Maternal and Child Health Nursing (NCM 65):

Nursing care during normal

Pregnancy & care of
developing fetus
Ms. Grace Bautista | Sept. 14, 2021

OUTLINE • End of 20th gestational week

I. Fetal Growth and Development
• End of 24th gestational week (second trimester
II. Embryonic and Fetal Structures
A. Circulation • End of 28th gestational week
B. Origin and Development of Organ Systems
C. Critical Periods of Fetal Growth • End of 32nd gestational week
III. 2020 Natl Health Goals r/t Fetal Growth
• End of 36th gestational week
IV. Assessing Fetal Growth and Development
V. Nursing Diagnoses: Fetal Growth and Development • End of 40th gestational week (third trimester)
VI. Nursing Outcomes: Fetal Growth and Development
VII. Implementing Nursing Care
VIII. Evaluating Nursing Care

I. FETAL GROWTH AND DEVELOPMENT

• Stages of development
1. Fertilization
o (also referred to as conception and
impregnation): union of ovum and
spermatozoon
o This usually occurs in the outer third of a
fallopian tube, termed the ampullar
portion.
o only one of a woman’s ova reaches
maturity each month.
o ovum is capable of fertilization for only
about 24 hours (48 hours at the most)
o functional life of a spermatozoon is also
about 48 hours, possibly as long as 72
hours
o the total critical time span during which
sexual relations must occur for fertilization
to be successful is about 72 hours (48
hours before ovulation plus 24 hours
afterward
2. Implantation II. EMBRYONIC AND FETAL STRUCTURES
o contact between growing structure and 1. THE DECIDUA OR UTERINE LINING
uterine endometrium, approximately 8 to
10 days after fertilization 2. CHORIONIC VILLI

3. THE PLACENTA

A. CIRCULATION
4. ENDOCRINE FUNCTION

5. PLACENTAL PROTEINS

• End of fourth gestational week

• End of eighth gestational week

• End of 12th gestational week (first trimester)

