Kuliah Sem4 2008-5

Fakulti Kejururawatan

Prenatal Care Aims and responsibilities & Preparation of mother & Minor disorders in pregnancy

By Nor Marini Ibrahim

Prenatal Care :Aims and responsibilities

Objectives: On completion of this topic, the student will be able to do the following: • List the goals of prenatal care • Explain the nurse’s role in prenatal care

Prenatal Care :Aims and responsibilities

• Introduction: - Pregnancy is temporary, physiological (normal) process that affects the woman physically and emotionally. - All system of her body adapt to support the developing fetus. - The focus of nursing care during pregnancy is to teach the mother how to maintain good health and to improve her health as much as possible.

Prenatal Care :Aims and responsibilities

• The major goals of prenatal care are as follows: i. Ensure a safe birth for mother & child by promoting good health habits and reducing risk factors. ii. Teach health habits that may be continued after pregnancy iii. Educate in self-care for pregnancy iv. Provide physical care v. prepare parents for the responsibilities of parenthood

Prenatal Care :Aims and responsibilities

• The major roles of the nurse during prenatal care include data collection from the pregnant woman, identifying and reevaluating risk factors, educating in self-care, providing nutrition counseling and promoting the family’s adaptation to pregnancy.

MINOR DISORDER OF PREGNANCY

By Nor Marini Ibrahim

Minor disorder of pregnancy

Objectives: On completion of this topic, the student will be able to do the following: i. discuss on the types of minor disorders of pregnancy ii. Explain the cause and effect of the pregnancy iii. Management of pregnant woman with minor disorders

Minor disorder of pregnancy

 Result of normal physiologic changes due to hormonal changes and the influence of the developing pregnancy on supporting organs, most of which revert to normal after delivery.  Education must be primary component of intervention in helping the pregnant mother deal with the discomforts of pregnancy.

Minor disorder of pregnancy 1. □ □

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Nausea and Vomiting CAUSE – occur due to increase level of hormon estrogen & progesterone and also emotional factors commonly associated with: - altered in CHO metabolism - orthostatic hypertension (sudden change of position from lying down to upright position) - may be aggravated by smell of food atc:cooking, petrol etc. Incidence : 50% of pregnant woman Accepted as a normal symptom of pregnancy. Its does not disturb the pregnancy or woman health Occurs from 6-12 weeks of pregnancy. Usually occurs soon after waking, often nausea rather than vomiting Usually stop at 14-16 weeks

□ If vomiting is persistent, mother cannot tolerate any food/drink, may lead hyperemesis gravidarum. □ MANAGEMENT : – Reassure the mother – Advise on – Frequent, small meats – Dry carbohydrate food before arising; snack before bedtime and drinking a glass of warm milk – Fluids between meals – Avoid cooking odors of greasy, highly seasoned foods – Vit. B, after meals or at bedtime – avoid sudden change of position □ TREATMENT – usually mild & require no treatment – If severe, must rehydrate with 6 paint normal saline over 24 hours. – Antiemetic : tab Avomine 25mg bd, iv maxolon 10mg tds

1.

Urinary Frequency □CAUSE: – increase blood flow, so increase glomerulo filtration rate – Pressure from gravid uterus or fetal presenting part □ between 6-12 weeks and later at 36 weeks of pregnancy □ MANAGEMENT: advise on – – – – – –

Empty bladder frequently Maintain daytime fluid intake Decrease fluids before bedtime Avoid caffeinated and carbonated beverages Wear panty liners Kegel exercises

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Constipation CAUSE - increase level of progesterone - lack of fluid intake - lack of fiber in the diet - habit – does not open bowel regularly daily MANAGEMENT – fluids intake (6 – 8 glasses/day) – High-fiber diet – Maintain daytime fluid intake – Warm beverages – Regular bowel habits – Exercise – Mild laxatives, stool softener or suppository recommended by doctor/midwife

1. Breasts Tenderness Cause : – Elevated estrogens & progesterone Management : – Wear supportive bra – Avoid soap on nipple & areola – Cleanse colostrum with water – Change sleep pattern

5.Increased Vaginal Discharge

(Leucorrhea)

□ A whitish, viscid discharge from the vagina and uterine cavity □ Cause: increase in vascular transudation and cervical mucus from the cervical glands due to the high level of estrogen □ Management : – Good hygiene – Cotton underwear – Avoid tight clothing – if discharge is purulent, blood stained, irritating or offensive – refer to doc for

6. Heartburns □ A Burning sensation & discomfort felt at the epigastrium. □ Cause: – ↑ progesterone causing ↓ GIT motility – Displacement of stomach and duodenum by ↑ gravid uterus □ Management : – Small frequent meals – Avoid fatty, fried foods – Avoid coffee & cigarettes – Frequent sips of warm milk or water – antacids : Magnesium trisillicate 2 tab TDS – Sleep with > pillows

1. Constipation □ Cause – progesterone – ↑ pelvic pressure – Iron supplements □ Management – fluids (6 – 8 glasses/day) – High-fiber diet – Maintain daytime fluid intake – Warm beverages – Regular bowel habits – Exercise – Mild laxatives, stool softener or suppository recommended by doctor/midwife

1. Backache □ Cause – faulty posture – such as lordosis – relaxing effects of hormone progesterone on the ligaments & joints of the pelvic – normally occurs in multipara

□ Management – Use good posture – Use good body mechanics – Flat, supportive shoes – Maternity girdle – Avoid overexertion – Sleep in lateral position on firm mattress – Good, gentle back massage

1. Varicose veins □ cause - relaxing effect of progesterone causing veins to dilate - prolong standing & working - pressure from the gravid uterus on the inferior vena cave or other veins □ Management – Elevated legs while resting – Frequent position changes – Avoid lengthy standing – Avoid crossing legs

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Tips to relieve swelling and varicose veins: Do not sit or stand for long periods of time. Elevate your legs whenever possible. Rest in your bed on your left side. Lie down with your legs raised on a small stool or several pillows. You may want to also elevate your hips if you have developed varicose veins in your vaginal area. Do not wear stockings or socks with tight elastic around the legs. Wear support pantyhose. Exercise regularly, especially walking, swimming, or riding an exercise bike. Do not cross your legs when you are sitting.