I. Psychological and Physiological changes of Pregnancy.

a. What is the significant health care goal that the nurse promote when
teaching a pregnant woman from any culture?
As the pregnant patient watches their body change, she may begin
to feel at a loss of control of her body or well-being. A pregnancy
nursing care plan acknowledges and respects those feelings, while
focusing on promoting patient autonomy. Interventions that the
patient can perform for themselves should be included in the
nursing care plan. or e!ample, if a particular goal on the nursing
care plan states that the patient will be free of nausea and vomiting
by their third trimester, a patient intervention might include avoiding
areas with strong or offensive smells and eating crackers. "his
allows the patient to feel proactive and more involved in their own
health care maintenance.
Pregnancy nursing care plans most often include patient education
listed as a goal and as a nursing intervention. "eaching the
pregnant patient how to recogni#e normal and abnormal symptoms
in her body provides an e!tra line of defense against fetal health
risks that might otherwise go unnoticed or addressed too late. It
also helps mothers-to-be feel more comfortable about the birthing
process and post-partum life. "his may include information about
proper diet, the risks and benefits of medications and activities that
should be avoided during pregnancy and immediately post-partum.
Patient teaching also should include information on birthing options,
breastfeeding and bottle feeding.
$ealthcare for pregnant women should have the ob%ective of a
better understanding of the changes in health status that occur over
the course of pregnancy because this should help women define
their e!pectations, and provide data to inform public policies related
to the health and function of women.
b. &ou are caring for a pregnant client in the third trimester. What are two
physiological reasons why you would advise her in the lateral recumbent
position while sleeping?
"he best sleeping position for a pregnant woman is on her side,
especially the left side, because it allows for ma!imum blood flow to
the fetus and improves kidney function in the mother. Improved
kidney flow helps to reduce any swelling. Placing a pillow between
the knees can help a pregnant woman sleep more comfortably on
her side. Also, using a bunched-up pillow or rolled-up blanket at
the small of your back may help to relieve some pressure.
In particular, sleeping on your left side may benefit your baby by
improving blood flow ' and therefore nutrients ' to the placenta. It
also helps your kidneys efficiently eliminate waste products and
fluids from your body, which in turn reduces swelling in your
ankles, feet, and hands.
c. (!plain why it is important that pregnancy be diagnosed as early as
possible and how this diagnosis may impact upon the woman)s
physiological and psychological health status?
(arly diagnosis of pregnancy and a better characteri#ation of the
women)s physiological and psychological health status would allow
the definition of risk factors for greater or persistent declines in
functional status, so that women at risk could be targeted for
interventions to promote health and well-being.
(arly detection of pregnancy is very important to distinguish
between an early normal and abnormal pregnancy. It is also
important to arrive at a correct dating for the patient prenatal
checkup. It is important to be aware of the possible confusion
caused by uterine cyst and other complications. (arly detection
stops any maintenance medications that maybe harmful to the
developing fetus.
"he impact of this diagnosis help saves the life of pregnant woman
and preserves the woman)s physical and mental health, depending
upon the age and health of the pregnant woman.
II. "he *rowing etus
a. (!plain how the nutrients are e!changed from the mother to the fetus
during pregnancy?
"he placenta is an organ that connects the developing fetus to the
uterine wall to allow nutrient uptake, waste elimination, and gas
e!change via the mother)s blood supply. It develops from the same
sperm and egg cells that form the fetus, and functions as a
fetomaternal organ wuth two components, the fetal part +chorion
frondosum,, and the maternal part +deciduas basalis,.
"he placenta is composed of numerous blood vessels. "hese blood
vessels are filled with fetal blood, while the placenta is rich in
maternal blood. As these blood vessels carry fetal blood through the
placenta, they come into contact with the mother)s blood, while
transfers nutrients into and removes waste, from the fetal blood
through the walls of the blood vessels. "he perfusion of the
intervillous spaces of the placenta with maternal blood allows the
transfer of nutrients and o!ygen from the mother to the fetus and the
transfer of waste products and carbon dio!ide back from the fetus to
the mother. -utrients transfer to the fetus is both actively and
passively mediated by proteins called nutrient transporters that are
e!pressed within placental cells.
