Notes 1 - Antepartum notes

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Review math!

Learning Objectives for Antepartum

Chapter 1 – Issues and Trends *
Identify, define and apply the concepts of the following terms
 Healthy People 2020
o Provides science-based national objectives and goals across all life stages, esp. reducing rate of fetal
& infant deaths, rate of maternal mortality, reducing preterm births, reducing C-section births among
low-risk women.
o To have healthy moms & babies the mom needs to maintain a healthy lifestyle and needs to have
access to medical care. RN responsibility is to both mom and fetus – 2 pts
o EMTLA – emergency medical treatment & labor act – ensures that anyone coming to the hospital
(ER) uninsured will be treated
 Problems with the US Healthcare system- define and solutions
o Expensive, inaccessible (lack of money, transportation, childcare, physicians refusing to take
Medicaid)
 US has higher cost of healthcare than the next 12 countries on the list. Physician involvement
with nurse practitioners is required in all states except 16 (costly). Most insurance will not
reimburse mid wives or nurse practitioners fully.
o Vulnerable populations: women, pregnant, minorities, incarcerated, homeless, etc.
o Info on the internet helpful for pts to become involved in their own care
o Infant mortality may be affected by financial, educational, sociocultural, and behavioral factors.
Barriers to care must be removed and services modified to meet needs.
 Trends in Fertility and Birth rate
o Low Birth weight & preterm birth – increases risks for morbidity & mortality
o Morbidity and Mortality both maternal and infant – incidence higher in AA babies. Factors: limited
maternal education, young maternal age, unmarried status, poverty, lack of prenatal care, smoking,
poor nutrition, alcohol use, maternal health conditions.
 Maternal mortality rate small, but a problem b/c most are preventable (usually HTN,
infection, hemorrhage, CV disease – major cause)
o Obesity – more than 1/3 women in US obese; racial disparity, increases risk from HTN & diabetes;
also decreased fertility, congenital anomalies, miscarriage, fetal death
 Trends in Nursing Practice
o Specialization, advanced degrees, certification programs
o Nurses in advanced practice may provide primary care
 Standards of Practice and Legal Issues
o Legislation enacted for mothers/babies to stay in hospital at least 48 hrs after vag birth & 96 after
cesarean if desired
o AWHONN (Association of Women Health Care & Neonatal Nursing) publishes standards of practice &
education for perinatal nurses: “Standards & Guidelines for Professional Nursing Practice in the Care
of Women & Newborns),” including an evidence-based approach to practice
 Must document! RN can be sued by pts for up to 18 yrs & 3 mos after delivery
o “Failure to rescue” - a death after a treatable complication. RN failed to recognize or act on early
signs of distress. Must identify complication through careful surveillance and put appropriate
measures in place through quick action.


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, o Sentinel event – “unexpected occurrence involving death or serious physical or psychological injury,
or risk thereof. Serious injury specifically includes loss of limb or function.” - any maternal death
related to process of birth, perinatal death unrelated to congenital condition, infant discharge to
wrong family, severe neonatal hyperbilirubinemia, etc.

Chapter 2 – Community Care and Culture

Identify Family
 Primary unit of socialization – whoever the pt considers to be family (nuclear, extended, multigenerational,
no-parent, married-blended, cohabiting parent, single parent, homosexual)

Identify cultural factors and the implications for nursing; define culture
Using childbearing beliefs and practices identify, define, and provide culturally appropriate care
 Definitions
o Subculture – a group within a larger cultural system that retains its own characteristics
o Acculturation – changes that occur w/in a group when mixing or contacting other cultures – often in
times of crisis or change (like childbearing) a woman may rely on old cultural patterns even after
acculturation
o Assimilation – when cultural group loses identity & becomes part of dominant culture
o Ethnocentrism – the view that one’s own culture’s way of doing things is best
o Cultural relativism – the opposite of ethnocentrism
 Culture has a direct effect on health
 Nurse’s role: develop cultural competence and integrate it into the nursing care plan, often considering
health promotion rather than illness care
 Some main differences:
o Childbearing beliefs & practices
o Personal space
o Time orientation
o Family roles
 Important to recognize disparity between nurse’s culture & pt’s culture, educate & promote healthy
behaviors in cultural context that has meaning for pts, apply abstract cultural knowledge in a practical way,
have respect for differences (including nontraditional & alternative), recognize importance of culturally
different communication styles, problem-solving techniques, concepts of space & time, and desire to be
involved with care decisions
 Communication often the most challenging part obstacle for nurses working with people from other
cultures. Use translators/interpreters when necessary
 Review pg. 27 (K)

Identify, define and provide appropriate nursing care to vulnerable Populations
 Vulnerable populations are groups who are at higher risk for development of physical, mental, or social
health problems, with racial and ethnic disparities existing for a number of health conditions and services
o Women in general
o socioeconomically disadvantaged
o racial & ethnic minorities (poverty, higher rates of chronic disease, preterm labor, LBW)
o adolescent girls (risky behaviors, misinformed)
o older women (chronic illness)


