Bulacan State University

City of Malolos Bulacan

COLLEGE OF NURSING

CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)

NCM 107 Hand- out No: 3

I. Definition of terms:

Antepartum
-Time between conception to onset of labor
-Describe the period during which a woman is pregnant
-Used interchangeably with prenatal
Intrapartum
-time from onset of labor until the birth of the infant & placenta
Postpartum
-time from birth until the woman’s body returns to an essentially pre-pregnant condition
Gestation
-The number of weeks since the 1st day of the last menstrual period (LMP)
Abortion
-Birth that occurs before 20 weeks gestation or the birth of every fetus- neonate who
weighs less than 500 g
Term
- The normal duration of pregnancy (37- 42 weeks gestation)
Preterm or premature labor
- Labor that occurs after 20 weeks but before the completion of 37 weeks of gestation
Post-term labor
-Labor that occurs after 42 weeks of gestation
Gravida
-Any pregnancy, regardless of duration, including present pregnancy
Nulligravida
-A woman who has never been pregnant
Primigravida
-A woman who is pregnant for the first time
Multigravida
-A woman who is on her second or any subsequent pregnancy
Para
-Birth after 20 weeks gestation, regardless of whether the infant is born alive or dead
Nullipara
-A woman who has not given birth at more than 20 weeks gestation
Primipara
-A woman who has had 1 birth at more than 20 weeks gestation, regardless of whether
the infant is born alive or dead
Multipara
-A woman who has had 2 or more births at more than 20 weeks gestation
Stillbirth
- A fetus born dead after 20 weeks of gestation

II. Recommended frequency of prenatal visit:

• Every 4 weeks for the first 28 weeks of gestation
• Every 2 weeks until 36 weeks’ gestation
• After 36 weeks, every week until child birth

III. Client history: TPAL

T- Term
• # of term infants born
• # of infants born after 37 weeks’ gestation or beyond, whether living or still birth
P-Preterm
• # of preterm infants born
 • # of infants born after 20 weeks but before the completion of 37 weeks’ gestation or
beyond, whether living or still birth
A- Abortion
• # of pregnancies ending in either spontaneous or therapeutic abortion
L- Living
• # of currently living children to whom the woman has given birth

IV. Psychological tasks of pregnancy

1st Trimester Accepting the Pregnancy

2nd Trimester Accepting the Fetus

3rd Trimester Preparing for the Baby

1st trimester
• Ambivalence, or feeling both pleased and not please about the pregnancy
2nd trimester:
• Concentrate on what it feels like to be a parent
• Role playing and increased dreaming are common
3rd trimester
• Prepare clothing and sleeping arrangements for the baby
• Grow impatient as they ready themselves for birth

V. Confirmation of Pregnancy

A. Presumptive Signs
 “Changes felt by woman”
 Subjective data. Could easily indicate other conditions

M- morning sickness
A- amenorrhea
C- changes in breast
F- fatigue
 L- lassitude
U- urinary frequency
Q- quickening (18TH-20TH weeks)

B. Probable Signs
 “Changes observed by examiner”
 Objective data

C- chadwicks: bluish discoloration of vaginal wall

H- hegar: softening of lower uterine segment
U- uterine enlargement: at 12 weeks gestation felt just above symphysis pubis
P- positive pregnancy test: presence of gonadotropin in urine
-venipuncture or urine specimen to detect presence of hcg
-Accurate: 97-99%
-Pregnant: with HCG as early as 24 to 48 hours after implantation
-Peak level of HCG: 60-80 days (after this time, hcg declines)
-2 Bars: denotes pregnancy
-Check expiration date. Out dated kit: false (+) result
-specimen: 1st urine in the morning (concentrated)
-Read result after designated time
-Test: the day of the missed menstrual period
B- ballottment: sinking and rebound of fetus
O- outlining of fetal body
G- goodells: softening of the cervix
S- souffle, contraction, Braxton hicks: painless contraction at 28 weeks

C. Positive signs
 “Definitive signs of pregnancy”
• Heartbeat
• Echocardiography: 5 weeks
• Ultrasound: 6-7 weeks
• Doppler: 10-12 weeks
• Stethoscope: 18-20 weeks
• Movement: felt by examiner usually after 16-20 weeks
• Skeleton: by sonography
VI. Maternal physiology during pregnancy

