Antepartum Nursing Diagnosis
Antepartum literally means "before birth," and it refers to pregnancy. In a normal pregnancy, nurses interact with patients briefly at routine checkups and rarely need to write diagnoses. However, when complications arise, especially those requiring bed rest, nurses become a critical part of antepartum care.
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Safety
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Pregnancy, especially in the third trimester, can wreak havoc on a woman's sense of balance. Her center of gravity has shifted and the risk for falls increases. With an increased risk for falls comes a risk for injury. Patients on complete bed rest are also at a risk for bed sores, which may be expressed according to the North American Nursing Diagnosis Association (NANDA) guidelines as "risk for impaired skin integrity related to immobility." Make sure your patient is changing position at least every two hours as permitted by her doctor. Some conditions require her to lie primarily on her left side to increase blood-flow to the baby. Check with her obstetrician before forming interventions.
Activity and Rest
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When a patient is put on bed rest due to complications, activity and rest diagnoses focus on the problems that can occur from lack of mobility. Activity intolerance and impaired mobility are obvious diagnoses, but it is also important to consider the effect of boredom on your patient. Lack of diversions can amplify fear, anxiety and other emotional disturbances. A possible diagnosis is "deficient diversional activity" related to complete bed rest as manifested by the patient who says she is "going out of my mind with boredom."
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Strain on Relationships
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A patient on bed rest often needs to rely on someone else to do the things she can't. This can cause strain on both the caregiver and the patient, especially if one person is shouldering the responsibility of both caring for the patient and the duties she typically performs. Caregiver issues can be expressed as "risk for caregiver role strain related to caring for a patient on bed rest." Bed rest can also cause "impaired social interaction" since your patient is unable to leave her home. Encourage her to find ways to keep in touch with her friends and family so she does not become isolated.
Emotional Well-Being
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Pregnancy is an emotional time even when the pregnancy is going smoothly. When complications arise, these emotions can become overwhelming. Fear and anxiety are two common diagnoses. Your patient may be experiencing death anxiety if she is afraid of the possibility of dying during delivery. She may feel anticipatory grieving if the baby is at high risk. Denial about her situation could be evident. Listen as your patient expresses her feelings and look for clues about her emotional state before forming your diagnoses.
Considerations
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The most important rule to remember when forming diagnoses is that each patient is unique. There is no "one size fits all" list of diagnoses. Not all pregnant women lack balance or experience fear and anxiety. Not all caregivers experience role strain. Remember the first step of the nursing process-assessment: Assess your patient, not her condition.
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