Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 1 Clinical Instructor Heartburn Increased Pats of butter PRENATAL CARE and progesterone before meals which dec. Avoid fried , HEALTH TEACHINGS gastric fatty foods motility Sips of milk at causing frequent esophageal intervals.Basic Concepts in Pregnancy reflux. Small, frequent mealsSigns of Pregnancy: taken slowly. Presumptive Signs Bends at the Amenorrhea – absence of menses knees, not at Nausea and Vomiting the waist Increased breast sensitivity and breast changes Take antacids Increased pigmentation Constipation Due to Increased Constipation displacemen fluids and Frequent urination t of the roughage in the Quickening stomach and diet. Abdominal enlargement intestines; Regular iron elimination Probable Signs supplements time. Uterine enlargement Increase Hegar’s Sign exercise Goodell’s Sign Avoid enemas, Chadwick’s Sign harsh laxatives Ballottement and mineral oil. Braxton Hick’s contraction Hemorrhoids Pressure of Warm sitz Positive Pregnancy Test growing bathing fetus, High fiber diet Positive Signs Increase and increase Fetal Heart Tone venous fluid. X-ray or Ultrasound of fetus pressure Sit on soft Palpable fetal movements pillow Urinary Increase Sleep on theDiscomforts of Pregnancy Frequency blood supply side at night. to the Limit fluid Changes Reason Health kidney/ intake during Teachings Pressure of eveningNausea and Increased Dry crackers enlarged BladderVomiting HCG 30 min. before uterus in the training arising 3rd Tri Small, Backache From Back exercise frequent, low exaggerated (pelvic rock) fat meals lumbo- Wear low- Liquids bet. sacral heeled shoes. meals curving Avoid heavy during lifting Avoid anti- pregnancy. emetics.
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 2 Clinical InstructorLeg Cramps Increase Frequent rest Presumptive Signs of Pregnancy pressure of with feet gravid fetus, elevated low calcium Regular exercise like walking Increase milk intakeAnkle Edema From Elevate legs at venous least twice a stasis day. Sleep on left sideVaricose From faulty Elevate feetVeins valves or when sitting. weakened Use support vessel walls hose Apply elastic bandage Avoid use of constricting gartersShortness of From Sleep with feetbreath pressure on elevated or on diaphragm regularly.Nasal Elevated Direct pressurestuffiness and Estrogen to the nasalepistaxis levels area Avoid blowing of nose.Fatigue Due to Get regular hormonal exercise changes Sleep as much as needed. Avoid stimulants.Breast Increase Wear wellTenderness estrogen and fitted bra progesterone Warm level compressIncreased Due to ConsultVaginal hyperplasia physician ifdischarges of mucosa infection is and increase suspected mucus Wash carefully production and keep it dry.
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 3 Clinical InstructorFormula Used In Providing Estimates In Pregnancy C. Estimated Fetal WeightA. To estimate the EDC Given the Use Formula Given the Use Formula Rump-to- Standard Rump-to-crownLast Menstrual Nagele’s Rule First day of crown length Formula length in utero cm.Period (LMP) LMP – 3 in utero cm. x 100 = weight in months + 7 gm days Johnson’s FH (cm)Date of Primi: Ruler - 11 (if unengaged )Quickening Q + 4 months - 12 ( if engaged ) x + 20 days 155 Multi: Q + 5 months Measuring the Fundic Height + 4 daysB. To estimate the AOG Given the Use FormulaFundic Height McDonald’s Height in cm rule FH x 2/7 = duration in months FH x 8/7 = Duration in weeks Fundus Height at Various week
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 4 Clinical InstructorPRENATAL VISIT High Risk Factors During PregnancyMaternal Health Program of the DOH Life of woman and fetus has significantly is tasked to reduced the maternal mortality increased risk of disability or death.ratio by three-quarters by 2015: MMR of 112/100,000 live births in 2010 Generally, these are: MMR of 80/100,000 live births in 2015 - abnormal fetal position or presentation - age 35 years or younger than age 15 yearsStrategic Thrusts for 2005-2010 - bleeding during pregnancy Launch and implement the Basic Emergency - drug or alcohol dependent Obstetric Care or BEMOC. The BEMOC - hydramnios strategy entails the establishment of facilities - hypertension of pregnancy that provide emergency care for every 125,000 - infection of mother population. - maternal illness Improve the quality of prenatal and postnatal - past history of difficult delivery care - post cesarean birth Reduce women’s exposure to health risks - potential for blood incompatibility through the institutionalization of responsible parenthood and provision of appropriate health Medical History and current status: care package to all women of reproductive ages. - obstetrical history, current status LGU’s, NGOs and other stakeholders must - Psychosocial risks, maternal behaviors and advocate for health through resource generation adverse