Prenatal care is important to promote good outcomes for both the mother and the newborn. Prenatal care includes gaining an understanding of the physiologic changes that occur during pregnancy, planning for the birth, dealing with the discomforts of pregnancy, nutritional needs, safety, what to expect during each trimester and delivery as well as many other topics. The main focus of prenatal care is the health and safety of the mother and child throughout the pregnancy. The goal of prenatal visits is to see how your pregnancy is proceeding and to provide you with information to help keep you and your baby healthy. It's important that you go to all of your prenatal appointments, even if you're feeling just fine and believe that everything is progressing perfectly.

Your first visit to the doctor should occur as soon as you suspect you're pregnant. Your physician or the nurse will take an extensive medical history of you and the baby's father, including your menstrual history, any previous pregnancies, and diseases or genetic disorders that might run in either family. You'll also talk about any habits you may have that could pose a danger to your baby, such as smoking, drinking alcohol, or using drugs. All information will be kept confidential. In addition, your doctor will examine you, conduct lab tests, determine your due date, and begin to chart your weight gain. You may be given a prescription for a prenatal vitamin, along with nutrition and exercise advice.

Pregnancies are usually counted by weeks (for example, "12 weeks pregnant" or "38 weeks pregnant"). A typical pregnancy is about 40 weeks long (from the first day of your last menstrual period to delivery) and divided into three sections called trimesters. How often you'll go to the doctor depends on your individual circumstances. You'll probably be seen once a month during the first and second trimesters. Starting at about 28 weeks, you'll go every two weeks, and then weekly from 36 weeks until you deliver. Women at higher risk of complications require more-frequent checkups. These women may have had difficulty conceiving or carrying a baby, be over age 35, be carrying multiple fetuses, have a higher risk of birth defects, or have conditions such as gestational diabetes.

At each checkup, your doctor will test your urine to ensure that sugar and protein levels are appropriate. The doctor or nurse will also chart your weight gain, check your blood pressure, examine your hands and feet for swelling, measure the size of your uterus, check the baby's heartbeat and closely monitor any complications you have or that you develop, and intervene if necessary. These visits will also give you a chance to discuss the many questions you'll have. Keep a list so you don't forget to ask anything that's been on your mind. At the end of the visit, your practitioner will review the findings with you, explain the normal changes to expect before your next visit and the warning signs to watch for, counsel you about lifestyle issues (such as the importance of good nutrition and avoiding tobacco, alcohol, and drugs), and discuss the pros and cons of optional tests you may want to consider.

You'll probably start to show – that is, be visibly pregnant – by late in your first trimester or the first part of your second. You're likely to hear your baby's heartbeat at your first or second visit to your healthcare provider, usually 10 weeks into pregnancy or later. You'll see your baby on an ultrasound during your mid-pregnancy visit (around 16 to 20 weeks), if not sooner. Mid-pregnancy is when your caregiver may be able to identify your baby's sex. Of course, you don't have to find out if you don't want to. Your body will change in many ways during pregnancy. Naturally, your belly will grow and you'll gain weight. In addition, you can expect your breasts to grow a cup size or more (and possibly become painful or sensitive). Your skin may look brighter, get darker, or break out; your hair may become fuller; and your nails may grow faster. On your belly, you may see stretch marks, notice a dark line (called the linea nigra) appear from your belly button to your pubic bone, and watch your innie belly button "pop" and become an outie. Most of these changes will fade after pregnancy.
The amount of blood in your body will rise dramatically during pregnancy. By the time you give birth, you'll have about 50 percent more blood circulating than usual. You'll end up peeing more frequently, thanks to increased blood flow in your body and pressure on your bladder from your growing uterus. You might feel really tired during pregnancy, especially at the very beginning and again at the end. You might experience a variety of aches and pains and other symptoms throughout pregnancy, from headaches to heartburn, low back pain, leg cramps, nausea, swollen hands and feet, bleeding gums, dizziness, and more. Many women feel their best during the second trimester, and some lucky moms-to-be feel pretty good all the way through – that's normal, too.

About 3 in 4 pregnant women have morning sickness during their first trimester. Despite being called "morning" sickness, the nausea or vomiting can happen at any time of day. You might develop food cravings or food aversions during pregnancy, coupled with changes to your appetite.
You'll start to feel your baby kick sometime in your second trimester, probably between 16 and 22 weeks. In late pregnancy, your big belly will get in your way. You probably won't be able to bend over to tie your shoes or shave your legs, the steering wheel will hit your belly, children won't fit on your lap, and your belly may bump into things because you're not used to your new dimensions. Getting out of bed or off a sofa becomes a challenge, too.

