NCM 2107- Care of the Mother, Child & Adolescent (Well Clients)
NursingProcessOverviewfor
CareoftheWomanDuringtheAntepartumPeriod
Preparedby:
RitaE.PenasoMAN,RN
Lecturer
Nursing Process Overview for
Care of the Woman During the Antepartum Period
A. Initial prenatal assessment
1. Health history
a) Current pregnancy history should include first day of the last menstrual period, cramping or
bleeding, results of the pregnancy test and discomfort (e.g. nausea, vomiting, headache, urinary
frequency, and fatigue).
b) History of previous pregnancies should include gravida, para, number of abortions, number
of living children, prenatal education, cesarean births, lengths of labor, stillbirths, preterm
labors, gestational age, and birth weight.
c) Gynecologic history should include previous infections, previous surgery, age of menarche
and menstrual cycle, and sexual, menstrual, and contraception history.
d) Current medical history should include weight, blood type and Rh, medications presently
taking (i.e. prescription and over the counter), habits (e.g. smoking, alcohol, caffeine, or drugs),
allergies, potential teratogenic effects on this pregnancy (e.g. infections, medications,
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
-cont. health history…
radiographs, or toxins in home or in workplace),
medical conditions (e.g. diabetes, hypertension,
cardiovascular, renal, or congenital), and
immunizations.
e) Medical history should include childhood
diseases, medical diseases and treatment,
sexually transmitted diseases, surgeries,
bleeding disorders or previous blood
transfusions, emotional problems, and accidents.
f) Family medical history should include medical
disorders (e.g. cancer, heart disease or diabetes),
multiple births, and genetic or congenital
disorders.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
cont. health history…
g) Occupational history should include type
of work and health hazards
h) History of the baby’s father should include
age, health problems, habits, blood type and
Rh, genetic or congenital disorders,
occupation, and attitude toward the
pregnancy
i) Personal information should include racial,
cultural, and religious practices, exercise,
housing and living conditions, income,
support system, use of health care system,
and work
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
2. Determination of the estimated date of
delivery (EDD) or estimated date of
confinement (EDC)
a. The average length of pregnancy is 280
days (40 weeks), 10 lunar months, or 9
calendar months), as calculated from the
first day of the last menstrual period
(LMP).
b. To calculate the EDD by Naegele’s rule,
count backward 3 calendar months from
the month in which the last menstrual
period occurred. Using the date of the For example: An LMP of May 15, 2000 would yield an
first day of this menses, add 7 days. EDD of February 22, 2001.
Change the year, if necessary
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
c. The following are ways to date the
pregnancy when LMP is unknown.
(1) Uterine size is reported in terms of weeks
of gestation at the first prenatal visit.
(2) Presence of the uterus in the abdomen
(fundal height) indicates at least 12
weeks’ gestation.
(3) Uterus in the pelvis (fundal height)
indicates less than 12 weeks gestation.
(4) Quickening indicates about 20 weeks’
gestation in primigravidas; it may occur
earlier in multigravidas
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
(5) Fetal heart tones can be detected at 10 to
12 weeks’ gestation with a Doppler ultrasound
transducer at 16 to 20 weeks with a fetoscope.
(6) Ultrasound can detect pregnancy 5 to 6
weeks after the LMP
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
3. Assessment of risk factors
a. Early identification of potential risk
factors may provide opportunities for
appropriate interventions.
b. Risk factors that could have a negative
effect on the pregnancy may be
characterized as demographic, obstetric,
medical, and miscellaneous.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
6. Physical examination. Perform a -the landmarks of the bony pelvis and
complete physical examination, including vital estimating their size.
signs, height, and weight (current and pre- (3) This assessment may be delayed until later
pregnant), and a pelvic examination. Two in pregnancy, when the procedure may be
additional parts of the physical examination
more comfortable for the mother; it is not
include assessment of the pelvic size for
crucial to determine pelvic adequacy at the
adequacy and a breast examination.
initial assessment.
a. Assessment of pelvic size for adequacy
(1) This assessment consists of
measurement of the dimensions and
proportion of the bony pelvis.
(2) Measurements are obtained during the
bimanual portion of the pelvic
examination by moving the fingers over
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
b. Inspection and palpation of the breasts for
normal and questionable changes of
pregnancy
(1) Normal changes associated with
pregnancy include increased size,
tenderness, darkening and enlargement
of areola, erection of nipples, leaking of
colostrum late in the first trimester, and
the appearance of a venous pattern and
striae formation.
(2) Questionable changes include recent
lumps or masses that feel hard or fixed,
dimpling, redness, edema, ulceration and
nipple retraction or elevation.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
5. Laboratory and diagnostic studies. (2) Blood group and type test to determine blood
type, Rh factor, and presence of antibodies to blood
During the initial assessment of physical group antigens.
status, which typically occurs during the first
(3) Blood glucose tests to screen for diabetes,
prenatal visit, baseline date are obtained. usually done between the 24th and 28th week of
These data provide a measure against which gestation because of hormonal effects that block
subsequent data are evaluated. (Common insulin usage.
