PSYCHOSOCIAL ADAPTATION INCREASE IN SEX DRIVE
- woman cannot be in supine position
FIRST TRIMESTER during sex (avoiding hypotension)
TASK 2. ACCEPTING THE BABY
DENIAL - mother needs to be able to say “A
- denial to the confirmation of baby is growing inside me”
pregnancy - mother needs to be able to make
- peace with her weight gain because
FEAR she is eating for herself and for her
- fear regarding pregnancy child
- even if the client has prepared for - mother needs to be able to make
the pregnancy, fear is still expected peace with her physical changes
to be felt because they are for the betterment
of her child
AMBIVALENCE
THIRD TRIMESTER
- two conflicting/opposing feelings
- client is happy but also sad at the
RENEWED FEAR/TENSION
same time
- fear towards labor/delivery concerns
- client wants the child but also
(can I handle delivery?)
unsure if she is ready
- fear towards parenthood (can I be a
good parent at this time?)
SUDDEN DECREASE IN SEX DRIVE
ANXIETY
Every emotion needs to be addressed by - client does not know what she is
tasks. scared of
TASK 1. ACCEPTANCE NESTING INSTINCT
- mother needs to be able to say “I - client is always found outside to
am pregnant” prepare for the arrival of the child
- client is always shopping for the
SECOND TRIMESTER child
ACCEPTANCE TASK 3. PREPARING FOR PARENTHOOD
- client has made peace with her - client needs to be able to say “I am a
pregnancy mother”
- client needs to think in advance
FOCUS: PHYSIOLOGIC CHANGES about parenthood to prepare herself
- client is noticing weight gain, for all the challenges
discoloration, physical changes
Hegar’s sign
- change in the consistency of the
CONFIRMATION/SIGNS OF PREGNANCY isthmus (lower uterine segment)
1. PRESUMPTIVE SIGNS Ballottement
- least indicative signs of pregnancy - sinking/rebounding of the uterine
- subjective signs/only felt by the client content once tapped
- can be because of the presence of a
AMENORRHEA tumor
- 3 months of non-menstruation
- only YOU know your cycle Positive in pregnancy test
- can be a symptom of an underlying - only indicates presence of HcG
condition about your repro - client may only be suffering from H-
mole (excessive trophoblasts)
NAUSEA/VOMITING - client may also be suffering from
- can be a symptom of an underlying chorionic carcinoma (cancer)
GI condition
3. POSITIVE SIGNS
URINARY FREQUENCY - definite, absolute confirmation of
FATIGUE pregnancy
QUICKENING Fetal heart tones
- subtle movements in the stomach - nursing assessment: check the pulse
- can be a movement of gas inside the of the mother and use a doppler at
GI the same time. synchronous sounds
may only be uterine bruits
BREAST CHANGES -
- enlarging of the breast Visualization
- ultrasound: transvaginal and
SKIN CHANGES abdominal ultrasound
- only YOU know your own skin
- only the client can tell whether the Fetal movement
“changes” in her skin are new - felt by the examiner
-
2. PROBABLE SIGNS BRONVONVOLWARD’S SIGN – tumor-like
- objective signs changes in the uterus (probable)
Chadwick’s sign
- vulvovaginal bluish discoloration
Goodell’s sign
- change in the consistency of the
cervix
management: side-lying position, or support
COMMON DISCOMFORTS OF the client’s hip with a pillow
PREGNANCY 9. leg cramps
prevention: take calcium supplements (milk
1. morning sickness or pills)
management: dry crackers, small frequent management: leg dorsiflexion
feedings, avoid foul-smelling food, avoid
spicy food 10. varicose veins and pedal edema
management: limit times of standing
2. heartburn up/sitting down, elevate the legs (not until
management: small frequent feedings, the level of the heart)
avoid foul-smelling food, avoid spicy food,
avoid caffeine, avoid xanthene (chocolates) 11. shortness of breath
management: frequent rest periods, proper
3. flatulence positioning for lung expansion
management: small frequent feedings,
avoid gas-forming food *** END OF COMMON DISORDERS ***
4. urinary frequency
management: practice kegel’s exercise
(tightening of pelvic muscles), wear cotton
underwear
5. fatigue
management: adequate rest periods
6. constipation
management: encourage small exercises,
increase fiber consumption, increase water
7. hemorrhoids (dilated blood vessel)
management: avoid constipation
client wants comfort to address the
hemorrhoid pain: give warm sit bath
(steaming the anus to relax the sphincter)
client wants to decrease the size of the
hemorrhoid: give cold compress (witch
hazel compound to constrict the
hemorrhoid)
8. supine hypotension
PRENATAL PREGNANCY - when was your PMP [past menstrual
period] (When was your last
- any danger sign of pregnancy should menstruation before LMP?)
be reported to the physician STEP 2. Gather medical surgical history
immediately - what are your coexisting diseases
- identification of high risk (Do you have hypertension, asthma,
diabetes?)
