Constipation Alteration in elimination related to physiologic and anatomic
changes in pregnancy including alteration in gastrointestinal tone by relaxation of smooth muscle, increased nausea
and vomiting and displacement of small
and large intestine by gravid uterus.
Problem No. 2: Altered fluid intake related to nausea and vomiting
Goal: Normal fluid intake
Outcome: Normal fluid intake and decreased nausea and vomiting
Nursing Actions
1. Assess factors that increase nausea and vomiting.
2. Suggest small frequent meals.
3. Decrease fluid intake with meals.
4. Avoid high-fat and spicy food.
5. Explore contributing factors to nausea in pregnancy.
6. Teach strategies for dealing with nausea in pregnancy.
7. Encourage the woman to experiment with strategies to alleviate nausea.
8. Suggest vitamin B6or ginger to decrease nausea.
Problem 3: Decreased gastric motility Goal: Increased motility
Outcome: Patient has normal bowel movement.
Nursing Actions
1. Provide dietary information to increase fiber and roughage in diet.
2. Review high-fiber foods, for example, pears, apples, prunes, kiwis, and dried fruits.
3. Bran cereal in the morning and instruct woman to check labels for at least 4–5 grams of fiber per serving.
4. Discuss strategies to increase fluid intake.
5. Drink warm liquid upon rising.
6. Encourage exercise to promote peristalsis.
7. Reinforce relationship of diet, exercise, and fluid intake on constipation.
Problem 4: Discomfort with defecation because of hemorrhoids Goal: Decreased pain with bowel movement
Outcome: Patient will have decreased pain and maintain ade- quate bowel function.
Nursing Actions
1. Reinforce strategies to avoid constipation.
2. Encourage the woman to not avoid defecation.
3. Instruct the woman to avoid straining on evacuation.
4. Discuss care of hemorrhoids, including TUCKS pads and hemorrhoid creams.
5. Discuss use of stool softeners.
6. Recommend that the woman support a foot on a foot stool to facilitate bowel evacuation.
7. Reinforce relationship of diet, exercise, and fluid intake on constipation.
TYING IT ALL TOGETHER
As a nurse in an antenatal clinic you are part of an interdisci- plinary team that is caring for Margarite Sanchez during her pregnancy. Margarite is a 28-year-old G3 P1 Hispanic woman here for her first prenatal care appointment. By her LMP she is at 8 weeks’ gestation. Margarite reports some spotting 2 weeks ago that prompted her to do a home pregnancy test that was positive. The spotting has stopped. She tells you that she is very tired throughout the day, has some nausea in the morning and breast tenderness. She is happy to be pregnant but a bit surprised.
Outline the aspects of your initial assessment.
Outline for Margarite what laboratory tests are done during this first prenatal visit and rationale for the tests.
Detail the prenatal education and anticipatory guidance appropriate to the first trimester of pregnancy.
What teaching would you do for Margarite’s discomforts of pregnancy?
Discuss nursing diagnosis, nursing activities, and expected out- comes related to this woman.
At 18 weeks’ gestation Margarite comes to the clinic for a prenatal visit. She states she thinks she felt her baby move for the first time last week and that the pregnancy now feels real to her. She states she feels “Great! The nausea and fatigue are gone.” She is concerned she is not eating enough protein as she has little interest in red meat but eats beans and rice at dinner. She remembers discussing with you at her first visit some screening tests for problems with the baby but now is unsure how they are done and what they are for.
Outline for Margarite nutritional needs during pregnancy, high- lighting protein requirements.
Outline for Margarite the screening tests that are done in the second trimester and what they are for.
Detail the prenatal education and anticipatory guidance appropriate to the second trimester of pregnancy.
Discuss nursing diagnosis, nursing activities, and expected out- comes related to this woman.
Margarite comes to your clinic for a prenatal visit and is now at 34 weeks’ gestation. She states she feels well but has some swelling in her legs at the end of the day, a backache at the end of the day, and difficulty getting comfortable to fall asleep. She is also having difficulty sleeping as she gets up to go to the bathroom two or three times a night.
She remembers from her first pregnancy some things she should be aware of that indicate a problem at the end of preg- nancy but is not sure what they are.
Detail the prenatal education and anticipatory guidance appropriate to the third trimester of pregnancy.
What teaching would you do for Margarite’s discomforts of pregnancy?
What warning signs would you reinforce with Margarite at this point in her pregnancy?
Discuss nursing diagnosis, nursing activities, and expected out- comes specific to Margarite.
C H A P T E R 4 ■ Physiological Aspects of Antepartum Care 81
■ ■ ■
Review Questions
■ ■ ■1. The appropriate recommended weight gain during preg- nancy for a woman with a normal BMI is:
A. 10–15 lbs.
B. 6–20 lbs.
C. 21–25 lbs.
D. 25–35 lbs.
2. The purpose of preconception care is to:
A. Prevent unwanted pregnancies B. Improve perinatal outcomes C. Facilitate desired pregnancy
D. Screen for sexually transmitted diseases 3. Presumptive signs of pregnancy are:
A. All the objective signs of pregnancy B. Those perceived by the healthcare provider
C. Physiological changes perceived by the woman herself D. Those attributed to the fetus.
4. Physiological changes in pregnancy:
A. Involve primarily reproductive organs B. Are protective of the woman and/or fetus C. Are most profound in the first trimester D. Primarily impact the musculoskeletal system 5. Intimate partner violence:
A. Consists of physical abuse B. Decreases during pregnancy
C. Crosses all ethnic, racial, religious, and socioeconom- ic levels
D. Primarily impacts maternal health
6. RhoGAM would be administered during pregnancy at 28 weeks’ gestation to women with the following:
A. Blood type O+
B. Blood type A+
C. Blood type O–
D. Blood type AB
7. Blood volume increases during pregnancy by:
A. 20%–30%
B. 30%–40%
C. 40%–50% (correct answer) D. 50%–60%
8. A woman presents for prenatal care at 10 weeks’ gesta- tion reporting nausea and vomiting. Self-care and relief measures include:
A. Suggest a high protein diet
B. Suggest avoiding eating early in the day C. Suggest increasing fluid intake
D. Suggest small, frequent meals
9. A woman who gets pregnant within 45 days of delivering a baby is at a higher risk for:
A. Iron deficiency anemia (correct answer) B. Periodontal disease
C. Urinary stasis D. Striae gravidarum
10. Treatment with IV antibiotics is indicated for patients with all of the following except:
A. History of group B streptococcus (GBS) in the urine during pregnancy
B. Scheduled for cesarean delivery prior to rupture of membranes or labor with a history of positive GBS (correct answer)
C. GBS status unknown with a history of an infant with invasive GBS infection
D. Screened negative for GBS at 37 weeks, now in labor with temperature >100.4° F (38° C)
11. Which of the following lab results indicates anemia?
A. Hemoglobin 11.2
B. Hemoglobin 10(correct answer) C. Hematocrit 34%
D. Hematocrit 38%
12. Which hormone is responsible for maintaining preg- nancy by relaxing smooth muscles leading to decreased uterine activity and decreasing the risk of spontaneous abortion?
A. Estrogen
B. Human chorionic gonadatropin (hCG) C. Progesterone (correct answer)
D. Oxytocin
13. Softening of the cervix that occurs in the second month of pregnancy is known as:
A. Hegar’s sign B. Braxton’s sign
C. Goodell’s sign (correct answer) D. Chadwick’s sign
14. Using Naegele’s rule, calculate the EDD for a patient with a LMP of 10 March.
A. December 3 B. December 7 C. December 10 D. December 17 References
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