107 lesson 9
it is not contaminated with virus and bacteria.
NURSING Care to promote FETAL AND MATERNAL
HEALTH
• Prenatal visit is the ideal setting where nurses
can give their health promotion and
education. This is where woman are eager to
learn things about what is happening on their
pregnancy journey. Emphasize the different
physiological and psychological changes.
Health promotion during pregnancy
 Self-care needs- pregnancy is a state of
wellness, few special care measure or advice
other than common sense measures about
self-care are needed. Many women , however
have heard different warning what they
should do and what should not do during
pregnancy.
• Bathing –sweating tends to increase because
woman excretes waste products for both
herself and fetus. She also has increase
vaginal discharges.
• Breast care- woman should wear firm and
supportive bra since there’s an increase of
breast size. 16th week of pregnacy colostrum
secretions begin
• Dental care- woman experience tirednes in
dental hygiene
• Perineal hygiene- increase vaginal discharge
• Sexual activity- sexual changes occur during
pregnancy. Asking woman at prenatal about
sexual activity allow her to voice the concerns
• Clothing- maternity clothing should be
comfortable. Avoid garterized garments.
• Exercise- assess properly the condition of the
pregnant woman before giving advice on the
exercise. Identify contraindications and
complications.
• Sleep- body growth occurs during sleep.
• Employment- always consider the working
environment if it is not harmful and toxic to a
pregnant woman.
• Travel- consider the environment to travel if
If it is long trip, advice for frequent rest.
Minor body changes of pregnancy
 THE FIRST TRIMESTER DISCOMFORTS
 Breast tenderness- first symptoms noticed
during early pregnancy
 Palmar erythema- or palmar pruritus occurs
in early prenancy and is probably cause d by
increased estrogen levels.
 Nausea, vomiting and pyrosis- symptoms
related to nutrition
 Fatigue- relieved by increase rest and sleep.
 Muscle Cramps- this problem is best relieved
if a woman lies on her back momentarily and
extends the involved leg while keeping her
knee straight and dorsiflexing the foot.
 Hypotension-advice the pregnant woman not
to sleep in suoine position but instead
sidelying position to promote circulation.
 Varicosities- commonly form in pregnancy
because of the weight of a distended uterus
puts pressure on the veins returning blood.
 Hemorrhoids- or varicosities in rectal veins
 Heart Palpitations- circulatory adjustments
necessary to accomodate increased blood
supply.
 Frequent urination- growing fetus on anterior
bladders
 Abdominal Discomfort-uncomfortable feeling
of abdominal pressure early inpregnancy
 Leukorrhea- whitish, viscous vaginal discharge
or an increase in the amount of normal
vaginal secretions
THE SECOND AND THIRD TRIMESTER DISCOMFORTS
 Muscular/Skeletal discomfort- lumbar
lordosis develops and postural changes
necessary to maintain balance lead to
backache
 Headache- because of expanding blood
volume which puts pressure on cerebral
arteries
  Dyspnea-expanding uterus places pressures
on the diaphragm, lung compression and
shortness of breath result.
 Ankle Edema- noticeable at the end of the
day. As long as proteinuria and hepertension
is absent then it can be considered as normal.
 Braxtons Hicks Contraction- periods of
abdominal contractions
PREVENTING FETAL EXPOSURE TO TERATOGENS
• Teratogens -Any factor that adversely affects
fertilized ovum, embryo or fetus. A fetus is
extremely vulnerable to environmental
injury, specifically at the beginning or early
weeks of pregnancy.
 Teratogenic maternal infections- involve viral,
bacterial or protozoan organism which cross
placenta from mother to fetus.
• Malaria- caused by intraerythrocytic protozoa
(Plasmodium)
• Toxoplamosis- protozoan infection from
uncooked meat
• Rubella ( German Measles)- virus usually
causes only a mild rash and mild systemic
illnes in a woman. But devastating in fetus
(hearing impairment,cataract,cognitive and
motor challenges, cadiac defect(ductus
arteriosus)
• Herpes Simplex Virus (Genital herpes
Infection)- virus from sexual contact. Can
cause premature birth, growth restriction,
neurologic diseases.
• Cytomegalovirus- member of HSV
family(droplet infection), can cause extensive
damage to a fetus while causing few
symptoms to a woman. The newborn skin
may covered with large petechia (“ blueberry-
muffin lesion”)
• Syphilis- sexually transmitted infection (
Treponema pallidum)
• Potentially Teratogenic Vaccines- Live virus
vaccines such as measles , HPV, mumps,
rubella and poliomyelitis are contraindicated
during pregnancy because they can transmit
viral infection to a fetus.
• Teratogenic Drugs- drugs that are harmful to
the fetus. Only prescribed drugs are to be
taken.
• Herbs- are not regulated by the DFA in the
way as medications; therefore, they are not
rated with regards to their safety to in
pregnancy.
• Teratogenicity of Alcohol- no amount of
alcohol is allowed during pregnancy. It may
lead to vitamin B deficiency neurologic
damage
• Teratogenicity of Tobacco- cause growth
restrictions,SIDS, low birth weights from
vasoconstriction on uterine wall.
• Environmental Teratogens- impure air and
water can be damaging to a fetus
• Metal and Chemical hazards- pesticides and
carbon monoxides are example of chemical
teratogens that should be avoided.
• Radiation- growing cells are extremely
vulnerable to destructiion by radiation
• Hyperthemia- detrimental effect to growing
fetus because it interferes with cell
metabolism.
• Teratogenic Maternal stress- can cause
anxiety and worry beyond usual amount could
cause physiological changes.
Lesson 10
Promoting Nutritional Health During Pregnancy
ADPIE
• Hyperplasia- Fetal growth that is associated
with increase in the number of cell formed in
early pregnancy.
• Hypertrophy- Enlargement of existing cells in
late pregnancy.
 Recommended weight gain- 11.2 to 16kg (25
to 40 lb)
• Underweight: BMI less tha 18.5
• Overweight: BMI more than 25 to 29.9
Note: use BMI computation
The Woman who is Underweight
 - A woman who enter a pregnancy underweight  Mineral needs- necessary for building new
needs nutritional counseling just as much as cells in a fetus.
an overweight woman. Underweight is
 Fiber needs- Constipations may occur,
defined as a state in which a womans weight
peristalsis is low during pregnancy.
is 10% to 15% less than the ideal weight for
her height.  Fluids needs- extra amount of water are
needed durimng pregancy to promote kidney
Contributing factors for underweight pregnant:
function.
• Dieting for weight loss

