1LINCOLN MEMORIAL UNIVERSITY CAYLOR SCHOOL OF NURSING NURS 246 LESSON PLAN: CARE OF WOMEN DURING THE PRENATAL PERIOD DATES & TIMES: See Syllabus OBJECTIVES: Upon completion of this unit, the student will demonstrate in the clinical/community setting, in individual and group conferences, and on written material an understanding of the following: 1. Define key terms found in each assigned chapter. 2. Describe the components of fertilization. 3. Explain milestones in human development from conception to term pregnancy. 4. Identify the etiology of risk factors that can affect conception, gestation, and embryonic/fetal growth and development adversely. 5. Describe fetal circulation and the development, structure, and functions of the placenta, amniotic fluid, and umbilical cord. 6. Describe methods of prenatal screening and diagnostic procedures. 7. Compose a nursing plan of care for a client facing prenatal diagnosis options. 8. Describe the presumptive, probable, and positive signs of pregnancy and relate them to physiologic changes in a woman’s body. 9. Identify approaches that will enable the nurse to provide culturally sensitive and relevant care to the expectant woman and family. 10. Explain the impact of age on pregnancy. 11. Describe physiological and emotional changes during pregnancy and identify nursing interventions for each change. 12. Compose a nursing plan of care for the physiological changes that occurs with pregnancy 13. Summarize the components of an assessment for pregnant women, focused on appropriate history taking, physical examination, and laboratory evaluation. 14. Utilize Naegele’s Rule to determine estimated date of delivery (EDD). 15. Describe methods of diagnostic assessment of the fetus. 16. Describe common discomforts of pregnancy and measures to relieve them. 17. Describe Rubin’s themes of maternal tasks of pregnancy. 18. Identify nutritional requirements during each trimester of pregnancy. 19. Develop a plan of care that maintains and promotes well-being in each trimester of pregnancy. 20. Perform nursing assessments and plan interventions for the family unit throughout the prenatal period. 21. Identify the role of risk assessment in pregnancy as well as areas of focus in2 performing such evaluation 22. Describe the psychosocial considerations along with communication techniques the nurse utilizes when working with a pregnant client with risk factors. 23. Outline the nursing process in the management of common disorders for the pregnancy at risk: respiratory disorders, anemia, autoimmune diseases, infections, psychosocial disorders, obesity, substance abuse, diabetes mellitus, cardiovascular disease, hyperemesis gravidarum, hypertensive disorders, DIC, and HELLP 24. Discuss the effects and treatment of infectious processes and environmental agents on pregnancy and the fetus. 25. Identify uses, side effects, and nursing implications of medications used during normal and high-risk pregnancies 26. Summarize reasons for early as well as perinatal loss and describe nursing interventions in each situation. 27. Describe the various prenatal care providers 28. Describe the relationship between childbirth preparation and health promotion for women, infants, children, and families. 29. Identify specific types of childbirth preparation classes and their areas of focus and emphasis. 30. Describe influences fear, pain, and control can have over a client’s preferences for labor and birth. REQUIRED READINGS: Orshan, S. A. (2008). Maternity, newborn, & women’s health nursing: Comprehensive care across the life span. Philadelphia: Lippincott, Williams & Wilkins. Chapters 11, 12, 13, 14. Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2009). Pharmacology: A nursing process approach (6th ed). St Louis: Elsevier Chapter, 52 & pages 805-808 TOPICAL OUTLINE: I. Conception/Fetal Development (362 - >) A. Membranes, Placenta, and Amniotic Fluid B. Fetal Circulation C. Teratology D. Multiple Gestations E. Fetal Development (to page 379) II. Assessment of the Woman Who is Pregnant A. Signs of Pregnancy 1. Presumptive 2. Probable 3. Positive3 B. Physiologic Changes in Pregnancy C. Physiologic Changes Related to Age/Race 1. Assessment 2. Nursing Care Related to Age/Race Variations a. age related variations b. sociocultural variations c. religious variations D. Psychological and Emotional Changes in Pregnancy III. Antepartal Health Assessment A. Initial Prenatal Health Assessment 1. Health History a. menstrual history b. sexual history c. past pregnancy history d. current pregnancy history e. past medical/surgical history f. family history g. sociocultural history h. history of abuse 2. Physical Examination a. Nagele’s Rule 3. General Survey and Pelvic Adequacy 4. Laboratory Evaluation and Disease Screening 5. Subsequent Follow-up Assessments B. Prenatal Screening and Diagnostic Procedures 1. MSAFP 2. Ultrasound Evaluation 3. Invasive Tests a. amniocentesis b. CVS c. PUBS C. Assessment of Fetal Well-Being 1. Fetal Activity 2. Biophysical Profile 3. CST/OCT 4. Umbilical Artery Doppler Velocimetry IV. Care of Women Experiencing Common Discomforts/Concerns of Pregnancy V. Nutrition During Pregnancy A. Weight Gain4B. Nutritional Requirements C. Supplements D. Role of Nutrients in Pregnancy (Down to Lactation, pg 102) E. Nutritional Concerns for Pregnant Adolescents (to adulthood, pg 109) VI. Caring for Women Experiencing A High Risk Pregnancy A. Pregnancy Risk Assessment 1. Psychosocial Risk Factors 2. Economic Risk Factors 3. Nutrition Risk Factors 4. Family Risk Factors B. Psychosocial Disorders & Problems C. Common Interventions in High Risk Pregnancies 1. Fetal Health Surveillance 2. Bedrest D. Pre-Gestational/Gestational Health Complications Found in Pregnant Women 1. Asthma 2. Cystic Fibrosis 3. Cardiovascular Disease 4. Anemia 5. Autoimmune Diseases 6. Infections a. TORCH b. Others 7. Renal/Urinary Problems 8. DM 9. Psychosocial Disorders 10. Obesity E. Caring for Women Experiencing High Risk Pregnancy Complications 1. Hyperemesis Gravidarum 2. Hypertensive Disorders 3. HELLP 4. DIC 5. Amniotic Fluid Abnormalities 6. Adolescent Pregnancy 7. Multiple Pregnancy 8.