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Nursing Care of the Family During Pregnancy 191 C HAPTER Nursing Care of the Family7 during Pregnancy DEITRA LEONARD LOWDERMILK LEARNING OBJECTIVES • Describe the process of confirming pregnancy • Identify the typical nursing assessments, and estimating the date of birth. diagnoses, interventions, and methods of • Summarize the physical, psychosocial, and evaluation in providing care for the pregnant behavioral changes that usually occur as the woman. mother and other family members adapt to • Discuss education needed by pregnant women pregnancy. to understand physical discomforts related to • Discuss the benefits of prenatal care and pregnancy and to recognize signs and problems of accessibility for some women. symptoms of potential complications. • Outline the patterns of health care used to • Examine the impact of culture, age, parity, and assess maternal and fetal health status at number of fetuses on the response of the the initial and follow-up visits during family to the pregnancy and on the prenatal pregnancy. care provided. KEY TERMS AND DEFINITIONS birth plan A tool by which parents can explore multifetal pregnancy Pregnancy in which more their childbirth options and choose those that than one fetus is in the uterus at the same are most important to them time; multiple gestation couvade syndrome The phenomenon of Nägele’s rule One method for calculating the expectant fathers’ experiencing pregnancy-like estimated date of birth, or “due date” symptoms pelvic tilt (rock) Exercise used to help relieve low cultural prescriptions Practices that are expected back discomfort during menstruation and or acceptable pregnancy cultural proscriptions Forbidden; taboo practices pinch test Determines whether nipples are doula Trained assistant hired to give the woman everted or inverted by placing thumb and support during pregnancy, labor and birth, and forefinger on areola and pressing inward; the postpartum nipple will stand erect or will invert home birth Planned birth of the child at home, supine hypotension Drop in blood pressure usually performed under the supervision of a caused by impaired venous return when the midwife gravid uterus presses on the ascending vena morning sickness Nausea and vomiting that cava, when woman is lying flat on her back; affect some women during the first few vena cava syndrome months of their pregnancy; may occur at any trimesters One of three periods of approximately time of day 3 months each into which pregnancy is divided Q 190 Lowdermilk6617_Ch007_main.indd 190 10/7/2009 4:34:59 PM CHAPTER 7 Nursing Care of the Family during Pregnancy 191 WEB RESOURCES Additional related content can be found on the companion website at http://evolve.elsevier.com/Lowdermilk/Maternity/ • NCLEX Review Questions • Nursing Care Plan: Adolescent Pregnancy • Assessment Videos: Chest wall, breast, • Nursing Care Plan: Discomforts of Pregnancy abdomen/fundal height, fetal heart rate and Warning Signs • Case Study: First Trimester • Spanish Guidelines: Assessment of Respiratory • Case Study: Second Trimester Symptoms • Case Study: Third Trimester • Spanish Guidelines: Prenatal Interview • Critical Thinking Exercise: Discomforts of • Spanish Guidelines: Prenatal Physical Pregnancy Examination • Critical Thinking Exercise: Teenage Pregnancy he prenatal period is a time of physical and after a positive home pregnancy test; however, the clinical psychologic preparation for birth and parent- diagnosis of pregnancy before the second missed period is hood. Becoming a parent is one of the mile- difficult in some women. Physical variations, obesity, or Tstones of adult life, and as such, it is a time of intense learning tumors, for example, may confuse even the experienced for both parents and those close to them. The prenatal examiner. Accuracy is important, however, because emo- period provides a unique opportunity for nurses and other tional, social, medical, or legal consequences of an inac- members of the health care team to influence family health. curate diagnosis, either positive or negative, can be During this period, essentially healthy women seek regular extremely serious. A correct date for the last (normal) men- care and guidance. The nurse’s health-promotion interven- strual period (LMP or LNMP) and for the date of inter- tions can affect the well-being of the woman, her unborn course and a basal body temperature (BBT) record are of child, and the rest of her family for many years. great value in the accurate diagnosis of pregnancy (see Regular prenatal visits, ideally beginning soon after the Chapter 4). first missed menstrual period, offer opportunities to ensure the health of the expectant mother and her fetus. Prenatal Signs and Symptoms health care permits diagnosis and treatment of preexisting Great variability is possible in the subjective and objective maternal disorders and any disorder that may develop signs and symptoms of pregnancy; therefore the diagnosis during the pregnancy. Prenatal care is designed to monitor of pregnancy is often uncertain for a time. Many of the the growth and development of the fetus and