NCLEX: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

 

Health Promotion and Maintenance; Nursing Care of the Childbearing Family: CHILDBEARING: PREGNANCY BY TRIMESTER

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

General overview: This review of the normal physiological and psychosocial changes occurring during each trimester of pregnancy provides essential components of the database for accurate nursing judgments and anticipatory guidance during the prenatal period. Complications of pregnancy are correlated with the trimester of common occurrence; relationships with other NCLEX® categories of human function are described.

I. GENERAL ASPECTS OF NURSING CARE

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Assessment:

Based on nursing knowledge of the following:

1. Biophysical and psychosocial aspects of conception and gestation.

2. Parameters of normal pregnancy.

3. Risk factors, signs, symptoms, and implications of deviations from normal patterns of maternal and fetal health.

B. Analysis/nursing diagnosis:

1. Knowledge deficit related to normal pregnancy-related alterations (physiological and emotional alterations per trimester).

2. Pain related to normal physiological alterations in pregnancy.

3. Altered elimination related to normal physiological changes during pregnancy (polyuria, constipation).

4. Altered nutrition related to increased metabolic needs due to pregnancy.

5. Impaired adjustment related to altered self-image; anticipated role change; resurgence of old, unresolved conflicts.

C. Nursing care plan/implementation:

1. Goal: emotional support.

  • Encourage verbalization of feelings, fears, concerns.
  • Validate normalcy of behavioral response to pregnancy.

2. Goal: anticipatory guidance.

  • Facilitate achievement of developmental tasks.
  • Strengthen coping techniques for pregnancy, labor, birth. Suggest appropriate resources (preparation for childbirth classes).

3. Goal: health teaching. Describe, explain, discuss:

  • Normal physiological alterations during pregnancy.
  • Common discomforts of pregnancy, management.

D. Evaluation/outcome criteria:

1. Woman takes an active, informed part in her pregnancy-related care.

2. Woman copes effectively with common alterations associated with pregnancy (physiological, psychological, role change).

3. Woman successfully carries an uneventful pregnancy to term.

II. BIOLOGICAL FOUNDATIONS OF PREGNANCY

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Conception

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Egg—life span, approximately 24 hours after ovulation.

2. Sperm—life span, approximately 72 hours after ejaculation into female reproductive tract.

3. Conception (fertilization)—usually occurs 12 to 24 hours after ovulation, within fallopian tube.

4. Implantation (nidation)—usually occurs within 7 to 9 days of conception, or about day 21 to 23 of a 28-day menstrual cycle.

5. Ovum—period of conception until primary villi have appeared; usually about 12 to 14 days.

6. Embryo—period from end of ovum stage until measurement reaches approximately 3 cm; 54 to 56 days.

7. Fetus—period from end of embryo stage until birth.

First Trimester
Susceptible to teratogens
Heart functions at 3–4 wk
Eye formation at 4–5 wk
Arm and leg buds at 4–5 wk
Recognizable face at 8 wk
Brain: rapid growth
External genitalia at 8 wk
Placenta formed at 12 wk
Bone ossification at 12 wk

Second Trimester
Less danger from teratogens after 12 wk
Facial features formed at 16 wk
Fetal heartbeat heard by 18–20 wk; with a fetoscope/Doppler at 10–12 wk
Quickening at 18–20 wk
Length: 10 inches, weight: 8–10 oz
Vernix: present

Third Trimester
Iron stored
Surfactant production begins in increasing amounts
Size: 15 inches, 2–3 lb
Calcium stored at 28–32 wk
Reflexes present at 28–32 wk
Subcutaneous fat deposits at 36 wk
Lanugo shedding at 38–40 wk
Average size: 18–22 inches, 7.5–8.5 lb at 38–40 wk

B. Anatomical and physiological modifications

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Bases of functional alterations

a. Hormonal—Hormones of Pregnancy discusses the effects of estrogen and progesterone during pregnancy. Nursing implications provide the knowledge base for the following:

  • Anticipatory guidance regarding normal maternal adaptations.
  • Early identification of deviations from normal patterns.

b. Mechanical—enlarging uterus → displacement and pressure; increased weight of uterus and breasts → changes in posture and pressure.

2. Breasts—enlarged darkened areolae; secrete colostrum.

3. Reproductive organs

a. Uterus

  • Amenorrhea. Occasional spotting common, especially at time of first missed menstrual period.
  • Increased vascularity adds to increase in size and softening of the lower uterine segment (Hegar’s sign).