ALL PREGNANT CLIENTS ARE AT RISK. - were you hospitalized before (Did
you undergo appendectomy before?
FREQUENCY OF VISIT: at least 4 visits Did you undergo CS before?)
[according to WHO] o if client says yes, place them
under high risk
IDEAL SCHEDULE OF VISIT: once a month,
every month, from the time you found out STEP 3. Gather family history
you were pregnant until 32 weeks - if client’s family has a history of DM,
hypertension, etc
32-36 weeks (age of gestation): every two
weeks
STEP 4. Gather client’s current health
problems
36 weeks to delivery: every week
- if client is coughing, cold, feverish,
etc.
First visit
- should be done asap
- preferably to be done at the first INITIAL SUBSEQUENT VISITS
missed period or when the
pregnancy test comes out positive STEP 1. Gather vital signs
- temperature: expected to rise
BASELINE DATA COLLECTION because of progesterone and
- done to identify if your client is at increased metabolic rate
high risk o abnormal temperature:
38degrees celcius
STEP 1. Gather obstetric history - heart rate: 15 beats per minute is
- when was your menarche (How old normal
are you when you had your first - blood pressure: should not be more
menstrual period?) than 120/80
- what is your usual menstruation like - respiratory rate: excessive shortness
(How long does your period last? of breath should be noted
How much do you bleed?)
- when was your LMP [last menstrual STEP 2. Assess the patient’s weight
period] (When is the first day of your - normal weight gain throughout the
last menstrual period?) pregnancy: 25-35 pounds
o 1st trimester: 3-4lbs gain
o 2nd-3rd trimester: 0.8-1lb per
week
- absence of change in the weight T1 = only 1 baby was delivered during the
should be noted and reported term (37-42 weeks)
P1 = the twins were delivered during
preterm (<36 weeks)
STEP 3. Assess the fundic height (cm). A1 = a fetus was aborted at the first
trimester (20 weeks)
OBSTETRIC HISTORY L3 = 3 babies were delivered alive (baby
boy, twins)
STEP 1. Assess GTPAL
Gravida Term Preterm Abortion Livebirths G4PARA1113
GRAVIDA – number of pregnancies *** end of gtpal ***
- how many times has the client been
pregnant, regardless of the number EDD/EDC
of fetus or outcome? Estimated Date of Delivery/Estimated Date
- kahit buntis pa client ng of Confinement
quadruplets, 1 gravida pa rin yun
Naegel’s Rule
TERM – 37 weeks
Full term – 38 weeks step 1. get the LMP
Post term – 41-42 weeks step 2. apply the formula:
-3, +7, +1 (mm/dd/yyyy)
PRETERM – below term (36 weeks)
- starting point: 20 weeks (age of example:
viability) step 1. get client’s LMP
ABORTION – abortion that occurred before 6 1 2020
20 weeks (age of viability)
step 2. apply the formula
LIVE BIRTHS – how many babies were
delivered alive? 6 1 2020
-3 +7 +1
EXAMPLE: = 3 8 2021
EDD: March 8 2021
Mittendorfs Rule
step 1. get the LMP and race of the client
CHOICES FOR RACE: Caucasian or Non-
G4 = 4 pregnancies in total (including Caucasian
current)
FOR CAUCASIANS:
LMP + 15 days – 3 months
If the fundus is in the level of the umbilicus,
FOR NON-CAUCASIANS: estimated AOG is 20-22 weeks.
LMP + 10 days – 3 months
*** end of EDD *** If the fundus is in the level of the xiphoid
process, estimated AOG is 36 weeks.
AOG
Age of Gestation *** END OF EDD ***
McDonald’s Rule ESTIMATED FETAL WEIGHT
Step 1. Get the fundic height (cm)
- from the level of the symphysis JOHNSON’S RULE
pubis to the level of the fundus
(palpable part of the entire uterus) Unengaged (floating) fetus:
EFW (in grams) = (Fundic height – 11) x 155
[Fundic height (cm) x 2]/7 = AOG in lunar
months Engaged fetus:
EFW (in grams) = (Fundic height – 12) x 155
*** END OF FETAL WEIGHT ***
ESTIMATED FETAL LENGTH
HAASE’S RULE
in weeks = multiply the lunar months by 4
FIRST HALF OF PREGNANCY (1-5 LUNAR
If months are not provided: MONTHS)
EFL = age of gestation (in months) squared
[Fundic height (cm) x 8]/7 = AOG in weeks
SECOND HALF OF PREGNANCY (6-10
ALTERNATIVE: BARTHOLOMEW’S RULE LUNAR MONTHS)
- in the absence of a tape EFL = age of gestation (in months) x 5
measure/calculator
*** END OF FETAL LENGTH ***
If the fundus is in the level of the symphysis
pubis, estimated AOG is 12 weeks and
below.
