NURSING ROLE IN

CARING FOR THE

PREGNANT FAMILY

PREPARED BY
PERTHA MARIE S. ALVARICO, MSN, RN
ASSESSMENT FOR THE PRESENCE OF
GENETIC DISORDER

▪ History Taking

▪ Physical Assessment
 ASSESSMENT FOR THE PRESENCE OF
GENETIC DISORDER
▪ Diagnostic Testing

1. Karyotyping
2. Barr Body Determination
3. Alpha Fetoprotein Analysis
4. Chorionic Villi Sampling
5. Amiocentesis
6. Percutaneous Umbilical Blood Sampling
7. Sonography
8. Fetoscopy
9. Preimplantation Diagnosis
 STAGES OF FETAL DEVELOPMENT
1. Fertilization – depends on 3 separate factors
a. Equal maturation of both sperm and ovum
b. Ability of the sperm to reach the ovum
c. Ability of the sperm to penetrate the zona pellucida and cell membrane

2. Implantation

3. Embryonic and Fetal Structures

a. The Decidua
b. Chorionic Villi
c. The Placenta
d. The Umbillical Cord
e. The Membranes and Amiotic Fluid
 TERM USED TO DENOTE FETAL
GROWTH
Name Time Period

Ovum From ovulation to fertilization

Zygote From fertilization to implantation

Embryo From implantation to 5-8 weeks

Fetus From 5-8 weeks until term

Conceptus Developing embryo or fetus and placenta structures

throughout pregnancy
 STAGES OF FETAL
DEVELOPMENT
Origin and Development of Organ Systems
Primary Germ Layers

a. Ectoderm
b. Mesoderm
c. Entoderm
Cardiovascular System
Fetal Circulation
Fetal Hemoglobin
Respiratory System
Nervous System
 STAGES OF FETAL
DEVELOPMENT

Endocrine System
Digestive System
Musculoskeletal System
Reproductive System
Urinary System
Integumentary System
Immune System
 DETERMINATION OF
ESTIMATED BIRTH DATE

▪ EDC – estimated date of confinement

▪ EDD – estimated date of delivery
▪ EDB - estimated date of birth

“It is impossible to predict the day of

birth with a high degree of accuracy.”
 DETERMINATION OF
ESTIMATED BIRTH DATE
▪ Gestational Age Wheels
▪ Birth Date Calculators
▪ Nagele’s Rule Nagele’s Rule
To calculate the date of birth, count
backward 3 calendar months from
the first day of the last menstrual
period and add 7 days
ASSESSING FETAL WELL-BEING
▪ Fetal Movement
▪ Fetal Heart Rate
▪ Ultrasound
▪ Placental Grading
▪ Amniotic Fluid Volume
Assessment
▪ Electrocardiography
▪ Magnetic Resonance Imaging
▪ Maternal Serum Alpha-
Fetoprotein
▪ Triple Screening
▪ Chorionic Villi Sampling
▪ Amniocentesis
▪ Lecithin/Sphingomyelin Ratio
▪ Percutaneous Umbillical Blood
Sampling
▪ Amnioscopy
▪ Fetoscopy
PSYCHOLOGICAL & PHYSIOLOGICAL
CHANGES
OF PREGNANCY
THE DIAGNOSIS OF PREGNANCY

I. Presumptive Signs of Pregnancy

II. Probable Signs of Pregnancy

III. Positive Signs of Pregnancy

PRESUMPTIVE SIGNS OF PREGNANCY

▪ Signs that are least

indicative of pregnancy

▪ Largely subjective in that

they are experienced by the
woman but cannot be
documented by the
examiner.
PROBABLE SIGNS OF
PREGNANCY

▪ In contrast with the

Presumptive Signs of
pregnancy, these can be
documented by the examiner.

▪ Although they are more

reliable than presumptive
signs, they are not positive or
true diagnostic findings.
POSITIVE SIGNS OF PREGNANCY
▪ There are only 3 positive signs of
pregnancy

1. Demonstration of fetal heart separate

from the mother’s

2. Fetal movements felt by the

examiner

3. Visualization of the fetus by

ultrasound
 PSYCHOLOGICAL CHANGES OF
PREGNANCY

▪ Social Influences

▪ Cultural Influences

▪ Individual Influence
 PSYCHOLOGICAL TASKS OF
PREGNANCY

i. First Trimester: Accepting the Pregnancy

ii. Second Trimester: Accepting the Baby

iii. Third Trimester: Preparing for Parenthood

- Reworking developmental task
- Role-Playing and Fantasizing
EMOTIONAL RESPONSES TO PREGNANCY
 Ambivalence
 Grief
 Narcissism
 Introversion vs. Extroversion
 Body Image and Boundary
 Stress
 Couvade Syndrome
 Emotional Lability
 Changes in Sexual Desire
 Changes in the Expectant Family
PHYSIOLOGIC CHANGES OF PREGNANCY

1. Reproductive System
Changes
- Uterine Changes
- Amenorrhea
- Cervical Changes
- Vaginal Changes
- Ovarian Changes
2. Changes in the breast
PHYSIOLOGIC CHANGES OF
PREGNANCY

