Nursing Care of the mother and the fetus during the prenatal period

1. NURSING CARE
OFTHE
MOTHER ANDTHE FETUS
DURING PRENATAL PERIOD
Promoting Fetal and Maternal Health

2. TOPIC LEARNING OUTCOMES
 Assess mother’s health status with the use of specific methods and tools to
address existing health needs.
 Formulate nursing diagnosis/es focusing on health promotion and disease
prevention related to mother’s health.
 Plan and implement safe and quality nursing interventions addressing
health needs affecting women during pregnancy.
 Conduct individual/group/health education activities based on the priority
learning needs of mother.
 Evaluate with the client the health outcomes of nurse-client working
relationship.

3. TOPIC LEARNING OUTCOMES
 Institute appropriate corrective actions to prevent or minimize
harm arising from adverse effects.
 Manage resources (human, physical, financial, time) efficiently
and effectively).
 Use appropriate technology to support the delivery of care to
the mother.
 Adhere to protocols and principles of confidentiality in
safekeeping and releasing of records and other information.
 Collaborate client care as a member of a health care team in the
implementation of programs and services for mothers.
 Ensure a working relationship with individual and family based
on trust, respect and shared decision-making using appropriate
communication/interpersonal techniques/strategies.

4. DISCOMFORTS OF EARLY
PREGNANCY: THE 1ST TRIMESTER
1. Breast tenderness:
wear a bra with wide shoulder strap for support
dress warmly to avoid cold drafts
rule out pain, nipple fissures
2. Palmar erythema (palmar pruritus)
Due to increased estrogen levels
Use calamine lotion on the affected site

5. 3. Constipation
drink at least 8 glasses of water each day. Avoid coffee, tea or
carbonated drinks because of their diuretic effect.
 eat foods high in fiber
 restrict cheese consumption which cause constipation
curtail intake of sweets which increase bacterial growth in the
intestines and can lead to flatulence
 a brisk walk of at least 1 mile per day stimulates peristalsis and
improves muscle tone
 avoid gas-forming foods
no enema, mineral oil, OTC laxatives (with prescription Colace,
glycerin suppository)

6. 4. Nausea & vomiting (morning sickness)
Due to elevated HCG levels and changes in CHO metabolism
Small frequent meals
• Eat small amounts of carbohydrate foods frequently during the day and 5 – 6
small meals
Eat dry crackers or toast
Drink fluids separately from meals
Avoid fried, greasy or spicy foods or those with strong odors
Provide emotional support
Report to the physician, if symptoms worsen

7. 5. Pyrosis or Heartburn
eat several small meals daily & avoid fatty or spicy foods
curtail smoking & coffee drinking which stimulates acid formation in the
stomach
Sit upright for at least 1 hour after meals to reduce reflux & relieve
symptoms
Do not eat or drink just before bedtime & sleep with extra pillow
Sip water to help relieve burning sensation

8.  6. Fatigue
rest and sleep
 sit with her feet elevated (adjoining chair)
 modify customary routine

9. 7. Muscle or Leg cramps ( Ca P interference in circulation)
elevate the legs to improve circulation
to relieve cramps, dorsiflex the foot affected If alone, stand and apply pressure
on the affected leg
Avoid excessive food high in phosphorous.
(Additional calcium or magnesium maybe helpful but should be taken only
with the advice of the health care provider?
“restless leg syndrome”
Walking at night because of spontaneous leg movement

10. 8. Hypotension
- it occurs when a woman lie on her back and the uterus
presses on the vena cava impairing blood return to the heart
- sleep or rest on her side
- if asleep at her back… insert small pillow under her right hip
(weight of the uterus shift off the vena cava)

11. 9.Varicosities
o Avoid constricting clothing & crossing the legs at
the knees which impedes blood return from the
legs
o Rest frequently with the legs, elevated above the
level of the hips (Sim’s position, lay down on the
back with leg raise against the wall 15-20 minutes)
o wear support or elastic stockings
o Avoid working in one position for prolonged
periods of time, walk around for a few minutes at
least every 2 hours
o Vitamin C (formation of blood vessel collagen &
epithelium)