"he substances that are transported from mother to the fetus
include glucose, amino acids, maternal antibodies, o!ygen and
waste products such as carbon dio!ide and bilirubin from the liver.
*lucose acts as the energy powerhouse for the fetal developmental
while amino acids are the building blocks of the developing baby.
.aternal immunity antibodies provide immunity to the fetus before it
is able to produce its own antibodies as its immune system matures.
b. Why should a pregnant woman avoid lying in the supine position?
/leeping on your back while pregnant can create pressure on a
ma%or vein called the inferior vena cava. "his vein returns blood
from the lower body to your heart. "his may lead to
lightheadedness and0or numbness. In addition this may cause
pressure on your back and intestines, leading to discomfort.
1ying on supine position while pregnant may develop supine
hypotensive syndrome +/$/,. "his occurs in the 2
nd
half of
pregnancy due to compression of the aorta and inferior vena cava
by the gravid uterus. "his results in a decrease in cardiac output
with effects ranging from transient asymptomatic hypotension to
cardio vascular collapse.
In supine position, the uterus can increase the oppression of the
abdominal aorta before the spine, resulting in reduced placental
blood perfusion to occur.
c. (!plain why the continued assessment of the eyes is important when
administering o!ygen to the premature infant?
3!ygen therapy for the premature infant can cause negative effects
such as retinopathy of prematurity +43P,. "his condition affects the
eyes, in particular the retina because in preterm infants the retina is
often not fully vasculari#ed. In severe cases, it can cause e!tensive
optical damage, or blindness. "hus, a continued assessment of the
eyes is important when administering o!ygen to the premature
infant.
III. Assessing etal and .aternal $ealth5 "he irst Prenatal 6isit
a. Identify the four types of pelvis and illustrate how the anatomy of the pelvis
may accommodate or hamper the fetus as it progresses the birthing
process.
1. The Gynecoid Pelvis. -ormal female pelvis7 optimal diameters
in all three planes. Its main features are the rounded brim, the
generous fore---pelvis +the part in front of the transverse diameter,,
straight side walls, a shallow cavity with a broad, well-curved
sacrum, blunt ischial spines, a wide sciatic notch and a pubic arch of
89 degrees. It is found in women of average build and height with a
shoe si#e of : or larger. It is well suited to child bearing. "he
outcome of labor in this situation depends on the fetus. If the fetal
si#e is consistent with the si#e of the maternal pelvis, normal labor
and birth will take place. 3ften these women have small babies and
the outcome is favorable. $owever, if the fetus is large, a degree of
cephalopelvic disproportion will result. "he same is true when a
malpresentation or malposition of the fetus e!ist.
2. The Android Pelvis. -ormal male pelvis7 posterior segments are
decreased in all three planes7 deep transverse arrest of descent of
the fetus and failure of rotation of the fetus are common. Its brim is
heart shaped with a narrow fore---pelvis, and has a transverse
diameter which is towards the back. "he side walls coverage,
making it a funnel shape with a deep cavity and a straight sacrum.
"he ischial spines are prominent and the sciatic notch is narrow. "he
angle of the pubic arch is less than 89 degrees. It is found in short
and heavily built women who have a tendency to be hirsute. "he
heart shaped brim favors a posterior position of the occiput as a
result of insufficient space for the bi parietal diameter in the narrow
forepelvis, combined with the fact that the greater space lies in the
hind pelvis. unneling in the cavity may hinder progress in labor. At
the pelvis outlet, the prominent ischial spines sometimes prevent
complete internal rotation of the head and the anteroposterior
diameter becomes caught on them, causing a deep transverse
arrest.