A. Reproductive system

1. Uterus
 Enlargement & Thickening (Hypertrophy) of the uterus; most marked in the fundus
 Increase in size
12th week: symphysis pubis
20-22 weeks: umbilicus
36 weeks: xiphoid process
38 weeks: Lightening
 Uterine growth could also suggest uterine tumor
 Hegar’s sign: softening of the lower uterine segment
 Ballottement: 16th-20th week
 Braxton Hicks Contraction: 12 weeks
uterine contraction

2. Cervix
 Goodell’s sign: Pronounced softening and cyanosis (due to increase vascularity,
edema, hypertrophy and hyperplasia of cervical glands
Consistency:
-Non-pregnant: Nose
-Pregnant: Earlobe
-Ripe: Butter
 Operculum: cervical plug formed by clot of thick mucus

3. Ovaries
 Ovulation ceases throughout pregnancy
Corpus Luteum: Increase Estrogen and Progesterone: Decrease FSH and LH: Inhibits
ovulation
Corpus luteum degenerates replaced by placenta

4. Vagina
 Chadwick’s sign
 Vaginal secretions increase

5. Breasts
 Increase in size, larger nipples, more pigmented
 Tender and tingle in the early weeks of pregnancy: Because of Increase estrogen
 Colostrum (Thin, watery high protein fluid) present by 2nd trimester
 Elevated glands of montgomery
B. Integumentary system

1. Striae Gravidarum: Reddish, slightly depressed streaks in the abdominal wall, breast
and thighs
 Because of Increase uterus size: Stretch
 Rupture and atrophy of small segment of connective layer of the skin
 Lighten after Delivery: become silver in color (striae albicantes or striae atrophicae)

2. Linia Nigra
 Line of dark pigment extending from the umbilicus down the midline to the
symphysis
 Narrow brown line
 Extra pigmentation: because of melanocyte stimulating hormone from pituitary
**After delivery: Decrease Melanocyte Stimulating Hormone: lighten but do not
always disappear

3. Chloasma or Melasma “Mask of pregnancy” are brownish patches of pigment on the

face
 Pigmentation: pigmentation changes occur because of melanocyte- stimulating
hormone elevated from the 2nd month of pregnancy
 Avoid sun exposure to prevent the pigmentation from getting any darker
**After delivery: Decrease Melanocyte Stimulating Hormone: lighten but do not
always disappear

4. Palmar erythema: Increase Estrogen

5. Telangiectasias: or vascular spiders: Small, fiery red blanching spots

C. Metabolic changes

Weight gain: Average is 11-13 kgs (24-28 lbs)

• 1st trimester: 2-4 lbs
• 2nd Trimester: 12-14 lbs
• 3rd trimester: 8-12 lbs

D. Endocrine system

 Placenta: produces estrogen, progesterone, hCG and hPL

 Pituitary
-suppressed LH, FSH
-Oxytocin (contraction)
 -Prolactin (milk production)
 Thyroid
-Increase basal metabolic rate
-Palpitation
-Perspiration
 Adrenal gland
-Increase corticostiroids and aldosterone: inhibit immune system
 Pancreas
-Increase insulin

E. Cardiovascular system
Heart
• Heart is displaced upwards by elevated diaphragm
• There may be splitting of the first heart sound, w/ common systolic murmurs
Circulation
• Cardiac volume increases by 40%- 50% causing slight cardiac hypertrophy and increase
in cardiac output (cardiac output increases when the woman turns from her back to her
left side)
• (+) physiologic anemia
• PR increases 10-15 bpm during pregnancy
• Slight decrease in BP (30%) during the 2nd & 3rd trimester
Hematologic
• Total circulating RBC increases
• Leucocyte count is elevated during labor
• Fibrinogen levels increase by 50% along with other clotting factor
F. Respiratory system
Ventilation
• Hyperventilation occurs: increasing RR, Tidal volume (by 45%)
Diaphragm
• Enlarging uterus elevates the diaphragm
• SOB (Dyspnea) because of pressure on the diaphragm and compression of the lungs:
usually happens at night when she lies flat
• Management: Head and chest elevated
Thoracic cage
Expand by means of flaring of the ribs hence increasing the mobility of rib attachments

