n107 – essentials of nursing care: reproductive health
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N107 – Essentials of Nursing Care: Reproductive Health
Needs of the Childbearing Family: Preconception
Chapter Objectives Know which topics to counsel and plan
with childbearing females/families Review health and lifestyle choices that
affect childbearing females/families Be able to perform a risk assessment Be able to create a care plan via the
nursing process regarding a patient with a preconception issue specifically
Counseling and Planning for Parenthood
Preconception care focuses on risk assessment and promoting healthy behaviors
Healthy well-informed women who plan pregnancy have better outcomes
Contraception is important aspect in planning process
Counseling and Planning for Parenthood Many women don’t realize they are
pregnant and don’t seek prenatal care until way into 1st trimester Half of all pregnancies in US are unintended The period of greatest danger for developing
fetus is 17 – 56 days after fertilization By end of first trimester, major structural
anomalies in the fetus are already present Fetus may be exposed to intrauterine
environmental hazards Radiation (x-rays, microwaves), carcinogens
(smoke, fumes)
Health and Lifestyle ChoicesPreconception Care Purposes:
Establish life-style behaviors to maintain optimum health
Diet, weight control, safe sex practices, rest & exercise, substance abuse
ID and treat “Risk Factors” before conception Medical conditions, substance abuse, test for immunity,
history of genetic defects, the need for genetic counseling To conceive absent of unnecessary Risk Factors
Monitor chronic illnesses (medications), environmental hazards (home, work)
ID carriers of inherited diseases African Americans/Southeast Asians (sickle cell disease),
Jewish Americans (Tay-Sachs disease) Prepare people psychologically for pregnancy and
responsibilities of parenthood
Health and Lifestyle ChoicesPreconception Care Why assess for and treat “Risk Factors”
Every woman of childbearing age is a potential mother
Nurses can make a difference through education and counseling; preconception education/counseling can decrease the incidence of birth defects
Type I diabetic with excellent glucose control reduces risk for congenital malformations in fetus
Adequate intake of folic acid (0.4 mg/day) decreases possibility for neural tube defects
Endocrine disorders interfere with female menstrual cycle and male libido
Renal and GU disorders affect sexual performance & reproductive capacity
Health and Lifestyle ChoicesPreconception Care Treating Risk Factors (Cont’d)
Hx of cholecystitis and hepatitis may be contraindications for oral contraceptives
Women under 15 and 0ver 40 at higher risk Cigarette smoking may delay conception Maternal smoking low birth weight
Increases risk for spontaneous abortion, fetal death, neonatal death & SIDS
Smoking increases morbidity in those using oral contraception,
and early menopause (Females) In males who also use drugs
Affects sperm count, causes impotence or decrease libido
Prenatal Care To promote positive outcomes for both mother
& child Should begin prior to conception First prenatal visit
Typically scheduled between weeks 8-12 of gestation Obtain health hx (first menarche, sexual & family
hx’s, Gravida/Para) Physical exam (vaginal exam, pap smear Confirm pregnancy Prenatal labs (blood type, Rh factor, rubella status,
Hep B status, STD, pap smear,
Prenatal Care Prenatal Visit (Cont’d)
Calculate EDC Nagel’s Rule
LMP – 3 months + 7 days Tables Wheels
Lines up LMP to indicate EDC & due date Auscultate fetal hear tones
May be difficult to hear prior to 12 weeks Only Positive signs of pregnancy
Presence of fetal heart tones Detection of fetus by US or X-ray
Testing (The Triple Screen)
Alpha-fetoprotein test Performed between week 16 – 18 Indicates neural tube defects and
chromosomal disorders High incidence of false positives If complication indicated
amniocentesis is recommended
The Triple Screen (Cont’d) Gestational Diabetes Screening
Performed at week 28 Fasting glucose test If failed, glucose tolerance test If positive, dietary consult and/or
diabetes educator consult Instruct on proper diet How to monitor blood glucose levels
(glucometer) If diet control unsuccessful, insulin injections
may be required
The Triple Screen (Cont’d) Group Beta Strep Bacteria detection
Not an uncommon finding Requires Abx upon rupture of membrane or
onset of active labor Recommended that one dose of Abx be
administered at least 4 hours prior to delivery to reduce risk of infant contracting group beta strep
Can cause serious illness in infant but harmless to mother
The Nursing Process Assessment
The Interview Process: Ask about current “lifestyle choices”
Nutrition, exercise, rest, substance abuse, alcohol & tobacco use, occupation, stressors, depression, support system domestic violence, and financial resources
Immunization status: Rubella, Hepatitis B Current medications to include OTC, non-
prescription and prescription meds
The Nursing Process Assessment (Cont’d)
Review of Systems Head to Toe assessment Discussion of any medical conditions
Reproductive System Review Previous pregnancies, miscarriages, living children’s
disorders Abnormal PAP smear results, mammogram results, STD
hx, sexual practices Obstetric History
Review of family planning and fertility counseling information
Previous abd/reproductive surgery, trauma’s or transfusions
The Nursing Process
Assessment (Cont’d) Environmental History
Home and/or work exposures Family History
Medical conditions Genetic conditions
Sickle cell, cystic fibrosis, bleeding disorders, hemophilia, PKU, birth defects
Should also include companions family history
The Nursing Process Assessment (Cont’d)
Risk Assessment Pediatric illnesses
Mumps in males sterility Rubella in childbearing females increases congenital
anomalies during 1st trimester Encourage immunization if not had or been
immunized Currently pregnant females should not receive
immunization Those planning pregnancy should wait 3 months
before becoming pregnant after receiving immunization
The Nursing Process Assessment (Cont’d)
Contraceptive and Obstetric History Psychosocial History
Family situation Ask directly “Have you been hit, slapped,
kicked or hurt with the past year?” “Are you afraid of your companion or anyone else?”