3. The Anthropoid Pelvis. Apelike pelvis with long anteriorposterior
diameter7 may allow for easy delivery of an occiput-posterior
presentation of the fetus. $as long, oval brim in which the antero
posterior diameter is longer than the transverse. "he side walls
diverge and the sacrum is long and deeply concave. "he ischial
spines are not prominent and the sciatic notch is very wide, as is the
sub-pubic angle. Women with this type of pelvis tend to be tall, with
narrow shoulders. 1abor does not usually present any difficulties,
but a direct occipitoanterior or direct occipitoposterior position is
often a feature and the position adopted for engagement may be
persist to delivery.
4. The Platypelloid Pelvis. lat female pelvis with wide transverse
diameter7 arrest of fetal descent at the pelvic inlet is common7 labor
progress can be poor. lat, with kidney shaped brim in which the
anteroposterior diameter is reduced and the transverse increased.
"he side walls diverge, the sacrum is flat and the cavity shallow. "he
ischial spines are blunt, and the sciatic notch and the sub-pubic
angle are both wide. "he head must engage with the sagittal suture
in the transverse diameter, but usually descends through the cavity
without difficulty. (ngagement may necessitate lateral tilting of the
head, known as asynclitism, in order to allow the bi parietal diameter
to pass the narrowest anteroposterior diameter of the brim.
b. .s. ; had delayed her first prenatal visit. /he visit the prenatal clinic after
she e!press edema of the feet and hands. As a nurse, you take the
history and physical assessment to begin, .s. ; care. (!plain history
taking of a pregnant woman, assessment and planning of care.
$istory taking of a pregnant woman, assessment and planning of
care help ensure their health and the health of the fetus. "he initial
routine prenatal visit should occur between < and = weeks
gestation. ollow up visits should occur at about : weeks interval
until 2=th week, at 2 weeks interval from 2= to >< weeks, and
weekly thereafter until delivery. Prenatal care includes screening for
disorders, taking measures to reduce fetal and maternal risk, and
counseling.
History:
1. Family History. Assessment of the maternal and paternal
history to determine if any family member has had any medical
conditions such as high blood pressure.
2. Genetic History. An assessment of any possible genetic
disorder, as several genetic maybe inherited, such as sickle cell
anemia, nerve breakdown disorder marked by progressive
mental and physical retardation.
3. Personal Medical History. Assessment of the woman personal
medical history to determine if there are any medical conditions
that may re?uire special care such as epilepsy, diabetes, high
blood pressure, anemia, and or allergies7 previous surgeries7 or
past pregnancy +gestation,, previous pregnancy complications,
pregnancy losses.
4. Vaccination tat!s. An assessment of current
vaccinations0inoculations to assess woman immunity to rubella
+*erman measles,, in particular since contracting this disease
during pregnancy can cause miscarriage or birth defects. If a
woman is not immune, a vaccine may be given at least >
months before conception to provide immunity.
5. "n#ection creenin$. "o determine if a woman has se!ually
transmitted infection, urinary tract infection that could be harmful
to the fetus and to the mother.
Physical Assessment: "he first physical e!amination during
pregnancy is very thorough. It includes the following5
1. .easurement of weight, height and blood pressure id done first.
2. -e!t is obstetric e!amination to check for lesions or discharges
then note the color and consistency of the cervi!, and obtain
samples for testing.
3. etal heart rate, and, in patients presenting later in pregnancy,
lie of the fetus are assessed.
4. Pelvic (!amination5 during this e!amination the doctor note the
si#e and position of the uterus. Pelvic capacity can be estimated
clinically by evaluating various measurements.
%. @lood test5 A sample of blood is taken and analy#ed. Analysis
includes the complete blood count, test for infectious diseases
+such as syphilis, hepatitis and human immunodeficiency virus
+$I6,, test foe evidence of immunity to rubella. @lood type
including 4h factor status +positive or negative,, is determined.
&. Arine test5 a sample of urine is taken cultured and analy#ed.
'. Papaniculaou +PAP, test on a variation of it5 samples of tissue
from the cervi! are taken to check for cancer of the cervi!.