 

Health Promotion and Maintenance; Nursing Care of the Childbearing FamilyHealth Promotion and Maintenance; Nursing Care of the Childbearing Family

Health Promotion and Maintenance; Nursing Care of the Childbearing Family

 

  • Growth is due to hypertrophy and hyperplasia of existing muscle cells and connective tissue.
  • Fundal height measurement landmarks:

 

Health Promotion and Maintenance; Nursing Care of the Childbearing Family

 

b. Cervix

  • Increased vascularity → softening (Goodell’s sign) and deepened blue-purple coloration (Chadwick’s sign).
  • Edema, hyperplasia, thickening of mucous lining, and increased mucus production; formation of mucous plug by end of second month.
  • Becomes shorter, thicker, and more elastic.

c. Vagina

  • Hyperemia deepens color (Chadwick’s sign).
  • Hypertrophy and hyperplasia thicken vaginal mucosa.
  • Relaxation of connective tissue.
  • pH acidic (4.0–6.0).
  • Leukorrhea—nonirritating.

d. Perineum

  • Increases in size—hypertrophy of muscle cells, edema, and relaxation of elastic tissue.
  • Deepened color—increased vascularization/hyperemia.

e. Ovaries

  • Ovum production ceases.
  • Corpus luteum persists; produces hormones to weeks 10 to 12 until placenta “takes over.”

C. Alterations affecting fluid-gas transport

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Cardiovascular system (Blood Values)

a. Physiological changes

  • Heart displaced upward and to the left.
  • Circulation:
    (a) Cardiac volume increases by 20% to 30%.
    (b) Labor—cardiac output increases by 20% to 30%.
  • Hemoglobin and hematocrit values remain between 10 and 14 gm and 35% and 42%; normal drop is 10% during second trimester.
  • Hypercoagulability—increased levels of blood factors VII, VIII, IX, and X.
  • Nonpathological increased sedimentation rate—due to 50% increase in fibrinogen level.
  • Blood pressure should remain stable with drop in second trimester.
  • Heart rate often increases 10 to 15 beats/min at term.
  • Compression of pelvic veins → stasis of blood in lower extremities.
  • Compression of inferior vena cava when supine → bradycardia → reduced cardiac output, faintness, sweating, nausea (supine hypotension). Fetal response: marked bradycardia due to hypoxia secondary to decreased placental perfusion.

 

Health Promotion and Maintenance; Nursing Care of the Childbearing Family

 

b. Assessment:

  • Apical systolic murmur.
  • Exaggerated splitting of first heart sound.
  • Physiological anemia.
  • Dependent edema in third trimester (Common Discomforts During Pregnancy).
  • Vena cava syndrome (supine hypotension)—drop in systolic blood pressure may occur due to compression of descending aorta and inferior vena cava when supine.
  • Varicosities (vulvar, anal, leg).

c. Nursing care plan/implementation: Goal: health teaching.

  • Elevate lower extremities frequently.
  • Apply support hose.
  • Avoid excess intake of sodium.
  • Assume side-lying position at rest.
  • Learn signs and symptoms of pregnancy-induced hypertension.

2. Respiratory system

a. Physiological changes:

  • Increased: tidal volume, vital capacity, respiratory reserve, oxygen consumption, production of [latex]CO_{2}[/latex].
  • Diaphragm elevated, increased substernal angle → flaring of rib cage.
  • Uterine enlargement prevents maximum lung expansion in third trimester.

b. Assessment:

  • Shortness of breath or dyspnea on exertion and when lying flat in third trimester.
  • Nasal stuffiness due to estrogen-induced edema (see Common Discomforts During Pregnancy).
  • Deeper respiratory excursion.

c. Nursing care plan/implementation: Goal: health teaching.

  • Sit and stand with good posture.

 

Health Promotion and Maintenance; Nursing Care of the Childbearing FamilyHealth Promotion and Maintenance; Nursing Care of the Childbearing Familysceenshot

 

  • When resting, assume semi-Fowler’s position.
  • Avoid over-distention of stomach.

