Module II

ANTEPARTUM
 PALAWAN STATE UNIVERSITY
College of Nursing and Health Sciences

Care of Mother and Child (Well Clients)

DIDACTICS

MODULE CONTRACT

Module Contract between GRACEL CAYE M. BERONIO (Student) and MA

ZENDRIA D. CATACUTAN (Instructor) for this module, Module 2: Antepartum, offered to
BSN II in 1st SEMESTER, SY 2020-2021.

TERMS & CONDITIONS

Learning resources required:
You need to obtain or access the following resources:
1. Maternal and Child Health Nursing
Care of the Childbearing & Childrearing Family 8th edition
JoAnne Silbert-Flag Adele Pillitteri
2. Google, Google classroom & Google meet.
3. Youtube
4. PSU Corporate Email

Requirement: You should complete this module on or before deadline

Module 1: Antepartum Week 2-4 (6 hours)

Course availability and completion assessment:

This module will be available for you online in google classroom or email address. Online
supplemental materials and useful links will be provided. Virtual class meetings will be
scheduled when necessary on the day and time of the class as reflected on your certificate of
registration (COR). Any concern or queries for this course will be entertained through email,
google classroom or scheduled google meeting. After the completion and submission of this
module, you can proceed to the next module. Completion of all the required modules for this
course will be one of the basis for the computation of your grades.

Type your name here as your Signature: GRACEL CAYE M. BERONIO

Date: SEPTEMBER 23, 2020
Mobile Number: 0917-553-2815
E-mail address: 201970020@psu.palawan.edu.ph
Anything I should know or you would like to share with me? NONE

MA ZENDRIA D. CATACUTAN, RN, MSN,ND

Instructor

PALAWAN STATE UNIVERSITY

College of Nursing and Health Sciences

Care of Mother and Child (Well Clients)

 DIDACTICS
Module 2 - Antepartum

STUDENT ACTIVITIES

Learning Outcome 1: Review the anatomy and physiology associated with conception and pregnancy

STUDENT ACTIVITY

IDENTIFY the female structures described by inserting your responses in the answer blanks.

1. UTERUS Chamber that houses the developing fetus

2. VAGINA Canal that receives the penis during sexual

intercourse

3. FALLOPIAN TUBE Usual site of fertilization

4. CLITORIS Erects during sexual stimulation

5. FALLOPIAN TUBE Duct through which the ovum/egg cell travels to

reach the uterus.

Learning Outcome 2: Define key terms associated with antepartal care

STUDENT ACTIVITY
DEFINE the following terms. Please refer to your Maternal & Child Health Nursing book, Chapter 9
Titled: Nursing Care During Normal Pregnancy and Care of the Developing Fetus, pages 173-199, to
find the answers.

1. Age of viability- the earliest age at which fetuses survive if they are born is generally accepted as 24
weeks or at the point a fetus weighs more than 500–600 g

2. Amniotic membrane- is a dual-walled sac with the chorion as the outmost part and the amnion as
the innermost part. The two fuse together as the pregnancy progresses, and by term, they appear to be
a single sac. They have no nerve supply, so when they spontaneously rupture at term (a pregnant
woman’s “water breaks”) or are artificially ruptured via a procedure, neither the pregnant woman nor
fetus experiences any pain

3. Cephalocaudal-(head-to-tail) direction; that is, head development occurs first and is followed by
development of the middle and, finally, the lower body parts. This pattern of development continues
after birth as shown by the way infants are able to lift up their heads approximately 1 year before
they are able to walk.

4. Chorionic membrane- The chorionic villi on the medial surface of the trophoblast (i.e., those that
are not involved in implantation because they do not touch the endometrium) gradually thin until
they become the chorionic membrane, the outermost fetal membrane.