(. "est for se!ually transmitted diseases such as gonnorhoea and
chlamydial infection.
). 3ther test maybe done, depending on the woman)s situation. If
the woman has 4h-negative blood is tested for antibody to the
4h factor5 having 4h antibodies can cause severe problems
+even death, for a fetus that has 4h positive blood. If antibodies
in pregnant woman)s blood are detected early, the doctor can
take measures to protect the fetus.
Plannin$ o# care: 4educing the risk of complications
1. Advice mother to eat a balanced diet before and during
pregnancy, not only good for her but for overall health, essential
for nourishing the fetus.
2. Advise her to e!ercise regularly and maintain a proper weight
before and during pregnancy. Women who are overweight may
e!perience medical problems such as high blood pressure and
diabetes. Women who are underweight may have babies with
low birth weight.
3. Pregnant women should take control of any current or pre-
e!isting medical problems, such as diabetes or high blood
pressure.
4. If the mother is smoker advise her to stop smoking. (!plain to
her that babies born to mothers who smoke tend to be born
prematurely, lower in birth weight and more likely to die of
sudden infant death syndrome +/IB/,.
%. or the prevention of birth defects, advise her to take
:99micrograms of folic acid each day, a nutrient found in some
green leafy vegetables, nuts, dried beans, citrus fruits, fortified
breakfast, cereals, and some vitamin supplements.
&. Avoid e!posure to alcohol and drugs during pregnancy, be sure
to inform the physicians of any medication taken.
'. Pregnant woman should avoid e!posure to to!ic and chemical
substances and radiation.
(. Pregnant woman should reduce the risk of infection by avoiding
the ingestion of undercooked meat and raw eggs. In addition
pregnant woman should avoid all contact and e!posure to cat
feces and cat litter, which may contain parasite called
to!oplasma gondii that causes to!oplasmosis which cause a
serious illness in. or death of the fetus.
). "ake daily vitamins, as prescribed by her physician, to make
certain that her body gets all the necessary nutrients and
vitamins needed to nourish a healthy baby.
1*. Identify domestic violence because women who are abused
before pregnancy maybe risk for increased abuse during
pregnancy.
11. 1astly advise pregnant women to avoid standing or sitting for a
long period of time since that swelling or edema is a very
common discomfort during pregnancy. Informing her that edema
of feet and hands are normal due to the pressure of the growing
uterus to the pelvic veins and on the vena cava resulting to slow
return of blood from the legs, causing it to pool, which forces
fluid from veins into the tissues of feet and ankles.

I6. Promoting etal and .aternal $ealth
a. Bescribe health practices important for a positive pregnancy outcome.
"here are many ways to achieve a more positive pregnancy
outcome.
C. Buring pre-conception5 be tested for infections and diseases
before becoming pregnant.
2. Bo not use over-the-counter and prescription medication unless
specified by health care provider. /everal varieties of drugs that
have been found to cause problems and should be avoided
during pregnancy. "hese include5 amphetamines, anabolic
steroids, tetracycline, streptomycin, antihistamines, anti-nausea,
aspirin and ibuprofen, diuretics, narcotics like codeine, retin-
mari%uana, sulphonamides. Avoid alcohol, as it may cause fetal
alcohol syndrome, irreversible birth defects.
>. @e nutrition aware and supplement with folic acid ad prenatal
multivitamins. Ander weight woman should try to gain 2= to :9
pounds7 normal weight should gain 2D to >D pounds7 and
overweigth should gain CD to 2D pounds. or woman carrying
twins or triplets should gain :9 pounds or greater.
:. Buring Pregnancy5 be aware of workplace, household, and
environmental ha#ards, including contact with chemicals,
radiation. And other harmful substances.
D. Bon)t become over heated, through e!cessive temperature
e!posure or over e!ercise. "he depth of breathing changes as
pregnancy progresses and the blood volume increases. "he use
of sauna, hot tubs, and steam rooms and sun lamps-especially
during the first > months-may cause fetal abnormalities, and
should be discontinued. Prolonged, intensive e!ercise can raise
body temp. "herefore e!ercise in moderation during pregnancy.