Prenatal Laboratory Tests).
(4) Rubella antibody titer to screen for rubella
a. Urinalysis includes tests for protein, (5) Blood culture to detect specific infectious
glucose, ketones, bilirubin, red blood microorganisms
cells, white blood cells, and bacteria.
(6) VDRL, EIA, and RPR are blood tests to detect the
b. Blood tests presence of certain sexually transmitted diseases.
(VDRL-Venereal Disease Research Laboratory-standard test for Syphilis)
(1) CBC (Complete Blood Count) to determine RPR- Rapid Plasma Reagin- a presumptive serologic screening test for syphilis)
hemoglobin and hematocrit levels EIA- enzyme immunoassay)
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
7. Hemoglobin and hematocrit determination
8. Hepatitis B test
9. Human immunodeficiency virus test
10. Sickle cell test to screen for sickle cell trait
and disease
c. Papanicolaou smear (Pap Smear) and
cytologic study to screen for cervical dysplasia
and assess hormone cytology and
inflammatory disease of the female genital
tract.
6. Evaluation of fetal well-being (discussed
and presented earlier)
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
7. Psychosocial assessment during the initial f. Family functioning, living situation, and
visits should include: sexual activity
a. Expectations for the pregnancy; g. Preparation for childbirth and parenthood
emotional and financial impact on family;
and the partner’s attitude toward the
pregnancy (e.g. excitement; or
apprehension)
b. Whether or not the pregnancy was
planned
c. Educational needs and resources
d. Support systems
e. Religious beliefs and cultural practices
related to childbirth and parenting
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
B. Subsequent prenatal assessments. In a low (c) Weight gain (distribution per trimester)
–risk pregnancy, prenatal visits are scheduled (d) Presence of edema
every 4 weeks for the first 28 weeks, every 2
weeks from 28 to 36 weeks, and then weekly (e) Uterine size (fundal height)
until delivery. (f) FHR
1. History and physical assessment with each (g) Urine for protein and glucose
prenatal visit should include: (h) Danger signals, including vaginal bleeding,
(a) Data concerning the course of the visual disturbances, leaking of amniotic fluid, rapid
pregnancy (e.g. common discomforts and weight gain, and elevated blood pressure,
headaches, persistent vomiting, abdominal pain,
how they are alleviated_ edema, increased temperature, painful urination,
(b) Maternal vital signs, including signs of preterm labor, and rupture of membranes
temperature, pulse, respiration, and (leaking of amniotic fluid)
blood pressure (i) Signs of impending labor (after 38 weeks),
including lightening, engagement, cervical
changes, and presence of contractions.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
2. Psychosocial assessment should focus on any (2) A normal pattern of weight gain is 1.5 lb. in
specific concerns of the woman or her partner, the first 10 weeks, 9 lbs. at 20 weeks, 19 lbs. by
which may include sexual activity, preparations 30 weeks, and 27.5 lbs. by 40 weeks.
for parenting, preparation for childbirth, and
signs of labor. (3) Nondietary factors affecting weight gain
include increased blood pressure and excess
3. Nutritional assessment should include: fluid retention.
a. Review of dietary intake of iron and iron
supplements
b. 24-hour diet recall
c. Comparison of prepregnancy weight with
weight gained during the pregnancy
(1) During the course of the pregnancy, a total
weight gain of 24 to 30 lb. is recommended
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
C. Assessment of common minor discomforts c) Urinary frequency, caused by the growing
of pregnancy uterus pressing on bladder, is seen in the first
1. First trimester trimester and again in the later part of third
trimester.
a) Nausea and vomiting (morning sickness)
generally occurs early in pregnancy and d) Breast tenderness occurs early in
subside by the fourth month of pregnancy and continues throughout the
pregnancy. This is most likely a system pregnancy due to hormonal changes.
reaction to increased estrogen or e) Ptyalism (excessive salivation) occurs,
decreased glucose levels in the blood probably as a local reaction to the influence of
(Family and Client Teaching) estrogen
b) Nasal stuffiness and epistaxis occur owing
to nasal edema from elevated estrogen
levels.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
f. Leukorrhea (increased vaginal discharge
that is white in color) results from the
increased activity of vaginal epithelial cells as
they prepare for distention during the birth
process.
g. Headaches are due to emotional tension,
eye strain, vascular engorgement , and
congestion of sinuses from hormonal
stimulation.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
2. Second and third trimesters
1) Heartburn, owing to regurgitation of acidic
gastric contents into the esophagus, may be
associated with tension and vomiting in the
third trimester.
2) Ankle edema is due to decreased venous
return in the lower extremity.
3) Varicose veins are due to poor circulation
and weakened vessel walls.