lifestyle. and allocation of health services for the mother - smoking and the unborn. - caffeine: 3 or more cups of coffee - alcohol: no safe dosePrenatal Clinic Visits - drugs - abuse and violence Schedule of first visit is as soon as the woman - Psychological status missed her menstrual period and pregnancy is - working more than 10 hours, heavy lifting suspected - standing more than 4 hours.First 32 weeks : once a month32-36 weeks : twice a month Socio-demographic risks:36-40 weeks : every week - low income - lack of prenatal care - height less than 145 cm ( 4’9”)Length of Pregnancy - parity more than 5 - marital status 267-280 days - residence 38-42 weeks (ave.40 weeks) - ethnicity 9 calendar months 10 lunar months Environmental risks: 3 trimester - infectionFirst Trimester: Period of Organogenesis - radiationSecond Trimester: Most comfortable for mother - chemicals with continued fetal growth. - physical; extreme heat more than 38.9 c,Third Trimester: Period of rapid fetal growth noise, vibration and atmospheric pressure, bec. of rapid deposition of fats iron and calcium.
Lecture Notes on Prenatal Care / Health Teachings Prepared By: Mark Fredderick R Abejo R.N, MAN 5 Clinical Instructor Components of a Prenatal Visits TPAL T = Full Term BabiesInitial interview P = Premature Health history A = Babies Abortion - Menstrual history: menarche, regularity, L = Living Children frequency and duration of flow and last period. - Obstetrical history; all pregnancy, outcome, Physical Examination complication, contraceptives use, sexual history Review of System Pelvic Examination Danger Signs of Pregnancy ( Cardinal Rule: EMPTY BLADDER ) - Vaginal Bleeding - Swelling of the face or finger - Severe headache Internal Exam (I.E) to determine: - Blurring of vision Hegar’s Sign – softening of the uterus - Flashes of lights Goodell’s Sign – softening of the cervix - Pain in the abdomen Chadwick’s Sign – bluish discoloration of - Persistent vomiting vagina. - Chills and fever - Sudden escape of fluids from the vagina - absence of fetal heart tone Demographic data Chief concern Family profile History of past illnesses Ballotement – fetus will bounce when History of family illness lower uterine segment is tapped Gynecologic history sharply Obstetric history ( on the 5th month ) Review of systems Support person’s role Fetal Heart Rate Assessment - Doppler Ultrasound ( 10-12 weeks ) - Stethoscope ( 18-20 weeks ) Expected Rate: 120-160 bpm
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 6 Clinical Instructor Pelvic Measurement are preferably done Classification of Findings th after the 6 lunar month. Xray Pelvimetry is the most effective Class 1 – absence of abnormal cells method of diagnosing cephalopelvic Class 2 – abnormal cell but no evidence of disproportion. But since Xrays are malignancy. teratogenic, the procedure can be done Class 3 – cytology suggestive of malignancy only two weeks before EDC. Class 4 – cytology strongly suggestive of malignancy Class 5 – conclusive for malignancyTypes of Pelvis Clinical Stages of Cervical Cancer Stage 1 - Cancer confined to the cervix Stage 2 - CA extends beyond the cervix into the vagina Stage 3 - metastasis to the pelvic wall Stage 4 - metastasis beyond pelvic wall into the bladder and rectum. Papanicolau ( Pap Smear) – cytological examination to diagnose cervical cancer. A. 1 : Nulligravida cervix 2 : Cervix after childbirth 3 : “Stellate” cervix seen after mild cervical tearing. B 1 : Herpes II 2 : Chancre of syphilis 3 : Erosion or infection
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 7 Clinical Instructor Leopold, Maneuvers – are a systematic to determine fetal back methods of observation and palpation to still facing the head part of the mother, palpate determine fetal position, presentation, lie and side to locate the fetal back. attitude which helps in predicting course of a feel smooth hard resistant surface is the back labor part. ( best place to hear the FHT ) a number of angular nodulation are knees andPreparatory Steps: elbows.1. Palpate with warm hands.2. Use palms, not fingertips. 3rd Maneuver3. Woman should lie in supine position with knees flexed slightly.4. Done with empty bladder.Procedure:1st Maneuver to determine engagement and mobility of presenting part. still facing the head part of the mother, grasp the lower portion of the abdomen just above the symphysis pubis to find out degree of engagement. to determine presenting part facing the head part of the pregnant woman, 4th Maneuver palpate for fetal part found in the fundus to determine presentation. ( a hard, smooth, ballotable mass at the fundus means fetus is breech presentation )2nd Maneuver to determine fetal attitude and descent. Now facing the feet of the mother, press fingers downward on both sides of the uterus above the inguinal ligaments to determine degree of flexion of fetal head.