"herefore, drink plenty of fluids, especially water.
<. Practice pregnancy. /afe work habit5 avoid prolonged standing
and over-e!ertion. /tanding for a long period is associated with
both preterm birth and increased uterine contractions.
E. When traveling by car, practice proper positioning of seatbelt.
Always wear the shoulder strap and ad%ust the lower part of the
safety belt to fit below the stomach. /afety seat belts worn too
loosely or too high on the stomach can cause broken ribs or
in%uries to the mother and the baby in the event of a crash.
=. (mphasi#e to the mother to sleep on her side, not on her back
during the last few months of pregnancy. When a woman lies
flat on her back, especially later in pregnancy, the combined
weight of the baby, the uterus, and the placenta puts pressure
on ma%or body vein. "his can slow down the flow of blood
throughout the body, contributing to abnormal swelling of the
legs, varicose veins, and fatigue. "he flow of o!ygen to the baby
can also be decreased. 1ying on her left side is helpful in
promoting good circulation and improving o!ygen flow to her
baby.
8. /creen for group @ /treptococcus before delivery. *roup @
/trep bacteria are the most common life-threatening infection in
newborn babies. 3ne in three women carry this bacteria in their
lower intestinal tract. "here are no symptoms but most of them
infect babies during labor or during delivery as they pass
through the birth canal.
C9. Ase the Fkick testG method to help assess the baby)s wellbeing.
.ost babies begin moving by the seven weeks, most pregnant
women do not notice until the si!teenth to the twentieth week.
Asually babies have a pattern of movement over the 2: hour
period. $ealth care provider can instruct on how to chart baby)s
movement to help in assessing the baby)s wellbeing.
CC. @e alert to signs of pregnancy complications and high risk
treatment options. Pregnancy can be high risk even at term. A
common signal to watch for is leaking of amniotic fluid. Any
sharp, abnormal pain, bleeding, fever, sudden weight gain, or
swelling also indicates a problem.
C2. @e an advocate for the pregnant woman)s body and her baby.
"hroughout her pregnancy, it is her right and responsibility to be
informed and involved.
b. Atili#e the nursing process to address the concerns and potentially
harmful health practices of a woman during pregnancy.
Assessment5 a thorough health history, physical evaluation, and
initial laboratory data are obtained at a first prenatal visit.
Hontinuing assessment concentrates on screening for any
abnormalities in physical and emotional health that might be
occurring and for the presence of teratogens in the pregnant
woman)s environment. (ncourage the pregnant woman to discuss
whatever concerns she has during visits. Assess the pregnant
woman for discomforts of pregnancy5 nasal congestion, nausea and
vomiting, palpitations, breast tenderness, shortness of breath,
backache, abdominal discomfort, @ra!ton $icks contractions,
urinary fre?uency, constipation, hemorrhoids, leucorrhea, muscle
cramps, varicosities, and ankle edema. asked about the last
menstrual period, check the uterine height, fetal heart rate, ask for
medication taken0 maintenance, history of cigarette smoking and
used of prohibited drugs.
-ursing Biagnosis5 health seeking behaviors related to interest in
maintaining optimal health during pregnancy, an!iety related to
minor symptoms of pregnancy, risk for deficient fluid volume related
to nausea and vomiting of pregnancy, constipation related to
reduced peristalsis during pregnancy, disturbed body image related
to change of appearance with pregnancy, risk for ineffective
se!uality patterns related to fear of harming fetus during pregnancy,
disturbed sleep pattern related to fre?uent need to empty bladder
during night, fatigue related to metabolic changes of pregnancy, risk
for fetal in%ury related to maternal cigarette smoking, risk for fetal
in%ury related to knowledge deficit concerning possible fetal
e!posure to teratogens.
