N107 – Essentials of Nursing
Care: Reproductive Health
Needs of the Childbearing Family:
Preconception
Chapter Objectives
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Know which topics to counsel and plan
with childbearing females/families
Review health and lifestyle choices that
affect childbearing females/families
Be able to perform a risk assessment
Be able to create a care plan via the
nursing process regarding a patient
with a preconception issue specifically
Counseling and Planning for
Parenthood
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Preconception care focuses on risk
assessment and promoting healthy
behaviors
Healthy well-informed women who plan
pregnancy have better outcomes
Contraception is important aspect in
planning process
Counseling and Planning for
Parenthood
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Many women don’t realize they are pregnant
and don’t seek prenatal care until way into 1st
trimester
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Half of all pregnancies in US are unintended
The period of greatest danger for developing fetus
is 17 – 56 days after fertilization
By end of first trimester, major structural
anomalies in the fetus are already present
Fetus may be exposed to intrauterine
environmental hazards
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Radiation (x-rays, microwaves), carcinogens (smoke,
fumes)
Health and Lifestyle Choices
Preconception Care
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Purposes:
 Establish life-style behaviors to maintain optimum health
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ID and treat “Risk Factors” before conception
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Monitor chronic illnesses (medications), environmental hazards
(home, work)
ID carriers of inherited diseases
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Medical conditions, substance abuse, test for immunity, history
of genetic defects, the need for genetic counseling
To conceive absent of unnecessary Risk Factors
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Diet, weight control, safe sex practices, rest & exercise,
substance abuse
African Americans/Southeast Asians (sickle cell disease), Jewish
Americans (Tay-Sachs disease)
Prepare people psychologically for pregnancy and
responsibilities of parenthood
Health and Lifestyle Choices
Preconception Care
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Why assess for and treat “Risk Factors”
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Every woman of childbearing age is a potential mother
Nurses can make a difference through education and
counseling; preconception education/counseling can
decrease the incidence of birth defects
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Type I diabetic with excellent glucose control reduces risk for
congenital malformations in fetus
Adequate intake of folic acid (0.4 mg/day) decreases possibility
for neural tube defects
Endocrine disorders interfere with female menstrual cycle and
male libido
Renal and GU disorders affect sexual performance &
reproductive capacity
Health and Lifestyle Choices
Preconception Care
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Treating Risk Factors (Cont’d)
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Hx of cholecystitis and hepatitis may be contraindications for
oral contraceptives
Women under 15 and 0ver 40 at higher risk
Cigarette smoking may delay conception
Maternal smoking  low birth weight
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Increases risk for spontaneous abortion, fetal death, neonatal
death & SIDS
Smoking
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increases morbidity in those using oral contraception, and 
early menopause (Females)
In males who also use drugs
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Affects sperm count, causes impotence or decrease libido
Prenatal Care
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To promote positive outcomes for both mother &
child
Should begin prior to conception
First prenatal visit
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Typically scheduled between weeks 8-12 of gestation
Obtain health hx (first menarche, sexual & family hx’s,
Gravida/Para)
Physical exam (vaginal exam, pap smear
Confirm pregnancy
Prenatal labs (blood type, Rh factor, rubella status, Hep B
status, STD, pap smear,
Prenatal Care
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Prenatal Visit (Cont’d)
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Calculate EDC
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Nagel’s Rule
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Tables
Wheels
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Lines up LMP to indicate EDC & due date
Auscultate fetal hear tones
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LMP – 3 months + 7 days
May be difficult to hear prior to 12 weeks
Only Positive signs of pregnancy
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Presence of fetal heart tones
Detection of fetus by US or X-ray
Testing (The Triple Screen)
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Alpha-fetoprotein test
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Performed between week 16 – 18
Indicates neural tube defects and
chromosomal disorders
High incidence of false positives
If complication indicated amniocentesis is
recommended
The Triple Screen (Cont’d)
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Gestational Diabetes Screening
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Performed at week 28
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Fasting glucose test
If failed, glucose tolerance test
If positive, dietary consult and/or diabetes
educator consult
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Instruct on proper diet
How to monitor blood glucose levels (glucometer)
If diet control unsuccessful, insulin injections may be
required
The Triple Screen (Cont’d)
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Group Beta Strep Bacteria detection
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Not an uncommon finding
Requires Abx upon rupture of membrane or onset
of active labor
Recommended that one dose of Abx be
administered at least 4 hours prior to delivery to
reduce risk of infant contracting group beta strep
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Can cause serious illness in infant but harmless to
mother
The Nursing Process
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Assessment
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The Interview Process: Ask about current
“lifestyle choices”
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Nutrition, exercise, rest, substance abuse,
alcohol & tobacco use, occupation, stressors,
depression, support system domestic violence,
and financial resources
Immunization status: Rubella, Hepatitis B
Current medications to include OTC, nonprescription and prescription meds
The Nursing Process
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Assessment (Cont’d)
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Review of Systems
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Reproductive System Review
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Head to Toe assessment
Discussion of any medical conditions
Previous pregnancies, miscarriages, living children’s disorders
Abnormal PAP smear results, mammogram results, STD hx,
sexual practices
Obstetric History
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Review of family planning and fertility counseling information
Previous abd/reproductive surgery, trauma’s or transfusions
The Nursing Process
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Assessment (Cont’d)
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Environmental History
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Home and/or work exposures
Family History
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Medical conditions
Genetic conditions
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Sickle cell, cystic fibrosis, bleeding disorders,
hemophilia, PKU, birth defects
Should also include companions family history
The Nursing Process
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Assessment (Cont’d)
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Risk Assessment
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Pediatric illnesses
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Mumps in males  sterility
Rubella in childbearing females increases congenital
anomalies during 1st trimester
 Encourage immunization if not had or been immunized
 Currently pregnant females should not receive
immunization
 Those planning pregnancy should wait 3 months
before becoming pregnant after receiving
immunization
The Nursing Process
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Assessment (Cont’d)
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Contraceptive and Obstetric History
Psychosocial History
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Family situation
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Readiness for pregnancy
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Ask directly “Have you been hit, slapped, kicked or
hurt with the past year?” “Are you afraid of your
companion or anyone else?”