Readiness for pregnancy Age, life goals, stressors
Financial stability and resources
The Nursing Process Assessment (Cont’d)
Occupational History Physical activities
Standing all day? Heavy lifting? Exposures
Religious and Cultural Preferences Physical Examination
Emphasis placed on thyroid gland, breasts and pelvic structure
Lab studies CBC, UA, blood type and Rh, rubella immunity,
STDs, Hep B surface antigen, PAP smear, cervical culture.
OTHERS: PPD, HIV, toxicology screen, thalassemia
The Nursing Process Analysis
In collaboration with the patient/family and members of the healthcare team, synthesize data to identify the patient’s actual or potential health problems that can be managed by independent nursing actions
Identify a Nursing Diagnosis (NANDA) When choosing a nursing dx, look at all data and
their commonalities The common theme reveals the existence of a
problem and the need for nursing intervention The nurse may use physician (dependent) and
nursing (independent) interventions to minimize complications.
The Nursing Process Analysis (Cont’d)
Areas of concern for preconception care
Health-seeking behaviors, Optimum nutrition Health maintenance Deficient knowledge Fear Pain Risk for Infection
The Nursing Process Planning
Planning phase consist of determining the expected outcomes and formulating specific strategies to achieve the expected outcomes.
Assign priorities to the nursing diagnosis Maslow’s Hierarchy of Needs Most crucial to least crucial
Specify expected outcomes Outcomes must be realistic and measurable Expected outcomes are the basis for evaluating the
effectiveness of the nursing interventions and deciding whether the plan of care needs to be revised.
The Nursing Process Specify goals of nursing action ID specific nursing interventions appropriate for
attaining the outcomes Interventions should be listed in preferential order Interventions should be individualized as well as age,
gender, and culture-appropriate Can the implementation of the intervention be
rationalized? ID interdependent interventions
Will a physician order be required Document plan of care Communicate to appropriate personnel any need for
multidisciplanary approach to plan of care
The Nursing Process Patient Values
Always include patient and family in process What does patient consider to be a priority? Conflicts should be resolved in a way that is
mutually acceptable
Expected Outcomes (patient centered goals)
Pt will be able to recite Signs & Symptoms of…….. Pt will verbalize understanding of the importance
of adequate amount of folic acid in the diet.
The Nursing Process Nursing Interventions
Plan nursing interventions n the basis of established standards and priorities to move the patient/family toward the expected outcomes
ANA Standard of Practice, Nurse Practice Acts, taxonomy of nursing interventions (NIC)
Should be patient focused and outcome driven Assign patient care activities to be
implemented by other members of the heath care team as appropriate
The Nursing Process Implementation
Plan of care is put into use The nurse (RN) assumes responsibility for the
implementation and coordinate activities of all involved
FOCUS: Resolving pt’s nursing diagnosis, achieving expected outcomes while meeting pt’s health care needs.
Implement a teaching plan that promotes a positive woman’s health outcomes
Supervise patient care activities that were delegated to other members of health care team
When nursing interventions have been completed, the Implementation phase of the process has ended.
The Nursing Process Evaluation Phase
Assess the pt’s response to nursing interventions, including progress toward the patient-centered goals
Assess whether objectives were achieved Document the extent of the
achievements Plan of care may need to be revised Questions to ask during evaluation phase
(see page 54)
The Nursing Process
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