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, o incarcerated women (unstable relationships, no family support, emotional stability, lifestyle choices)
o immigrant, refugee, and migrant women (not US citizens, fear of deportation, poverty)
o homeless women (nutrition, lifestyle, risk for injury & illness, victim of domestic abuse,
transportation)
o rural women (lack of transportation, far from medical care, poverty)
 Treat with dignity, avoid judgment, be professional, exhibit cultural sensitivity, be nonthreatening

Apply to guidelines for nursing practice for home care in the community
 Partnerships among community residents and health workers necessary
 Three levels of preventative care:
o Primary – immunizations, exercise, nutrition
o Secondary – targeting populations at risk for certain diseases – screenings
o Tertiary – rehab
 Variety of health-promoting strategies used; prepared childbirth classes, publications, coalitions, faith-based
organizations helpful
 Home care – extension of in-hospital care
o Pros: bed rest maintained, neonate not exposed to infection, teaching tailored to home conditions,
safety & resources assessed
o Cons: limited availability of nurses, nurse safety, expensive
 Telephonic nursing – internet & Skype, telemedicine; less expensive
o nursing assessments after postpartum home care visit reassess pt’s knowledge
 Perinatal home care incorporates knowledge from community health nursing, acute care nursing, family
therapy, health promotion, and client education
 Referrals – consider health status of both pts, availability of med care in community, family resources, level
of home support & care, availability of third party reimbursement, cost-effectiveness
 Nursing considerations
o Careful history of meds, ensure taking correctly
o Teach how to respond in emergency situation
o If using medical equipment, inspect equipment/environment/electricity
o Give written instructions as well as verbal ; share info on support groups
o Follow protocol & do psychosocial assessment
o Documentation, forms – third party payers base payment on nurse written record
o Communicate with health care provider about any new orders required

Chapter 3 – Nursing and Genomics

Identify and define the various genetic testing in the childbearing family
 Family history important – single most cost-effective piece of information (complete = three generations)
o Preconception ideal time for this
 Most tests now offered are tests for single-gene disorders in pts with clinical symptoms or w/ family Hx of
genetic disease
 Maternal serum screening
 Fetal ultrasound or sonogram
 Invasive procedures (chorionic villus sampling & amniocentesis)
 Noninvasive testing for fetal aneuploidy – abnormal # of chromosomes w/in a cell (now recommended for all
women during prenatal assessment)

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,  Carrier screening test
 Predictive testing, presymptomatic testing, predispositional testing

Define the following and identify the common diseases and clinical manifestation of the following: (Identity the
name, clinical manifestation and medical and nursing care as well as a common disease for the following
chromosomal abnormalities)
 Numerical
o Monosomy – only one chromosome (X) from mother (these people have 45 chromosomes in most
cells)
o Trisomy – 3 chromosomes; various types of trisomy (these people have 47 chromosomes in most
cells) – Down syndrome most common
 Structural
o Translocation – piece of DNA or RNA moved from correct spot
o Deletions - part of a chromosome or a sequence of DNA is lost during DNA replication
o Inversions - a chromosome breaks in two places and the resulting piece of DNA is reversed and re-
inserted into the chromosome
 Sex Chromosome Abnormalities – (K)sex chromosomes (boy or girl?)
o Turner Syndrome - Monosomy X
 Missing an x chromosome - most common deviation in females
 Juvenile external genitalia, undeveloped ovaries, short, webbing of neck, low hairline in back,
low-set ears, lymphedema of hands and feet. Intelligence may be impaired
o Klinefelter Syndrome - Trisomy XXY
 Extra x chromosome, most common deviation in males
 Poorly developed secondary sex characteristics, small testes, infertile, unusually tall, slow to
learn
 Unifactorial Inheritance - define and Identity common diseases
o Autosomal Dominant Inheritance – only one gene needed to be expressed; affects males & females
equally, usually comes from multiple generations having the disorder
 Marfan syndrome, neurofibromatosis, etc.
o Autosomal Recessive Inheritance – both genes needed to be expressed, can have carriers, affects
males & females equally, most have severe clinical manifestations
 PKU, Galactosemia, Tay-Sachs, sickle cell anemia, CF
o Inborn errors of metabolism – defective enzyme action, normal metabolism cannot occur
 Phenylketonuria, Tay-Sachs disease
o X linked Dominant – mimics autosomal dominant except male-to-male transmission has to occur –
the father has to have Klinefelter syndrome; females usually less severely affected (few identified)
o X linked Recessive – abnormal genes carried on x chromosome, most common in males w/ abnormal
gene on his single X chromosome
 Hemophilia, color blindness, Duchenne muscular dystrophy
 Passed down by mother on her affected X chromosome

Define the nursing role in genetics
1. Provide information
2. Construct Family pedigree
3. Clarify information
4. Refer to support group


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