PANGASINAN STATE UNIVERSITY

Bayambang Campus
INSTITUTE OF NURSING
Bayambang, Pangasinan

HANDOUTS IN NCM 117 – CARE OF MOTHER, CHILD, AND ADOLESCENTS

Emotional Reactions Experienced by a Newly Pregnant Woman

1. Ambivalence
 refers to the simultaneous negative and positive response of the woman to pregnancy.
2. Fear and Anxiety
 related to the woman’s concern about her own health and the health of her baby.
3. Introversion or Narcissism
 Woman may become concerned for her welfare and the effects of pregnancy on her health
and lifestyle
4. Uncertainty
 some women may still doubt that they are pregnant despite a (+) PT and confirmation by a
doctor.

Diagnostic Tests

1. Amniocentesis
 aspiration of amniotic fluid from the pregnant uterus.
 Purpose: to determine genetic disorders, sex, & fetal maturity and growth
 If done 14-16 wks/ purpose is to det. Chromosomal disorders
 If done after 35 wks/ purpose is to assess fetal lung maturity & assessment of fetal well
being

 Risk to Client:
1. Maternal hemorrhage
2. Infections
3. Abruptio placenta
4. Labor
5. Fetal death
6. Injury from needle

 Nursing Responsibilities:
1. Informed consent.
2. Have client empty bladder before procedure.
3. Baseline V/S & FHR, then check every 15 mins.
4. Position supine with abdominal scrub
5. Encourage bedrest & avoidance of strenuous activities.
6. Instruct client to report any S/E
a. Chills
b. Fever
c. fluid leakage
 d. decreased fetal movement
e. uterine contractions

Information from Amniocentesis

a) Color > normally, the color of water

Yellow tinge – suggests blood incompatibility
Green color – suggests meconium staining

b) L/S ratio > they are protein component of the lung enzyme surfactant that alveoli begin to
form about the 22nd to 24th week of pregnancy
 Normal ratio is 2:1 or greater which signifies lung maturity
c) Bilirubin determination > normally, should be negative for blood or should have no false-
positive reading
d) Chromosome analysis > chromosomal study of fetal tissues should be free of diseases

2. Alpha-Fetoprotein Screening
 Measures the quantity of fetal serum proteins
 Assess the presence of neural tube defect and down’s syndrome
 Elevated result is associated with open neural tube defects such as anencephaly (congenital
absence of all or a major part of the brain) and spina bifida (congenital cleft of the spinal
column with hernial protrusion of the meninges and sometimes the spinal cord); or twins
 Significantly decreased amount means chromosomal defects such as Down’s Syndrome
Trisomy 21, Edward’s syndrome or Trisomy 18, Patau Syndrome or Trisomy 13)
 Assessed with maternal blood sample drawn at 15-18 weeks gestation/14-16 weeks

3. Assessment of Lochia > to detect the presence of infection and bleeding

Findings: Normal Color as follows: Lochia Rubra (Reddish) – 1-3 days postpartum
Lochia Serosa (Brownish) – 4-10 days
Lochia Alba (Whitish) – 10-14 days
 The longest possible time for the patient to have lochial discharge can be up to 3 weeks to
sixty days postpartum

4. Chorionic Villi Sampling

 Determines genetic aberrations
 Aspiration of villi done during the 10th -12th week
 Instruct the client to fill the bladder to aid in the attainment of the desired position of the
uterus (instruct client to drink water)
 Risks:
a) Spontaneous abortion
b) Infection
c) Hematoma
d) Intrauterine death
 Involves the insertion of a thin catheter into the uterus (informed consent)

5. Contraction Stress Test

 Indicates uteroplacental insufficiency & identifies pregnancies at risk.
 (-) result indicates absence of abnormal decelerations with all contractions
  (+) results indicates abnormal fetal heart rate decelerations with contractions
 Indication: pregnancy of more than 40 wks

6. Non-Stress Testing
 As fetus moves, FHR should be increased by 15 beats per minute and remain elevated for 15
seconds then return to its pattern as the fetus quiets
 Test is reactive if 2 accelerations of fetal heart rate lasting for 15 seconds occur following
movement within 10 mins period.
 Test in non-reactive if no accelerations occur with fetal movements
 If 10 minutes period passed without fetal movement, it means that the fetus is sleeping
(give the mother oral carbohydrate snacks to increase the glucose level and stimulate fetal
movement)

7. Ultrasonography
 High frequency sound wave testing
 Discerns placental location and gestational age
 Encourage client to drink and refrain from voiding before the test to improve visualization

8. Serum Estriol Levels

 Confirms healthy fetal placental functioning
 Done particularly for patients with diabetes mellitus
 Results: falling levels at term may be indicative of impending fetal distress (2 or more tests
are necessary to make a diagnosis
 Nursing Care: Encourage the mother to return for testing