Prenatal care diagnosis and nursing measures

Currently, the clinically recognized core prenatal care diagnoses are mainly divided into three categories - physical discomfort related to physiological changes in gestational age, emotional abnormalities related to childbirth/fetal health concerns, and health cognitive deviations related to mixed information. There is no universal standard answer to the corresponding care. The plan must be customized based on the individual gestational age, basic diseases, psychological state, and family support of the pregnant woman. Any one-size-fits-all care requirements may have the opposite effect.

Last week, I met Xiao Zhou, a 28-week pregnant mother at the outpatient clinic. Her husband helped her in and her eyes turned red as soon as she sat down. She said her back pain was so bad that she needed help even putting on socks. The elderly at home said that back pain during pregnancy was normal and asked her to lie down more. After lying down for almost two weeks, the pain became even worse, and even her ankles were so swollen that she couldn't put on shoes. I measured her blood pressure and urine protein, and they were all normal. There were no signs of premature labor such as uterine contractions or shortened cervix, so I made an appointment for her to take a pregnancy stretching class in the rehabilitation department. She was asked to do 15 minutes a day, not lie down all the time, and to go downstairs and walk slowly for 20 minutes every day. She also increased the calcium dosage to 1200mg a day. This week she came for a follow-up visit and she can walk on her own. She said that the pain was 80% gone.

This kind of "physical discomfort (low back pain, lower limb edema, constipation) related to the enlargement of the uterus that compresses the pelvic floor and the decrease in muscle tone" is the prenatal care diagnosis with the highest clinical proportion. Previously, the old nursing routine in our department also required such pregnant women to reduce their activities and stay in bed. In recent years, we have cooperated with maternal-fetal medicine and rehabilitation departments to do more research After medical discussions, the current consensus is that only pregnant women with cervical insufficiency who have undergone cerclage and have clear signs of premature labor need to restrict their activities. For other pregnant women with normal pregnancies, long-term bed rest will increase the risk of venous thrombosis of the lower limbs, muscle disuse atrophy, and worsening constipation, which is not conducive to subsequent delivery. Of course, there are different opinions. Many veteran doctors in grassroots hospitals still habitually ask pregnant women to lie down more. This is actually the collision of empirical medicine and evidence-based medicine. Our current approach is to conduct high-risk assessment first and then give personalized suggestions. We will not generalize.

Physiological problems are actually easy to adjust. The most challenging thing is actually the emotional nursing diagnosis, which is "anxiety and sleep disorders caused by unknown childbirth and concerns about fetal health." Our department had an argument before about whether to show pregnant women a live delivery video. At first, everyone thought that reducing the information gap would reduce anxiety, so they put the complete delivery video in the mission area for everyone to watch. As a result, a 32-week pregnant mother suffered from insomnia for three days after watching it, and her blood pressure rose to 140/90. She said that when she closed her eyes, she thought of scenes of side cutting and bleeding. Later, we adjusted the method. Case: First, we will give each pregnant mother an anxiety self-rating scale. If the score is lower than the normal threshold, we will show her a warm version of the video that has been edited and focuses on delivery coordination movements. For pregnant mothers with high scores, we will only slowly explain the signs of labor and the admission process, which are useful to her, when she is approaching term. We will not fill her in too many details of delivery in advance, which will increase the psychological burden. Speaking of this, I think of the 36-week pregnant mother who had her first child. She watched too many short videos about dystocia and cesarean section. She cried when she came to the prenatal check-up and said she didn't want to give birth anymore. We talked to a nurse in the delivery room who had just returned from maternity leave and talked with her for half an hour about her true experience of giving birth. We taught her two mindful breathing techniques and asked her not to watch related short videos. Two weeks later, she came for fetal heart rate monitoring and said she could sleep through the night and was no longer afraid.

Another very common type of nursing diagnosis is "lack of health knowledge related to mixed information sources and cognitive biases." This is really too common. Pregnant women often ask, "Can't eat crabs, eat ice, and can't cut hair?" Some mothers-in-law force pregnant women to eat 4 eggs a day and stew two pounds of pork ribs, saying, "One person eats and two people make up for it." There was a pregnant mother who had high blood sugar when she was 24 weeks into her pregnancy and had gained 20 pounds in weight. She said that her mother-in-law asked her to eat two bowls of rice every day. If she didn't eat, she would say she was starving her grandson. We printed out the pregnancy dietary guidelines of the Chinese Nutrition Society and showed them to her mother-in-law. We calculated the daily calories needed for her and listed specific recipes. After the birth, she only gained 28 pounds in total, and the baby was 6 pounds and 2 taels. The baby was born in two hours, which was very smooth. It should also be said here that people's cognitions vary greatly in different cultural backgrounds. We nurses will not directly deny the experience of the elderly. We will use data and guidelines to speak. After all, the ultimate goal is to make mothers and babies healthy.

I have been doing prenatal care for almost 6 years, and I have seen too many cases where the "standard procedure" was followed but problems occurred. For example, a mother with her second child had a premature birth for her first child, and she asked to stay in bed when she was pregnant with her second child. We monitored her cervical length for four consecutive weeks, and it was stable at more than 3cm. There were no high-risk factors for premature birth, so we advised her to go to work normally and take a normal walk every day. Finally, she gave birth to a 7-pound baby at 40 weeks + 1, which was smoother than her first child. In fact, there has never been a standard answer to prenatal care. It does not mean that just listing 1234 by gestational age is enough. Each person’s physical condition, mental state, and even family support must be taken into consideration. After all, in the final analysis, care is not about taking care of the “pregnant belly”, but a living person.