TOPIC OUTLINE Methods of Monitoring Fetal Movement

Sadovsky Technique
I. After meal, the pregnant woman is asked
to lie in recumbent position
• Observe the fetal movement for an
hour. The estimated movement is 4
movements per hour
• If not felt, try for another hour
• Call provider for fetal monitoring if the
movement is <4 movements per hour

Cardiff Technique
• AKA “Count-to-Ten”
• Starting from the morning, the mother
CONTENT is expected to monitor the interval od
fetal movement
• This is usually 60 minutes; expecting
10 fetal movements for 12 hours

Calculating Fetal Heart Rate

Fetal Heart Rate

• around 120-160 fetal heart rates is estimated

throughout the pregnancy

• As early as 10-11 weeks, fetal heart rate can be

I. NORMAL DIAGNOSTIC/ LABORATORY
FINDINGS AND DEVIATIONS
Calculating the Fetal Movement
Fetal Movement
• or quickening, can be felt around 18-20 weeks
& peaks in intensity around 28-38 weeks at
10×/h
• a healthy fetus, or fetus that receives sufficient
nutrients moves in a degree of consistency for at
least 10 times a day
• the mother should be asked to monitor the fetal
movement to assess the fetal well being
monitored through ultrasonic Doppler Technique
• the baseline range is around 110-160 bpm, more
160 bpm is considered Tachycardia is a
nonreassuring pattern and should consult
professionals
Non-Stress Test
• this may be done after 26 to 28 weeks of
pregnancy for about 10-20 minutes
• the baby's heart rate is monitored to see how it
responds to the baby's movements; used to
evaluate a baby’s health before birth

• typically, a non-stress test is recommended when

it's believed that the baby is at an increased risk of
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death
Contraction Stress Test Chorionic Villi Sampling

• checks to see if your baby will stay healthy • prenatal test that involves taking a sample of tissue
during contractions when you are in labor. from the placenta to test for chromosomal
abnormalities and certain other genetic problems
• done when you are 34 or more weeks
pregnant • CVS is usually done between the 10th and 12th
weeks of pregnancy
• During a contraction, the blood and oxygen
supply to your baby drops for a short time • there are two types of CVS procedures: transcervical
and transabdominal
• During this test, your baby’s heart rate may
slow down (decelerate) in a certain pattern
after a contraction instead of speeding up
(accelerating)

• This means your baby may have problems

with the stress of normal labor

Ultrasonography

• Ultrasound (also called sonogram) is a

prenatal test offered to most pregnant women

• It uses sound waves to show a picture of

your baby in the uterus (womb)
• helps your health care provider check on
your baby’s health and development as well
as to detect or screen birth defects
Amniocentesis
• a procedure used to take out a small sample of the
amniotic fluid for testing

• offered to women between the 15th and 20th weeks

Maternal Serum Alpha-Fetoprotein
• the presence of alpha-fetoprotein (AFP) , a
plasma protein normally produced by the
fetus, in the mother’s blood
of pregnancy who are at greater risk for birth defects.
It may also be used to follow-up when an earlier test
suggests a problem

• MSAFP serves as the basis for some

valuable tests for several disorders including:

• Open neural tube defects

(anencephaly and spina bifida)
• Down syndrome or trisomy 21(and
other chromosome abnormalities)