• End of 16th gestational week

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6. THE AMNIOTIC MEMBRANES

7. THE AMNIOTIC FLUID

8. THE UMBILICAL CORD

B. ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS

9. STEM CELLS

10. ZYGOTE GROWTH

11. PRIMARY GERM LAYERS

12. CARDIOVASCULAR SYSTEM

o One of the first systems to become functional in
intrauterine life. Simple blood cells joined to the walls of o Blood arriving at the fetus from the placenta is highly
the yolk sac progress to become a network of blood oxygenated. This blood enters the fetus through the
vessels and a single heart tube, which forms as early as umbilical vein (which is still called a vein even though it
the 16th day of life and beats as early as the 24th day carries oxygenated blood because the direction of the
o The septum that divides the heart into chambers blood is toward the fetal heart).
develops during the sixth or seventh week; heart valves o Specialized structures present in the fetus then shunt
develop in the seventh week. The heartbeat may be blood flow to first supply the most important organs of
heard with a Doppler instrument as early as the 10th to the body: the liver, heart, kidneys, and brain.
12th week of pregnancy. o Blood flows from the umbilical vein to the ductus
o An electrocardiogram (ECG) may be recorded on a venosus, an accessory vessel that discharges
fetus as early as the 11th week, although early ECGs oxygenated blood into the fetal liver, and then connects
are not accurate until conduction is more regulated at to the fetal inferior vena cava so oxygenated blood is
about the 20th week of pregnancy. directed to the right side of the heart.
o The heart rate of a fetus is affected by oxygen level, o Because there is no need for the bulk of blood to pass
activity, and circulating blood volume, just as in through the lungs, the bulk of this blood is shunted as it
adulthood. After the 28th week of pregnancy, when the enters the right atrium into the left atrium through an
sympathetic nervous system matures, the heart rate opening in the atrial septum called the foramen ovale.
stabilizes, and a consistent heart rate of 110 to 160 o From the left atrium, it follows the course of adult
beats/min is assessed. circulation into the left ventricle, then into the aorta, and
o Fetal Hemoglobin Fetal hemoglobin differs from adult out to body parts. A small amount of blood that returns
hemoglobin in several ways to the heart via the vena cava does leave the right
o It has a different composition (two α and two γ atrium by the adult circulatory route; that is, through the
chains compared with two α and two β chains tricuspid valve into the right ventricle and then into the
of adult hemoglobin). pulmonary artery and lungs to service the lung tissue.
o It is also more concentrated and has greater However, the larger portion of even this blood is
oxygen affinity, two features that increase its shunted away from the lungs through an additional
efficiency. Because hemoglobin is more structure, the ductus arteriosus, directly into the
concentrated, a newborn’s hemoglobin level is descending aorta.
about 17.1 g/100 ml compared with a normal o As the majority of blood cells in the aorta become
adult level of 11 g/100 ml; a newborn’s deoxygenated, blood is transported from the descending
hematocrit is about 53% compared with a aorta through the umbilical arteries (which are called
normal adult level of 45%. arteries because they carry blood away from the fetal
o The change from fetal to adult hemoglobin heart) back through the umbilical cord to the placental
levels begins before birth (γ cells are villi, where new oxygen exchange takes place.
exchanged for β cells), but the process is still o At birth, an infant’s oxygen saturation level is 95% to
not complete at birth. 100% and pulse rate is 80 to 140 beats/min. Because
o Major blood dyscrasias, such as sickle cell there is a great deal of mixing of blood in the fetus, the
anemia, tend to be defects of the β-hemoglobin oxygen saturation level of fetal blood reaches only about
chain, which is why clinical symptoms of these 80%.
disorders do not become apparent until the o A normal fetal heart rate is 110 to 160 beats/min,
bulk of fetal hemoglobin has matured to adult supplying needed oxygen to cells. Even with this low
hemoglobin, at about 6 months of age blood oxygen saturation level, however, carbon dioxide
Forro, Gwyn Oona Florence L. | 2
 does not accumulate in the fetal system because it o All parts of the brain (cerebrum, cerebellum, pons, and
rapidly diffuses into maternal blood across a favorable medulla oblongata) form in utero, although none are
placental pressure gradient. completely mature at birth. Brain growth continues at
13. RESPIRATORY SYSTEM high levels until 5 or 6 years of age.
o By the end of the fourth week, a septum begins to divide o Brain waves can be detected on an
the esophagus from the trachea. At the same time, lung electroencephalogram (EEG) by the eighth week.
buds appear on the trachea. Until the seventh week of o The eye and inner ear develop as projections of the
life, the diaphragm does not completely divide the original neural tube. By 24 weeks, the ear is capable of
thoracic cavity from the abdomen. responding to sound, and the eyes exhibit a pupillary
o At the third week of intrauterine life, the respiratory and reaction, indicating sight is present.
digestive tracts exist as a single tube. Like all body o The neurologic system seems particularly prone to insult