You may find that sleeping is difficult or uncomfortable, especially during the first and third trimesters. Several common pregnancy sleep problems are to blame. (Your dreams can get a little wacky, too.) If you're not already a side sleeper, you may need to get used to a new position, since experts say that sleeping on your left side is best for you and your baby in the last half of pregnancy.

Pregnancy can affect your emotional health, in part because hormonal changes during pregnancy alter your brain chemistry. You may experience heightened emotions, both good and bad, or you might feel moody or anxious. At least 1 in 10 pregnant women suffer from bouts of depression.
Your relationship with your partner, family, and friends can change during pregnancy (and will even more so after your baby is here). Pregnancy may shake up your relationship with your partner the most. Your relationship with strangers will change, too. They may touch your belly, ask personal questions, give you advice, comment on your body, or guess whether you're having a boy or a girl. If you know you won't like this, you might want to come up with a plan for how to respond.
You might find that your pregnancy affects your sex life. In most cases, sex during pregnancy is perfectly safe, but pregnancy can boost or dampen your sex drive or force you to change the positions you use.

Your pregnancy could affect your work schedule. Depending on your health, how you're feeling, and the type of job you have, you may not be able to work full-time through the whole pregnancy or right up until your due date. Look into your options for maternity leave (and possibly paternity leave) and how it will affect your income. You need to request maternity leave at least 30 days before taking it, but many women request it several months in advance. Think about whether you'll return to work or stay home with your baby. If you'll be returning, you may want to find out if your employer offers any family-friendly work arrangements.

Your baby will change your budget, so it's smart to prepare yourself. Look ahead at what kinds of costs you'll face during the first year and beyond, and factor in any changes in income you might expect due to leave from your job or an altered work schedule. (Consider putting some extra padding in your budget, if possible, in case you can't work as much as you meant to during pregnancy.). Ask your insurance company what your co-pay or deductible will be for your delivery costs, and plan ahead as needed. You may need to buy various pregnancy products as your body changes – like a body pillow, maternity clothes, and bigger bras or shoes. Sometime during pregnancy, you'll need to get at least a few pieces of baby gear. Some things you can get cheap or secondhand, but one thing worth buying new is a car seat. (When you don't know a car seat's history, you can't be sure it's safe. Accidents and extreme temperatures can weaken it.). Other purchases may include a crib, stroller, and baby carrier. With a new family member on the way, you may decide you need a bigger car or home. If that's the case, dealing with it before the baby comes can make things less hectic later.

As you go through pregnancy, you'll learn all types of bizarre-sounding words. Your vocabulary will soon include the likes of colostrum, meconium, vernix, lanugo, and Braxton-Hicks, to name a few.
Your personal habits and schedule may change during pregnancy. For example, you might be too tired to stay out late, have to drop certain hobbies, reach a point where you can't exercise like you used to, or want to avoid people who smoke. Your interests and priorities may change, too, which could affect the way you want to spend your time. Consider taking a childbirth prep class and maybe newborn care, infant CPR, and breastfeeding classes, too. If you're planning to travel during pregnancy, make sure you're traveling safely. Be aware of airline policies that prohibit pregnant women from flying in late pregnancy. You may want to prepare your pet and/or other children for life with a baby.

Almost all pregnant women need to get more protein, more of certain vitamins and minerals such as folic acid and iron, and more calories (for energy). If your diet is poor to begin with, making the transition to eating nutritious meals is one of the best things you can do for your baby's health. Eating better doesn't mean eating more ­­– or rather, not much more. If you start off at a healthy weight, you need no extra calories during the first trimester, about 300 extra calories a day in the second trimester, and about 450 extra calories a day in the third trimester. If you're overweight or underweight, you'll need more or less than this, depending on your weight gain goal.

Steer clear of raw seafood (such as oysters or uncooked sushi), unpasteurized milk and cheese made from unpasteurized milk soft cheeses, such as Brie or Camembert, and Mexican cheeses like queso blanco and panela), pâté, and raw and undercooked meat and poultry. All are possible sources of bacteria that can harm an unborn child.