palpate the
presenting part
o STEP 4: SECOND PELVIC GRIP
palpate the
COMPLETE PHYSICAL ASSESSMENT presenting part and
check the
INTERNAL EXAMINATION engagement
In Philippine and US practice, IE is allowed - Leopold’s maneuver is for
to be performed by the nurse, granted that identification of the position and
there is no antenatal bleeding. engagement
BREAST *** END OF PHYSICAL ASSESSMENT ***
- any abnormality in the breast, take
note and report LABORATORY TESTS
ABDOMEN
- perform Leopold’s maneuver Blood studies
o make sure the client has 1. CBC – hemoglobin (normal: 12-16 g/dl),
urinated first to empty the hematocrit, WBC (normal: 5000-10000
bladder millimeter cube, pregnant: 12000 mm3. pag
o make sure your hands are nag-15000 na during pregnancy, infection
warm and clean na siya)
o STEP 1: FUNDIC GRIP
palpate what is lying 2. Blood typing and Rh factor – high risk
in the fundus factor: Rh-
if what you palpated
was round, mobile, 3. VDRL – venereal disease research
and hard, it’s laboratory (to diagnose syphilis)
probably the baby’s
head (baby is in 4. Rubella – ask the client if she’s ever had
breached position) measles. if the client can’t remember, ask if
if what you palpated she’s ever been vaccinated with Rubella
was soft, immobile, vaccine. Rubella has teratogenetic effects,
then that was the the baby might have Rubella disease
baby’s butt or feet (congenital cataract, patent ductus
(baby is in cephalic arteriosus, microcephaly, deafness).
position) - normal: positive Antibody (>1:8)
o STEP 2: UMBILICAL GRIP - high risk: Antibody (<1:8)
palpate what is lying
in the fundus and 5. glucose check
lower your hands to
the sides of the URINALYSIS
tummy - check for protein, pus, bacteria
o STEP 3: FIRST PELVIC GRIP - check if patient has UTI (high risk)
- UTI can lead to abortion in 1st - make sure your clothing is
trimester, UTI in 3rd trimester can comfortable, including underwear
cause preterm labor
Sleep and Rest
*** END OF PRENATAL CHECKUP *** - minimum is 8 hours, average is 10
hours
HEALTH TEACHINGS:
PREGNANCY MANAGEMENT
Travelling
Nutrition - if land travel, take a stopover every
- normal caloric intake: 1200-2400 2 hours to walk and get the blood
o for pregnancy, +300kcal/day flowing
- increase iron intake - if air travel, secure an ExMo
o take diet history of patient (EXPECTANT MOTHER) certificate
before recommending from the OB
o note for dietary restrictions
(religious, cultural) Exercises
o leafy vegetables + meat - breathing exercises
products, together with - pelvic rock (ocho-ocho)
supplements - squatting (supported, legs are
o for iron supplements, 30- separated)
60mg/day is recommended, o tailor sitting (legs are being
best combined with vitamin pushed down in an Indian
C sitting position
- take folic acid (lack thereof leads to
neural tube defects)
o 400mcg is recommended
o if client has history with
neural tube defect, dosage is
increased to 1200 mcg
- take calcium
o 4 glasses of milk
o take supplements:
1200mg/day
Bathing
- Kegel’s exercise
- douching is not recommended
o hold the perineal exercises
- bathing in the bathtub is not
for 30-45 seconds
recommended
- shoulder rolling
- back exercising
Clothing
- avoid tight clothing
Coitus
- 1st trimester: sexual intercourse is o baby is shaking when
not prohibited unless you have delivered
spotting - herbal medications
- 2nd trimester: sexual intercourse is o not recommended to self-
allowed as long as the woman is not medicate
in supine position o always consult your physician
- 3rd trimester: sexual intercourse is first
not recommended because of the
prostaglandin in semen (early labor)
Employment
- high-risks jobs and conditions:
o if client is a preschool
teacher and has not been
exposed to Rubella
o if client is a nurse
Care of teeth
- any procedure involving the teeth is
restricted because of the anesthesia
- use a soft bristled brush and avoid
flossing
*** END OF HEALTH TEACHINGS ***
SAD HABITS
S – smoking
- interuterine growth retardation
- smoking can lead to
vasoconstriction. this will make your
baby small.
- associated with cleft palate
A – alcohol
- no safe amount of alcohol for
pregnant women
- baby might get fetal alcohol
syndrome
D – drugs
- heroin: baby might get withdrawal
abstinence syndrome