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Cordocentesis
• also known as percutaneous umbilical blood
sampling — is a diagnostic prenatal test in
which a sample of the baby’s blood is removed
from the umbilical cord for testing
• done after week 18 of pregnancy, can be used
to detect certain genetic disorders, blood
conditions and infections, and deliver blood and
medication to a baby through the umbilical cord
Biophysical Profile
• a test done after the 28th week of pregnancy.
• noninvasive diagnostic test helps evaluate the
fetus. It measures body movement, muscle
tone, breathing movement and amniotic fluid
volume around the fetus
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II. APPROPRIATE NURSING DIAGNOSES
• Developing and implementing a nursing diagnosis
helps nurses determine the plan of care for their
patients. These diagnoses drive possible
interventions for the patient, family, and community.
They are developed with thoughtful consideration of
a patient’s physical assessment and can help
measure outcomes for the patient’s care plan.
What Is a Nursing Diagnosis?
• According to NANDA-I, the official definition of the
nursing diagnosis is:
“Nursing diagnosis is a clinical judgment about
individual, family, or community responses to actual
or potential health problems/life processes. Nursing
diagnosis provides the basis for selection of nursing
interventions to achieve outcomes for which the
nurse is accountable.”
What’s the Purpose of a Nursing Diagnosis?
• According to NANDA International, a nursing
diagnosis is:
“a judgment based on a comprehensive nursing
assessment.” The nursing diagnosis is based on the
patient’s current situation and health assessment,
allowing nurses and other healthcare providers to
see a patient from a holistic perspective.
• Proper nursing diagnoses can lead to greater
patient safety, quality care, and increased
reimbursement from private health insurance,
Medicare, and Medicaid.
What are the types of Nursing Diagnoses?
• There are 4 types of nursing diagnosis according
to NANDA-I. They are:
• Problem-focused diagnosis
A patient problem present during a nursing
assessment is known as a problem-focused
diagnosis. Generally, the problem is seen
throughout several shifts or a patient’s entire
hospitalization. However, it may be resolved during
a shift depending on the nursing and medical care.
 • Risk nursing diagnosis
A risk nursing diagnosis applies when risk
factors require intervention from the nurse and
healthcare team prior to a real problem
developing.
This type of diagnosis often requires clinical
reasoning and nursing judgement.
Nursing Diagnosis vs Medical Diagnosis vs
Collaborative Problems
• The nursing diagnosis can be mental, spiritual,
psychosocial, and/or physical. It focuses on the
overall care of the patient while the medical
diagnosis involves the medical aspect of the
patient’s condition.

• Health promotion diagnosis • A medical diagnosis does not change if the

The goal of a health promotion nursing
diagnosis is to improve the overall well-being
of an individual, family or community.
• Syndrome diagnosis
A syndrome diagnosis refers to a cluster of
nursing diagnoses that occur in a pattern or
can all be addressed through the same or
similar nursing interventions.
condition is resolved, and it remains part of the
patient’s health history forever. A nursing diagnosis,
however, generally refers to a specific period of
time.
• Collaborative problems are ones that can be
resolved or worked on through both nursing and
medical interventions. Oftentimes, nurses will
monitor the problems while the medical providers
prescribe medications or obtain diagnostic tests.

Nursing Diagnosis Components

The three main components of a nursing
diagnosis are:

1. The problem statement explains the

patient’s current health problem and
the nursing interventions needed to
care for the patient.

2. Etiology, or related factors, describes

the possible reasons for the problem or
the conditions in which it developed.
These related factors guide the
appropriate nursing interventions.

3. Finally, defining characteristics are

signs and symptoms that allow for
applying a specific diagnostic label.
Risk factors are used in the place of
defining characteristics for risk nursing
diagnosis. They refer to factors that
increase the patient’s vulnerability to
health problems.

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III. ADDRESSING THE NEEDS & • Balasana position to relieve
DISCOMFORT OF PREGNANT MOTHERS hemorrhoids

Relieving Positions for Pregnant

• Kegel’s position for constipating

pregnant mother

Psychological Changes During Pregnancy

First Trimester: Acceptance of Pregnancy

• 50% of pregnancies are unwanted,
• Feet-up break helps prevent fatigue unintended, or mistimed.
• Women sometimes experience
disappointment, uncertainty, or anxiety
• Partner should give emotional support
• Partner’s feelings about the pregnancy
vary

Second Trimester: Acceptance of the Baby

• Straightening and massaging • Second turning point is quickening,
relieves leg cramp in pregnancy proof of child’s existence
• Anticipatory role playing
• Educate both parents

Third Trimester: Acceptance of the Baby

• Couple usually begin nest building
activities
• Elevating the feet to relieve • Interested in attending prenatal classes
viscosity • Helpful to attend in child birth education
classes

