3.2b Care Management Flashcards
1
Q
Prenatal Care
A
- Promotes health of baby and family in office or health center
- Education on healthy lifestyles (nutrition and physical activity)
- Self-care for common pregnancy discomforts
- Information about changes in mother and development of fetus
- Routine screenings for risk factors and potential problems
- Emphasis on preventative care
2
Q
Reasons people delay prenatal care
A
- Cost
- Lack of insurance
- Lack of childcare
- Transportation barriers
- Inability to take off work
- Lack of culturally sensitive providers
- Discrimination based on sexual orientation
- Barriers to communication
- Cultural differences regarding perceived value of prenatal care
3
Q
Prenatal Visit Schedule
A
By Week 12 - First visit within the first trimester
Week 16-28 - Monthly Visits
Weeks 29-36 - Every 2 weeks
Weeks 36 - Weekly Visits
4
Q
Group Prenatal Care
A
- Alternative to prenatal visits
5
Q
Preconception Care (Important for Pregnancy Outcomes)
A
- Good Nutrition
- Entering pregnancy with healthy weight
- Adequate intake of folic acid
- Avoidance of alcohol and other substances
- Prevention of STI’s
- Special needs for women with chronic diseases such as DM
6
Q
INITIAL PRENATAL VISIT
A
7
Q
Prenatal Interview
A
- Therapeutic relationship built between woman and nurse
8
Q
Reason for seeking Care
A
- Why the patient has come in
9
Q
Current Pregnancy
A
- Signs of pregnancy such as nausea or vomiting
- Review of systems
- Early teachings
10
Q
Childbearing and Reproductive System History
A
- Age at menarche (first menstrual period)
- Menstrual history
- Contraceptive history
- Infertility or reproductive system conditions
- History of STI’s
- Sexual history
- Detailed history of all pregnancies
- Date of last pap test
- Date of LMP to obtain EBP
11
Q
Health History
A
- Physical condition and surgical procedures
- History of allergies and reactions
- Medication use
- Immunizations
12
Q
Nutritional History
A
Diet assessment reveals
- Special dietary practices
- Food allergies
- Eating behaviors
- Practice of PICA
- BMI should be assessed to counsel weight gain, physical activity, and healthy food choices
13
Q
Medication History
A
- OTC, vitamins, herbs, caffeine, alcohol, tobacco, drugs Immunizations should include - Rubella (German Measles) - Varicella (Chicken Pox) - Season influenza - Hepatitis B - Pertussis (whooping cough)
14
Q
Family HIstory
A
- Information about immediate family (parents, siblings, children)
- Family history of patients partner (if the partner is the father)
15
Q
Social, experimental and occupational history
A
- Ethnic/cultural background and socioeconomic status
Remain alert for potential parenting issues - Depression, lack of family support, inadequate living conditions, attitude towards health care, expectations of HCPs, patient view of patient-nurse relationship
Assessing patient knowledge in various areas - Pregnancy, maternal change, fetal growth, self-care, concerns and desires related to labor, understanding of newborn care, plan for infant feeding, attitudes towards medicated birth, knowledge of available parenting skills, decision making abilities and lifestyles such as exercise, sleep, diet, recreational interests, person hygiene.
16
Q
Mental Health Screening
A
- All pregnant patients should be screened for mental health
- Perinatal depression is the most common complication of pregnancy
- RISK FACTORS
- Lack of support from partner
- Inadequate social support
- History of intimate partner violence
- Personal history
- Pregnancy complication or loss
- Stressful life events
17
Q
Risk of Intimate Person Violence
A
- Abuse Assessment Screen is the most widely used tool
- Nurses can ask patients screening questions as routine assessments of pregnancy
18
Q
Review of Systems
A
- For each system problem describe Onset Location Duration Characteristics Aggravating or relieving factors Treatments Associated symptoms
19
Q
Physical Examination
A
- Provides baseline for subsequent changes
- BP should be measured every visit seated position with back and arm support
20
Q
Lab Tests
A
- HIV
- Syphilis
- Hepatitis B
- Chlamydia or Gonorrhea
- The above are repeated at 3rd trimester for high risk patients
- Tuberculin test
Urine Test
(Protein, glucose, leukocytes, urine culture if indicated) - Pap test
- Genetic testing
21
Q
Human Trafficking
A
- Use of force, fraud, or coercion to compel a person into commercial sex acts or labor against their will.