3utcome identification5 client will demonstrate positive behaviors to
reduce risk of in%ury to the fetus. etal growth and development will
be within appropriate parameters. Hlient will reduce smoking during
pregnancy or giving up cigarettes %ust for the duration of the
pregnancy. Hlient will maintain good nutrition and ade?uate weight
gain and adapt her lifestyle to the pregnancy symptoms.
3utcome evaluation5 client reports a decrease in smoking to C9
cigarettes0day or less no alcohol consumption7 verbali#es no use of
recreational drugs, including mari%uana7 demonstrates absence of
behaviors indicative of alcohol or drug use7 client maintain good
nutrition, gained ade?uate weight, and verbali#ed able to adapt her
lifestyle to pregnancy symptoms.
Interventions5 4ationales5
4eview history of sinus headache for
onset, type, duration, and relief
obtained.
$istory review provides a baseline to
determine future interventions and
provides information of the severity of
the client)s condition
Honsult with client)s primary and
maternal health care providers about
safety of over-the-counter
medications.
3"H medication use must be
addressed to determine the degree of
possible teratogenicity to the fetus.
discuss possible dangers of drug and
alcohol use during pregnancy and
instruct client possible dangers
Alcohol and drug use, including 3"H
medications, can be teratogenic to the
fetus. (ducation provides valuable
information to foster client)s motivation
for changing behavior.
(ncourage the client to decrease
smoking and ?uit if possible. 3ffer
suggestions to accomplish this,
including use of sugar-free gums or
candies, distraction, and activity.
4efer to a smoking cessation group if
appropriate.
Higarette use during pregnancy can
lead to fetal growth retardation. /upport
and suggestions provide concrete
measures to assist client with ctting
down and cessation.
/uggest client replace alcohol
consumption with caffeine-free
beverage intake.
Alcohol consumption during pregnancy
is associated with fetal alcohol
syndrome. Haffeine maybe an
associated fetal teratogen.
4eview measures to combat nausea
and vomiting, such as dry crackers,
small fre?uent meals, and fluid
intake. (ncourage client to participate
in discussion and offer suggestions
appropriate for her lifestyle.
Ade?uate nutrition and hydration are
important for fetal growth and
development. Hlient participation helps
to individuali#e care, increase feelings
of control, and promote compliance.
Anticipate the need for follow-up
ultrasound e!amination for fetal
growth evaluation.
ollow-up ultrasound e!amination
provides evidence for evaluation of fetal
growth and development according to
age-appropriate parameters.

c. Biscuss the categories of potential terratogens.
A teratogen is any factor, chemical or physical, that adversely
affects the fertili#ed ovum, embryo, or fetus.
Terato$enic Maternal "n#ections: can involve either se!ually
transmitted or systemic infections. "his group of diseases has been
described collectively under the umbrella term "34H$, an
abbreviation for to!oplasmosis, rubella, cytomegalovirus, and
herpes simple! virus. /ome sources identify 3 with Fother
infectionsG which could include syphilis, hepatitis @ virus, and
human immunodeficiency virus. All these infections are known to
cross the placenta and affect the fetus during pregnancy.
C. "o!oplasmosis. A proto#oan infection, is spread most commonly
through contact with uncooked meat, although it may also be
contracted through handling eat stool in soil or cat litter. If
infection crosses the placenta, the infant maybe born with
central nervous system damage, hydrocephalus, microcephaly,
intracerebral calcification, and retinal deformities.
2. 4ubella. Asually causes only a mild rash and mild systemic
devastating. etal damage from maternal infection with rubella
+*erman measles, includes deafness, mental and motor
challenges, cataracts, cardiac defect +most commonly patent
ductus arteriosus and pulmonary stenosis,, retarded intrauterine
growth +small for gestational age,, thrombocytopenic purpura,
and dental and facial clefts such as cleft lip and palate.