tubes, initially, this forms as a solid structure, which then during the early weeks of the embryonic period and can
canalizes (i.e., hollows out). By the end of the fourth result in neural tube disorders, such as a meningocele
week, a septum begins to divide the esophagus from (i.e., herniation of the meninges), especially if there is
the trachea. lack of folic acid (which is contained in green leafy
o At the same time, lung buds appear on the trachea. vegetables and pregnancy vitamins) (Cohen & Uddin,
Until the seventh week of life, the diaphragm does not 2011).
completely divide the thoracic cavity from the abdomen. o All during pregnancy and at birth, the system is
This causes lung buds to extend down into the vulnerable to damage if anoxia should occur.
abdomen, reentering the chest only as the chest’s o By 24 weeks, the ear is capable of responding to sound,
longitudinal dimension increases and the diaphragm and the eyes exhibit a pupillary reaction, indicating sight
becomes complete (at the end of the seventh week). is present.
o Other important respiratory developmental milestones 15. ENDOCRINE SYSTEM
include: o The fetal pancreas produces insulin needed by the
1. Spontaneous respiratory practice movements fetus.
begin as early as 3 months gestation and o The thyroid and parathyroid glands play vital roles in
continue throughout pregnancy. fetal metabolic function and calcium balance.
2. Specific lung fluid with a low surface tension o The fetal adrenal glands supply a precursor necessary
and low viscosity forms in alveoli to aid in for estrogen synthesis by the placenta
expansion of the alveoli at birth; it is rapidly o The function of endocrine organs begins along with
absorbed shortly after birth. neurosystem development:
3. Surfactant, a phospholipid substance, is 1. The fetal pancreas produces insulin needed by
formed and excreted by the alveolar cells of the fetus (insulin is one of the few substances
the lungs beginning at approximately the 24th that does not cross the placenta from the
week of pregnancy. This decreases alveolar mother to the fetus).
surface tension on expiration, preventing 2. The thyroid and parathyroid glands play vital
alveolar collapse and improving the infant’s roles in fetal metabolic function and calcium
ability to maintain respirations in the outside balance.
environment at birth (Rojas-Reyes, Morley, & 3. The fetal adrenal glands supply a precursor
Soll, 2012). necessary for estrogen synthesis by the
o Surfactant has two components: lecithin and placenta
sphingomyelin. Early in the formation of surfactant, 16. DIGESTIVE SYSTEM
sphingomyelin is the chief component. At approximately o The digestive tract separates from the respiratory tract
35 weeks, there is a surge in the production of lecithin, at about the fourth week of intrauterine life and, after
which then becomes the chief component by a ratio of that, begins to grow extremely rapidly.
2:1. As a fetus practices breathing movements,
surfactant mixes with amniotic fluid. Using an
amniocentesis technique, an analysis of the
lecithin/sphingomyelin (L/S) ratio in surfactant (whether
lecithin or sphingomyelin is the dominant component) is
a primary test of fetal maturity.
o Respiratory distress syndrome, a severe breathing
disorder, can develop if there is a lack of surfactant or it
has not changed to its mature form at birth
o Any interference with the blood supply to the fetus, such
as placental insufficiency or maternal hypertension, may 17. MUSCULOSKELETAL SYSTEM
raise steroid levels in the fetus and enhance surfactant o During the first 2 weeks of fetal life, cartilage prototypes
development. provide position and support to the fetus.
o Synthetically increasing steroid levels in the fetus (e.g., o Ossification of this cartilage into bone begins at about
the administration of betamethasone to the mother late the 12th week and continues all through fetal life and
in pregnancy) can also hurry alveolar maturation and into adulthood.
surfactant production without interfering with permanent o Carpals, tarsals, and sternal bones generally do not
lung function prior to a preterm birth (Smith, 2016). ossify until birth is imminent.
14. NERVOUS SYSTEM o A fetus can be seen to move on ultrasonography as
o A neural plate (a thickened portion of the ectoderm) is early as the 11th week, although the mother usually
apparent by the third week of gestation. does not feel this movement (quickening) until 16 to 20
o All parts of the brain (cerebrum, cerebellum, pons, and weeks of gestation. It is usually felt earlier in
medulla oblongata) form in utero, although none are multigravida women.
completely mature at birth. 18. REPRODUCTIVE SYSTEM
o Like the circulatory system, the nervous system begins o A child’s sex is determined at the moment of conception
to develop extremely early in pregnancy. by a spermatozoon carrying an X or a Y chromosome
o A neural plate (a thickened portion of the ectoderm) is and can be ascertained as early as 8 weeks by
apparent by the third week of gestation. The top portion chromosomal analysis or analysis of fetal cells in the
differentiates into the neural tube, which will form the mother’s bloodstream. At about the sixth week after
central nervous system (brain and spinal cord), and the implantation, the gonads (i.e., ovaries or testes) form
neural crest, which will develop into the peripheral o If testes form, testosterone is secreted, apparently
nervous system. influencing the sexually neutral genital duct to form