- Inducing a minor into commercial sex is human trafficking regardless of force
22
Q
Action-Means-Proposal Model (AMP)
A
- Trafficker takes action and employs means of force for the purpose of compelling victim to provide labor services
- One of each element must be present to establish human trafficking
23
Q
After First Interview
A
24
Q
Follow up visits
A
- Briefer and less intensive than the initial visit
- Patient is asked to summarize relevant events that have occurred since previous visit
ASK ABOUT - Mood swings
- Reaction to changes in body image
- Bad dreams
- Worries
- Reactions of the partner and family member to the pregnancy
- Warning signs of emergency
- Signs of preterm and term labor
- Labor process
- Concerns about labor, fetal development, or methods to assess fetal well-being
- Whether patient is planning to attend child birth preparation classes
- Management of discomfort during labor
25
Q
Physical Examination
A
- BP and weight
- Appropriate gestational weight gain
- Urine checked by dip stick
- Presence and degree of edema
- Supine Hypotension (low BP from lying on back)
26
Q
LAB TESTS
A
27
Q
Hemoglobin, Hematocrit, WBC, Differentials
A
- Detects anemia and infections
28
Q
Hemoglobin Electrophoresis
A
- Identifies patients with hemoglobinopathies
29
Q
Blood Type, RH, and Irregular Antibodies
A
- Patients whose fetuses are at risk for erythroblastosis fetalis or hyperbilirubinemia in neonatal period
30
Q
Rubella Titer
A
- Determines immunity to Rubella
31
Q
Tuberculin Test
A
- Screens for exposure to tuberculosis
32
Q
Urinalysis
A
- Identifies patients with glycosuria, renal disease, hypertensive disease, disease of pregnancy, infection, occult hematuria, hCG for confirmed pregnancy
33
Q
Urine Culture
A
- Identifies asymptomatic bacteriuria
34
Q
BUN, Creatinine, Electrolytes, Creatinine Clearance, Total Protein Excretion
A
- Identifies level of renal compromise in diabetes patients
- Hypertension
- Renal Disease
35
Q
Pap test
A
- Screens for cervical intraepithelial neoplasia and HPV
36
Q
Cultures for gonorrhea and chlamydia
A
- Screens for asymptomatic infection
37
Q
Vaginal/Anal culture
A
- GBS test done at 35-57 weeks for infection
38
Q
RPR, VDRL, FTA-ABS
A
- Identifies untreated syphilis
39
Q
HIV antibodies, Hepatitis B surface antigen, toxoplasmosis
A
- Screens for specific Infections
40
Q
1-H Glucose Tolerance
A
- Screens for gestational diabetes
- Done at initial visit (for patients with risk factors)
- Done at 24-28 weeks for patients who came out negative but were at risk, or for first timers
41
Q
3-H Glucose Tolerance
A
- Tests for gestational diabetes in patients with elevated glucose levels after 1-H test
- Must have 2 elevated readings for diagnoses
42
Q
ECG, Chest X-Ray, Echocardiogram
A
- Evaluates cardiac function for patients with history of cardiac disease or hypertension
43
Q
FETAL ASSESSMENT
A
44
Q
Gestational Age
A
- Determined by menstrual history, contraceptive history, pregnancy test results, and findings
- Date/Size of first uterine evaluation
- Date and method of first fetal heartbeat
- Date of first feelings of fetal movement (quickening)
- Current fundal height and estimated fetal weight (EFW)
- Current week of gestation by history of LMP or ultrasound
45
Q
Fetal Heart Tones
A
- Can be detected with ultrasound early in pregnancy
- Can be heard with doppler in late first trimester
46
Q
Health Status
A
Determined By
- Fetal Movement
- Gestational hypertension
- Intrauterine growth restriction (IUGR)
- Prelabor rupture of membranes (PROM)
- Irregular or absent FHR
- Decreased or absent of movement after quickening
47
Q
Fundal Hieght
A
- Uterus becomes abdominal organ during second trimester
- Measured by height of uterus above symphysis pubis
- Measurement provides estimation of duration of pregnancy
- Weeks 18-30 height of fundus in CM is same as weeks of gestation
- If bladder is empty at time of measurement, stable or decreased fundal height can indicate IUGR
- Excessive increase in height can mean multiple gestation or polyhydramnios (too much amniotic fluid)
