1. Abortion.
    2. Cultural, ethnic influences on decisions: will influence range of activities, types of safeguarding actions, diet, and health-promotion behaviors.
    3. Parenting potential: actively seeking medical care and information about pregnancy, childbirth, parenthood
    4. Family readiness for childbearing and child rearing:
      1. Physical maintenanc
      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).
    5. Perceptions of present and projected family relationships.
    6. Review lifestyle for smoking, drugs, alcohol (ETOH), attitudes to pregnancy, health care practices, and risks for hepatitis and human immunodeficiency virus (HIV).

  2. Analysis/nursing diagnosis:
    1. Altered role performance related to stress imposed by developmental tasks.
    2. Ineffective coping: individual, family related to stress caused by developmental tasks/crises.
    3. Altered family process related to developmental tasks. First baby may precipitate individual or family developmental crisis.

  3. Nursing care plan/implementation:
    1. Goal: anticipatory guidance/support.
      1. Discuss mood swings, ambivalent feelings, negative feelings.
      2. Reinforce “normalcy” of such feelings.
    2. Goal: increase individual/family coping skills, reduce intrafamily stress.
      1. Reinforce family strengths (both partners), sense of family identity.
        1. Encourage open communication between partners; share feelings and concerns.
        2. Increase understanding of mutual needs, encourage mutuality of support.
        3. Increase tendency of mother to turn to partner as most significant person (as opposed to physician).
        4. Enhance bond, success of childbirth preparation classes.
      2. Promote understanding/acceptance of role chang
        1. Facilitate/support achievement of developmental tasks.
        2. Reduce probability of postpartal psychological problems.
        3. Promote family bondin
    3. Goal: health teaching
      1. Siblings:
        1. Alert parents to sibling needs for security, love
        2. Include sibling in pregnancy experience
        3. Provide clear, simple explanations of happenings.
        4. Continue demonstrations of love
        5. Describe increased status (“big sister/ brother”).
        6. 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.
  4. Evaluation/outcome criteria:
    1. Actively participates in pregnancy-related decision making
    2. Expresses satisfaction with decisions mad
    3. Demonstrates growth and development in parenting role
    4. Prepared for the birth and for early parenthood

Antepartum

  1. Nursing care and obstetric support
    1. General aspects of prenatal management
      1. Scheduled visits:
        1. Once monthly - until week 28.
        2. Every 2 week - week 28-36.
        3. Weekly - week 36 until labor.
      2. Assessment:
        1. General well-being, signs of deviations, concerns, questions.
        2. Weight gain pattern.
        3. Blood pressure (sitting).
        4. Abdominal palpation:
          1. Fundal height; tenderness, masses, hernia
          2. Fetal heart rate (FHR).
          3. Leopold’s maneuvers for presentation (after week 32).
        5. Laboratory tests:
          1. Urinalysis - for protein, sugar, signs of asymptomatic infection.
          2. Venous blood - for Hgb, Hct; done initially: VDRL, anti-body titer, sickle cell. HIV recommended for high-risk groups, and hepatitis for high-risk groups.
          3. Cultures (vaginal discharge; cervical scrapings, for Chlamydia trachomatis) prn.
          4. Tuberculosis (TB) screening in highrisk areas.
          5. Maternal alpha-fetoprotein screen, 16-18 week optimum time
          6. Serum-glucose screen, 24-28 week.
        6. Follow-up on medications (vitamins, iron) and nutrition.
        7. If TB positive during pregnancy, isoniazid (INH) and rifampin given daily. INH is associated with increase in fetal malformations, particularly neurotoxicity. Pyridoxine administered simultaneously to prevent their development.
    2. Common minor discomforts during pregnancy
      1. Etiology: normal maternal physiologic/psychological alterations in pregnancy.
      2. Nursing care plan/implementation:
        1. Goal: anticipatory guidance Discuss the importance of adequate rest, exercise, diet, and hydration in minimizing symptoms.
        2. Goal: health teaching
      3. Evaluation/outcome criteria: woman avoids, minimizes, or copes effectively with minor usual discomforts of pregnancy.
    3. Danger signs:
      1. Etiology: Specific disease processes are discussed under Complications.
      2. Nursing care plan/implementation:
        3. Goal: health teaching - to safeguard status. Signs to report immediately:
        1. Persistent vomiting beyond first trimester or severe vomiting at any time Possible cause: Hyperemesis gravidarum.
        2. Fluid discharge from vagina - bleeding or amniotic fluid (anything other than leukorrhea). Possible causes: Placental problem, rupture of membranes (ROM).
        3. Severe or unusual pain: abdominal. Possible cause: Abruptio placenta
        4. Chills or fever. Possible cause: Infection.
        5. Burning on urination. Possible cause: UTI.
        6. Absence of fetal movements after quickening Possible cause: Intrauterine fetal death
        7. Visual disturbances - blurring, double vision, “spots before eyes.” Possible cause: Preeclampsia
        8. Swelling of fingers or face Possible cause: Preeclampsia
        9. Severe, frequent, or continual headache Possible cause: Preeclampsia
        10. Muscle irritability or convulsions. Possible cause: Preeclampsia
      3. Evaluation/outcome criteria:
        1. Actively participates in own health rnaintenance/pregnancy management.
        2. Identifies early signs of potentially serious complications during the antepartal period
        3. Promptly reports and seeks medical attention.