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 other male organs (i.e., maturity of the wolffian, or C. CRITICAL PERIODS OF FETAL GROWTH
mesonephric, duct).
o In the absence of testosterone secretion, female organs
will form (i.e., maturation of the müllerian, or
paramesonephric, duct).
o The testes first form in the abdominal cavity and do not
descend into the scrotal sac until the 34th to 38th week
of intrauterine life. Because of this, many male preterm
infants are born with undescended testes. These boys
need a follow-up to be certain their testes do descend
when they reach what would have been the 34th to 38th
week of gestational age because testicular descent
does not always occur as readily in extrauterine life as it
would have in utero.
o Testes that do not descend (cryptorchidism) require
surgery as they are associated with poor sperm
production and possibly testicular cancer later in life
19. URINARY SYSTEM
o Although rudimentary kidneys are present as early as
the end of the fourth week of intrauterine life, the
presence of kidneys does not appear to be essential for
life before birth because the placenta clears the fetus of
waste products.
o Urine, however, is formed by the 12th week and is
excreted into the amniotic fluid by the 16th week of
gestation.
o At term, fetal urine is being excreted at a rate of up to
500 ml/day. An amount of amniotic fluid less than usual
(oligohydramnios) suggests fetal kidneys are not
secreting adequate urine and that there is a kidney,
ureter, or bladder disorder (Kumar, 2012).
o The complex structure of the kidneys gradually develops
during intrauterine life and continues to mature for
months afterward.
o Early in the embryonic stage of urinary system
development, the bladder extends as high as the
umbilical region, and there is an open lumen between III. 2020 NATL HEALTH GOALS R/T FETAL GROWTH
the urinary bladder and the umbilicus.
o Reduce the fetal death rate (death between 20 and 40
o If this fails to close, (termed a patent urachus), this is
weeks of gestation) to no more than 5.6 per 1,000 live
revealed at birth by the persistent drainage of a clear,
births from a baseline of 6.2 per 1,000.
acid–pH fluid (urine) from the umbilicus (Samra, o Reduce low birth weight to an incidence of 7.8% of live
McGrath, & Wehbe, 2011).
births and very low birth weight to 1.4% of live births
20. INTEGUMENTARY SYSTEM
from baselines of 8.2% and 1.5%.
o Skin is covered by soft downy hairs (lanugo) that serve
o Increase the proportion of women of childbearing
as insulation to preserve warmth in utero as well as a potential with an intake of at least 400 mg of folic acid
cream cheese– like substance, vernix caseosa, which is
from fortified foods or dietary supplements from a
important for lubrication and for keeping the skin from
baseline of 23.8% to 26.2%.
macerating in utero
21. IMMUNE SYSTEM
o Immunoglobulin (Ig) G maternal antibodies cross the IV. ASSESSING FETAL GROWTH AND DEVELOPMENT
placenta into the fetus as early as the 20th week and 1. Reasons for testing
certainly by the 24th week of intrauterine life to give a o Predict outcome of pregnancy
fetus temporary passive immunity against diseases for o Manage remaining weeks of pregnancy
which the mother has antibodies. o Plan for possible complications at birth
o These often include poliomyelitis, rubella (German o Plan for problems that may occur in newborn
measles), rubeola (regular measles), diphtheria, o Decide whether to continue pregnancy
tetanus, infectious parotitis (mumps), hepatitis B, and o Find conditions that may affect future pregnancies
pertussis (whooping cough). Infants born before this 2. Health history
antibody transfer has taken place have no natural 3. Physical examination
immunity and so need more than the usual protection 4. Estimating fetal health
against infectious disease in the newborn period. o Fetal growth
o A fetus only becomes capable of active antibody  McDonald’s rule
production late in pregnancy. Generally, it is not 5.
necessary for a fetus to produce antibodies because
they need to be manufactured only to counteract an
invading antigen, and antigens rarely invade the
intrauterine space.
o Because IgA and IgM antibodies (the types which
develop to actively counteract infection) cannot cross
the placenta, their presence in a newborn is proof that
the fetus has been exposed to an infection.