G. Urinary tract
Ureters
• Ureters become dilated and elongated during pregnancy due to mechanical pressure
GFR
• GFR increases during pregnancy
• Glucosuria may be evident because of decrease renal threshold for glucose
• Protein in the urine should be reported because it may be a sign of hypertensive disorder
of pregnancy or renal problem

VII. Complications and discomforts of pregnancy

A. Breast tenderness
Cause:
• Increased estrogen and progesterone production
Management:
• Wear bra with wide shoulder straps for support
B. Constipation
Cause:
• Weight of growing uterus
• Slow intestinal peristalsis: because of Relaxin and progesterone: usually during
2nd trimester
Management:
• Evacuate bowels regularly
• Increase the amount of fluids and fibers in the diet

C. Fatigue
Cause:
• Increase metabolic demand
Management:
• Increase the amount of rest and sleep
• Avoid strenuous activity

D. Frequent urinations
Cause:
• Early: Pressure in the growing uterus on the anterior bladder
• Late: fetal head presses against the bladder
Management:
• Decrease the amount of caffeine consumed
• Explain that this occurrence is normal
• Void as often: urine stasis can lead to UTI: pain, burning on urination, blood in
the urine,

E. Hemorrhoids
Cause:
• Pressure in the rectal veins by the growing uterus
• varicosities of the rectal veins
Management:
• Regular bowel movement
• Rest in modified sim’s position
• Knee chest position at the end of the day (10-15 min)

F. Hypotension
Cause:
• Uterus pressing on vena cava
Management:
• Lie on the side
• Rise slowly
• Avoid extended periods of standing

G. Leukorrhea: whitish, viscous vaginal discharge

Cause:
• High estrogen level & increased blood supply to the vagina; epithelium and cervix
Management:
• Advised to take a baths or shower
• Wear cotton underwear
• Avoid wearing tight underwear or pantyhose

H. Muscle cramps
Cause:
• Decreased serum calcium and increased serum phosphorus levels
Management:
• Lie on the back & extend legs
**Waddling gait: change in center of gravity
**Softening of pelvic ligaments and joints: passage of fetus: bec of Relaxin and progesterone
I. Nausea, vomiting, pyrosis
Cause:
• Sensitivity to high levels of hcg, estrogen causing diminished gastric motility
Management:
• Increase carbohydrate intake
• Eat dry crackers before arising

J. Palpitations
Cause:
• Circulatory adjustments to increased blood volume
Management:
• Gradual and slow body movements

K. Palmar erythema
Cause:
• Increased estrogen level
Management:
• Apply calamine lotion

L. Varicosities: distended veins; inflamed, enlarged and painful

Cause:
• Pressure of the uterus on the veins of the lower extremities
Management:
• Use elastic support stockings: put them on before arising in the morning
• Rest in sims, on the back w/ legs raised against the wall or elevated in foot stool
• Exercise and walk: 2x a day: increase circulation
• Take Vitamin C (fresh fruits, juice) formation of blood vessel collagen
 M. Ankle edema: swelling of ankle and feet
Cause:
• Reduced blood circulation in the lower extremities
Management:
• Rest on the left side lying position
• Sitting w/ the legs elevated
• Avoid wearing constrictive clothing and knee high stockings

N. Backache
Cause:
• To maintain balance due to the growing uterus
• Increased estrogen & progesterone production
Management:
• Wear shoes w/ low heels
• Walk w/ the pelvis titled forward
• Apply local heat
• Squat rather than bend
• Lift object by holding them close to the body

O. Headache
Cause:
• Expanding blood volume puts pressure on the cerebral arteries
Management:
• Rest w/ a cold towel on the forehead
Danger signs of pregnancy
Sign
Swelling of face, finger, legs
Headache, continuous &
severe
Abdominal/ chest pain
Vaginal bleeding
Vomiting, persistent
Visual changes
Escape of vaginal fluids
Prepared by: Charmaine Dale B. Robles
Possible Cause
HPN of pregnancy & Thrombophlebitis
HPN of pregnancy
Ectopic pregnancy, uterine rupture, and pulmonary embolism
Placental problems (previa, abruption, premature separation)
Infection (also with fever and chills), and hyperemesis
HPN of pregnancy
Premature rupture of membrane