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 8 Clinical Instructor Benedict’s Test Nutritional Assessment Test for glycosuria, a sign of possible - Food preferences and eating habits gestational diabetes. - Cultural and religious influences Urine should be collected before breakfast - Education and occupational level results: Blue - no sugar Green - +1 sugar Yellow - +2 sugar Assessing Maternal Weight Gain Orange - +3 sugar Red - +4 sugar Vital Signs During Pregnancy Blood Pressure : limit increase is 10/15 mmHg systolic – diastolic above baseline BP. Pulse : 60 -90 beats per min. Respiration : 16 – 24 cycles per min. Temperature : 36.2 – 37.6 C ( 97-100 F ) PRENATAL HEALTH TEACHINGSNutritional Health During PregnancyNutrition – most important aspectWeight Gain 11.2 to 15.9 kg. ( 25 – 30 lb )recommended as an average weight gain inpregnancy. 2 – 4 lbs during 1st trimester 11 – 14 lbs during 2nd trimester 8-11 lbs from the 3rd trimesterNote: Pattern of weight gain is more importantthan amount of weight gain. Computation of Caloric EquivalentsWomen who need special attention: Pregnant teenagers Carbohydrates X 4 Low pre-pregnant weight and obese Proteins X 4 Low income women Fats X 9 Successive pregnancies Vegetarians
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 9 Clinical Instructor
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 10 Clinical InstructorFood Sources Pregnat 10,000 1 For 4 Vit. A women IU cap / weeks shouldProtein Meat, fish, eggs, milk, poultry, with day upon not be cheese, beans, mongo night diagnosis given toVit. A Eggs, carrots, squash, all green blindness woman leafy vegetables whoVit. D Fish, liver, egg, milk, margarine already Note: excess vit.D may lead to taking fetal cardiac problem vit. that alsoVit. E Green leafy vegetables, fish, corn containVit. C Tomatoes, guava, papaya, citrus Vit. A fruitsFolic Acid Asparagus, organ meat, green leafy vegetables Iron SupplementationVit. B ( foods rich in protein )Calcium and Milk, cheese, green leafy Target Prep. Dose / RemarksPhosphorus vegetables, whole grains, Duration seafood, tofu Pregnant Coated 1 tab/day forIron Pork liver, lean meat, kamote Women Tab. 6 months or leaves, soybeans, seaweeds, contains 180 days mongo 60 mg during A dose ofIodine Iodized salt, seafood, milk, egg, elemental pregnancy 800 mcg bread iron with period folic acid 400 mg OR is stillMicronutrient Supplementation folic acid 2 tab/day if safe to prenatal pregnant consultation womanVitamin A Supplementation are done during the Target Prep. Dose Duration Remarks 2nd/3rdPregnant 10,000 1 Start from Vit. A trimesterWomen IU cap the 4th should Lactating Coated 1 tab / day for 2x a month of not be Women Tab. 3 months or week pregnancy given to contains 90 days until woman 60 mg delivery who elemental already iron with taking 400 mg vit. that folic acid also contain Iodine Supplementation Vit. APost 200,000 1 One dose Vit.A Target Prep. Dose / DurationPartum IU cap only (200K Women Iodized oil 1 capsule for 1Women within 4 IU) 15-45 capsule with year weeks should yrs.old 200 mg. after not be to iodine delivery pregnant women.
