NURSING CARE DURING NORMAL PREGNANCY AND CARE OF THE

DEVELOPING FETUS
Group 1-B members:
CORONEJO, PATRICIA S
DELFINADO, JORGE ALLEN S.
DESTAJO, KRISTEL ERICA P.
DIMAPILIS, MA. ERIKA ANN M
DORIA, MELODY M.
ENERA, ANGELICA MAE A
GALUTAN, ALESSANDRA D.
CASE INTRODUCTION
A PREGNANT WOMAN WITH CONCERNS FOR HER FETUS
Jessica Menendez is a 20-year-old woman who is 20 weeks pregnant. You care
for her in an emergency room after she was stabbed in her upper abdomen from an
argument with her boyfriend.
The client lives in one-bedroom apartment. She has a high school education but is
unable to find employment, especially since she’s been pregnant. The client had
nephrosis as a preschooler; no apparent sequelae. She had no childhood diseases
such as mumps or chickenpox. She had MSAFP test in early pregnancy: negative
result.
OBJECTIVES
To maintain and improve maternal/ infant health and well-being through
education including nutrition, laboratory testing, and risk assessment including risks of
genetic disease and birth defects.
1. To reduce pre-term births, intrauterine growth retardation, congenital anomalies,
and failure to thrive.
2. To promote health supervision, and healthy fetal growth and Development.
3. To promote the health and well-being of the mother, fetus, and family.
4. Accurately present the assessment of the client includes personal health history,
physical assessment, laboratory results, and family history taking.
5. Formulate comprehensive nursing care plan in accordance to the patients need
and evaluate nursing management
6. Provide comprehensive discharge plan of the patient to ensure the continuation
of the management for the patient’s case at home.
DEFINITION OF CASES
Violence - Violence, an act of physical force that causes or is intended to cause harm.
The damage inflicted by violence may be physical, psychological, or both. Violence may
be distinguished from aggression, a more general type of hostile behaviour that may be
physical, verbal, or
passive in nature. Violence is more common than any other health problem among
women during pregnancy. It greatly threatens both the mother's and baby's health.
Domestic violence is a pattern of assault and coercive behavior, including physical,
sexual and psychological attacks, as well as economic coercion that adults use against
their partners
Nephrosis - A noninflammatory disease of the kidneys chiefly affecting function of the
nephrons also : nephrotic syndrome
Mumps – Mumps is a viral infection that primarily affects saliva - producing (salivary)
glands that are located near your ears. Mumps can cause swelling in one or both of
these glands. Mumps was common in the United States until mumps vaccination
became routine. Since then, the number of cases has dropped drama. Mumps that
occurs in pregnant women is generally benign and not more severe than in women who
are not pregnant. Like other infections, there is a theoretical risk that mumps during the
early months of pregnancy may cause complications.
Uterine Cancer - Cancer that forms in tissues of the uterus (the small, hollow, pear-
shaped organ in a woman's pelvis in which a fetus develops). Two types of uterine
cancer are endometrial cancer (cancer that begins in cells lining the uterus) and uterine
sarcoma (a rare cancer that begins in muscle or other tissues in the (uterus)
CURRENT TRENDS
TITLE: Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes
SOURCE: NCBI, PMC, J Womens Health (Larchmt). 2015
Intimate partner violence (IPV) during pregnancy is a serious public health issue with
significant negative health consequences for women and children.1–6 The majority of
research has found that between 3% and 9% of women experience abuse during
pregnancy,7,8 though there are well established risk factors that are associated with
higher rates of abuse, including young age, single relationship status, minority
race/ethnicity, and poverty.9,10 Indeed, studies conducted among samples of low-
income, predominantly single women have noted higher prevalence with rates up to
50%.11–13 The wide range in prevalence estimates has been attributed to several
causes including differences among the populations sampled, measurements used to
assess for IPV, inconsistencies in defining IPV, and differences in defining the time
frame for abuse during the perinatal period. This review uses the U.S. Centers for
Disease Control and Prevention's uniform definition for IPV;14 that is, IPV is a pattern of