>. Hytomegalovirus. A member of the herpes virus family. It is
another teratogen that can cause e!tensive damage to a fetus
while causing few symptoms in the woman. It is transmitted by
droplet infection from person to person. If a woman ac?uires a
primary H.6 infection during pregnancy and the virus crosses
the placenta, congenital H.6 infection can occur. "he infant
may be born severely neurologically challenged +hydrocephalus,
microcephaly, spasticity,, with eye damage +optic atrophy,
chorioretinitis,, deafness, or chronic liver disease. "he child)s
skin may be covered with large petechiae +blueberry-muffin
lesion,.
:. $erpes simple! virus +*enital $erpes Infection,. "he first time a
woman contracts a genital herpes infection, systemic
involvement occurs. "he virus spreads into the bloodstream
+viremia, and crosses the placenta to the fetus. If the infection
occurs in the first trimester, severe congenital anomalies or
spontaneous miscarriage may occur. If the infection occur
during 2
nd
and >
rd
trimester, there is a high incidence of
premature birth, intrauterine growth retardation, and continuing
infection of the newborn at birth.
D. 3ther viral diseases. yphilis: a syphilis infection during
pregnancy can place the fetus at risk for congenital syphilis. "he
causative spirochete, Treponema pallidum can e!tensively
damage the fetus after the C<
th
to C=
th
week of intrauterine life,
when the cytotrophoblastic layer of the placental villi has
atrophied and no longer protects against it. "he newborn with
congenital syphilis may have congenital anomalies, e!treme
rhinitis, and a characteristic syphilitic rash. +yme ,isease. A
multisystem disease caused by the spirochete Borrelia
burgdorferi, is spread by the bite of a deer tick. Infection in
pregnancy can result in spontaneous miscarriage or severe
congenital anomalies.
Potential Terato$enicity o# Vaccines. 1ive virus vaccines such as
measles, mumps, rubella, and poliomyelitis are contraindicated
during pregnancy because they may transmit the viral infection to
the fetus.
Terato$enicity o# ,r!$s: it is important to recogni#e two principles
related to drug intake during pregnancy. C. Any drug or herbal
supplement, under certain circumstances, may be detrimental to
fetal welfare. "herefore, during pregnancy, women should not take
any drug or supplement not specifically prescribed or approved by
their physician or nurse-midwife. 2. A woman of childbearing age
and ability should take no drugs other than those prescribed by a
physician or nurse-midwife to avoid e!posure to a drug should she
become pregnant.
-ate$ory ,escription ./ample
A Ade?uate studies in pregnant women have
failed to show a risk to the fetus in the first
trimester of pregnancy7 there is no evidence
of risk in later trimester.
"hyroid hormone
0 Animal studies have not shown an adverse
effect on the fetus, but there are no ade?uate
clinical studies in pregnant women
Insulin
- Animal studies have shown an adverse effect
on the fetus, but there are no ade?uate
studies on humans, or ther are no ade?uate
studies in animals or humans. Pregnancy risk
is unknown
Bocusate sodium
+Holace,
, "here is evidence of risk to the human fetus,
but the potential benefits f use in pregnant
women may be acceptable despite potential
risks
1ithium citrate
1 /tudies in animals or humans show fetal
abnormalities, or adverse reaction reports
indicate evidence of fetal risk. "he risks
involved clearly outweigh potential benefits
Isotretinoin
+Accutane,
Terato$enicity o# Alcohol. etuses cannot remove the breakdown
products of alcohol from their body. "he large buildup of these leads
to vitamin @ deficiency and accompanying neurologic damage. It is
important to screen women during pregnancy for alcohol use
because an infant born with fetal alcohol syndrome is small for
gestational age and cognitively challenged and has a characteristic
craniofacial deformity including short palpebral fissures, a thin upper
lip, and an upturned nose.
Terato$enicity o# -i$arettes. Higarette smoking by pregnant
woman has been shown to have teratogenic effects on the fetus,
especially growth retardation. In addition, these children are at
greater risk than others for sudden infant death syndrome. 1ow birth
weight in infants of smoking mothers result from vasoconstriction of
the uterine vessel, an effect of nicotine that limits the blood supply to
the fetus.