Nearly all fish contain traces of methylmercury, a metal believed to be harmful in high doses to the growing brains of fetuses and young children. The FDA recommends limiting your consumption of fish to about 12 ounces a week, the equivalent of about two servings. You'll need to give up that cocktail after work, too. Drinking alcohol during pregnancy can cause physical defects, learning disabilities, and emotional problems in children, so many experts recommend that you give up alcohol for your entire pregnancy. Consider cutting back or skipping caffeinated beverages. That may be a snap if you're suddenly revolted by the stuff during your first trimester. If you're still craving it, cut back very gradually to avoid side effects such as headaches.

Some studies suggest that women who consume 200 or more milligrams (mg) of caffeine per day (about one 12-ounce cup) are twice as likely to miscarry as women who consume no caffeine. Large amounts of caffeine have also been linked to slightly lower birth weight and even stillbirth.
In addition to coffee, caffeine is found in teas, colas, other soft drinks, cocoa, and chocolate. Switch to decaffeinated brews and sodas instead. Better still, replace these nutritional losers with healthier choices such as skim milk, 100 percent fruit juice, or water with a squeeze of lemon. A mug of flavored steamed milk can stand in for your morning latte.

In an ideal world – free of morning sickness and food aversions – a well-balanced diet would be all an expectant mom needed to meet her nutritional needs. But in the real world, a vitamin-mineral supplement helps ensure that you'll get the nutrients you need. Make sure the vitamin you choose contains folic acid. (You need 400 mcg before you become pregnant and in early pregnancy, and then at least 600 mcg.) A lack of this B vitamin has been linked to neural tube birth defects (NTDs) such as spina bifida. Another important nutrient that researchers now believe may help prevent NTDs is choline. You need 450 mg of choline a day during pregnancy, and most prenatal vitamins don't contain it, so you'll have to get it from food. Later in your pregnancy you may need to take iron or calcium supplements to make sure you're getting enough of these key minerals. Many experts also recommend taking a vitamin D supplement throughout pregnancy.

Strict vegetarians and women with medical conditions such as diabetes, gestational diabetes, or anemia, as well as those who've previously delivered low-birth-weight babies, should talk with their healthcare provider about supplements they might need. A registered dietitian can also help with diet specifics. If you have trouble swallowing your vitamins or keeping them down, search for a chewable supplement or one in a powdered form that you can mix with water. Keep in mind, too, that more isn't always better: Don't take megadoses of any vitamin or mineral or any individual vitamin or herbal supplements without medical supervision – they could be harmful to your developing baby.

Dieting during pregnancy is potentially hazardous to you and your baby. Many weight-loss regimes are likely to leave you low not only on calories, but on iron, folic acid, and other important vitamins and minerals. Weight gain is one of the most positive signs of a healthy pregnancy. Women who eat well and gain the appropriate amount of weight are more likely to have healthy babies. So if you're eating fresh, wholesome foods and slowly adding pounds, relax: You're supposed to be getting bigger. Just remember, you're not really eating for two!

When you put on your pregnancy weight may be as important as the total tally of pounds. You should gain the least weight during the first trimester (roughly 1 to 5 pounds) and then gain roughly a pound a week in the second and third trimesters. Talk with your healthcare provider if you're carrying twins or if you're underweight or overweight at the start of pregnancy, as the recommended pace of weight gain might be different for you. If you're overweight, for instance, your goal will probably be to put on about half a pound a week in your second and third trimesters rather than a full pound. And if you're carrying twins, you'll need to gain more than the amounts recommended for moms who are carrying single babies.

It's fine to get creative with your eating schedule during pregnancy. If nausea, food aversions, heartburn, or indigestion make full-size meals unpleasant, try eating five or six mini meals scattered throughout the day. As your pregnancy progresses and your baby increasingly crowds your stomach and other digestive organs, you’ll have less space in your body for big meals anyway. If you're most hungry between traditional mealtimes, go ahead and eat when the feeling strikes. Eating in a pattern that works for you will help you meet your nutritional needs during pregnancy. Satisfying snacks are fine, but make your choices count. Limit junk food, which offers little more than empty calories. Processed foods, packaged snacks, and sugar-loaded desserts shouldn't be the mainstay of your diet, but you don't have to give up all your favorite goodies just because you're pregnant. Some smart – and tasty – snack ideas to try: A banana smoothie, frozen all-fruit nonfat sorbet, or trail mix. Don't beat yourself up if you cave in to temptation. The occasional cookie or piece of cake won't hurt you or your baby.