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6. Measuring V. NURSING DIAGNOSES: FETAL GROWTH AND
Fundal Height DEVELOPMENT
1. Focus on mother, family, and fetus:
o Readiness for enhanced knowledge related to
usual fetal development
o Anxiety related to lack of fetal movement
o Deficient knowledge related to need for good
prenatal care for healthy fetal well-being
7. Fetal well-being
o Fetal movement (kick counts) VI. NURSING OUTCOMES: FETAL GROWTH AND
o Fetal heart rate: DEVELOPMENT
1. Outcome identification and planning
o Parental education
 Be realistic
 Based on parents’ previous knowledge
and desire for information
 Explain additional assessment measures
needed
Quality & Safety Education for Nurses (QSEN)
• Patient-Centered Care
• Teamwork & Collaboration
o Ultrasonography • Evidence-Based Practice
o Biophysical profile • Quality Improvement
o MRI • Safety
8. • Informatics

VII. IMPLEMENTING NURSING CARE

• Teaching about fetus at various points in pregnancy to help
parents visual coming newborn
• Teaching about healthy behaviors
• Showing sonogram to help initiate bonding
• Individualize care

VIII. EVALUATING NURSING CARE

• Outcomes evaluation
• Were healthy lifestyle changes made?
• Do the parents have confidence that baby is healthy and
growing?
9. Maternal serum analysis
o Maternal serum α-fetoprotein
o Maternal serum for pregnancy-associated plasma
protein A Q&A
o Quadruple screening A fetus is able to maintain blood circulation in utero by the presence
o Fetal gender of circulatory shunts. The nurse understands this is because the
10. Invasive fetal testing ductus arteriosus in utero shunts blood in which direction?
o Chorionic villi sampling A. Left to right heart atria
o Amniocentesis: B. Aorta to the pulmonary veins
C. Right ventricle to the aorta
D. Pulmonary artery to the aorta
Mrs. Smith asks the nurse to compute her expected due date. Based
on the fact that her last menstrual flow began on July 20, which due
date would the nurse estimate?
A. April 27
B. March 13
C. April 13
D. May 20
Which of the following nursing interventions is appropriate when
preparing a woman for an amniocentesis?
A. Inform her that a narcotic premedication will be given to
prevent pain during needle insertion.
B. Be certain she knows that there is a slight risk of
complication, such as premature labor, from
amniocentesis.
C. Instruct her not to empty her bladder prior to the procedure.
D. Suggest that she take a deep breath and hold it during
o Percutaneous umbilical blood sampling needle insertion.
o Fetoscopy

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 Maternal and Child Health Nursing (NCM 65):
NURSING CARE r/t PSYCHOLOGICAL &
PHYSIOLOGIC CHANGES OF
PREGNANCY
Ms. Grace Bautista | Sept. 15, 2021