Physical Changes During Pregnancy

Changes in the breast

• Growth and enlargement – Around weeks
6-8, your breasts will get bigger and
continue to grow throughout your
pregnancy and may develop stretch marks
• Tenderness and hypersensitivity
• Darkening of nipples and areolas due to
hormones that affect the pigmentation of the
skin.
• Darkened veins along with your breasts
• Around month three, breasts may start
leaking a yellowish, thick substance known
as colostrum
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• May also notice little bumps on the areolas
Pigmentation changes
• The area around your nipples and the
skin on your inner thighs, genitals and
neck might darken, possibly due to
hormonal changes.
Linea nigra
• You might notice a dark line from your
navel to your pubic bone during
pregnancy
Chloasma
• Dark patches might develop on your
face
• Avoid sun exposure, which can worsen
chloasma.
• After childbirth, skin typically returns to
its normal pigment over a period of
several months. However, some dark
patches due to chloasma might never
go away.
Acne
• Some women have trouble with acne
during pregnancy. To counter acne,
wash with a gentle cleanser.
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Varicose veins
• You might develop enlarged veins in your
legs (varicose veins) due to your uterus
exerting greater pressure on these veins.
• Hormonal changes during pregnancy also
might play a role. Varicose veins that
develop during pregnancy generally
improve without medical treatment three to
12 months after delivery.
Stretch marks
• Stretch marks (striae) are indented streaks
that often appear on the abdomen, breasts,
hips, buttocks and thighs.
• They’re caused by the stretching of the skin
and are common during the second and
third trimesters.
• Many creams, ointments and other
products claim to prevent or treat stretch
marks. However, treatments are only
partially effective and won’t remove stretch
marks completely.
IV. PRENATAL EXERCISES Low-impact aerobics classes

• At your first prenatal care checkup, ask
your health care provider whether exercise
during pregnancy is safe for you.
• Healthy pregnant women need at least 2½
hours of aerobic activity, such as walking or
swimming, each week.
• Regular physical activity can help reduce
your risk of pregnancy complications and
ease pregnancy discomforts, such as back
pain.
• Some activities, such as basketball, hot
yoga, downhill skiing, horseback riding and
scuba diving, aren’t safe during pregnancy.
These activities usually are safe during
pregnancy:
Walking
Taking a brisk walk is a great workout that doesn’t
strain your joints and muscles. If you’re new to
exercise, this is a great activity
During low-impact aerobics, you always have
one foot on the ground or equipment. Examples
of low-impact aerobics include walking, riding a
stationary bike and using an elliptical machine.
Low-impact aerobics don’t put as much strain on
your body that high-impact aerobics do.
High impact aerobic classes
During high-impact aerobics, both feet leave the
ground at the same time. Examples include
running, jumping rope and doing jumping jacks.
Tell your instructor that you’re pregnant so that
they can help you modify your workout, if
needed.
Strength training
Strength training can help you build muscle and
make your bones strong. It’s safe to work out
with weights as long as they’re not too heavy.
Ask your provider about how much you can lift.

Swimming and water workouts

The water supports the weight of your growing

baby and moving against the water helps keep
your heart rate up. It’s also easy on your joints and
muscles. If you have low back pain when you do
other activities, try swimming.

Riding a stationary bike

This is safer than riding a regular bicycle during

pregnancy. You’re less likely to fall off a stationary
bike than a regular bike, even as your belly grows.

Yoga and Pilates classes

Tell your yoga or Pilates teacher that you’re

pregnant. The instructor can help you modify or
avoid poses that may be unsafe for pregnant
women, such as lying on your belly or flat on your
back

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V. PREPARATION FOR LABOR AND
DELIVERY

Lamaze Method
• Popularized by Dr. Ferdinand Lamaze, the
method of childbirth focuses on labor and
delivery as a natural event. Laboring women
are encouraged to move around, if they like,
and follow their body’s urges to push. The
method stresses special breathing patterns
and other natural relaxation techniques for
dealing with pain.

