Pregnancy Complication
Woman diagnosed with high risk pregnancy
Problem No. 1: Fear related to uncertain fetal outcome Goal: Decreased fear
Outcome: Patient will express decreased fear related to uncer- tain fetal outcome.
Nursing Actions
1. Provide time for the patient and family to express their concerns regarding fetal outcome.
2. Encourage the woman to vent apprehension, uncertainty, anger, fear, and/or worry.
3. Discuss prior pregnancy outcomes if applicable.
4. Explain pregnancy complication, management, and reason for each treatment.
5. Help the woman to obtain needed social support.
6. Refer the family to community or hospital resources such as social worker, case manager, or chaplain services as needed.
7. Provide contact information for the woman and family as issues arise.
Problem No. 2: Impaired self-esteem related to pregnancy complication
Goal: Improved self-esteem
Outcome: Patient will express improved self-esteem.
Nursing Actions
1. Encourage verbalization of feelings.
2. Practice active listening.
3. Provide emotional support.
4. Encourage the patient to participate in decision making.
5. Make needed referrals to social services and mental health specialists.
Problem 3: Anxiety related to unexpected pregnancy complication
Goal: Decreased anxiety
Outcome: Patient verbalizes that she feels less anxious.
Nursing Actions
1. Be calm and reassuring in interactions with patient and family.
2. Explain all information repeatedly related to complication.
3. Provide autonomy and choices.
4. Encourage patient and family to verbalize their feelings regarding diagnosis by asking open-end questions.
5. Explore past coping strategies.
6. Explore with the woman spiritual practices and beliefs.
TYING IT ALL TOGETHER
As a nurse in an antenatal clinic, you are part of an interdiscipli- nary team that is caring for Margarite Sanchez during her pregnancy. Margarite is 10 weeks pregnant and is a 28-year-old G3 P1 Hispanic woman. She began prenatal care at 8 weeks’ ges- tation visit. She works in a day-care center. She has a 2-year-old son. José, her husband, has not accompanied her to her second prenatal appointment as he is in his busy season at work in land- scaping. Margarite reports they are pleased about the pregnancy although planned to wait another year or two before attempting another pregnancy. Margarite was seen for some spotting at 6 weeks’ gestation that has resolved. Marguerite tells you has she has been irritable and short tempered with her husband and son, particularly at the end of the day when she feels exhausted. She states she is relieved the spotting stopped but is not sure she feels ready to be a mother of two children. Her mother lives four blocks away and they speak on the phone daily and see each other several times a week. She is very involved in her parish, and the women in her church study group all know she is pregnant and are all certain the baby is a girl.
Detail the aspects of your psychosocial assessment at 10 weeks’
gestation.
Discuss the rationale for the assessment.
Discuss the nursing diagnosis, nursing activities, and expected outcomes related to this problem.
Discuss the importance of the pregnant woman’s mother dur- ing pregnancy.
Suggest two interventions that could help to prepare Margarite’s 2-year-old son during the pregnancy.
Problem 4: Frustration related to pregnancy complication Goal: Positive pregnancy adaptation
Outcome: Patient demonstrates adaptation to pregnancy.
Nursing Actions
1. Allow the woman to express her feelings related to loss of normal pregnancy.
2. Allow the woman to express her feelings related to not having a normal birth.
3. Allow the woman to express her feelings related to uncer- tainty of fetal outcome.
4. Provide choices related to management when possible.
■ ■ ■
Review Questions
■ ■ ■1. Signs of possible maladaptation to pregnancy include:
A. Denial of fears about childbirth and unrealistic expec- tations about birth
B. Excessive maternal weight gain and limiting physical activity
C. Denial of physical symptoms of pregnancy and emo- tional lability
D. Changes in couple’s interactions and sexual activity
2. Nursing interventions that facilitate adaptation to preg- nancy in the first trimester focus on:
A. Physiological changes in pregnancy
B. Promoting pregnancy and birth as a family experience
C. Readiness for parenting
D. Partners’ role during labor and birth
3. Ambivalent feelings toward pregnancy in the third trimester may indicate:
A. Normal expected finding B. Unresolved conflict C. Depression
D. Unwanted pregnancy 4. Prescriptive behavior is:
A. Behavior during the childbearing period that is limit- ed for pregnant women
B. Expected behavior for pregnant women
C. Behavior that is restricted for pregnant women that has supernatural consequences
D. An unacceptable practice that has implications for pregnant women
5. Measurable outcomes of social support interventions during pregnancy include:
A. Improved coping and functional status B. Improves relationship with mother C. Reduced stress
D. Reduced depression
6. When conducting a psychosocial assessment, it is impor- tant to determine the ____, _____, and ____ of mood or emotional disturbances.
