Prenatal care diagnosis

The clinical judgment made by nursing staff about the existing or potential health problems of pregnant women through comprehensive assessment of the three dimensions of maternal physical, psychological, and social adaptation is the core hub connecting pregnancy assessment and personalized nursing intervention. It is neither a templated summary of prenatal examination questions nor an unchanging risk determination. It must be dynamically adjusted based on individual conditions, while taking into account medical safety and the actual needs of pregnant women.

I have been in the obstetrics clinic for almost 8 years. What impressed me the most was the 32-year-old pregnant mother who had her second child by caesarean section last year. She was pregnant with twins this time. She had been checked in another hospital before, and the nursing diagnosis only said "risk of uterine rupture". She was so scared that she had insomnia for 3 weeks in a row, and she did not gain any weight. Turning to us, I looked through her previous examination report. Her uterine incision healing rating was level 1, her weight control in the early pregnancy was better than the standard, and she had no symptoms of uterine contractions or abdominal pain. What's more, she herself mentioned that recently she was worried that her two babies were not getting enough nutrition, and her legs would easily swell after she had to stand for 6 hours at work. Our adjusted nursing diagnosis not only marked the risk of uterine rupture as low risk and attached specific evidence, but also added two special questions for her: "anxiety about nutritional intake" and "potential risk of lower limb edema". We adjusted her dietary guidance and gave her some tips on putting her feet on her feet at work and sitting for 3 minutes every half hour. When she came for the second prenatal check-up, she felt much more relaxed.

Speaking of which, there are actually some differences in the standards for prenatal care diagnosis in the industry. One group is evidence-based and strictly benchmarks against the more than 200 standardized items of the North American Nursing Diagnosis Association (NANDA). All pregnant mothers must be uniformly screened for common risks such as gestational diabetes, hypertension, and depression. The advantage is that no items will be missed, which is equivalent to ensuring safety during pregnancy and making medical errors less likely.； The other group is the humanistic group that has been promoted by the domestic maternal and child care system in recent years. They feel that the standardized items are too rigid and many individualized social issues are not covered at all - such as whether left-behind pregnant mothers are unaccompanied for prenatal check-ups, whether there is a risk of domestic violence, and whether ethnic minorities have special eating habits. If these issues are not included in the diagnosis, the intervention plan will not be implemented at all. I met a pregnant mother of the Yi ethnic group before. The diet she was given according to the general nutrition guidelines included lean pork. She did not eat pork. She took the recipe and threw it away. Her albumin was found to be low twice in a row. Later, we added her dietary preferences into the nursing diagnosis and replaced her with the combination of beef, mutton, and buckwheat products that she often eats. In less than a month, the index was up. The current consensus in the industry is basically a combination of the two. There must be no shortage of standardized items that must be checked, but enough space should be left for personalized issues.

Don’t believe it, many pregnant mothers think that nursing diagnosis is a medical record written by a doctor and has nothing to do with them. In fact, it is not. Last week, a pregnant mother who was 26 weeks pregnant came for a prenatal check-up. There were no problems with the blood test and B-ultrasound. I saw that she always rubbed her calves when walking. After asking more questions, I found out that she had leg cramps every night recently. I forgot to mention this during the prenatal check-up. This was not mentioned in the previous nursing diagnosis. The problem is that the dose of calcium supplement given is only the basic amount. We added the "existing problem of muscle spasm in the lower limbs" on the same day, adjusted the amount of calcium supplement, and taught her a few relaxing acupuncture points that her husband can help press. This week she said she has not used it much. Some people think that nursing diagnosis is a lifelong assessment. How can this be the case? A pregnant mother I followed up last month had a "potential risk of overnutrition" at 24 weeks because she loved to eat sweets. She failed to pass the glucose tolerance test at 28 weeks, so it was directly adjusted to "existing problems with abnormal blood sugar during pregnancy". The entire intervention plan was completely changed. This thing is supposed to be updated at every prenatal check-up and changes with your status.

I was particularly impressed by a pregnant mother who was a rock climbing instructor before. She was still doing low-intensity rock climbing training when she was 4 months pregnant. According to the standardized items, she must have written "trauma and risk of miscarriage" and asked her to stop exercising. However, we evaluated that she has 10 years of rock climbing experience and has better control over her physical condition than ordinary pregnant women. The mother was more accurate, but if we really forced her to stop exercising, she would be prone to anxiety and depression. Finally, we marked the risk as low risk, made a note that it was related to professional exercise habits, and gave her a specific upper limit of exercise intensity and a signal that she must stop. Her entire pregnancy went smoothly, and she finally gave birth to a 7-pound baby boy.

The first reaction of many pregnant mothers after receiving the nursing diagnosis is to look for the word "high risk". They panic when they see it. In fact, there is no need. There are two types of problems in diagnosis. One is existing symptoms, which are symptoms that have already appeared, such as pregnancy-induced hypertension. For this kind of problem, just follow the guidance of the doctor and make adjustments. ； The other is potential. To put it bluntly, it means "reminding you to pay attention to this pit in advance." It does not mean that you will definitely have problems. I often tell pregnant mothers who come for prenatal check-ups, don’t treat this diagnosis as a test report card. When you see problems, you will feel that you are not pregnant. This thing is essentially your own exclusive navigation during pregnancy. If you talk to the doctor and nurse more, talk about whether you have slept well recently, whether you have quarreled with your husband, whether you are tired from work, or even what you like to eat and what you don’t like to eat. This navigation can be more accurate and you can walk more worry-free.

To put it bluntly, prenatal care diagnosis is never a tool for labeling pregnant mothers. It just helps you mark the pitfalls you may step into in advance. If you don’t understand something in the report, don’t hold it back and ask the nurse or doctor. After all, you are the first person responsible for conceiving a baby.