Bradley Method
• Emphasizes that birth is a natural process:
mothers are encouraged to trust their body
and focus on diet and exercise throughout
pregnancy; and it teaches couples to
manage labor through deep breathing and
the support of a partner or labor coach

Home Delivery
• A home birth is a birth that takes place in a
residence rather than in a hospital or a
birthing center. They may be attended by a
midwife, or lay attendant with experience in
managing home births. Home birth was, until
the advent of modern medicine, the de facto
method of delivery

Alternative Birth Center

• An “alternative birth center” means a clinic
that is not part of a hospital and that provides
comprehensive perinatal services and
delivery care to pregnant women who remain
less than 24 hours at the facility

• Low risk laboring mothers should give birth at

a birthing center as it provides more benefits
than a hospitalized birth experience including
a decreased risk of cesarean section, lower
hospital expense, and better neonatal health
outcomes

Hospital Setting
• Your baby is less likely to die or have
complications caused by childbirth. Doctors
and researchers have recently reported that
babies born at home via midwives have four
times the risk of neonatal deaths than those
delivered in the hospital by midwives
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 Practice Test
Match the column A with column B by writing the designated letter for every
answer in the space provided.

A B

1. It is caused by stretching of the skin that a) Lamaze Method

usually appear on the breasts, abdomen, hips,
buttocks or thighs b) Chloasma
2. The time when couples attend prenatal and
child birth education classes c) Biophysical Profile
3. The signs and symptoms that allow for applying
a specific diagnostic label d) Cardiff’s Technique
4. Dark patches that develop om the face during
pregnancy e) Problem-focused
5. Also known as the count-to-ten that happens Diagnosis
around 12 hours
6. Clinical judgment about individual, family, or f) Striae
community responses to actual or potential
health problems/life processes g) Ultrasound
7. AKA Sonogram, a prenatal test that uses sound
waves offered to most pregnant women h) Defining
8. The procedure used to take out a small sample characteristics
of the amniotic fluid for testing
9. The patient problem is present during a nursing i) 3rd Trimester
assessment
10. It measures body movement, muscle tone, j) Nursing Diagnosis
breathing movement and amniotic fluid volume
around the fetus k) Amniocentesis

40
 Answer Key

1. F

2. I

3. H

4. B

5. D

6. J

7. G

8. K

9. E

10. C

41
 References
https://nurse.org/resources/nursing-diagnosis-guide/#:~:text=%E2%80%9CNursing%20diagnosis
%20is%20a%20clinical,which%20the%20nurse%20is%20accountable.%E2%80%9D
https://slideplayer.com/slide/4092098/
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/skin-cha
nges-during-pregnancy/faq-20416440#:~:text=The%20area%20around%20your%20nipples,expos
ure%2C%20which%20can%20worsen%20chloasma.
https://www.babycenter.com/pregnancy/your-body/the-lamaze-method-of-childbirth_640#:~:te
xt=The%20Lamaze%20method%20of%20childbirth%20focuses%20on%20labor%20and%20delive
ry,techniques%20for%20dealing%20with%20pain.
https://en.m.wikipedia.org/wiki/Bradley_method_of_natural_childbirth#:~:text=The%20Bradley
%20method%20emphasizes%20that,a%20partner%20or%20labor%20coach.
https://my.clevelandclinic.org/health/diagnostics/21013-biophysical-profile#:~:text=The%20biop
hysical%20profile%20is%20a,fluid%20volume%20around%20the%20fetus.
https://www.rxlist.com/maternal_serum_alpha-fetoprotein_msafp/definition.htm#:~:text=Mater
nal%20serum%20alpha%2Dfetoprotein%20(MSAFP)%3A,basis%20for%20some%20valuable%20t
ests.
https://www.marchofdimes.org/pregnancy/ultrasound-during-pregnancy.aspx#:~:text=Ultrasoun
d%20(also%20called%20sonogram)%20is,your%20baby’s%20health%20and%20development.

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