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 11 Clinical Instructor TeTox Routine Immunization of Dont’s During Pregnancy Pregnant Women Smoking Causes vasoconstriction,Vaccine Minimum Percent Duration of leading to low birth weight Interval Protected Protection babiesTeTox 1 As early as Drinking Alcohol When excess can cause possible respiratory depression in during newborn and fetal pregnancy withdrawal syndrome.TeTox 2 4 weeks 80% infant will Delayed fetal growth and after be developmentMinimum TeTox 1 protected Drugs are dangerousrequired Drugs st by neonatal especially during 1 Tri.TeTox forpregnant tetanus Thalidomide Causes amelia ormother 3 years phocomelia (short or no protection extremities for the Steriods Can cause cleft palate and mother abortionTeTox 3 6 months 95 % infant will Cough Can cause enlargement of after be suppressant fetal thyroid gland leading TeTox 2 protected to tracheal compression and by neonatal dyspnea at birth tetanus Vit.K Cause hemolysis and 5 years hyperbilirubinemia protection Aspirin Causes bleeding disorder for the Streptomycin Cause damage to the 8th mother cranial nerveTeTox 4 1 year 99 % infant will Tetracycline Causes staining of the tooth after be enamel and inhibits growth TeTox 3 protected of long bones by neonatal Cocaine Causes abruption placenta, tetanus preterm labor and fetal 10 years death protection Amphetamines Can cause jitteriness and for the poor feeding at birth mother Marijuana Increase incidence ofTeTox 5 1 year after 99 % all infant respiratory infection TeTox 4 born to that Narcotics Small gestational age, mother will increase rate of fetal distress, be meconium aspiration, protected abnormal fetal liver and lung lifetime tissue protection Inhalants Cardiac irregularities, for the severe respiratory mother depression.
Lecture Notes on Prenatal Care / Health TeachingsPrepared By: Mark Fredderick R Abejo R.N, MAN 12 Clinical InstructorSexual Activity Traveling Sexual desires continue throughoutpregnancy, but levels change: No travel restriction, but postpone a trip during the last trimester. During the First Trimester: there is a decrease On long rides, 15 – 20 minute rest period every in sexual desire because the woman is more 2-3 hours to walk about or empty the bladder is preoccupied with the changes in her body. advisable. During the Second Trimester: there is an improvement in sexual desire because the Exercises woman has adapted to the growing fetus. During the Third Trimester: there is another Chief Aim : To strengthen the muscles used in decrease in sexual desire because the woman is labor and delivery afraid of hurting the fetus. Should be done in moderationNote: Should be individualized: according to age, Sex in moderation is permitted during physical condition, customary amount ofpregnancy but not during the last 6 weeks since exercise and stage of pregnancythere is increased incidence of postpartuminfection in women who engage in sex during thelast 6 weeks. Recommended ExercisesRecommended Position Squatting Increase circulation in the- side by side position perineum, make pelvic joints- woman on top more pliable .- entrance at the back (dog’s style ) When standing from squatting- side on the back position, raise buttocks first before raising the head to preventSex is CONTRAINDICATED postural hypotension Tailor Strengthens the thighs and Sitting stretches perineal muscles to Spotting or bleeding make them more supple. Ruptured BOW Pelvic Rock Maintains good posture Incompetent cervical OS Relieve abdominal pressure Deeply-engage presenting part and low back pain Placenta previa Strengthens abdominal History of spontaneous miscarriage muscles Modified Relieve pelvic pressure and knee-chest cramps in the thighs andEmployment position buttocks Relieves discomfort from hemorrhoids. As long as the job does not entail handling Shoulder- Strengthens muscles of the chest toxic substance or lifting heavy objects or circling excessive physical and emotional strain, there is Walking BEST EXERCISE no contraindication to work. Kegel Relieve congestion and Advise pregnant women to walk about every discomfort in pelvic region. few hours of her work day during long periods of standing or sitting to promote circulation. Tones up pelvic floor muscles