5. Chorionic Villi- As early as the 11th or 12th day after fertilization, are miniature villi, resembling
probing fingers that reach out from the trophoblast cells into the uterine endometrium to begin
formation of the placenta. Chorionic villi have a central core consisting of connective tissue and fetal
capillaries surrounded by a double layer of cells, which produce various placental hormones, such as
hCG, somatomammotropin (human placental lactogen [hPL]), estrogen, and progesterone.
6. Decidua- the uterine endometrium will continue to grow in thickness and vascularity instead of
sloughing off as in a usual menstrual cycle. The endometrium is now typically termed the decidua
(the Latin word for “falling off”) because it will be discarded after birth of the child.

7. Embryo- Almost immediately, the blastocyst burrows deeply into the endometrium and establishes
an effective communication network with the blood system of the endometrium. Once implanted, the
zygote is called an embryo.

8. Estimated date of birth- It is impossible to predict with a high degree of accuracy the exact day an
infant will be born because fewer than 5% of pregnancies end exactly 280 days from the last
menstrual period; fewer than half end within 1 week of the 280th day. Traditionally, this date was
referred to as the estimated date of confinement (EDC). Because women are no longer “confined”
after childbirth, the acronym EDB (estimated date of birth) is more commonly used today.

9. Fertilization- is the union of an ovum and a spermatozoon. This usually occurs in the outer third of a
fallopian tube, termed the ampullar portion.

10. Fetoscopy- in which the fetus is visualized by inspection through a fetoscope (an extremely narrow,
hollow tube inserted by amniocentesis technique), can be yet another way to assess fetal well-being.
This method allows direct visualization of both the amniotic fluid and the fetus

11. Fetus- The healthy development of the unborn child, referred to as the fetus,

12. Foramen ovale- Because there is no need for the bulk of blood to pass through the lungs, the bulk of
this blood is shunted as it enters the right atrium into the left atrium through an opening in the atrial
septum called the foramen ovale.

13. Hydramnios- If for any reason the fetus is unable to swallow (esophageal atresia or anencephaly are
the two most common reasons), excessive amniotic fluid or hydramnios (more than 2,000 ml in total
or pockets of fluid larger than 8 cm on ultrasound) will result.

14. Implantation- contact between the growing structure and the uterine endometrium, occurs
approximately 8 to 10 days after fertilization. About 8 days after ovulation, the blastocyst sheds the
last residues of the corona and zona pellucida, brushes against the rich uterine endometrium (in the
second [secretory] phase of the menstrual cycle), and settles down into its soft folds.

15. McDonald’s rule- is a measure of the size of the uterus used to assess fetal growth and development
during pregnancy. It is measured from the top of the mother's uterus to the top of the mother's pubic
symphysis.

16. Meconium- a collection of cellular wastes, bile, fats, mucoproteins, mucopolysaccharides, and
portions of the vernix caseosa (i.e., the lubricating substance that forms on the fetal skin),
accumulates in the intestines as early as the 16th week.

17. Nonstress test- can be conducted using a portable monitor no bigger than 3 × 4 in. in size. A
birthing parent straps this device to the abdomen for 20 to 30 minutes at a set time every day or at
any time they feel contractions or are concerned about the lack of fetal movement

18. Oligohydramnios- reduction in the amount of amniotic fluid

19. Organogenesis- organ formation during 8 weeks gestation (the end of the embryonic period)

20. Surfactant- a phospholipid substance, is formed and excreted by the alveolar cells of the lungs
beginning at approximately the 24th week of pregnancy. This decreases alveolar surface tension on
 expiration, preventing alveolar collapse and improving the infant’s ability to maintain respirations in
the outside environment at birth

21. Trophoblast - the cells in the outer ring. They are the part of the structure that will later form the
placenta and membranes.

22. Umbilical cord- is formed from the fetal membranes, the amnion and chorion, and
provides a circulatory pathway that connects the embryo to the chorionic villi of the placenta. Its
function is to transport oxygen and nutrients to the fetus from the placenta and to return waste
products from the fetus to the placenta.