12. 10. Hemorrhoids
Prevention:
establish a regular pattern of bowel elimination that does not
require straining. Drink plenty of water, eat foods rich in fiber
and exercise regularly
How to relieve:
 Use of sitz baths. Apply cool with hazel compresses or
anesthetic ointments
gently push the hemorrhoids back into the rectum. Put on a
glove and lubricate the index finger. Maintain pressure for
1-2 minutes.
if pain persists or bleeding occurs, call your health carprovider
Avoid sitting on toilet for long periods
 knee-chest (10-15 mins)
stool softener (Colace)

13. 11. Heart Palpitation
result of circulatory adjustments necessary to accommodate increased
blood supply during pregnancy
advise the mother to refrain from making sudden, rapid movements at
anytime
 frequent, continuous accompanied by pain should be reported to
the physician

14. 12. Urinary urgency and frequency
Due to pressure of fundus (growing fetus) on bladder
Do not limit fluid intake
Perform kegel exercise
Stress incontinence (involuntary loss of urine on coughing and
sneezing)

15. 13. Abdominal discomfort
rising slowly from lying to a sitting position; from sitting to a
standing position
evaluate pain (ectopic)

16. 14. Leukorrhea (whitish, viscous discharge)
daily bath
wear cotton underpants
perineal pads to control the discharge
don’t use tampons
contact physician if change in color, odor or character (infection)
avoid tight underpants & panty hose

17. DISCOMFORTS OF MIDDLETO
LATE PREGNANCY
1. Backache
maintain correct posture
 avoid high heeled shoes to improve posture
 to pick up objects, squat rather than bend at the waist
 when sitting, use foot supports, arm rests and pillows behind the
back
 exercises using tailor sitting, shoulder circling and pelvic rocking
 lift objects by holding them close to the body
Acetaminophen, acupuncture (no herbal remedies, muscle relaxants &
analgesics without prescription)

18. 2. Headache
- resting with cold towels on forehead; acetaminophen
- continuous sharp headache (danger sign PIH)
3. Dyspnea
- sleep with head & chest elevated
- limit activities during the day
- ask to describe the symptom during prenatal visits

19. 4. Ankle edema
- L sidelying position
- avoid wearing constricting clothes
- sit for 30 minutes in the afternoon and night
- check signs of proteinuria (PIH)

20. 5. Braxton Hicks Contraction
- inform primary health care provider (though its normal)
- *** rhythmic pattern, persistent contractions = beginning
sign of labor

21. HEALTH PROMOTION DURING
PREGNANCY
 Self-care needs
 Bathing
 Breast care
 Dental care
 Perineal hygiene
 Clothing

22.  Exercise
 Lowers cholesterol level
 Reduces risk of osteoporosis
 Increases energy level
 Maintains a healthy body weight
 Decreases risk of heart disease
 Increases self-esteem and well-being

23.  Sleep
 Drink a glass of warm milk
 Relaxing exercises (lying quietly)
 Sleep with 2 pillows or on a coach with an armrest
(heartburn/pyrosis)
 Rest period (sim’s position); avoid resting on back SHS

24. EMPLOYMENT/TRAVEL
 The pregnant woman may continue to be employed unless the job
involves handling toxic substances, lifting heavy objects or other
excessive physical strain
 No restrictions to travel early in pregnancy, unless otherwise advised
by the physician
 If travelling in long distances, advise to have scheduled stops in
between and have a short walk or ambulation

25.  Know nearby health care facility if
to spend time in remote location…
 Avoid uncooked fruits, vegetables
or meat; don’t drink unpurified
water
 Prescribed vitamin supplement

26. REFERENCES
 Flagg, JoAnne and Pillitteri, Adele. 2018. Maternal & Child Health
Nursing. 8th edition. Lippincott Williams &Wilkins
 Wong, D., Hockenberry, M, Perry, S., Lowdermilk, DL.Wilson D.
2009. Maternal Child Nursing Care 3rd ed. . Elsevier Pte. Ltd.,
Singapore