coercive control of one intimate partner by the other that includes physical and sexual
violence, threats of physical or sexual violence, and emotional abuse in the context of
physical and sexual violence
TITLE: Intimate partner violence during pregnancy
SOURCE: World Health Organization
Violence against women, committed by an intimate partner, is an important public health
and human rights issue. In recent years, attention has focused also on intimate partner
violence during pregnancy due to its prevalence, adverse health consequences and
intervention potential. According to WHO, Intimate partner violence during pregnancy
has been found to be associated with fatal and non-fatal adverse health outcomes for
the pregnant woman and her baby due to the direct trauma of abuse to a pregnant
woman’s body, as well as the physiological effects of stress from current or past abuse
on fetal growth and development. Physical, sexual and psychological intimate partner
violence during pregnancy are associated with higher levels of depression, anxiety and
stress, as well as suicide attempts, lack of attachment to the child and lower rates of
breastfeeding (20,21).
ASSESSMENT
Contents:
• Nursing Related Theory
• Biographical Data
• Reasons for Seeking Health Care
• History of Present Health Concern Using COLDSPA
Nursing Related Theory
The Conservation Model
It believes that nursing intervention is a conservation activity, with energy
conservation as a fundamental concern. Four conservation principles of nursing. It
guides nurses to concentrate on the importance and responses at the level of the
person. Nurses fulfil the theory’s purpose by conserving energy, structure, personal and
social integrity.
CONCEPT OF THEORY OF CONSERVATION
Patient Jessica with a present chief complaint for her fetus. Jessica has a history
of chief concern and states that “I know her body parts are still forming so if a body part
is hurt, will a new body part form? What if I start labor and has to be born?”. She was
stabbed in her upper abdomen from an argument with her boyfriend.
 She was stabbed in her upper abdomen from an argument with her boyfriend –
Conservation of Structural Integrity.
Goal: To maintain or restore the body’s structure, prevents physical breakdown and
promotes healing.
FOUR PRINCIPLES OF CONSERVATION:
Conservation of Energy - refers to balancing energy input and output to avoid
excessive fatigue.
Conservation of Structural Integrity - Refers to maintaining or restoring the body’s
structure, preventing physical breakdown and promoting healing.
Conservation of Personal Integrity - Recognizes the individual as one who strives for
recognition, respect, self-awareness, selfhood and self-determination.
Conservation of Social Integrity - Exists when a patient recognized as someone who
resides within a family, community, religious group, an ethnic group, political system
and nation.
MAJOR CONCEPT OF CONSERVATION MODEL:
In this section, we will define the nursing metaparadigm and the major concepts of the
theory:
Environment
Person
Health
Nursing
Adaptation
Conservation
Personal Integrity
BIOGRAPHICAL DATA
Name: Jessica Menendez
Age: 20 years old
Gender: Female
REASONS FOR SEEKING HEALTH CARE:
“Is my baby all right? Do you think the knife hit it?”
HISTORY OF PRESENT HEALTH CONCERN USING COLDSPA
CHARACTERISTICS:
She was stabbed in her upper abdomen.
ONSET:
From an argument with her boyfriend
LOCATION:
Upper abdomen
DURATION:
Not stated
SEVERITY:
The client has felt the fetus move since the incident.
PATTERN:
She states movement feels “same as always.”
ASSOCIATED FACTORS:
Not stated
Personal Health History
1. History of chief concern
The client and her boyfriend were arguing over who should have the last piece of
popcorn in a bowl when he stabbed her with a kitchen paring knife. The client has felt
the fetus move since the incident; she states movement feels “same as always.” She
states, “I know her body parts are still forming so if a body part is hurt, will a new body
part form? What if I start labor and she has to be born?”
2. Nephrosis
3. MSAFP test (negative)
Family History
1. Uterine Cancer (Her mother died at age 36 years of uterine cancer)
2. “Some kind of heart condition” (An aunt has “some kind of heart condition.”)
Lifestyle and Health Practices
• She has no prenatal care and not taking prenatal vitamins
• Alcohol Consumption (Beer) – Help her sleep at night
• 2 packs of cigarettes a day

