As a practical nurse, you have the opportunity to assist the expectant mother in attaining healthier patterns of living and to reinforce health-promoting behaviors.
Skin care, hair care, breast care, dental care, bowel elimination, vaginal douching, and clothing are all important to the pregnant patient.
a. Skin Care. The glands of the skin may be more active during pregnancy and the patient may tend to perspire more. Frequent baths or showers are recommended.
(1) Baths can be therapeutic–relaxes tensed and tired muscles, helps counter insomnia, and makes the patient feel fresh and sweet smelling.
(2) Baths may pose a physical maneuverability problem which increases the chance of falling late in the pregnancy; showers are recommended, but with caution when getting in and out and moving around in the shower.
(3) The possibility of infecting the vaginal tract as a result of tub baths is considered highly unlikely.
(4) Tub baths are contraindicated after rupture of the membranes.
b. Hair Care. The hair tends to become oily more frequently during pregnancy due to overactivity of oil glands of the scalp and may require shampooing more frequently. The hair may grow faster during pregnancy and may require cutting more often.
c. Breast Care. It is important to begin preparing the breast for breastfeeding during the prenatal period.
(1) A well-fitting support bra should be worn at all times. This will provide good support for the enlarging breasts. As the breasts enlarge, an increase in bra and cup size should be worn.
(2) Pads may be worn inside the bra cups to absorb possible colostrum leakage from the nipples. The pads should be changed if they become wet from leakage. Prolonged moisture against the nipples may lead to tenderness and cracking once the newborn infant begins nursing.
(3) The breasts should be washed daily (without soap) to remove dried colostrum and to prevent irritation to the nipples. Lanolin may be applied to the nipples to prevent evaporation of perspiration, thereby softening the skin. Wet tea bags may be placed on the nipples, as the tea will release tannic acid, which will toughen the skin. The nipples should be air dried or blow dried after washing to help toughen them, especially if the patient plans to breastfeed.
d. Dental Care. The patient must maintain normal, daily dental care. There is no documentation that supports increased dental cavities during pregnancy.
(1) Minor dental work, such as fillings and simple extractions, may be done during pregnancy; however, patients are advised to avoid anesthetics.
(2) Major dental work, to include all dental surgery, should be postponed until after the pregnancy because of the need to use anesthetics. Anesthetics may affect the developing fetus and the need to use analgesics may also affect the fetus.
Brookside Note
While many medications, including general anesthesia, should be avoided during pregnancy, local anesthesia (without epinephrine) is safe for needed dental work, such as replacement of the broken filling shown here.
In our opinion, avoiding local anesthesia for necessary dental work is needlessly painful for the mother and of no benefit to the fetus.
e. Bowel Elimination.
(1) Patients who normally had no problems with bowel elimination habits will usually experience little or no change in the daily routine.
(2) Patients who have a tendency toward constipation become noticeably more irregular during pregnancy because of:
(a) Decreased physical exertion.
(b) Relaxation of bowel as a response to hormone.
(c) Pressure on the bowel from the gravid uterus.
(d) Constipating effect of iron supplements.
(3) To prevent or to relieve constipation, you should encourage the patient to eat a diet high in fiber, maintain an adequate fluid intake, and to exercise–especially walking.
f. Vaginal Douching. Explain to the patient that normal vaginal secretions are usually intensified during pregnancy due to increased circulation and hormone.
(1) Vaginal douching should only be done with a physician’s order for treatment of a specific condition. There is potential for introduction of infection and development of an air embolism.
(2) Vaginal douching should never be done after a rupture or even suspected rupture of the membrane.
(3) Feminine hygiene deodorant sprays should not be used due to increased chance of perineal irritation, cystitis, and urethritis. Undesirable odors can be controlled with daily use of soap and water.
(4) If a douche is ordered, it should be done slowly using a gravity bag. Bulb syringe and “squeeze” operated pre-packaged douches should be avoided, as they are capable of producing too much force.
(a) Douche while sitting on a toilet to decrease the risk of injury by falling.
(b) The tip is not to be inserted deeper than 3 inches.
(c) The bag should not be higher than 2 feet above the level of the vagina. The bag higher than 2 feet above will increase the force of pressure.
g. Clothing. During pregnancy, the clothes should be given the same or perhaps even a little more attention than at other times.
(1) The clothes should be lightweight, nonconstrictive, adjustable, absorbent, and enhance the sense of well-being of the patient.
(2) No constrictive round garters or girdles should be used due to interference in the blood’s circulation from the legs.
(3) The shoes should be comfortable and well-fitting, easy to apply, especially in the last trimester when it is difficult to bend over to tie or buckle. They should also have a good solid base of support (broad heel) to avoid tottering, which may lead to a fall.