23. Zygote- Immediately after penetration of the ovum, the chromosomal material of the ovum and
spermatozoon fuse to form a zygote. (From fertilization to implantation)

Learning Outcome 3: Differentiate between the stages of fetal development

STUDENT ACTIVITY
Assign the correct gestational age to the description. Answers can be found from your book (Chapter 9)

1. End of Eighth Gestational Week - Heart has septum and valves. Facial features are
definitely discernible.

2. End of 32nd Gestational Week - Average weight is 1,600 grams; assumes delivery
position ; iron stores begin building.

2. End of 36th Gestational Week - Additional subcutaneous fat is deposited; lanugo

starts to diminish.

4. End of 28th Gestational Week - Average weight is 1,200grams; lung alveoli are almost
mature; surfactant can be found in amniotic fluid

5. End of 16th Gestational Week - Formation of lanugo; liver and pancreas are
functioning; fetus demonstrates swallowing reflex.

6. End of 20th Gestational Week - Spontaneous fetal movements experienced by the

mother; beginning of vernix caseosa.

7. End of 12th Gestational Week (First Trimester) - Nail beds forming on toes and fingers;
tooth buds present; heart sounds
audible by Doppler instrument.

8. End of 24th Gestational Week (Second Trimester) - Average weight is 550grams; eyes
are open; pupils reactive to light.

Learning Outcome 4: Differentiate between the signs of pregnancy

STUDENT ACTIVITY
Match the terms in Column II with a definition, example, or related statement from Column I. Place the letter
corresponding to the answer in the space provided. Terms can be used more than once. Answers can be found
from your book.

COLUMN I COLUMN II
B
_____1. Positive test for hCG hormone in urine a. Presumptive sign of pregnancy
C
_____2. Palpation of fetal movements b. Probable sign of pregnancy
A 3. Quickening
_____ c. Positive sign of pregnancy
B
_____4. Chadwick sign
A
_____5. Striae gravidarum
C
_____6. Auscultation of fetal heart sounds
B
_____7. Fetal outline felt by examiner
A
_____8. Breast changes
B
_____9. Braxton hicks contractions
C
_____10. Sonographic evidence of fetal outline

Learning Outcome 5: Describe common physiological changes of pregnancy and relate it to clinical
manifestations

STUDENT ACTIVITY (ESSAY)

1. The heart may increase in size during pregnancy due to an increase in its workload. Why do you think
the workload of the heart has to increase? (5 POINTS)

The heart may increase in size due to an increase in its workload, such as a 25% to 50% increase in
cardiac output to increase blood volume (from 4,000 to 5250 ml). This would be essential in order to
compensate for blood loss at birth, ensure transport of nutrients to fetus. Thus it has to pump blood
through the placenta, fetus and the much larger uterus and abdomen of the pregnant woman.

Workload of the heart is also increased in order to supply nutrients via the bloodstream, for the
mother and her unborn child. An example of these would be the supply of iron (800 μg more daily)
which contribute to fetal growth, and increase maternal red blood cells.

2. What information might help you to make a decision on the need for medical advice when a pregnant
woman has shortness of breath? (5 points)

The uterus enlarges so much during pregnancy, the diaphragm, and ultimately, the lungs, receive
an increasing amount of pressure. Toward the end of pregnancy, this can actually displace the
diaphragm by as much as 4 cm upward. Even with all this crowding, however, a woman’s vital
 capacity (the maximum volume exhaled after a maximum inspiration) does not decrease during
pregnancy because, although the lungs are crowded in the vertical dimension, they can still expand
horizontally. Two major changes do occur with pregnancy: a more rapid than usual breathing rate (18
to 20 breaths/min) and a chronic feeling of shortness of breath

Shortness of breath and difficulty breathing while lying down may be due to the mechanical effect
of the enlarging uterus as pregnancy progresses. Palpitations, or an awareness of the heartbeat, may
occur because the diaphragm shifts up in the chest during pregnancy, causing the heart to sit higher in
the chest. Any of these symptoms occurring at rest may be serious and due to underlying significant
heart disease and should be further evaluated.