D. Alterations affecting elimination

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Urinary system

a. Physiological changes:

  • Relaxation of smooth muscle results in conditions that can persist 4 to 6 weeks after birth:
    (a) Dilatation of ureters.
    (b) Decreased bladder tone.
    (c) Increased potential for urinary stasis and urinary tract infection (UTI).
  • Increased glomerular filtration rate (50%) during last two trimesters.
  • Increased renal plasma flow (25%–50%) during first two trimesters; returns to near-normal levels by end of last trimester.
  • Increased renal-tubular reabsorption rate—compensates for increased glomerular activity.
  • Glycosuria—reflects kidney’s inability to reabsorb all glucose filtered by glomeruli (may be normal or may indicate gestational diabetes; glycosuria always warrants further testing).
  • Increased renal clearance of urea and creatinine (creatinine clearance used as test of renal function during pregnancy).
  • Hormone-induced turgescence of bladder and pressure on bladder from gravid uterus (see Blood Values).

b. Assessment:

  • Urinary frequency, first and third trimesters (see Common Discomforts During Pregnancy).
  • Nocturia.
  • Stress incontinence in third trimester.

c. Nursing care plan/implementation: Goal: health teaching.

  • Void with urge, to prevent bladder distention.
  • Learn signs and symptoms of UTI.
  • Decrease fluid intake in late evening.
  • Perform Kegel exercises to reduce incontinence.

2. Gastrointestinal system (see Common Discomforts During Pregnancy)

a. Physiological changes:

  • General decrease in smooth-muscle tone and motility due to actions of progesterone.
  • Intestines: slowed peristalsis, increased water reabsorption in bowel.
  • Stomach
    (a) Gastric emptying time is delayed (e.g., 3 hours vs. 1 1/2 hours). (b) Gastric secretion of HCl and pepsin decreases.
    (c) Decreased motility delays emptying; increased acidity.
  • Cardiac sphincter relaxes.
  • Increasing size of uterus and displacement of intra-abdominal organs.
  • Gallbladder: decreased emptying.

b. Assessment:

  • Nausea and vomiting in first trimester.
  • Constipation and flatulence.
  • Hemorrhoids.
  • Heartburn, reflux esophagitis, indigestion.
  • Hiatal hernia.
  • Epulis—edema and bleeding of gums.
  • Ptyalism—excessive salivation.
  • Jaundice.
  • Gallstones.
  • Pruritus due to increased retention of bile salts.

c. Nursing care plan/implementation: Goal: health teaching: dietary.

  • Nausea and vomiting
    (a) Avoid fatty food; increase carbohydrates.
    (b) Eat small, frequent meals.
    (c) Eat dry crackers in morning.
    (d) Decrease liquids with meals.
    (e) Avoid odors that predispose to nausea.
    (f) Avoid acidic foods (e.g., citrus, tomatoes).
  • Constipation and flatulence
    (a) Increase fluids (6–8 glasses/day).
    (b) Maintain exercise regimen.
    (c) Add fiber to diet.
    (d) Avoid mineral oil laxatives.
    (e) Avoid gas-producing foods (e.g., beans, cabbage).
  • Heartburn and indigestion
    (a) Eliminate fatty, spicy, or acidic foods.
    (b) Eat small, frequent meals (6/day).
    (c) Eat slowly.
    (d) Avoid gastric irritants (e.g., alcohol, coffee).
    (e) Avoid lying flat.
    (f) Take antacids without sodium or phosphorus.
    (g) Try chewing gum to increase the secretion of alkaline saliva.
    (h) Wait 2 to 3 hours after meals before lying down.
    (i) Wear loose-fitting clothes.
  • Hemorrhoids
    (a) Increase fluid and fiber intake.
    (b) Maintain exercise regimen. (c) Avoid constipation and straining to defecate.
    (d) Take warm sitz baths.
    (e) Apply witch hazel pads.
    (f) Elevate hips and legs frequently.
    (g) Use hemorrhoidal ointments only with advice of health-care provider.

E. Alterations affecting nutrition

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Physiological changes:

a. Gastrointestinal system

  • Gingivae soften and enlarge due to increased vascularity.
  • Increased saliva production.

b. Endocrine system

  • Increased size and activity of pituitary, parathyroids, adrenals.
  • Increased vascularity and hyperplasia of thyroid.
  • Pancreas—increased insulin production during second half of pregnancy, needed to meet rising maternal needs; human placental lactogen (HPL) and insulinase deactivate maternal insulin; may precipitate gestational diabetes in women who are susceptible.

c. Metabolism

  • Basal metabolic rate (BMR)—increases 25% as pregnancy progresses, due to increasing oxygen consumption; protein-bound iodine (PBI) increases to 7 to 10 mcg/dL; metabolism returns to normal by sixth postpartum week.
  • Protein—need increased for fetal and uterine growth, maternal blood formation.
  • Water retention—increased.
  • Carbohydrates—need increases to spare protein stores.
    (a) First half of pregnancy—glucose rapidly and continuously siphoned across placenta to meet fetal growth needs; may lead to hypoglycemia and faintness.
    (b) Second half of pregnancy—placental production of anti-insulin hormones; normal maternal hyperglycemia; affects coexisting diabetes.
  • Fat—increased plasma lipid levels.
  • Iron—supplements recommended to meet increased need for red blood cells (RBCs) by maternal/placental/fetal unit.