.nvironmental Terato$ens. "eratogens from environment sources
can be as lethal to the fetus as those that are directly or deliberately
ingested.
1. Metal and chemical ha2ards. Pesticides and carbon mono!ide
such as from automobile e!haust are e!amples of chemical
teratogens that are harmful and should be avoided. Hhemicals in
a variety of work environments also can be ?uite dangerous,
such as arsenic a by product of copper and lead smelting, used
in pesticides, paints, and leather processing7 formaldehyde, used
in paper manufacturing7 and mercury, used in the manufacture of
electrical apparatus. 1ead poisoning generally is considered a
problem of early childhood, but it is also a fetal ha#ard because
lead is teratogenic. 1ead ingestion during pregnancy may lead to
a newborn who is cognitively or neurologically challenged.
2. 3adiation. 4apidly growing cells are e!tremely vulnerable to
destruction by radiation. 4adiation has been proven to be a
potent teratogen to unborn children because of the high
proportion of rapidly growing cells present. It produces a range of
malformations depending on the stage of development of the
embryo or fetus and the strength and length of e!posure. If the
e!posure occurs before implantation, he growing #ygote
apparently is killed. "he most damaging time for e!posure and
subse?uent damae is from implantation to < weeks after
conception +when many women are not yet aware that they are
pregnant,. "he nervous system, brain, and the retinal
innervations are most affected.
3. Hyperthermia and Hypothermia. $yperthermia to the fetus may
be detrimental to growth because it interferes with cell
metabolism. .aternal fever early in pregnancy +: to < weeks,
may cause abnormal fetal brain development and possibly
sei#ure disorders, hypotonia, and skeletal deformities. "he effect
of hypothermia on pregnancy is not well known. @ecause the
uterus is an internal organ, the woman)s body temperature would
have to be lowered significantly before a great deal of fetal
change would result.
Terato$enicity o# Maternal tress. "here is some evidence,
however, that an emotionally disturbed pregnancy, one filled wih
an!iety and worry beyond the usual amount associated with
pregnancy, could produce physiologic changes through its effect on
the sympathetic division of the autonomic nervous system. "he
primary changes include an increase in heart rate, constriction of the
peripheral blood vessels, a decrease in gastrointestinal motility, and
dilation of coronary vessels +the fight-or-flight syndrome,. If the
an!iety is prolonged, the constriction of uterine vessels could
interfere with the blood and nutrient supply to the fetus.
d. .ake a teaching plan for a working woman that address their needs and
problems.
"he following guidelines for a safe pregnancy practices5
C. Allow yourself to rest during your break periods rather than
running errands, etc.
2. "ry to use at least part of your lunch hour to rest. 1ie on your left
side in a break room if possible. If this is not possible, then rest
sitting with your legs elevated.
>. If your %ob involves long periods of standing, think of times you
could stop and elevate your legs +working in a low file drawer,
reading time in a classroom, etc.,
:. Walk around periodically to avoid prolonged standing in one
position if possible7 stretch your back periodically to avoid
backache.
D. Wear support hose to improve venous return to your lower
e!tremities.
<. Avoid e!cessive overtime or working longer than =-hour shifts.
(mpty your bladder every2 hours to help prevent bladder infection.
E. *et e!tra rest on weekends or days off.
=. "ake great caution when working around e?uipment that re?uires
good balance. Avoid ladders or climbing late in pregnancy, when
balance may be a problem.
8. 1earn your target heart rate for e!ercise. If your %ob involves
strenuous e!ercise, stop and rest at the point your target heart
rate is e!ceeded.
C9. @e sure you are not relying on fast foods for meals. "ake time to
pack or purchase nutritious foods.
.I/A.I/ A-I6(4/I"&
3#ami# Hity
*raduate /tudies
Final Examination
Major in Maternal and
Child Nursing

/ubmitted by5
1ady 1yn Iustine .. 6idal
.H- >C2
/ubmitted to5
.rs. .aricar .. .utia
Professor