eyes  dimness or blurring of vision  severe, continuous headache  decreased urine output

 Increase or Decrease in Fetal Movement:  fetus normally moves the same amount every day  change can be the fetus responding to a need for oxygen

Teratogens  Any factor, chemical or physical, that adversely affects the fertilized ovum, embryo or fetus.  Effects of Teratogens on the Fetus:  Factors:  strength of teratogen (radiation)  timing of the teratogen; before implantation, when the main body systems are being formed (2 to 8 weeks)  effects caused by organisms of syphilis and toxoplasmosis  affinity for specific tissue (lead, thalidomide, tetracycline, rubella virus)

 Teratogenic Maternal Infections:  sexually transmitted of systemic infections  TORCH  T-toxoplasmosis-a protozoan infection, spread through contact with uncooked meat, cat stool  almost no symptoms - malaise and posterior cervical lymphadenopathy  CNS damage, hydrocephalus, microcephaly, intracerebral calcification and retinal deformities

 O-other infections (syphilis, HBV, HIV)  rubeola, coxsackievirus, mumps, varicella, poliomyelitis, influenza, viral hepatitis and parvovirus B19 (5th disease) are all teratogenic.  Syphilis - congenital syphilis, extremely damaging to fetus at week 16 to 18  deafness, cognitive challenge, osteochondritis, and fetal death.  test for VDRL or RPR at first prenatal visit

 Lyme Disease:  multisystem disease  avoid tick repellent with diethyltoluamide  monitor for migratory rash and joint pain  Tx. Penicillin  Illness at birth  gonorrhea, candidiasis, chlamydia, strep B, hepatitis B

 R-rubella  mild rash and mild systemic illness in mother  deafness, mental and motor challenges, cataracts, cardiac defects, retarded intrauterine growth, thrombocytopenia, purpura, dental and facial clefts  a titer > 1:8 suggests immunity to rubella  can not be be immunized during pregnancy because the vaccine uses a live virus which will effect the same as a case of rubella  advise women to not become pregnant for 3 months after immunization  avoid children with rashes  infants born to mothers who had rubella can transmit the disease for 8 months after birth  isolate the newborn  nurses should be immunized against rubella

 C-cytomegalovirus:  member of herpes virus family  severe neurological damage, hydrocephalus, microcephaly, spasiticity, optic atrophy, chorioretinitis, deafness, chronic liver disease, blueberry-muffin lesions  no Tx.  H-herpes simplex virus:  1st trimester > severe congenital anomalies or spontaneous miscarriage  2nd and 3rd trimester > premature birth, intrauterine growth retardation, continuing infection of newborn at birth  Hx of herpes and lesions needs a C section  recurrence; antibodies prevent systemic transfer  IV or oral Zovirax during pregnancy  All are known to cross the placenta and affect the fetus during pregnancy  TORCH screen provides a quick way to assess the potential risk of teratogenic infection in pregnant women and newborns  infections can be viral, bacterial or protozoan  most cause flu-like symptoms in the woman and much more serious effects on the fetus.

 Vaccines:  Live virus vaccines are contraindicated.  Wait 3 months before becoming pregnant.

 Drugs:  women should not take any drug or supplement not prescribed by a physician.  accutane - acne  recreational drugs effects fetus 2 ways-direct effect and exposure to HIV HepB  Cocaine causes vasoconstriction in the mother causing decreased placental blood supply > decreased nutrients.  Miscarriage, preterm labor, meconium staining, growth retardation, learning disorders or poor attention span.  Alcohol > congenital deformaties and cognitive impairment, vitamin B deficiency  fetal alcohol syndrome-small for gestational age craniofacial deformity, short palpebral fissures, thin upper lip upturned nose.

 Cigarettes:  associated with infertility  growth retardation of fetus, SIDS, low birth weight due to limited blood supply to fetus,  inhaled carbon monoxide, second hand smoke  nicotine patches are harmful to fetus

 Environmental:  can be lethal to the fetus  Metal and Chemical Hazards  pesticides, carbon monoxide, arsenic,  formaldehyde, mercury, lead.

 Radiation  rapid growing cell destruction depending on the stage of development and length of exposure  most damaging from implantation to 6 weeks (lead apron)  nervous system, brain and retinal innervation, Ca, genetic mutation  Sonogram and MRI replaced X Ray

 Hyperthermia and hypothermia;  interferes with cell metabolism (growth)  saunas, hot tubs, tanning beds (limit 10 min), work environment  abnormal brain development, seizure disorder, hypotonia and skeletal deformaties  hypothermia - mothers temperature lowered significantly before fetal changes result

 Stress:  myths exist  teach common sense  effects on sympathetic division of autonomic nervous system(fight or flight)  prolonged - constriction of uterine vessels > interfere with blood supply and nutrients

Preparation For Labor  Midpoint of pregnancy is time to review the events that signal the beginning of labor.  Lightening - settling of the fetal head into the inlet of the true pelvis (2 weeks before labor in primiparas)  not SOB, increased urination, abdominal contour changed, sciatic pain  Show - release of cervical plug and beginning of cervical dilatation  Rupture of the Membranes:  a sudden gush of fluid  danger of cord prolapse and uterine infection  Excess Energy:  clean house, finish paperwork and exhaust herself before labor begins  Uterine Contractions:  start in the back and sweep froward across the abdomen like the tightening of a band  Gradually increase in frequency and intensity; notify health care provider  5 minutes apart and regular