2. Assessment:

a. Weight gain: 20 to 35 lb (11.5–16 kg); depends on body mass index (BMI) and prepregnant nutritional status.

b. Normal pattern: first trimester, 2 to 5 lb (1–2.3 kg); remainder of gestation, approximately 1 lb/wk (0.4–0.5 kg/wk).

3. Nursing care plan/implementation: Goal: health teaching.

a. Evaluate diet for adequacy of nutrient and caloric intake.

b. Evaluate cultural, religious, and economic influences on diet.

c. Review dietary recommendation for pregnancy with woman.

d. Avoid dieting in pregnancy (even if obese).

e. Supplement diet with vitamins, iron, or folic acid on advice of health provider.

f. Ptyalism:

  • Suck hard candies.
  • Perform frequent oral hygiene.
  • Maintain adequate oral intake (6–8 glasses/day).
  • Use lip balm to prevent chapping.

g. Epulis:

  • Frequent oral hygiene.
  • Use soft toothbrush.
  • Floss gently.
  • See dentist regularly.

F. Alterations affecting protective functionsintegumentary system

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Physiological changes—estrogen-induced vascular and pigment changes.

2. Assessment:

a. Increased pigmentation (chloasma and linea nigra).

b. Striae gravidarum (stretch marks).

c. Increased sebaceous and sweat gland activity.

d. Palmar erythema.

e. Angiomas—vascular “spiders.”

3. Nursing care plan/implementation: Goal: health teaching.

a. Bathe or shower daily.

b. Reassure woman that skin changes decrease after pregnancy.

G. Alterations affecting comfort, rest, mobilitymusculoskeletal system

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Physiological changes

a. Progesterone, estrogen, and relaxin-induced relaxation of joints, cartilage, and ligaments.

b. Function in childbearing—increases anteroposterior diameter of rib cage and enlarges birth canal.

2. Assessment:

  • Complaint of pelvic “looseness.”
  • Duck-waddle walk.
  • Tenderness of symphysis pubis.
  • Lordosis (exaggerated lumbar curve)—increased weight of pelvis tilts pelvis forward; to compensate, woman throws head and shoulders backward; complaint of leg and back strain and fatigue (see Common Discomforts During Pregnancy).
  • Feet often increase by half a shoe size or more.

3. Nursing care plan/implementation: Goal: health teaching.

a. Good body alignment—tuck pelvis under; tighten abdominal muscles.

b. Pelvic-rock exercises.

c. Squat; bend at knees, not at waist.

d. Wear low-heeled, sturdy shoes.

e. Avoid tight-fitting clothing that interferes with circulatory return in legs.

III. PSYCHOSOCIAL-CULTURAL ALTERATIONS

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Emotional changes—affected by: age, maturity, support system, amount of current stresses, coping abilities, physical and mental health status. Developmental tasks of pregnancy:

1. Accept the pregnancy as real: “I am pregnant”; progress from symbiotic relationship with the fetus to perceiving the child as an individual.

2. Seek and ensure acceptance of child by others.

3. Seek protection for self and fetus through pregnancy and labor (“safe passage”).

4. Prepare realistically for the coming child and for necessary role change: “I am going to be a parent.”

B. Physical bases of changes

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Increased metabolic demands may result in anemia and fatigue.

2. Increased hormone levels (steroids, estrogen, progesterone)—affect mood as well as physiology.

C. Characteristic behaviorsBehavioral Changes in Pregnancy describes behaviors commonly exhibited in each trimester.

D. Sexuality and sexual expression—feelings and expressions of sexuality may vary during pregnancy due to maternal adaptations and physiological changes.

E. Intrafamily relationships

1. Pregnancy is a maturational crisis for the family.

 

Health Promotion and Maintenance; Nursing Care of the Childbearing Family

 

2. Requires changes in lifestyle and interactions:

a. Increased financial demands.

b. Changing family and social relationships.

c. Adapting communication patterns.

d. Adapting sexual patterns.

e. Anticipating new responsibilities and needs.

f. Responding to reactions of others.