4) Hemorrhoids may occur from pressure of
the gravid uterus on the spine, which
interferes with venous circulation.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
5) Constipation is caused by decreased 9. Shortness of breath occurs due to pressure
intestinal peristalsis and displacement of the exerted on the diaphragm by an enlarging
intestines from a gravid uterus, insufficient uterus.
fluid intake, or use of iron supplements. 10. The enlarged uterus causes difficulty
6) Backache results from altered posture due sleeping.
to increased curvature of the lumbosacral 11) Round ligament pain results from
vertebrae from the enlarging uterus. stretching and hypertrophy of the ligaments;
7) Leg cramps may be caused by spasms of this should not be mistaken for labor.
the gastrocnemius muscle, possibly from
insufficient calcium.
8) Faintness is due to changes in blood volume
and postural hypotension.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
D. Nursing diagnoses E. Planning and outcome identification
1. Health-seeking behaviors 1. The woman will have a complication-free
pregnancy.
2. Noncompliance
3. Altered nutrition: less than body 2. The woman will achieve adequate
requirements nutritional status and fluid intake.
4. Altered nutrition: more than body 3. The woman will learn how to relieve
requirements common discomforts of pregnancy.
5. Knowledge deficit 4. The woman and her partner will achieve a
positive psychosocial adjustment toward
6. Altered role performance the pregnancy.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
F. Implementation 2. Promote an adequate nutritional status and
1. Stress the importance of regular prenatal fluid intake.
appointments throughout the pregnancy (a) Stress well-balanced meals, review the
to detect prenatal complications and to food pyramid, and discuss vitamin and
assess fetal growth and development. mineral supplementation.
(a) Explain prenatal testing to the woman (b) Explain the importance of increasing the
and her partner. fluid intake to prevent urinary tract
infection and improve kidney function.
(b) Prepare the woman and her partner for
prenatal testing. 3. Provide client teaching about ways to
(c) Teach the woman about the danger relieve the common discomforts of pregnancy
signals of pregnancy
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period
4. Promote a positive psychosocial (2) Maternal weight gain, nutritional status,
adjustment to pregnancy. and fluid intake are within normal limits.
(a) Discuss sexual concerns with the client (3) The woman reports increased comfort
and partner, as appropriate , include
(4) The woman and her partner demonstrate a
reasons for altered libido (increased or positive psychosocial adjustment to
decreased). pregnancy.
(b) Provide information concerning
parenting, sibling, and grandparent
classes.
G. Outcome evaluation
(1) The woman exhibits no signs of
complications, and fetal growth and
development is normal.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period: Common
Discomfort of Pregnancy
Discomfort Solution
Ankle edema Rest your feet elevated. Avoid standing for long periods
Avoid restrictive garments on the lower half of your body.
Backache Apply local heat. Avoid long periods of standing. Stoop to pick up objects.
Paracetamol in usual adult dose may help. Wear low-heeled shoes.
Breast tenderness Wear a supportive bra. Decrease the amount of caffeine and carbonated
beverages ingested.
Constipation Increase fiber in your diet.
Drink additional fluids.
Have regular time for bowel movements
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period: Common
Discomfort of Pregnancy
Discomfort Solution
Difficulty sleeping Drink a warm, caffeine –free drink before bed and practice relaxation
techniques.
Fatigue Schedule a rest period daily. Have a regular bedtime routine.
Use extra pillows for comfort.
Faintness Move slowly. Avoid crowds. Remain in a cool environment.
Lie on your left side when at rest.
Headache Avoid eye strain. Visit your eye doctor. Rest with a cool cloth on your
forehead. Take Paracetamol in regular adult dose, as needed. Report frequent
or persistent headaches to your primary care provider.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period: Common
Discomfort of Pregnancy
Discomfort Solution
Heartburn Eat small, frequent meals each day. Avoid overeating, as well as spicy, fatty
and fried foods.
Hemorrhoids Avoid constipation and straining with a bowel movement.
Take a sitz bath. Apply a witch hazel compress.
Leg cramps Avoid pointing your toes. Straighten your leg and dorsiflex your ankle.
Nausea Eat six small meals per day rather than three. Eat a piece of dry toast or some
crackers before getting out of bed. Avoid foods or situations that worsen the
nausea. If it persists, report the problem to your primary care provider.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period: Common
Discomfort of Pregnancy
Discomfort Solution
Nasal stuffiness Use cool air vaporizer or humidifier, increase fluid intake, place moist towel on
the sinuses, and massage sinuses.
Ptyalism Use mouthwash as needed. Chew gum or suck on hard candy.
Round ligament pain Avoid twisting motions. Rise to a standing position slowly and use your hands
to support the abdomen. Bend forward to relieve discomfort.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
Nursing Process Overview for
Care of the Woman During the Antepartum Period: Common
Discomfort of Pregnancy
Discomfort Solution
Shortness of breath Use proper posture. Use pillows behind head and shoulders at night.
Urinary frequency Void as necessary, at least every 2 hours, increase fluid intake. Avoid caffeine.
Practice Kegel exercises.
Vaginal discharge Wear cotton underwear. Bathe daily. Avoid tight pantyhose.
Varicose veins Walk regularly. Rest with feet elevated. Avoid long periods of standing. Do not
cross your legs when sitting. Avoid knee-high stockings. Wear support hosiery.
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
7/18/2021 Rita E. Penaso MAN, RN (Lecturer)
