Maternal and Child Health Nursing

Psychological Changes of a Pregnant & Parenthood activities

 Role-playing
Woman, Health Promotion & Discomforts of  fantasizing
Pregnancy, Danger Signs
Health Promotion
Factors that influence the Woman’s Attitude towards 1. Self-care needs
Pregnancy 1. Bathing
1. Social  daily tub baths or showers are
 Personal experiences recommended.
 Experiences of friends & relatives  heat exposure for a lengthy time could
2. Cultural lead to hyperthermia in the fetus and
 Beliefs birth defects (specifically esophageal
 Taboos atresia, omphalocele, and
3. Family gastroschisis)
 The family in which the woman was raised 2. Breast care
4. Individual  wear a firm, supportive bra with wide
 Woman’s ability to cope with or adapt to straps
stress  Teach her to wash her breasts with
 Ability to adapt to being a mother clear tap water (no soap, because that
could be drying and cause her nipples
Emotional Responses to crack) daily to remove the
1. Ambivalence colostrum and reduce the risk of
2. Grief infection.
3. Narcissism 3. Dental Care
4. Introversion vs. Extroversion  There is a strong correlation between
5. Body Image & Boundary poor oral health and preterm birth, so
6. Stress maintaining good oral health during
7. Couvade Syndrome pregnancy is important
8. Emotional Lability  When bacteria in the mouth interact
9. Changes in Sexual Desire with sugar, this lowers the pH of the
10. Changes in the Expectant Family mouth, creating an acid medium that
can lead to etching or destruction of
Psychological Tasks the Pregnant Woman the enamel of teeth
has to Accomplish in each Trimester 4. Perineal Hygiene
 Maintain good perineal hygiene.
First Trimester  Caution them to always wipe front to
Task: Accepting the  Common reaction is back after voiding to prevent bringing
Pregnancy ambivalence contamination forward from the
rectum.
 Begins to imagine herself
nd
2 Trimester 5. Clothing
as a mother (anticipatory
Task: Accepting the Baby role-playing)  Women should be cautioned to avoid
 Woman feels fetal garters, extremely firm girdles with panty
movement legs, and knee-high stockings during
3rd trimester pregnancy because these may impede
Task: Preparing for the Baby  “nest-building” lower extremity circulation.

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 Maternal and Child Health Nursing
 Suggest wearing shoes with a moderate-
to-low heel to minimize pelvic tilt and
possible backache as well as to reduce the
risk of falling.
2. Sexual activity
 Women who have a history of previous
preterm birth should consult their
obstetric provider for specific advice.
 Women whose membranes have ruptured
or who have vaginal spotting should be
advised against coitus until examined by
their primary care provider to prevent
possible infection or complications.
 Changes in sexual position may be needed
to increase comfort.
3. Exercise
 220 – 20 (age of woman) = 200 x 70% =
140 bpm
 Walking is the best exercise during
pregnancy
o women should be encouraged to
take a walk daily unless inclement
weather, many levels of stairs, or
an unsafe neighborhood are
contraindications.
 Yoga is also a good exercise as long as
positions are limited to those in which
pregnant women are able to maintain
balance
 Swimming is a good activity for pregnant
women and, like bathing, is not
contraindicated as long as membranes are
intact.
 Please refer to the GUIDELINES FOR
EXERCISE IN PREGNANCY p. 261
4. Sleep
 growth hormone secretion is at its highest
level—that is, during sleep.
 A good resting or sleeping position is a left-
sided Sims position, with the top leg forward
5. Employment
 May continue to work unless a woman’s job
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.
6. Travel
 Advise a woman who is taking a long trip by
automobile to plan for frequent rest or stretch
periods.
o Preferably every hour, but at least
every 2 hours, she should get out of
the car and walk a short distance.
o This break relieves stiffness and
muscle aches and improves lower
extremity circulation, helping prevent
varicosities, hemorrhoids, and
thrombophlebitis.
 Caution her not to eat unwashed fruits or
vegetables or raw meats and not to drink
unpurified water.
 she should make arrangements to visit a
healthcare provider in that area so she can
keep the schedule of her regular prenatal
visits. Also, make certain she has enough of
her prescribed vitamin supplement plus
adequate prescriptions for refills as necessary.
Minor Body Changes of Pregnancy (1st Trimester)
1. Breast tenderness - wide strap bra
2. Palmar erythema (palmar pruritus)
 due to increased estrogen
 may apply calamine lotion
3. Constipation
4. Nausea, vomiting and pyrosis (heartburn)
5. Fatigue
 due to ↑ metabolic requirement
 ↑ amount of rest & sleep
6. Muscle cramps
 dorsiflex foot; elevate LE freq.,
 Due to decreased serum calcium levels,
increased serum phophorus levels, and
possibly, interference with circulation.
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 Maternal and Child Health Nursing

