Physical risks

late or absent prenatal care,

pregnancy-induced hypertension, and

poor nutritional status

Psychosocial risks

difficulty dealing with adolescent maturation as well as the changes due to pregnancy,

disrupted school attendance,

decreased vocational opportunities,

difficulty adapting to parenting,

repeat pregnancies

May & Mahlmeister, Chpt. 9

I. B.2. Lists 3 benefits of prenatal care for the mother and/or fetus

Benefits for the mother

confirm pregnancy,

obtain assistance in dealing with discomforts of pregnancy,

prevent or treat pregnancy complications,

plan and prepare for childbirth.

Benefits for the fetus

assess fetal growth,

identify and treat certain congenital disorders,

decrease likelihood of premature labor or childbirth complications.

I.B.3. List at least 1 warning sign for each of the following pregnancy complications:

· preterm labor

· placenta previa and/ or

· placenta abruptio

· premature rupture of membrane

· fetal demise

· preeclampsia

Placenta previa - painless vaginal bleeding (rarely, abdominal pain without bleeding)

Placenta abruptio - external or concealed bleeding, abdominal pain, uterine tenderness, increased uterine tone -"boardlike"

Premature rupture of membranes - the amniotic fluid may be expelled in large amounts; in some instances the fluid is expelled in small amounts and may be confused with episodes of urinary incontinence associated with urinary urgency, coughing, or sneezing

Fetal demise - a slowing or stopping of fetal movement

Preeclampsia - hypertension, proteinuria, and edema; not all of these parameters have to be present - hypertension and proteinuira are the most significant indicators

I.C.1. Identify the purpose and one implication for changes in client’s plan of care related to the following laboratory tests:

· HIV

· glucose tolerance test (GTT)

· triple marker screen

glucose tolerance test - test for diabetes (<135 mg/dl one hour after 50 gm. glucose drink)

triple marker screen - screening (not diagnostic) test for neural tube defect and certain other (chromosomal) abnormalities, including Down syndrome (within normal limits)

I.C.2. Describes the purpose of and how to prepare the client for the following procedures:

· ultrasound

· amniocentesis

· nonstress test (NST)

 

 

amniocentesis - collection of a small sample of amniotic fluid for genetic screening, fetal lung maturity, culture for infection (L/S ratio 2:1 and PG present usually indicates lung maturity)

nonstress test (NST) - test of fetal well-being using external fetal monitor (reactive)

II.A.1. Lists recommended dietary requirements during pregnancy:

· using the food guide pyramid

· specific nutrients, their food sources and their function in supporting a healthy pregnancy

Protein: Rapid fetal tissue growth; amniotic fluid; placenta growth & development; maternal tissue growth; increased maternal circulating blood volume; maternal storage reserves for labor, delivery, and lactation. Milk, cheese, egg, meat, grains, legumes, nuts.

Thiamine: Coenzyme for energy metabolism. Pork, liver, whole or enriched grains, legumes.

Vitamin A: Promotes growth and development. Needed for healthy skin. Also protects against infections and is important for normal vision. Vegetable group.

B₆: Coenzyme in protein metabolism; Increased fetal growth requirements. Wheat, corn, liver, meat.

B₁₂: Coenzyme in protein metabolism, especially vital cell proteins such as nucleic acid; formation of red blood cells. Milk, Egg, meat, liver, cheese.

Folate: Helps the body form red blood cells and aids in the formation of genetic materials within every body cell. Helps prevent neural tube defects. Liver, dark green vegetables, dried beans, lentils, nuts, cereals fortified with folic acid.

Calcium: Fetal skeleton formation; fetal tooth bud formation; increased maternal calcium metabolism. Helps build and maintain strong bones and teeth. Helps muscles and nerves function normally. Helps blood clot. Milk, cheese, whole grains; leafy vegetables; egg yolk

Iron: Increased maternal circulating blood volume, increased hemoglobin; fetal liver iron storage; high iron cost of pregnancy. Helps form and maintain blood cells. Helps protect against infection. Helps the body carry oxygen to cells. Liver, meats, egg, whole or enriched grain, leafy vegetables, nuts, legumes, and dried fruits.