• Inability to buy adequate food while

impoverished

• Excessive worry or stress,which can a chronic

loss of appetite

• Depression ,which can cause a chronic loss of

appetite

• An eating disorder,such as anorexia nervosa

or bulimia in which a woman has developed
an unhealthy relationship with food

Components of healthy nutrition for Pregnant

woman.

The pregnant woman should always “eat for two”

that it could benefit the growing fetus inside the
womb.

• Energy (Calorie) Needs- 2,200 calories for Foods to avoid or limit in pregnancy
childbearing woman. Ana additional of 300
calories is recommended to meet the • Alcohol- no amount of alcohol is allowed
increased need of pregnancy (Whitney&
• Caffeine- central nervous sytem stimulant
Rolfes,2016)
capable in increasing heart rate, diuresis and
• Protein Needs- 34 to 46g. During the secretion of acid in the stomach
pregnancy, the need for protein increases to
• Artificial sweeteners- pregnant women needs
71g daily.
gluccose from regular sugar
 Complete proteins- contain 9 essential amino
• Weight loss diets-weight reduction is not
acids required.
wise.
 Incomplete pretein- nonanimal sources does
Promoting Nutritional Health
not contain essential amino acid.
Nutritional outcomes
 Complementary proteins- proteins that when
cooked together provide essential amino acid. • Family considerations- meal planning is best
when it is planned with the family.
 Fat Needs- Omega 3 fatty acids, particularly
Linoleic acid are fats that are essential for new • Financial considerations- women would view
cell growth but cannot be matured by the that food expenditure is benificial for her
body. baby

 Vitamin Needs- the intake of vitamins as a • Cultural considerations- it should always

daily dietary supplementary has become culturally favored
common place.
 Common problems: 2. THE PASSENGER ( THE FETUS) is of adequate
size and in an advantageous position and
• Nausea and vomiting
presentation.
• Cravings
3. THE POWER of labor (uterine factors) are
• Pyrosis adequate.