to identify indicators of pregnancy are clinically useful in the diagno- any abnormalities that will interfere with the course of sis of pregnancy. They are classified as presumptive, prob- normal labor. Prenatal care also provides education and able, or positive (see Table 6-2). support for self-management and parenting. The presumptive indicators of pregnancy can be caused Pregnancy spans 9 months, but health care providers by conditions other than gestation. For example, illness do not use the familiar monthly calendar to determine or excessive exercise can cause amenorrhea, anemia or fetal age or discuss the pregnancy. Instead, they use lunar infection can be the cause of fatigue, a tumor may months, which last 28 days, or 4 weeks. According to the cause enlargement of the abdomen, and a gastrointestinal lunar calendar, normal pregnancy lasts approximately 10 (GI) upset or food allergy may cause nausea or lunar months, which is the same as 40 weeks or 280 days. vomiting. Therefore these signs alone are not reliable for Health care providers also refer to early, middle, and late diagnosis. pregnancy as trimesters. The first trimester lasts from weeks 1 through 13; the second, from weeks 14 through Estimating Date of Birth 26; and the third, from weeks 27 through 40. A pregnancy After the diagnosis of pregnancy, the woman’s first ques- is considered at term if it advances to the completion of tion usually concerns when she will give birth. This date 37 weeks. has traditionally been termed the estimated date of confine- The focus of this chapter is on meeting the health needs ment (EDC), although estimated date of delivery (EDD) is also of the expectant family over the course of pregnancy, or used. However, the term estimated date of birth (EDB) pro- the prenatal period. motes a more positive perception of both pregnancy and birth. Because the precise date of conception is generally DIAGNOSIS OF PREGNANCY unknown, several formulas can be used for calculating the EDB. None of these guides is infallible, but Nägele’s rule Women may suspect pregnancy when they miss a men- is reasonably accurate and is usually used (Johnson, Q strual period. Many women come to the first prenatal visit Gregory, & Niebyl, 2007). Lowdermilk6617_Ch007_main.indd 191 10/7/2009 4:34:59 PM 192 UNIT TWO PREGNANCY BOX 7-1 changes in readiness for parenthood as she prepares for Use of Nägele’s Rule her new role. She moves gradually from being self-con- tained and independent to being committed to a lifelong July 10, 2009, is the first day of the last menstrual concern for another human being. This growth requires period (LMP). mastery of certain developmental tasks: accepting the preg- Month Day Year nancy, identifying with the role of mother, reordering the LMP 7 10 2009 relationships between herself and her mother and between –3 +7 herself and her partner, establishing a relationship with the Estimated day of birth: 4 17 2010 unborn child, and preparing for the birth experience (Lederman, 1996). The partner’s emotional support is an The estimated date of birth (EDB) is April 17, 2010. important factor in the successful accomplishment of these developmental tasks. Single women with limited support may have difficulty making this adaptation. Nägele’s rule is as follows: After determining the first day of the LMP, subtract 3 calendar months and add 7 Accepting the Pregnancy days; or alternatively, add 7 days to the LMP and count The first step in adapting to the maternal role is accept- forward 9 calendar months. Box 7-1 demonstrates use of ing the idea of pregnancy and assimilating the pregnant Nägele’s rule. Nägele’s rule assumes that the woman has a state into the woman’s way of life. Mercer (1995) described 28-day menstrual cycle and that pregnancy occurred on this process as cognitive restructuring and credited Reva the fourteenth day. Obtaining an accurate menstrual Rubin (1984) as the nurse theorist who pioneered our history is important as well in using this method of dating. understanding of maternal role attainment. The degree of acceptance is reflected in the woman’s emotional responses. ADAPTATION TO PREGNANCY Many women are upset initially at finding themselves preg- nant, especially if the pregnancy is unintended. Eventual Pregnancy affects all family members, and each family acceptance of pregnancy parallels the growing acceptance member must adapt to the pregnancy and interpret its of the reality of a child. However, do not equate nonac- meaning in light of his or her own needs. This process of ceptance of the pregnancy with rejection of the child; a family adaptation to pregnancy takes place within a cul- woman may dislike being pregnant but feel love for the tural environment influenced by societal trends. Dramatic unborn child. changes have occurred in Western society in recent years, Women who are happy and pleased about their preg- Case Study: First Trimester and the nurse needs to be prepared to support single- nancy often view it as biologic fulfillment and part of their parent families, reconstituted families, dual-career families, life plan.
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