Age, life goals, stressors
Financial stability and resources
The Nursing Process
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Assessment (Cont’d)
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Occupational History
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Physical activities
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Standing all day? Heavy lifting?
Exposures
Religious and Cultural Preferences
Physical Examination
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Emphasis placed on thyroid gland, breasts and pelvic
structure
Lab studies
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CBC, UA, blood type and Rh, rubella immunity, STDs, Hep
B surface antigen, PAP smear, cervical culture.
OTHERS: PPD, HIV, toxicology screen, thalassemia
The Nursing Process
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Analysis
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In collaboration with the patient/family and
members of the healthcare team, synthesize data
to identify the patient’s actual or potential health
problems that can be managed by independent
nursing actions
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Identify a Nursing Diagnosis (NANDA)
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When choosing a nursing dx, look at all data and their
commonalities
The common theme reveals the existence of a problem
and the need for nursing intervention
The nurse may use physician (dependent) and nursing
(independent) interventions to minimize complications.
The Nursing Process
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Analysis (Cont’d)
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Areas of concern for preconception care
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Health-seeking behaviors,
Optimum nutrition
Health maintenance
Deficient knowledge
Fear
Pain
Risk for Infection
The Nursing Process
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Planning
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Planning phase consist of determining the
expected outcomes and formulating specific
strategies to achieve the expected outcomes.
Assign priorities to the nursing diagnosis
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Maslow’s Hierarchy of Needs
Most crucial to least crucial
Specify expected outcomes
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Outcomes must be realistic and measurable
Expected outcomes are the basis for evaluating the
effectiveness of the nursing interventions and deciding
whether the plan of care needs to be revised.
The Nursing Process
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Specify goals of nursing action
ID specific nursing interventions appropriate for attaining
the outcomes
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ID interdependent interventions
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Interventions should be listed in preferential order
Interventions should be individualized as well as age, gender,
and culture-appropriate
Can the implementation of the intervention be rationalized?
Will a physician order be required
Document plan of care
Communicate to appropriate personnel any need for
multidisciplanary approach to plan of care
The Nursing Process
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Patient Values
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Always include patient and family in process
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What does patient consider to be a priority?
Conflicts should be resolved in a way that is mutually
acceptable
Expected Outcomes (patient centered goals)
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Pt will be able to recite Signs & Symptoms of……..
Pt will verbalize understanding of the importance of
adequate amount of folic acid in the diet.
The Nursing Process
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Nursing Interventions
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Plan nursing interventions n the basis of
established standards and priorities to move the
patient/family toward the expected outcomes
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ANA Standard of Practice, Nurse Practice Acts, taxonomy
of nursing interventions (NIC)
Should be patient focused and outcome driven
Assign patient care activities to be implemented
by other members of the heath care team as
appropriate
The Nursing Process
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Implementation
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Plan of care is put into use
The nurse (RN) assumes responsibility for the
implementation and coordinate activities of all involved
FOCUS: Resolving pt’s nursing diagnosis, achieving expected
outcomes while meeting pt’s health care needs.
Implement a teaching plan that promotes a positive
woman’s health outcomes
Supervise patient care activities that were delegated to other
members of health care team
When nursing interventions have been completed, the
Implementation phase of the process has ended.
The Nursing Process
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Evaluation Phase
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Assess the pt’s response to nursing
interventions, including progress toward
the patient-centered goals
Assess whether objectives were achieved
Document the extent of the achievements
Plan of care may need to be revised
Questions to ask during evaluation phase
(see page 54)
The Nursing Process