Pregnancy can sap your energy, but regular bouts of exercise will help you get through your daily tasks or cope with a demanding schedule: Exercise strengthens your cardiovascular system, so you don't tire as easily. With muscles that are strong and toned, you need less effort to engage in any activity, whether that means grocery shopping or sitting through meetings at the office.
According to the American College of Obstetricians and Gynecologists (ACOG), you can safely take part in 30 minutes or more of moderate exercise every day, as long as you don't have a medical condition or complication that your doctor or midwife has told you rules out exercise or limits your activity level.

There are significant benefits to exercising while pregnant. When you're carrying an extra 15 pounds (or more!) in front of you, finding a comfortable sleeping position can be a real challenge, But exercise will help you work off any excess energy and tire you enough to lull you into a more restful sleep. Overall, regular exercise stretches and strengthens your muscles, which helps your body cope better with the aches and pains of pregnancy. Stretches ease back pain, walking improves your circulation, and swimming can strengthen your abdominal muscles. It makes perfect sense: The better shape you're in, the stronger you'll be come labor and delivery time. Giving birth is akin to running a marathon, which requires stamina, determination, and focus. Though it hasn't been well researched, training for childbirth through exercise may ease labor and even shorten the time it takes to deliver your baby. Having a child is a life-changing, momentous experience that can leave you feeling simultaneously ecstatic, overwhelmed, and anxious. One study found that exercise boosts levels of serotonin, a brain chemical linked to mood, putting you in better spirits.
Watching the scale inch its way up to numbers you've never seen before can be disheartening. Staying active helps you feel better about yourself and improves your odds of gaining a healthy amount of weight. When you've maintained your strength and muscle tone all through your pregnancy, your body will have an easier time bouncing back after you give birth. You’ll also gain less surplus weight if you exercise during your pregnancy.

If you exercised regularly before getting pregnant and your pregnancy is uncomplicated, you can most likely continue working out as before, with modifications as noted below. In some cases it's not okay to exercise during pregnancy, though, so talk to your doctor or midwife about your fitness routine to make sure your activities don't put you or your baby at risk. If you didn't work out much before conceiving, see our pregnancy exercise guide for beginners, and talk to your healthcare provider.

Exercise burns calories, so make sure to eat well to help nourish and strengthen your body. While you're pregnant, you'll naturally gain weight as your baby grows. The amount you'll need to gain will vary based on your pre-pregnancy weight. If your body mass index (BMI) is in a healthy range (between 18.5 and 24.9), you'll need to eat 300 or so more calories a day than before you were pregnant – and probably more than that if you're exercising. If you're underweight or overweight you may need to gain a little more or a little less than someone with a healthy BMI and adjust your calories accordingly. Your doctor will monitor your weight as your pregnancy progresses and can help you figure out how to keep your weight gain on track through diet and exercise.

Avoid contact sports, as well as activities that might throw you off balance, such as horseback riding, downhill skiing, or mountain biking. Regular cycling early in your pregnancy should be okay if you're comfortable on a bike, but it's probably best to stick to stationary or recumbent bikes later in pregnancy. Even if you're normally graceful, keep in mind that during pregnancy the increased levels of the hormone relaxin, which relaxes pelvic joints in preparation for childbirth, loosen all ligaments and joints, making you more susceptible to sprains and injury from falls. Wear loose-fitting, breathable clothing. Dress in layers so it's easy to peel off a layer or two after you've warmed up or if you feel too hot. Make sure your maternity bra offers enough support, and choose athletic shoes that fit your feet properly and offer good support. If your shoe size has changed because of mild swelling, stash away your pre-pregnancy sneakers and buy a new pair. Warm-ups prepare your muscles and joints for exercise and build your heart rate up slowly. If you skip the warm-up and jump into strenuous activity before your body is ready, you could strain your muscles and ligaments and experience increased postworkout aches and pains.