OUTLINE III. 2020 NATL HEALTH GOALS R/T PSYCHOLOGICAL &

I. Psychological Changes PHYSIOLOGICAL CHANGES OF PREGNANCY
II. Physiological Changes • Increase abstinence from alcohol, cigarettes, and illicit drugs
III. 2020 Natl Health Goals r/t Psychological & Physiological among pregnant women from baselines of 89.4%, 89.6%,
Changes of Pregnancy and 94.9% to target levels of 98.4%, 98.6%, and 100%
IV. Nursing Process: Psychological & Physiological Changes of • Reduce maternal deaths from a baseline of 12.7/100,000 live
Pregnancy births to a target of 11.4/100,000.
• Increase the proportion of pregnant women who receive
A. Nursing Care Planning Tips for Effective
early and adequate prenatal care from a baseline of 70.5% to
Communication a target level of 77.6%.
B. Assessing Events that Could Contribute to Difficulty
Accepting a Pregnancy IV. NURSING PROCESS: PSYCHOLOGICAL & PHYSIOLOGICAL
C. Assessing Physiologic Changes of Pregnancy
CHANGES OF PREGNANCY
D. Nursing Diagnoses: Psychological & Physiological
• Assessment
Changes of Pregnancy • Nursing Diagnosis
E. Nursing Outcomes: Psychological & Physiological • Outcome identification and planning
Changes of Pregnancy • Implementation
F. Nursing Care for Psychological & Physiological • Outcome evaluation
Changes of Pregnancy
V. Presumptive Indications of Pregnancy A. NURSING CARE PLANNING TIPS FOR EFFECTIVE
VI. Probable Indications of Pregnancy COMMUNICATION
VII. Positive Indications of Pregnancy

I. PSYCHOLOGICAL CHANGES
• Social

• Cultural

• Family

• Personal influences

II. PHYSIOLOGICAL CHANGES

B. ASSESSING EVENTS THAT COULD CONTRIBUTE TO

DIFFICULTY ACCEPTING A PREGNANCY

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C. ASSESSING PHYSIOLOGIC CHANGES OF PREGNANCY D. NURSING DIAGNOSES: PSYCHOLOGICAL & PHYSIOLOGIC
CHANGES OF PREGNANCY
• Altered breathing patterns r/t respiratory system changes of
pregnancy
• Disturbed body image r/t weight gain from pregnancy
• Deficient knowledge r/t normal changes of pregnancy
• Imbalanced nutrition, less than body requirements, r/t early
morning nausea
• Powerlessness r/t unintended pregnancy
• Possible impaired health and prenatal care behaviors
associated with cultural beliefs

E. NURSING OUTCOMES: PSYCHOLOGICAL & PHYSIOLOGIC

CHANGES OF PREGNANCY
• Patient states that she is able to continue her usual lifestyle
throughout the pregnancy
• Family members describe ways they have adjusted their
lifestyles to accommodate the mother’s fatigue
• Couple states they understand the physiologic changes of
pregnancy

F. NURSING CARE FOR PSYCHOLOGICAL & PHYSIOLOGIC

CHANGES OF PREGNANCY

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 V. PRESUMPTIVE INDICATIONS OF PREGNANCY
1. Breast changes
o Feelings of tenderness, fullness, tingling
o Enlargement and darkening of areola
2. Nausea and vomiting when rising or when fatigued
3. Amenorrhea
o Absence of menstruation
4. Frequent urination
o Sense of having to void more often than usual
5. Fatigue (general feeling of tiredness)
6. Uterine enlargement
o Uterus can be palpated over symphysis pubis
7. Linea nigra
o A line of dark pigment form on the abdomen
8. Melasma
o Dark pigment forms on the face
9. Striae gravidarum
o Stretch marks form on the abdomen

VI. PROBABLE INDICATIONS OF PREGNANCY

1. Maternal serum test
2. Chadwick’s sign
3. Hegar’s
sign:

4. Ballottement
o When lower uterine segment is tapped on a
bimanual examination, the fetus can be felt to rise
against the abdominal wall
5. Braxton Hicks contraction
o Periodic uterine tightening occurs

VII. POSITIVE INDICATIONS OF PREGNANCY

1. Sonographic evidence of fetal outline
2. Fetal heart audible
3. Fetal movement felt by examiner

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 Maternal and Child Health Nursing (NCM 65):
NURSING CARE r/t ASSESSMENT OF
A PREGNANT FAMILY
Ms. Grace Bautista | Sept. 15, 2021

OUTLINE
I. Prenatal Health Assessment
A. Review of Systems
II. Assessing Health Status During Pregnancy
III. Nursing Diagnoses: Prenatal Health Assessment
IV. Implementing Care During Pregnancy
V. Common Gynecologic Disorders Seen in Pregnancy