During pregnancy, many women find they get short of breath. This is because the growing baby
crowds the mother’s lungs and she has less room to breathe. But if a woman is also weak and tired, or
if she is short of breath all of the time, she should be checked for signs of sickness, heart problems,
anaemia or poor diet. Medical advice is needed if she may have any of these problems.

3. After how many weeks of pregnancy can the fundus of the uterus be palpated at the height of the
woman’s umbilicus (belly-button)? (2 points)

The fundus of the uterus can be palpated at the height of the woman’s belly-button by the 20th or
nd
22 week of pregnancy.

Learning Outcome 6: Recommend interventions to manage the discomforts of pregnancy

STUDENT ACTIVITY (ESSAY)

Case Study

Coleen, 31 years of age, visits your clinic for her first prenatal check-up. She is in her first trimester of
pregnancy. She complains of skipping heartbeats, headache, and nausea, and states she is worried that the
“tension” of her job as an accountant in a perfume factory will have a negative effect on her baby. Her blood
pressure and pulse are in normal range.

1. What would you explain to Coleen about a common physical change of pregnancy that has likely
resulted in both the headache and heart palpitation? What will you recommend to her to address her
problem?(15 points)

It must be explained to Coleen bit by bit that there are a number of discomforts that can be felt
during the first trimester. This is the time when the body is just starting to adjust to the pregnancy, and
hormones are still in chaos.

Thus, her heart palpitations could be an underlying manifestation or signs of normal pregnancy.
These may occur when upon sudden movement the woman experiences bounding palpitation of the
heart. This is mainly due to circulatory adjustments necessary to accommodate her increased blood
supply during pregnancy. The nurse could recommend Coleen that she should always be slow and
steady. Advise the woman to move in slow, gradual movements to prevent heart palpitations.

Moreover, it must be explained to Coleen also that many women experience headaches during
pregnancy, apparently from their expanding blood volume, which puts pressure on cerebral arteries.
Causative situations must be reduced, such as eye strain or tension, this may lessen the number of
headaches she experience. Resting with an ice pack on the forehead and taking a usual adult dose of
acetaminophen usually furnishes adequate relief (Spierings & Sabin, 2016). Compounds with
ibuprofen (Motrin, Advil) (class C drugs) are not usually recommended.
 On the other hand, nausea and vomiting are also one of the earliest symptoms of pregnancy. Pyrosis
or heartburn typically occurs when the woman ate a large meal. It is advised that Coleen must take
small frequent feedings and avoid greasy foods. Encourage her to keep in an upright position after
meals to avoid reflux.

2. What measures would you suggest to help Coleen reduce anxiety from her job? (10 points)

Assuming to be her attending nurse, the following measures are supposed to be taken in order to
reduce anxiety from her job:

First, tell her that it is okay to feel anxious and afraid for her baby’s well-being during her
pregnancy, and assure her that there are many ways on how to protect her unborn child and herself
during this time.

“If you’re feeling very anxious during your pregnancy, it’s important to tell someone. Me as
your nurse, your partner, a close friend, or family member may be able to offer support. Simply
sharing your thoughts and feelings may be enough to keep them from taking over your everyday
life.”
Second, engaging in activities that help to lower stress and anxiety may be a good option.
Physical activity helps the body release endorphins. These act like natural painkillers in the brain.
Moving the body is one of the most recommended ways to manage stress.

Third, she should make sure that she’s getting enough sleep. Though sleep may seem elusive
during pregnancy, making it a priority may help significantly with anxiety symptoms.