Drink water before, during, and after exercising. Otherwise, you can become dehydrated, which can cause contractions and raise your body temperature, sometimes to levels that are dangerous for you and your baby. James M. Pivarnik, director of the Center for Physical Activity and Health at Michigan State University, says that while there's no official recommendation for how much water pregnant women should drink while exercising, a good guideline is to drink one cup (8 ounces) before you exercise, one cup for every 20 minutes of exercise, and one cup after you finish your workout. In hot or humid weather, you'll need more. Avoid lying flat on your back after the first trimester. This position puts pressure on a major vein called the vena cava, which will reduce blood to your heart and may diminish blood flow to your brain and uterus, making you dizzy, short of breath, or nauseated. Some women are comfortable in this position well into their pregnancies, but this isn't necessarily a good gauge of whether blood flow to the uterus is affected. Placing a pillow under your right hip or buttock will allow you to be almost supine without compressing the vena cava. Standing in one place for prolonged periods – as when you're lifting weights or doing yoga poses – can decrease blood flow to the uterus and cause blood to pool in your legs, making you dizzy. Keep moving by switching positions or walking in place. Don't exercise until you're exhausted. A good rule of thumb: Slow down if you can't comfortably carry on a conversation. In general, the best guideline is to listen to your body. When something hurts, that means something's wrong, so stop. You should feel like you're working your body, not punishing it. Avoid letting yourself get too hot, especially during the first trimester when your baby's major organs are developing. Raising your core temperature above 102 degrees Fahrenheit for more than 10 minutes could harm your baby. The increased blood flow and higher metabolic rate that happen when you're pregnant mean you'll feel warmer than usual, and doubly so when you exercise, and, since feeling warm is common in pregnancy, you may get overheated much faster than you normally would, even before your belly is big. Signs of being overheated are largely individual, but pay attention if you're sweating a lot or feel uncomfortably warm, nauseated, dizzy, or short of breath. To cool off quickly, stop exercising, take off layers, and change your environment: Seek out air conditioning or step into a cool shower. Hydrating is key, too, so drink lots of water. As your belly grows, your center of gravity shifts. That's why it's important to take great care when you change positions. Getting up too quickly can make you dizzy and may cause you to lose your footing and fall. At the end of your workout, take five to 10 minutes to walk in place and do some pregnancy-friendly stretching. This will allow your heart rate to get back to normal and help to prevent sore muscles. Make a commitment to work regular exercise into your schedule. Keeping up a routine is easier on your body than long periods of inertia interrupted by spurts of activity. According to the American College of Obstetricians and Gynecologists, you can safely engage in 30 minutes or more of moderate exercise on most, if not all, days of the week as long as you have your healthcare provider's go-ahead.

While there are numerous conditions, illnesses, disease and complications that can affect the health of both mother and child during pregnancy, we will discuss only a few...

Hypovolemic shock is an urgent medical condition in which a rapid decrease of the volume of the intravascular fluid (blood) results in inadequate perfusion of the peripheral tissues and, eventually, in multiple organ failure.
Some pregnancy related causes of hypovalemic shock include:
Pregnancy-related bleeding:
Ruptured ectopic pregnancy
Placenta previa
Placental detachment (abruptio placentae)
Uterine rupture
Bleeding after delivery
Prognosis of hypovolemic shock mainly depends on the volume of blood lost, the speed of fluid replacement and underlying health conditions.

If you have placenta previa, it means that your placenta is lying unusually low in your uterus, next to or covering your cervix. The placenta is the pancake-shaped organ – normally located near the top of the uterus – that supplies your baby with nutrients through the umbilical cord.If the placenta covers the cervix completely, it's called a complete or total previa. If the placenta covers the cervix completely, it's called a complete or total previa. If it's right on the border of the cervix, it's called a marginal previa. (You may also hear the term "partial previa," which refers to a placenta that covers part of the cervical opening once the cervix starts to dilate.) If the edge of the placenta is within two centimeters of the cervix but not bordering it, it's called a low-lying placenta.
The location of your placenta will be checked during your mid-pregnancy ultrasound exam (usually done between 16 to 20 weeks) and again later if necessary.

People with different blood types have proteins specific to that blood type on the surfaces of their red blood cells (RBCs). There are four blood types — A, B, AB, and O.

Each of the four blood types is additionally classified according to the presence of another protein on the surface of RBCs that indicates the Rh factor. If you carry this protein, you are Rh positive. If you don't carry the protein, you are Rh negative.

Most people — about 85% — are Rh positive. But if a woman who is Rh negative and a man who is Rh positive conceive a baby, there is the potential for a baby to have a health problem. The baby growing inside the Rh-negative mother may have Rh-positive blood, inherited from the father. Approximately half of the children born to an Rh-negative mother and Rh-positive father will be Rh positive.

Rh incompatibility usually isn't a problem if it's the mother's first pregnancy because, unless there's some sort of abnormality, the fetus's blood does not normally enter the mother's circulatory system during the course of the pregnancy.