A. Anxiety, depression, level B. Coping, support, distress C. Frequency, duration, intensity D. Acceptance, avoidance, character
7. To facilitate adaptation to pregnancy during the first trimester, an appropriate nursing action would be to:
A. Encourage the woman to sign up for prepared child- birth classes
B. Assess the woman’s response to pregnancy C. Encourage the woman to “tune in” to fetal
movement
D. Give anticipatory guidance regarding breastfeeding 8. When caring for a woman who speaks limited English,
the appropriate method for translating information is:
A. Using a trained medical interpreter
B. Asking a student nurse who speaks the woman’s pri- mary language to translate
C. Providing printed material for the woman to take home
D. Asking for a family member to translate
C H A P T E R 5 ■ The Psycho-Social-Cultural Aspects of the Antepartum Period 111 9. While planning care for the lesbian client, it is most
important for the nurse to include a goal that addresses the need for:
A. Referrals to a perinatal social worker on admission to the hospital
B Establishing a trusting relationship with health care providers
C. Providing counseling to lesbian mothers regarding legal issues they may face with parenting
D. Choosing a name for the infant and obtaining supplies for the new baby
10. According to May’s research, it is during the _______
phase that many expectant fathers appear to put con- scious thought of their partner’s pregnancy aside.
A. Announcement B. Transition C. Moratorium D. Developing References
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Antepartal Tests 6
I
NTRODUCTIONThis chapter presents various antenatal tests offered to pregnant women. The focus of the chapter is on tests for at- risk and/or high-risk pregnancies. Common maternal con- ditions indicating need for antenatal tests are presented in Table 6-1. The purpose, indication, basic procedure, inter- pretation, advantages, risks, and nursing actions are out- lined. Specifics on procedures are not detailed as they may vary from institution to institution. Routine tests per- formed during pregnancy are presented in Chapter 4.
Antenatal tests are often performed as outpatient proce- dures, such as ultrasound, amniocentesis, and non-stress tests. Antenatal tests may also be performed during an antenatal hospitalization for a high-risk pregnancy. The nurse’s role and responsibility related to antenatal tests may vary based on the inpatient or outpatient setting.
Nursing care may be provided before, during, and/or after a procedure.
A
SSESSMENT FOR RISK FACTORSThe nurse needs to assess for factors that place the woman and/or her fetus at risk for adverse outcomes:
■ Biophysical factors originate from the mother or fetus and impact the development or function of the mother or fetus. They include genetic, nutritional, medical, and obstetric issues (see Table 6-1).
■ Psychosocial factors are maternal behaviors or lifestyles that have a negative effect on the mother or fetus.
Examples include smoking, caffeine use, alcohol/drug use, and psychological status.
■ Sociodemographic factors are variables that pertain to the woman and her family and place the mother and the fetus at increased risk. Examples include access to prena- tal care, age, parity, marital status, income, and ethnicity.
■ Environmental factors are hazards in the workplace or the general environment that impact pregnancy outcomes.
115 EXPECTED STUDENT OUTCOMES
On completion of this chapter, the student will be able to:
䊐 Define terms used in antenatal tests.
䊐 Identify the purpose and indication for key antenatal tests.
䊐 Describe the procedure, interpretation, advantages, and risks of common antenatal tests.
䊐 Articulate the nursing responsibilities related to key antenatal tests.
䊐 Identify patient teaching needs related to antenatal tests.
Nursing Diagnosis
䊏 Knowledge deficit related to antenatal tests 䊏 Anxiety related to antenatal tests
䊏 Risk of fetal injury or death related to invasive antenatal tests
Nursing Outcomes
䊏 The pregnant woman and her family will verbalize understanding of antenatal tests.
䊏 The pregnant woman will be able to make informed decisions.
䊏 Complications of antenatal tests will be identified promptly and appropriate nursing interventions will be initiated.