Review of Related Systems (ROS)

 • Essentially negative; She has notice occasional constipation during pregnancy.
Anatomy and Physiology
Abdominal Wall
Abdominal Wall
 The abdominal wall surrounds the abdominal cavity, providing it with flexible
coverage and protecting the internal organs from damage.
 It is bounded superiorly by the xiphoid process and costal margins, posteriorly by
the vertebral column and inferiorly by the pelvic bones and inguinal ligament.
 The abdominal wall can be divided into two sections: anterolateral and posterior
abdominal walls.
Layers of the abdominal wall
From superficial to deep:
 - Skin
 - Superficial fascia
 - Muscles
 - Transversalis fascia
 - Extraperitoneal fat (extraperitoneal fascia)
 - Peritoneum
Functions
1. Protection of the internal abdominal organs
2. Stabilization and rotation of the trunk
3. Increase of internal abdominal pressure
4. Abdominal muscles make up core muscles and help keep your body stable
and balanced, and protects your spine.
Anterolateral abdominal wall muscles
 Transversus abdominis muscle
 Internal abdominal oblique muscle
 Rectus abdominis muscle
 External abdominal oblique muscle
 Pyramidalis muscle
Female Reproductive System
External Structures
Vulva
 Labia majora
 Labia minora
 Bartholin’s glands
 Clitoris
Internal Reproductive Organs
 Vagina
 Uterus (Womb)
 Ovaries
 Fallopian Tube
Layers of the abdominal wall
From superficial to deep:
 - Skin
 - Superficial fascia
 - Muscles
 - Transversalis fascia
 - Extraperitoneal fat (extraperitoneal fascia)
 - Peritoneum
Functions
Vulva
1. protect the internal parts of the female reproductive system (labia majora and
minora)
2. play a role in sexual arousal and stimulation (clitoris)
3. facilitate sex, such as through providing lubrication (Bartholin’s glands) and
cushioning (mons pubis)
Vagina
1. receiving a penis during sex
2. serving as the birth canal during childbirth
3. allowing menstrual blood to pass out of your body during your period
 Uterus
1. that receives the fertilized egg and supports its development during
pregnancy
Fallopian Tube
1. work to transport an egg from the ovaries to the uterus
2. Smooth muscle contractions and the rhythmic beating of small hair-like structures
called cilia help to keep the egg moving toward the uterus.
3. It is where fertilization often occurs