I. PRENATAL HEALTH ASSESSMENT

• Reasons for assessment
1. Establish baseline for present health
2. Determine gestational age of fetus
3. Monitor fetal development and maternal well-being
4. Identify women at risk for complications
5. Minimize risk of possible complications by anticipating
and preventing problems before they occur
6. Provide education about pregnancy, lactation, and
newborn care
• Preconceptual visit
o Accurate reproductive life planning information
o Assurance about fertility based on health history and
PE
o Identification of any problems needing correction
o Hemoglobin level and blood type determined
o Pap smear taken
• Choosing a healthcare provider who will:
1. Provide care throughout pregnancy and birth
2. Initiate prenatal care early
o Nurse’s role:
1. Educate
2. Listen
3. Counsel
o Include support people
• Typical day and social history for a pregnant:
o Nutrition
o Exercise
o Hobbies
o Tobacco, alcohol, drug consumption
o Medication and herbal therapy
o Intimate partner violence

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 A. REVIEW OF SYSTEMS II. ASSESSING HEALTH STATUS DURING PREGNANCY
• Baseline height/weight • Types of pelvises:
• Vital sign measurement
• Body systems
o General appearance and mental status
o Head and scalp
o Eyes
o Nose and sinuses
o Ears
o Mouth, teeth, throat
o Neck
o Lymph nodes
o Breasts
o Heart
o Lungs
o Back
o Rectum
o Extremities and skin
• Physical examination
o Appearance of cervix:

• Estimating pelvic size by

o Diagonal conjugate
o Ischial tuberosity diameter
• Laboratory assessments
o Blood serum studies
 CBC; genetic screen
 Serologic test for syphilis
 Blood typing and Rh factor
 Maternal serum for AFP and PAPP-A
 Cultures for chlamydia and gonorrhea
 Indirect Coombs test
 Serum antibody titers
 HIV screening
 Glucose challenge test
o Pelvis (establishing adequacy for childbirth): o Urinalysis
o Tuberculosis screening
o Ultrasonography

III. NURSING DIAGNOSES: PRENATAL HEALTH ASSESSMENT

• Health-seeking behaviors r/t guidelines for nutrition and
activity during pregnancy
• Deficient knowledge regarding exposure to teratogens during
pregnancy
• Health-seeking behaviors r/t strong cultural desire to have a
healthy child
• Risk for injury to fetus r/t lifestyle choices

IV. IMPLEMENTING CARE DURING PREGNANCY

• Danger signs to report during pregnancy
1. Vaginal bleeding
2. Persistent vomiting
3. Chills and fever
4. Escape of fluid from vagina
5. Abdominal or chest pain
6. Swelling of face and fingers
7. Vision changes or continuous headache
8. Rhythmic cramping
9. Burning with urination
10. Pronounced decrease in fetal movement
11. Uterine contraction before 37 wks of pregnancy

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V. COMMON GYNECOLOGIC DISORDERS SEEN IN
PREGNANCY

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 Q&A
A woman’s diagonal conjugate measurement is 10.5 cm. You would
interpret that her pelvis is which of the following?
A. Adequate for childbearing
B. Narrow anterior-posterior
C. Narrow transversely
D. Larger than normal

Which of the following suggestion would be the best technique to help

a patient relax during a pelvic examination?
A. “Bear down as if you have to move your bowels.”
B. “Take a deep breath and hold it.”
C. “Count backward from 20 at a steady pace.”
D. “Tense your abdominal muscles so the uterus contracts less.”