Lastly, suggest to her that if possible, refrain from her work for the mean time because
working for a great amount of period in the perfume factory could possibly have a negative effect
to the unborn baby, especially if she is exposed. Most perfumes contain Phthalates, these are
found most commonly in commercial air fresheners, perfume, household cleaning products,
detergents and personal care products to convey their smells. Fetuses exposed to phthalates in utero
may also be born prematurely, below normal birth weight and more susceptible to becoming obese.
Learning Outcome 7: Identify various prepared childbirth education methods

STUDENT ACTIVITY

Supply the missing term or the information requested. (Fill in the Blanks)

1. Encouraging progressive breathing, including conscious relaxation, is called psychosexual method.

2. Effleurage is light abdominal massage in conjunction with breathing exercises.

3. Kegel exercises are used with repetition to strengthen the floor of the perineum.

4. Prevention of pain during birth by use of the mind is called psychoprophylactic method.

Match the terms in Column I with a definition, example, or related statement from Column II. Place the letter
corresponding to the answer in the space provided.

COLUMN I COLUMN II

D
_______1. Imagery a. Measure that maintains blood supply to the
lower limbs while stretching the perineum
F
_______ 2. Dick-Read Method b. A physical response prompted by the
occurrence of a stimulus
B
_______3. Conditioned Reflex c. Method of childbirth based on the belief that
birth is a natural process that should include
the partner during the entire birthing process
A
_______4. Tailor sitting d. Intense focusing on an object (“sensate
focus”) to keep sensory input from reaching
the cortex of the brain
E
_______5. Squatting e. Positioning the feet flat on the floor while
stretching the perineal muscles
C
_______6. Bradley method f. Methods of childbirth based on the premise
that fear leads to tension, which leads to pain
Learning Outcome 8: Evaluate expected outcomes of nursing care for antepartal clients thru the nursing
process

STUDENT ACTIVITY:

Search the internet and copy paste to a new word document THE LIST OF ALL NURSING DIAGNOSIS
(latest) (20 points). Send it to me together with this module on the deadline date. Make sure the you read all
the nursing diagnoses and familiarize yourself because you are going to use it in your Nursing Care Plan.

________________ ON A S E P A R A T E P D F F I L E ________________________
STUDENT ACTIVITY
Create a Nursing Care Plan given the following Assessment Data. (30 points)
ASSESSMENT/CUES
SUBJECTIVE DATA:
(Patient Verbalized)
“Kapag nagbabyahe ako o nasa
labas, nahihilo ako, tapos
parang naduduwal ako
lagi,kaya naman lagi ako
dumudura o kumakain ng
candy.”
OBJECTIVE DATA:
3 months pregnant as
confirmed by
ultrasound I
Increase swallowing
Increase salivatioN
Gagging action
NURSING PLANNING/ INTERVENTION
DIAGNOSIS OBJECTIVE
Nausea related to Patient will report a Determine the cause, and
motion-sickness decrease in nausea if whether nausea is
associated with within in 6 hours. potentially self-limiting
pregnancy . and/or mild. (eg. First
trimester of pregnancy)
The patient will Eliminate strong odors
verbalize underlying from the surrounding
manifestations of the (e.g., perfumes, dressings,
nausea and 3 emesis)
techniques shared by
the nurse on how to
reduce it. Allow the patient to use
non-pharmacological
nausea control techniques
such as relaxation, guided
imagery, music therapy,
distraction, or deep
breathing exercises.
Give frequent, small
amounts of foods that
appeal to the patient.
Example: Dry food like
crackers or toast
RATIONALE EVALUATION
Indicates degree of After 6 hours, the
effect on patient should have
fluid/electrolyte reported a decrease in
balance and nutritional nausea.
status.
The patient should
have verbalized
Strong and noxious understanding of the
odors can contribute to causative factors and
nausea. known necessary
interventions.
These methods have
helped patients
alleviate the condition
but needs to be used
before it occurs.
This approach will
help maintain
 nutritional status. For
some patients, an
empty stomach
exacerbates nausea.

Crackers or toast
before rising are
especially known to be
effective for
pregnancy-related
nausea.

Review about the prenatal

vitamins the patient is
taking.
Having too much iron
may cause nausea, and
switching to a
different vitamin could
help.