3. Systemic Changes
▪ Integumentary System
▪Respiratory System
▪Temperature
▪Cardiovascular System
▪GI/GU System
▪Skeletal System
▪Immune System
 ASSESSMENT DURING
PRENATAL VISIT

1. Initial Interview
2. Components of Health History-
Demographic data, chief concerns, family
profile, hx of past illness, hx of family
illness, day history/social profile,
gynecologic hx, obstetric hx, baseline
height and weight and vital signs
measurement,review of systems
3. Measurement of fundal height and fetal
heart sounds
 ASSESSMENT DURING PRENATAL VISIT

4. Pelvic Examination 10. Estimating Pelvic Size

5. External Genitalia a. Diagonal
6. Internal Genitalia Conjugate

7. Pap Smear
8. Vaginal Inspection b. True Conjugate/
Conjugate Vera
9. Rectovaginal
Examination
c. Ischial tuberosity
ASSESSMENT DURING
PRENATAL VISIT

11. Laboratory Studies

- Blood Studies
- Urinalysis
- Ultrasonography
- Tuberculosis
Screening
PROMOTING FETAL AND MATERNAL
HEALTH
HEALTH PROMOTION DURING
PREGNANCY
1. Self- Care Needs-
bathing, breast care, dental
care, perineal hygiene,
dressing
2. Exercise
3. Sleep
4. Sexual Activity
5. Employment
6. Travel
▪ Self- Care Needs- bathing, breast care, dental care,
perineal hygiene, dressing
Exercise
▪ Sleep
▪ Sexual Activity
▪ Employment
▪ Travel
DISCOMFORTS OF EARLY PREGNANCY
The First Trimester

Breast tenderness
Palmar Erythema
Constipation
Nausea, Vomiting
and Pyrosis
Fatigue
Muscle Cramps
DISCOMFORTS OF EARLY PREGNANCY
The First Trimester
Hypotension
Varicosities
Hemorroids
Heart Palpitation
Urinary Frequency
Abdominal
Discomfort
Leukorrhea
DISCOMFORTS OF MIDDLE TO
LATE PREGNANCY

Backache
Headache
Dyspnea
Ankle Edema
Braxton Hicks
Contraction
DANGER SIGNS OF PREGNANCY
 Vaginal Bleeding
 Persistent Vomiting
 Chills and Fever
 Sudden escape of fluid from the
vagina
 Abdominal or chest pain
 Pregnancy-Induced Hypertension
 Increase or Decrease in Fetal
Movement
PREVENTION OF FETAL EXPOSURE TO TERATOGENS
1. Teratogenic Maternal Infections
2. Potential Teratogenicity of Vaccines
3. Teratogenicity of Drugs
4. Teratogenicity of Alcohol
5. Teratogenicity of Cigarettes
6. Environmental Teratogens
7. Teratogenicity of Maternal Stress
PREPARATION FOR LABOR

▪ Lightening
▪ Show
▪ Rupture of the
Membranes
▪ Excess Energy
▪ Uterine Contraction
PROMOTING NUTRITIONAL HEALTH
DURING PREGNANCY
RELATIONSHIP OF MATERNAL
DIET TO INFANT HEALTH
▪ Recommended Weight Gain During Pregnancy
▪ Calculating Body Mass Index

NORMAL PREGNANCY BMI

Underweight Under 19.8

Normal Weight 19.8 – 26.0

Overweight 26.1 – 29.0

Obese Above 29.0

COMPONENTS OF HEALTHY NUTRITION

1. Calorie Needs
2. Protein Needs
3. Fat Needs
4. Vitamin Needs
5. Mineral Needs
6. Fluid Needs
7. Fiber Needs
 FOODS TO AVOID IN PREGNANCY

 Foods with Caffeine

 Artificial Sweeteners
 Weight Loss Diets
 PROMOTING NUTRITIONAL
HEALTH DURING PREGNANCY

1. Family
Consideration

2. Financial
Consideration

3. Cultural
Consideration
 MANAGING COMMON PROBLEMS
AFFECTING NUTRITIONAL HEALTH
1. Nausea and Vomiting
 MANAGING COMMON PROBLEMS
AFFECTING NUTRITIONAL HEALTH

2. Cravings
 MANAGING COMMON PROBLEMS
AFFECTING NUTRITIONAL HEALTH

3. Pyrosis
 MANAGING COMMON PROBLEMS
AFFECTING NUTRITIONAL HEALTH
4. Hypercholesterolemia
PROMOTING NUTRITIONAL HEALTH
IN WOMEN WITH SPECIAL NEEDS

1. The Adolescent
2. The Woman Over
Age 40
3. The Woman with
decreased
nutritional stores
4. The woman who
is underweight
5. The woman who
is overweight
6. The woman who
is a vegetarian
PROMOTING NUTRITIONAL HEALTH IN
WOMEN WITH SPECIAL NEEDS

11. The woman who eats

many eats many fast-food
meals
12. The woman with lactose
intolerance
13. The woman with
Hyperemesis Gravidarum
PROMOTING NUTRITIONAL HEALTH
IN WOMEN WITH SPECIAL NEEDS

7.The woman with PKU

8. The woman with a
multiple pregnancy
9. The woman who smokes
or uses drugs and alcohol
10. The woman with
concurrent health
problems
THANK YOU!!!