• Hypercholesterolemia 4. THE PSYCHE or woman’s psychological state

which may either encourage or inhibit labor.
Lesson 11 This can be based on her past life experinces
Theories of why labor begins as well as her present psychological state.

 Labor is a series of events by which uterine

contraction contractions and abdominal 1. THE PASSAGE( a womans pelvis)
pressure expel a fetus and placenta from the
uterus. - Refers to the route a fetus must travel from
the uterus through the cervix and vagina to
 Labor and birth are unique events requiring a the external perineum.
woman to employ all the psychological and
physical coping methods she has available.

Combined Theories:

• The uterine muscle stretches from the

increasing size of the fetus , which results in
release of prostaglandins.

• The fetus presses on ghe cervix, which

stimulates the release of oxytocin from
posterior pituitary.

• Oxytocin stimulation works together with

2. THE PASSENGER (the fetus)
prostaglandins
-the body part of the fetus that has the widest
• Changes in the ratio of estrogen in relation to
diameter is the head, so this is the part least likely to
progesterone occurs , increasing estrogen in
be able to pass through the pelvic ring.
relation to progesteron,which interpreted as
progesterone withdrawal. -the cranium, the uppermost portion of the skull, is
composed of eight bones.
• The placenta reaches the a set age,which
triggers contraction. - The smallest diameter of fetal skull: 9.25cm
(Biparietal diameter or tranverse)
• Rising fetal cortisol level reduce
progesterone formnation and increase - The smallest anteroposterior diameter: 9.5cm
prostaglandin formation. (suboccipitobrematic measure)- measure
from inferior aspect of the occiput to the
• The fetal membrane begins to produce
center of the anterior fontanelle.
prostaglandins which stimulates contraction.
( Bienstock ,Fox & Wallach ,2015) Fetal Presentation and Position:
The components of labor • Fetal attitude- describes the degree of flexion
a fetus assumes during labor or the relation of
 A successful labor depends on four
the fetal parts to each other. A fetus in good
integrated concepts often referred to as the
attitude is in complete flexion.
four P’s:
Legend:
1. THE PASSAGE( a womans pelvis) is adequate
size and contour. a. Vertex (full-flexion)

b. Sinciput (moderate flexion)

 c. Brow (partial extension)

d. Face (complete extension) 3. THE POWER- the third important requirement for a
successful labor is effective power of labor. This is the
Fetal Lie- is the relationship between the long
force supplied by the fundus of the uterus and
(cephalocaudal) axis of the fetal body and the
implemented by the uterine contraction which causes
long axis of the woman.
cervical dilatation and then expulsion of the fetus
• Fetal presentation- denotes the body part from uterus.
that will first contact the cervix or be born
first and is determined by the combination of
fetal lie and degree of fetal flexion. or the woman psychological outlook that brings into
labor.
• Fetal position- is the relationship of the
presenting part to a specific quadrant and side Nursing role and responsibility:
of woman pelvis.
• Provide adequate support.
1. In a vertex presentation- the occiput is the
• Encourage woman to ask question during
chosen points
prenatal visit.
2. In a face presentation- it is the chin.
• Psychological task should be realized.
3. In a breech presentation- it is the sacrum

4. In shoulder presentation – it is the scapula or

the acromion process.

Fetal position- is the relationship of the

presenting part to a specific quadrant and side
of woman pelvis.

Mechanism (cardinal movement) of labor

• Effective passage of a fetus through the birth

canal involves not only position and
presentation but also a number of different
position changes in order to keep the smallest
diameter of the fetal head in the pelvis.

1. DESCENT- is the downward movement of the

biparietal diameter of the fetal head in the
pelvic inlet.

2. FLEXION- as descent is completed and the

fetal head touches the pelvic floor, the head
bends forward onto the chest causing the
smallest anteroposterior diameter.

3. INTERNAL ROTATION- the occiput rotates so

the head is brought into the best relationship
to the outlet of the pelvis

4. EXTENSION- the head extends , and the

foremost parts of the head , the face and the
chin are born.

5. EXTERNAL ROTATION- the final rotation of

the fetus

6. EXPULSION- delivery of the baby