However, during delivery, the mother's and baby's blood can intermingle. If this happens, the mother's body recognizes the Rh protein as a foreign substance and can begin producing antibodies (protein molecules in the immune system that recognize, and later work to destroy, foreign substances) against the Rh proteins introduced into her blood.

Other ways Rh-negative pregnant women can be exposed to the Rh protein that might cause antibody production include blood transfusions with Rh-positive blood, miscarriage, and ectopic pregnancy.

Rh antibodies are harmless until the mother's second or later pregnancies. If she is ever carrying another Rh-positive child, her Rh antibodies will recognize the Rh proteins on the surface of the baby's blood cells as foreign, and pass into the baby's bloodstream and attack those cells. This can lead to swelling and rupture of the baby's RBCs. A baby's blood count can get dangerously low when this condition, known as hemolytic or Rh disease of the newborn, occurs.

When you're pregnant, you may develop anemia. When you have anemia, your blood doesn't have enough healthy red blood cells to carry oxygen to your tissues and to your baby.

During pregnancy, your body produces more blood to support the growth of your baby. If you're not getting enough iron or certain other nutrients, your body might not be able to produce the amount of red blood cells it needs to make this additional blood.

It's normal to have mild anemia when you are pregnant. But you may have more severe anemia from low iron or vitamin levels or from other reasons.

Anemia can leave you feeling tired and weak. If it is severe but goes untreated, it can increase your risk of serious complications like preterm delivery.

Here's what you need to know about the causes, symptoms, and treatment of anemia during pregnancy.

Types of Anemia During Pregnancy

Several types of anemia can develop during pregnancy. These include:


Iron-deficiency anemia
Folate-deficiency anemia
Vitamin B12 deficiency
Here's why these types of anemia may develop:

Iron-deficiency anemia. This type of anemia occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin. That's a protein in red blood cells. It carries oxygen from the lungs to the rest of the body.

In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout the body.

Iron deficiency is the most common cause of anemia in pregnancy.

Folate-deficiency anemia. Folate, also called folic acid, is a type of B vitamin. The body needs folate to produce new cells, including healthy red blood cells.

During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body.

Folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities (spina bifida) and low birth weight.

Vitamin B12 deficiency. The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead to preterm labor.

Blood loss during and after delivery can also cause anemia.

Risk Factors for Anemia in Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual. But the risk is higher if you:

Are pregnant with multiples (more than one child)
Have had two pregnancies close together
Vomit a lot because of morning sickness
Are a pregnant teenager
Don't eat enough foods that are rich in iron
Had anemia before you became pregnant

Nurses play an important role in the care of expectant mothers. There are many indications for nursing care during the prenatal period. We will discuss three nursing diagnoses and their related interventions to give you an example of how nurses care for mothers-to-be and their unborn babies.

Our first nursing diagnosis to explore is;

Altered nutrition: knowledge deficit related to metabolic needs during pregnancy

Expected Outcomes

Patient verbalizes and demonstrates selection of foods or meals that will achieve a healthy weight gain during pregnancy and provide adequate nutrients for self and fetus.
Patient weighs within 10% of ideal pregnancy weight.

Ongoing Assessment
Actions/Interventions/Rationale

1.Document actual weight; do not estimate.
Patients may be unaware of their actual weight or weight loss due to estimating weight.

2.Obtain nutritional history; include family, significant others, or caregiver in assessment.
Patient's perception of actual intake may differ.

3.Determine etiologic factors for reduced nutritional intake.
Proper assessment guides intervention. For example, patients with nausea or food aversions, or those who lack access to nutritious foods may need additional help with nutritional needs.

4.Encourage patient participation in recording food intake using a daily log.
Determination of type, amount, and pattern of food or fluid intake as facilitated by accurate documentation by patient or caregiver as the intake occurs; memory is insufficient.


Therapeutic Interventions
Actions/Interventions/Rationale

1.Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support.
Dietitians have a greater understanding of the nutritional value of foods and may be helpful in assessing specific needs.

2.Establish appropriate short- and long-range goals.
Without realistic short-term goals to provide tangible rewards, patients may lose interest in addressing this problem. A STG could be something as simple as eating 3 servings of fruit per day; a LTG could include weight gain goals for the entire pregnancy, and/or nutritional goals for healthy pregnancy, breast feeding and post pregnancy weight loss.