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 Maternal and Child Health Nursing (NCM 65):
NURSING CARE TO PROMOTE
FETAL AND MATERNAL HEALTH
Ms. Grace Bautista | Sept. 16, 2021

OUTLINE II. MINOR BODY CHANGES OF PREGNANCY: 1ST TRIMESTER

I. Self-Care Needs During Pregnancy • Assessing a woman for minor body changes of pregnancy:
II. Minor Body Changes Of Pregnancy: 1st Trimester
III. Assessing 2nd And 3rd Trimester Discomforts
IV. Preventing Fetal Exposure to Teratogens
A. Assessing Exposure to Teratogens
V. Nursing Diagnoses: Healthy Pregnancy
VI. Nursing Outcomes: Healthy Pregnancy
VII. Nursing Care To Promote Healthy Behavioral Practices

I. SELF-CARE NEEDS DURING PREGNANCY

• Bathing
o Daily tub baths or showers
o Do not ask for long periods in extremely hot water
o Change to showering or sponge bathing if indicated
• Breast care
o As size increases, wear firm, supportive bra
o When colostrum begins, wash with clear water and
dry
• Dental care
o Maintain good oral health
o Poor oral hygiene is seen to be associated with
preterm birth
• Perineal hygiene
o Maintain good hygiene
o Douching contraindicated
• Clothing
o Avoid garments that impede lower extremity
circulation
o Moderate-to-low heeled shoes recommend
• Sexual activity
o May continue as long as woman is comfortable
• Exercise
o Can continue but intensity depends on baseline • Technique to relieve a leg cramp:
fitness
o Continue sports participation unless it involves body
contact
• Sleep
o If trouble falling asleep, drink glass of warm milk
o Try relaxation exercises
o Sleep in left-sided Sims position
• Employment
o May continue unless it involves exposure to toxic
substances, lifting heavy objects, other kinds of
excessive physical strain, long periods of standing
or sitting, or having to maintain body balance
o If unable to continue, protected from loss of
employment benefits by federal law
• Travel
o No restriction except when vaccine is required
o Investigate location/s of nearby health facility of the • Position to relieve varicosities:
travel destination
o If long travel time, take frequent rest and stress
breaks

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• Knee-Chest positions to prevent hemorrhoids:
• Live virus vaccines

• Alcohol

• Herbs

• Tobacco

• Environment

• Metal and chemical hazards

• Radiation

• Hyperthermia and hypothermia

• Maternal stress

III. ASSESSING 2ND AND 3RD TRIMESTER DISCOMFORTS

• Muscular/skeletal discomforts (backache)

• Headache

• Dyspnea

• Ankle edema

• Braxton Hicks contractions V. NURSING DIAGNOSES: HEALTHY PREGNANCY

• Health-seeking behaviors r/t interest in maintaining optimal
health during pregnancy
IV. PREVENTING FETAL EXPOSURE TO TERATOGENS • Anxiety r/t minor body changes of pregnancy
• TERATOGEN • Risk for deficient fluid volume r/t gestational nausea and
1. Any factor, chemical or physical, that adversely vomiting
affects the fertilized ovum, embryo, or fetus • Disturbed body image r/t changes in appearance with
2. A fetus is extremely vulnerable to environmental pregnancy
injury, specifically at the beginning or early weeks of • Risk for altered sexuality patterns r/t fear of harming fetus
pregnancy during pregnancy
3. Although the causes of many anomalies occurring • Disturbed sleep pattern r/t frequent need to empty bladder
in utero are still unknown, many specific teratogenic during night
factors have been isolated • Risk for fetal injury r/t intimate partner violence

A. ASSESSING EXPOSURE TO TERATOGENS VI. NURSING OUTCOMES: HEALTHY PREGNANCY

• Maternal infections that affect fetus: • Set realistic goals and short-term goals
1. Malaria • Teaching
• Direct application
2. Rubella (German measles)

3. Toxoplasmosis

4. Herpes simplex virus (HSV)

5. Cytomegalovirus

6. Syphilis
• Infections that cause illness at birth
1. Gonorrhea

2. Candidiasis

3. Chlamydia

4. Streptococcus B

5. Hepatitis B

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 VII. NURSING CARE TO PROMOTE HEALTHY BEHAVIORAL
PRACTICES
1.
5.

2.

3. Implementation
o Pregnancy education
o Role modelling
4. Outcome evaluation
o Are identified goals being met?

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