 Take a calcium supplement 3. Chills and fever or pain on urination

 Take magnesium lactate or citrate once in  May indicate an intrauterine infection, a
the morning and again in the evening as potentially serious complication for both a
these bind phosphorus in the intestinal woman and a fetus.
tract and thereby lower its circulating level  Pain on urination is a symptom of a
7. Hypotension urinary infection, and are associated with
8. Varicosities - elevate leg 15-20 min 2x/day preterm birth.
9. Hemorrhoids
10. Heart palpitations 4. Sudden escape of clear fluid from the vagina
 due to increased blood volume  means the membranes have ruptured
 Gradual, slow movements will help  umbilical cord may prolapse.
prevent this from happening.  If the fetal head then presses on the
11. Frequent urination misplaced cord, oxygenation can be
 void as often as necessary, as urine stasis compromised and the fetus will be in
can lead to infection. immediate and grave danger.
 perform Kegel exercises are exercises  Urine can be identified by Nitrazine paper
designed to strengthen the pubococcygeal as urine is acidotic (the test strip turns
muscles. Each is a separate exercise and yellow), whereas amniotic fluid is alkaline
should be done about three times per day. (the strip turns blue).
12. Abdominal discomfort
13. leukorrhea 5. Abdominal or chest pain
 Abdominal pain could be a sign of
Minors Body Changes of Pregnancy 1. tubal (ectopic) pregnancy,
2. separation of the placenta (abruptio
(Late Pregnancy) placenta)
1. Backache
3. preterm labor (regular contractions,
 pelvic rock/tilt; squat instead of bend
cervical changes)
2. Headache
4. appendicitis
 due to expanding blood volume
5. ulcer, or pancreatitis.
3. Dyspnea
 Chest pain and shortness of breath may
4. Ankle Edema
indicate a pulmonary embolus, a
 due to general fluid retention
complication that can follow
5. Braxton Hicks Contractions
thrombophlebitis

Complications of Pregnancy 6. Increase or decrease in Fetal movement

(Danger Signs) * Sandovsky method
1. Vaginal Bleeding  Normal: 10-12x/hr.
 all women with spotting need further
evaluation 7. Gestational Hypertension
 usually after 20 weeks of pregnancy.
2. Persistent Vomiting  S/Sx:
 Persistent or extended vomiting depletes 1. Rapid weight gain
the nutritional supply available to a fetus o Over 2 lbs/week in 2nd tri, 1
and thus is a danger to the pregnancy lb/week 3rd tri (Normal: 3-12-12)
2. Swelling of the face or fingers

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3. Flashes of light or dots before the eyes

4. Dimness or blurring of vision
5. Severe, continuous headache
 may signal cerebral edema
or acute hypertension.
6. Decreased urine output
 (Normal: 30 ml/hr)
7. Right upper quadrant pain unrelated
to fetal position
 ischemia of the liver
8. Blood pressure ↑ above 140/90
mmHg

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