Ovaries
1. release matured egg cells called ovulation
2. produce a variety of female sex hormones, which are important for regulating a
woman’s cycle and pregnancy. These include progesterone and estrogen.
NURSING CARE PLAN
Family Assessment
 The client lives in one-bedroom apartment.
 Finances are provided by government assistance.
 Her mother died at age 36 years of uterine cancer.
 Her father’s health history is unknown.
 An aunt has “some kind of heart condition.”
Patient Assessment
 Patient is a 20-year-old woman who is 20 weeks pregnant
 Patient was stabbed with a kitchen paring knife in her upper abdomen from an
argument with her boyfriend
 The client has felt the fetus move since the incident; she states movement feels
“same as always.”
 She states, “I know her body parts are still forming so if a body part is hurt, will a
new body part form? What if I start labor and she has to be born?”
 When asked if she intended to continue relationship with boyfriend, she
answered, “He ain’t all bad. Just Patient had no prenatal care and not taking
prenatal vitamins
 Patient states she consumes alcohol every night to help her sleep
 Patient smokes two packs of cigarettes a day
 No recreational or prescription drugs
  Patient has been sexually active since age 13 years old
 Patient had gonorrhea at age 14 years and was treated at city health center
 Patient has noticed occasional constipation during pregnancy. has a bad
temper.”
Wellness Diagnosis and Health Promotion Diagnosis
NURSING DIAGNOSIS: Readiness to learning new information about current condition
NURSING DIAGNOSIS: Readiness for enhanced coping behaviors
NURSING DIAGNOSIS: Readiness for enhanced nutrition related to fetal growth and
development
NURSING DIAGNOSIS: Readiness for enhanced fetal health and self-health
management
 .ACTUAL DIAGNOSIS
• Fear related to threat of death as evidenced by increased tension, feeling of
helplessness, and hopelessness
• Acute pain related to actual tissue damage because of violence
• Impaired Tissue related to mechanical factor (stab wound on her upper
abdomen)
• Possible Chronic Low self-esteem related to shame and guilt because of
gonorrhea
• Imbalanced Nutrition: Less than body requirements related to unhealthy
lifestyle as evidenced by loss, of appetite, consumption of alcohol and
cigarettes.
• Fetal Alcohol Syndrome related to excessive consumption of alcohol as
verbalized by the patient
RISK-DIAGNOSIS
Risk for Infection related to presence of stab wound
Risk for uterine infection as evidenced by the presence of illness in the family
Risk for Altered Family Processes as evidenced by
Risk for anticipatory grieving related to perceived potential death of the baby.
Risk for Impaired Physical Mobility related to acute pain
Risk for Altered Skin Integrity due to mechanical factor (stab wound on upper abdomen)
Risk for Post-Traumatic Stress Disorder related to overwhelming anxiety due to physical
assault (beating)
Risk for low birth weight as evidenced by unhealthy lifestyle (not taking prenatal
vitamins)
Risk for Intrauterine Growth Restriction may be related to Infection
Discharge Planning/Health Teaching for Patient and Family
• Medications
Acetaminophen
• Environmental management
 Advise woman to be in a place where she is safe from all the injury that she just
encounters and from harmful people.
• Treatment

Stop the Bleeding

Apply firm, direct pressure with sterile gauze or clean cloth until bleeding stops.
Clean and Protect the Wound
Rinse the wound under clean water for several minutes. Then wash the area with mild
soap and water and rinse again. to prevent infections
Apply an antibiotic cream.

• Health Education, personal care, activity, rest, exercise, spiritual and emotional
care

 Talk to the patient and advised her that the father of her baby may harm them
both again and that is not good for their health. If they stay together it will
increase the chance of death of the baby.
 Advise the patient to stop alcohol and cigarette consumption because it will harm
them both.
 Advise the patient to have proper nutrition such as eating vegetable and fruits
that are health for the body, also to do exercises at least 3x a week for 30
minutes do yoga and relaxation, praying.
• Out-patient referral and follow-up appointments

 Prenatal care

• Diet/Nutrition

Recommended Diet
A pregnant woman’s diet should have the nutrients and calories needed to
support changes in her body and to help the fetus grow and develop.

1
Food Group Servings Foods
Breads, Cereals 6-11  Bread, tortilla, crackers, roll, bun, bagel, muffin,
& Grains biscuit, pancake, cooked rice, noodles, macaroni,
spaghetti, cereal
Vegetables 3-5  Vitamin A-Rich Vegetables: Carrot, greens,
tomato, spinach, winter squash, sweet potato,
bokchoy, red bell pepper, red chili pepper
 Vitamin C-Rich Vegetables: Broccoli, tomato,
cabbage, cauliflower, bell pepper, chili pepper
 Other Vegetables: Potato, peas, green beans,
corn, lettuce, summer squash, zucchini,
asparagus
Fruits 2-4  Vitamin A-Rich Fruits: Cantaloupe, apricot,
mango, papaya
 Vitamin C-Rich Fruits: Orange, lemon, tangerine,
cantaloupe, strawberry, kiwi, grapefruit, mango,
papaya, orange juice, grapefruit juice, juices with
Vitamin C Added
 Other Fruits: Apple, banana, grapes, peach,
nectarine, raisins, pear, watermelon, pineapple
Milk Products 3-4  Milk, yogurt, cheese, cottage cheese. Eat mostly
non-fat or low-fat milk products.
Protein Foods 2-3  Vegetable Protein: Cooked dry beans or peas,
peanut butter, nuts, seeds, soy products (such as
tofu)
 Animal Protein: Chicken, turkey, fish, beef, pork,
eggs