TERNOPIL STATE MEDICAL UNIVERSITY

INSTITUTE OF NURSING

INTERNATIONAL NURSING SCHOOL

ASSOCIATE DEGREE NURSING PROGRAM

NURSING CARE OF THE CHILDBEARING FAMILY

METHODICAL INSTRUCTION FOR

PRACTICAL CLASS # 1 (5 hours)

Themes: Maternal and Fetal Health, introduction to maternity nursing.

Aim: The goal of the maternity nursing curriculum is to equip the student nurse with the knowledge, skills, and attitudes necessary to provide care to the woman throughout her life cycle.

Professional orientation of students:

Nursing care of the woman during pregnancy, labor, postpartum is designed to prepare nurses to be competent providers of antenatal care services, intrapartum care services, comprehensive nursing care during puerperium, and manage complaints and complication during pregnancy, labor, and postpartum, able to counsel mothers about family planning methods, and apply comprehensive nursing intervention for women with gynecological problems.

STUDENT’S INDEPENDENT STUDY PROGRAM

Themes: Maternal and Fetal Health, introduction to maternity nursing.

Control questions:

1. Physiologic maternal changes.

· General appearance.

· Cardiovascular

· Respiratory

· Hematologic

· Gastrointestinal

· Urinary

· Endocrine

· Musculoskeletal

· Integumentary

· Reproductive

2. Maternal psychological changes – developmental tasks of pregnancy.

· Acceptance of Pregnancy by self, partner.

· Adjustment to changes in self.

· Prenatal attachment to fetus.

· Preparation to maternal role.

· Preparation for fetal separation and birth process.

3. Signs and symptoms of pregnancy.

· Presumptive evidence.

· Probable evidence.

· Positive evidence.

4. Pregnancy Testing.

5. Placental Function and Anatomy.

6. Cultural Consideration.

TEST QUESTIONS:

I. The nurse should prepare a woman who is pregnant for the first time to expect which of the following changes in

her breasts during the first trimester?

1. striae development on the breasts

2. presence of a tingling sensation

3. leakage of colostrum

4. appearance of secondary areola

II. When teaching a pregnant woman about the expected enlargement of her abdomen, the nurse should include which of the following pieces of information?

1. The fundus cannot be felt during weeks 10–12.

2. During weeks 20–22 the fundus is half-way between the symphysis and umbilicus.

3. At 28 weeks the fundus is one finger breadth above the umbilicus.

4. At 36 weeks the fundus is just below the ensiform cartilage.

III. Question: What is the normal duration of pregnancy?

36 weeks
38 weeks
40 weeks
42 weeks

IV. Question: When a fertilized egg implants itself outside the uterus, it is known as:

Preeclampsia
Ectopic pregnancy
High risk pregnancy
Caesarean section

Answers:

I(2) During the first trimester, which is the first 12 weeks after conception, the woman might experience a tingling sensation

in her breasts. This is normal. The tingling sensation is also present in the third trimester. Striae develop on the breasts during pregnancy but are most common in multiparas rather than primimparas. Colostrum is not present until the 12th week of gestation. After 20 weeks of gestation, secondary areola might appear and are characterized by washed-out spots surrounding the primary areola.

II(4) At 36 weeks gestation the pregnant woman can anticipate her fundus to be just below the ensiform cartilage.

However, the size of the uterus can be inconsistent with the length of gestation. During weeks 10–12 the fundus can be palpated slightly above the symphysis pubis. During weeks 20–22 the fundus is at the umbilicus. At 28 weeks the fundus is three finger breadths above the umbilicus.

III. The correct answer is 40 weeks.
The normal duration of pregnancy averages 280 days or 40 weeks (10 lunar months; 9 calendar months) from the 1st day of the last normal menstrual period.

