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The prenatal period is a time of physical and psychological preparation for birth and parenthood. Becoming a parent is a time of intense learning both for par­ents and for those close to them. The prenatal period provides  a unique  opportunity for nurses  and  other members of the health care team to influence family health. During this period, essentially healthy women seek regular care and guidance. The nurse's health pro­motion interventions can affect the wellbeing of the woman, her unborn child, and the rest of her family for many years.

 Ante/Intra/Postpartum and Newborn Care

Regular prenatal visits, ideally beginning soon after the first missed menstrual period, offer opportunities to en­sure the health of the expectant mother and her infant. Prenatal health care permits diagnosis and treatment of maternal disorders that may have preexisted or may de­velop during the pregnancy. Care is designed to monitor the growth and development of the fetus and to identify abnormalities that may interfere with the course of normal labor. The woman and her family can seek support for stress and learn parenting skills.

Pregnancy lasts 9 calendar months, but health care providers use the concept of lunar months, which last 28 days, or 4 weeks. Thus normal pregnancy lasts approxi­mately 10 lunar months, or 40 weeks. Health care providers also refer to early, middle, and late pregnancy as trimesters. The first trimester lasts from weeks 1 through 13; the sec­ond, from weeks 14 through 26; and the third, from weeks 27 through 40. A pregnancy is considered at term if it ad­vances to 38 to 40 weeks. The focus of this chapter is on meeting the health needs of the expectant family over the course of pregnancy, which is known as the prenatal period.

Care Management

Prenatal care is ideally a multidisciplinary activity in which nurses work with physicians or midwives, nutritionists, social workers, and others. Collaboration among these indi­viduals is necessary to provide holistic care. The case man­agement model, which makes use of care maps and critical pathways, is one system that promotes comprehensive care with limited overlap in services. To emphasize the nursing role, care management here is organized around the cen­tral elements of the nursing process: assessment, nursing diagnoses, expected outcomes, plan of care and interven­tions, and evaluation.

Assessment and Nursing Diagnoses

Once the presence of pregnancy has been confirmed and the woman's desire to continue the pregnancy has been val­idated, prenatal care is begun. The assessment process be­gins at the initial prenatal visit and is continued through­out the pregnancy. Assessment techniques include the interview, physical examination, and laboratory tests. Be­cause the initial visit and follow-up visits are distinctly dif­ferent in content and process, they are described separately.

Physical examination. Reevaluation is a constant as­pect of a pregnant woman's care. At each visit, pulse and respirations are measured; blood pressure (same arm with woman sitting) is taken; her weight is determined, and whether the weight gain (or loss) is compatible with the overall plan for weight gain is evaluated; urine may be checked by dipstick; and the presence and degree of edema are noted. Abdominal inspection and palpation are done, as well as measurement of fundal height. While assessing the pregnant woman's abdomen with the woman in the lithotomy position during the second and third trimesters, the nurse must watch for the occurrence of supine hy­potension When a woman is lying in this position, the weight of abdominal contents may compress the vena cava and aorta, causing a drop in blood pressure (BP) and a feeling of faintness.

Fetal assessment. Toward the end of the first trimester, before the uterus is an abdominal organ, the fe­tal heart tones (FHTs) can be heard with an ultrasound fetoscope or an ultrasound stethoscope. To hear the FHTs the instrument is placed in the midline just anterior to the symphysis pubis and firm pressure applied. The woman and her family should be offered the opportunity to listen to the FHTs. The health status of the fetus is assessed at each visit for the remainder of the pregnancy.

Plan of Care and Interventions

The nurse-patient relationship is critical in setting the tone for further interaction. The clinic, home visits, or tele­phone conversations all provide opportunities for contact and can be used effectively for these interactions. Some­times women repeatedly seek information about a particu­lar problem. At other times, there may be another under­lying problem the woman is hesitant to discuss. The nurse needs to be astute in identifying such unvoiced needs and can help the woman by asking for a patient-generated so­lution and a subsequent report of its effectiveness.

Care Paths

Because a large number of health care professionals are in­volved in care of the expectant mother, unintentional gaps or overlaps in care may occur. Care paths are used to im­prove the consistency of care and reduce costs (Simon, Heaps, & Chodroff, 1997). Use of care paths may con­tribute to improved satisfaction of families with the pre­natal care that is provided, and members of the health care team may function more efficiently and effectively

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