3.Suggest ways to assist patient with meals as needed: ensure a pleasant environment, facilitate proper position, and provide tips for dealing with nausea, cravings and food aversions.


Education/Continuity of Care
Actions/Interventions/Rationale

1.Review and reinforce the following to patient/caregivers:
The basic food groups, as well as the need for specific minerals or vitamins.
Foods high in calories/protein that will promote healthy weight gain during pregnancy.

2.Refer to www.myplate.gov for more information on healthy eating during pregnancy.
Patients may not understand what is involved in a balanced diet.

3.Encourage the use of prenatal vitamins.
Prenatal vitamins can supplement some the nutrients, vitamins and minerals lacking in the diet during pregnancy.

Our second nursing diagnosis is:

Body image disturbance

Body Image Disturbance


Expected Outcome
Patient demonstrates enhanced body image and self-esteem as evidenced by ability to look at, touch, talk about, and care for actual or perceived altered body part or function.

Ongoing Assessment
Actions/Interventions/Rationale

1. Assess perception of change in structure or function of body part (also proposed change).
The extent of the response is more related to the value or importance the patient places on the change than the actual value or importance.

2. Assess perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.

3. Note patient's behavior regarding actual or perceived changed body part or function.
There is a broad range of normal behaviors associated with body image disturbance, ranging from totally ignoring the altered structure or function to preoccupation with it.

Therapeutic Interventions
Actions/Interventions/Rationale

1. Acknowledge normalcy of emotional response to actual or perceived change in body structure or function.
Stages of grief over changes of a body part or function is normal, and typically involves a period of denial, the length of which varies from individual to individual.

2. Help patient identify actual changes.
Patients may perceive changes that are not present or real, or they may be placing unrealistic value on a body structure or function.

3. Encourage verbalization of positive or negative feelings about actual or perceived change.
It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth.

4. Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities. Opportunities for positive feedback and success in social situations may hasten adaptation.

Education/Continuity of Care
Actions/Interventions/Rationale

1. Teach patient about the normalcy of body image disturbance and the grief process related to pregnancy.

2. Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants, and others).
To compensate for actual changed body structure and function.

3. Help patient identify ways of coping that have been useful in the past.
Asking patients to remember being that being pregnant is temporary, and that with proper nutrition and exercise it is possible to regain pre-pregnancy weight. Remind them that are bringing new life into the world and that nothing is more beautiful than that.

Our third nursing diagnosis is:

Sleep pattern disturbance

Expected Outcomes
Patient achieves optimal amounts of sleep as evidenced by rested appearance, verbalization of feeling rested, and improvement in sleep pattern.

Ongoing Assessment
Actions/Interventions/Rationale

1. Assess past patterns of sleep in normal environment: amount, bedtime rituals, depth, length, positions, aids, and interfering agents. Sleep patterns are unique to each individual.

2. Assess patient's perception of cause of sleep difficulty and possible relief measures to facilitate treatment. Examples of possible causes of sleep disturbance in pregnancy include: nausea and vomiting, heartburn and general discomfort.

3. Identify factors that may facilitate or interfere with "normal patterns."
Considerable confusion and myths about sleep exist. Knowledge of its role in health/wellness and the wide variation among individuals may allay anxiety, thereby promoting rest and sleep.


Therapeutic Interventions
Actions/Interventions/Rationale

1. Instruct patient to follow as consistent a daily schedule for retiring and arising as possible.
This promotes regulation of the circadian rhythm, and reduces the energy required for adaptation to changes.

2. Instruct to avoid heavy meals and caffeine before retiring, strategies for preventing heartburn and nausea before bed and relaxation techniques to aid in sleeping.
Though hunger can also keep one awake, gastric digestion and stimulation from caffeine can disturb sleep. Frequent trips to the restroom, suffering from nausea and heartburn can also disrupt the sleep cycle.

3. Instruct to avoid large fluid intake before bedtime.
To decrease urinary frequency at night.

4. Increase daytime physical activities as tolerated and permitted by physician.

5. Encourage daytime naps, as applicable, if patient is overly tired throughout the day.

Education/Continuity of Care
Actions/Interventions

1.Teach about possible causes of sleeping difficulties and optimal ways to treat them.

2. Instruct on nonpharmacological sleep enhancement techniques.

~ Care Plan Constructor Home ~

That concludes our presentation on prenatal care. Does anyone have any questions?