[sociallocker]

Health Promotion and Maintenance; Nursing Care of the Childbearing Family: Prenatal Management

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

I. INITIAL ASSESSMENT: Goal: establish baseline for health supervision, teaching, emotional support, or referral.

II. OBJECTIVES:

A. Determine woman’s present health status and validate pregnancy.

B. Identify factors affecting or affected by pregnancy.

C. Determine current gravidity and parity.

D. Identify present length of gestation.

E. Establish an estimated date of delivery (EDD). Nägele’s determination of EDD—subtract 3 months, add 7 days to last menstrual period (LMP).

F. Determine relevant knowledge deficit.

III. ASSESSMENT: history

A. Family—inheritable diseases, reproductive problems.

B. Personal—medical, surgical, gynecological, past obstetric, average nonpregnant weight.

1. Gravida—a pregnant woman.

  • Nulligravida—woman who has never been pregnant.
  • Primigravida—woman with a first pregnancy.
  • Multigravida—woman with a second or later pregnancy.

2. Para—refers to past pregnancies (not number of babies) that reached viability (20–22 weeks whether or not born alive).

  • Nullipara—woman who has not carried a pregnancy to viability (e.g., may have had one or more abortions).
  • Primipara—woman who has carried one pregnancy to viability.
  • Multipara—woman who had two or more pregnancies that reached viability.
  • Grandmultipara—woman who has had six or more viable pregnancies.

3. Examples of gravidity/parity. Several methods of describing gravidity and parity are in common use. One method (GTPAL) describes number of “Gravida” (pregnancies), Term (or full-term) infants, Preterm infants, Abortions, and number of Living children.

  • A woman who is pregnant for the first time and is currently undelivered is designated as 1-0-0-0-0. After giving birth to a full-term
    living neonate, she becomes 1-1-0-0-1.
  • If a woman’s second pregnancy ends in abortion and she has a living child from a previous pregnancy, born at term, she is designated as 2-1-0-1-1.
  • A woman who is pregnant for the fourth time and whose previous pregnancies yielded one full-term neonate, premature twins, and one abortion (spontaneous or induced), and who now has three living children, may be designated as 4-1-1-1-3.
  • Others record as follows: number gravida/number para. Applying this system to the examples given above, those mothers would be designated as follows: a—G1P1; b—G2P1; c—G4P2.
  • Others include recording of abortions:
    G1P1 Ab0
    G2P1 Ab1
    G4P2 Ab1

IV. ASSESSMENT: initial physical aspects:

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Height and weight.

B. Vital signs.

C. Blood work—hematocrit and hemoglobin for anemia; type and Rh factor; tests for sickle cell trait, syphilis, rubella antibody titer, and hepatitis B screen.

D. Urinalysis—glucose, protein, ketones, signs of infection, and pregnancy test (human chorionic gonadotropin [HCG]).

E. Breast examination.

F. Pelvic examination.

1. Signs of pregnancy.

2. Adequacy of pelvis and pelvic structures.

3. Size and position of uterus.

4. Papanicolau smear.

5. Smears for monilial and trichomonal infections.

6. Signs of pelvic inflammatory disease.

7. Tests for STIs: Gonorrhea (gonococcus [GC]), chlamydia.

G. Validation of pregnancy—physician or midwife makes differential diagnosis between presumptive/probable signs/symptoms of early pregnancy and other signs.

1. Presumptive symptoms—subjective experiences.

  • Amenorrhea—more than 10 days past missed menstrual period.
  • Breast tenderness, enlargement.
  • Nausea and vomiting.
  • Quickening (weeks 16–18).
  • Urinary frequency.
  • Fatigue.
  • Constipation (50% of women).

2. Presumptive signs

  • Striae gravidarum, linea nigra, chloasma (after week 16).
  • Increased basal body temperature (BBT)

3. Probable signs—examiner’s objective findings.

  • Positive pregnancy test.
  • Enlargement of abdomen/uterus.
  • Reproductive organ changes (after sixth week):
    (1)Goodell’s sign—cervical softening.
    (2)Hegar’s sign—softening of lower uterine segment.
    (3)Vaginal changes (Chadwick’s sign): purple hue in vulvar/vaginal area.
  • Ballottement (after 16–20 weeks).
  • Braxton Hicks contractions.