IV. The correct answer is Ectopic pregnancy

Ectopic pregnancy is any pregnancy implanted outside the uterus. It usually occurs in the fallopian tubes, but may occur in the ovary, cervix, abdomen or the site where the fallopian tube and uterus join. This condition requires removal of the embryo (developing fertilized egg) to prevent rupture of the internal organs and severe bleeding.

4. LITERATURE

A lecturer notes (handouts).

Essential books:

1. Miller Alistair W.F. et al (1998): Obstetric illustrated, 5^th ed, Britain, Harcourt Brace and company limited.

2. Lowdermilk Perry (1999) :Maternity nursing, 6 ^th ed, USA.

3. Hacker & Moore, (1998): Essential of Obstetric and Gynecology, 3^rd ed, W.B. Saunders Company, USA.

4. Fraser Dian M, et al, (2003): Myles textbook for midwives, 14^th ed, Elsevier science limited, china.

5. Ladwing Patrica W, et al, (2003): Maternal and newborn nursing. 1^st ed, Addison wesley longman, Canada.

5. Practical work – 9⁰⁰-12⁰⁰ (4 hours)

Visual Aids and Material Tools: Tables, slides, compact-disk

Task 1. Performing home pregnancy test.

There are many different types of home pregnancy tests, or HPTs.

How you use them - Be sure to follow the directions and check the expiration date.

The majority tell the user to hold a stick in the urine stream. Others involve collecting urine in a cup and then dipping the stick into it. At least one brand tells the woman to collect urine in a cup and then put a few drops into a special container with a dropper. Testing the urine first thing in the morning may help boost accuracy.

Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, a woman is pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive.

Most tests also have a "control indicator" in the result window. This line or symbol shows whether the test is working or not. If the control indicator does not appear, the test is not working properly. It is necessary to repeat the test in a few days, no matter what the results. One negative result (especially soon after a missed period) does not always mean a woman are not pregnant. All HPTs come with written instructions.

Task 2. Describe gravidity and parity with the four digit system.

TPAL

In some obstetric services, a woman's obstetric history is summarized by a series of four digits, such as 5-0-2-5. These digits correspond with the abbreviation TPAL.

• T—represents full-term deliveries, 37 completed weeks or more.
• P—represents preterm deliveries, 20 to less than 37 completed weeks.
• A—represents abortions, elective or spontaneous loss (miscarriage) of a pregnancy before the period of viability.
• L—epresents the number of children living. If a child has died, further explanation is needed for clarification.

Explain summarising of a particular woman's history as G 7, P 5-0-2-5.

Task 3. Describe gravidity and parity with the five digit system.

GTPALM

In some institutions, a woman's obstetric history can also be summarized as GTPALM.

• G—represents gravida.
• T—represents full-term deliveries, 37 completed weeks or more.
• P—represents preterm deliveries, 20 to less than 37 completed weeks.
• A—represents abortions, elective or spontaneous loss of a pregnancy before the period of viability.
• L—represents the number of children living. If a child has died, further explanation is needed for clarification.
• M—represents the number of multiple gestations and births (not the number of neonates delivered).

Explain summarising of a particular woman's history as G 5, P 5-0-0-6-1.

6. Seminar Discussion of pracrical work – 12.30-14.45 (2 hours)

7. Test control of students’ knowledges – 1415-1500 (1 hour).

Basic level:

Student must know:

· The changes that occur physiologiclly and physiologically with the pregnant female.

· Psycho-social issues facing the new mom and family.

· The expected maternal anatomic and physiological adaptations to pregnancy.

· The maternal hormones produced during pregnancy, their target organs, and their major effects on pregnancy.

Student must have the skills:

· Describe gravidity and parity with the four- and five- digit systems.

· Perform the various types of pregnancy tests.

· Differentiate among presumptive, probable, and positive signs of pregnancy.

· Compare the characteristics of the abdomen, vulva, and cervix of the nullipara and multipara.

Prepared by Dr. Inna Korda, MD, PhD.

Adopted at the Chair Sitting N 2009