Iodine: Increased basal metabolic rate - increased thyroxine production. Iodized salt.

Magnesium: Coenzyme in energy and protein metabolism; enzyme activator; tissue growth, cell metabolism; muscle action. Nuts, soybeans, cocoa, seafood, whole grains, dried beans and peas.

II.A.2. Assess weight gain using a standard weight gain grid for a 15 year old G1P0 who is 16 weeks pregnant, pre-pregnant weight is 113 pounds and weighs 118 at 16 weeks

III.A.1. List 1 self-care measure for each of the following discomforts associated with pregnancy

· backache

· frequent urination

· heart burn

· leg cramps

· nausea & vomiting

· varicose veins

Frequent urination may be caused by uterine pressure on the bladder. Comfort measures may include limiting caffeine, voiding often enough to prevent bladder distention, and doing Kegel exercises.

Heartburn is caused by the increased production of progesterone, decreasing gastrointestinal motility and increasing relaxation of the cardiac sphincter, displacement of stomach by the enlarging uterus thus regurgitation of acidic gastric contents into the esophagus. Comfort measures include eating small and more frequent meals; using low-sodium antacids; avoiding overeating fatty and fried foods, lying down after meals and sodium bicarbonate.

Leg cramps may be caused by calcium/phosphorus imbalance, fatigue, or muscle strain. Comfort measures involve correcting dietary deficiencies, assessing for and treating phlebitis, dorsiflexing the foot when cramps occur, applying local heat, and mild exercise.

Nausea and vomiting may be related to increased progesterone, HCG, or gastric secretions. Comfort measures may include small frequent meals, drinking fluids

between (rather than with) meals, high protein snacks.

Varicose veins is due to the venous congestion in the lower veins that increase due to pregnancy, hereditary factors, and increased age and weight gain. Comfort measures include elevating legs frequently, wearing supportive hose, avoiding crossing legs at knees, standing for long periods and hosiery with constrictive bands.

III.A.2. Describe the impact of 3 of the following smoking, drugs, alcohol and environmental hazards on fetal growth and development:

· cigarette smoking

· marihuana

· cocaine

· heroin

· alcohol

Marihuana has been associated with intrauterine growth retardation and preterm birth.

Cocaine has been associated with growth retardation, prematurity, and cerebral, myocardial, and intestinal infarcts in the fetus.

Heroin use is associated with fetal infection, fetal death, prematurity and growth retardation, fetal distress in labor, and narcotic withdrawal after birth.

Alcohol use is associated with fetal alcohol syndrome, including mental retardation and physical abnormalities.

III.A.3. List at least 1 preventive measure for each of the following:

· car safety for pregnant women and infants

· sleep safety (positioning, bedding, crib)

always wear seat belt

wear seat belt low on the hips, under the baby/abdomen

How to Protect Your New Baby in the Car, National Highway Traffic Safety Administration, 4/97 and Children are Depending on You to Buckle’Em Up Properly! Governor’s Highway Safety Commission, Vt

Place baby on back to sleep unless the baby has a health condition that requires sleeping on the tummy

Crib slats are spaced no more than 2 3/8 inches apart

Mattress fits snugly - less than two fingers width between edge of mattress and crib side

Remove pillows, quilts, comforters, sheepskins, stuffed toys and other soft products from the crib

Do not place baby on a waterbed, sofa, soft mattress, pillow or other soft surface to sleep

Consider using a sleeper as an alternative to blankets, with no other covering. If using a blanket, put baby with its feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as far as the baby’s chest. Make sure your baby’s head remains uncovered during sleep.

Corner posts are no higher than 1/16 inch to prevent entanglement of clothing, etc.

Do not place a crib near draperies or blinds where a child could become entangled and strangle on cords

Back to Sleep Campaign, 6/98 ; Tips for Your Baby’s Safety, Consumer Product Safety Commission and CPSC April 1999 Recommendations Revised to prevent Infant Deaths from Soft Bedding