4. Positive signs of pregnancy:

  • Fetal heart tones.
    (1)Doptone: weeks 10 to 12.
    (2)Fetoscope: week 20.
  • Examiner visualizes and feels fetal movements (usually after week 24).
  • Sonographic examination (after week 14) when fetal head is sufficiently developed for accurate determination of gestational age. Pregnancy may be detected as early as fifth or sixth week after LMP.

V. ASSESSMENT: nutritional status:

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Physical findings suggesting poor nutritional status:

1. Skin: rough, dry, scaly.

2. Lips: lesions in corners.

3. Hair: dull, brittle.

4. Mucous membranes: pale.

5. Dental caries.

B. Height, weight, age—average weight gain approximately 24 lb. Range 24 to 32 lb is best for mother and neonate.

C. Laboratory values—Hemoglobin (Hgb): less than 10.5/100 mg; hematocrit (Hct): less than 32% indicates anemia.

D. Nutrition history.

E. Analysis/nursing diagnosis:

1. Altered nutrition: less than body requirements related to anemia, vitamin/mineral deficit.

2. Altered nutrition: more than body requirements related to obesity.

F. Nursing care plan/implementation: Goal: health teaching.

1. Nutritional counseling for diet in pregnancy and/or lactation.

G. Evaluation/outcome criteria:

1. If underweight at conception: should gain 28 to 42 lb (12.5–18 kg).

2. If overweight at conception: 15 to 25 lb (7–11.5 kg).

3. If obese at conception: 15 lb (7 kg) or more.

VI. ASSESSMENT: psychosocial aspects:

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Pregnancy: planned or not; desired or not.

B. Present plans:

1. Carry pregnancy, keep baby.

2. Carry pregnancy, adoption.

3. Abortion.

C. Cultural, ethnic influences on decisions: will influence range of activities, types of safeguarding actions, diet, and health-promotion behaviors.

D. Parenting potential: actively seeking medical care and information about pregnancy, childbirth, parenthood.

E. Family readiness for childbearing and child rearing:

1. Physical maintenance.

2. Allocation of resources: identify support system.

3. Division of labor.

4. Socialization of family members.

5. Reproduction, recruitment, launching of family members into society.

6. Maintenance of order (relationships within family).

F. Perceptions of present and projected family relationships.

G. Review lifestyle for smoking, drugs, alcohol (ETOH), attitudes about pregnancy, health-care practices, and risks for hepatitis and human immunodeficiency virus (HIV).

VII. ANALYSIS/NURSING DIAGNOSIS:

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Altered role performance related to stress imposed by developmental tasks.

B. Ineffective coping: individual, family related to stress caused by developmental tasks/crises.

C. Altered family process related to developmental tasks. First baby may precipitate individual or family developmental crisis.

VIII. NURSING CARE PLAN/IMPLEMENTATION:

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Goal: anticipatory guidance/support.

1. Discuss mood swings, ambivalent feelings, negative feelings.

2. Reinforce “normalcy” of such feelings.

B. Goal: increase individual/family coping skills, reduce intrafamily stress.

1. Reinforce family strengths (both partners), sense of family identity.

  • Encourage open communication between partners; share feelings and concerns.
  • Increase understanding of mutual needs, encourage mutuality of support.
  • Increase tendency of mother to turn to partner as most significant person (as opposed to physician).
  • Enhance bond, success of childbirth preparation classes.

2. Promote understanding/acceptance of role change.

  • Facilitate/support achievement of developmental tasks.
  • Reduce probability of postpartum psychological problems.
  • Promote family bonding.

C. Goal: health teaching.

1. Siblings:

  • Alert parents to sibling needs for security, love.
  • Include sibling in pregnancy experience.
  • Provide clear, simple explanations of happenings.
  • Continue demonstrations of love.
  • Describe increased status (“big sister/brother”).
  • Discuss possible misbehavior to gain attention.

2. Relatives: alert parents to possible negative feelings of in-laws.

3. Referral to childbirth preparation/parenting classes.

4. Appropriate community referrals for financial relief to decrease stress and provide aid.

IX. EVALUATION/OUTCOME CRITERIA:

A. Actively participates in pregnancy-related decision making.

B. Expresses satisfaction with decisions made.

C. Demonstrates growth and development in parenting role.

D. Prepared for the birth and for early parenthood.

[/sociallocker]

FURTHER READING/STUDY:

Resources:

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.