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NR-NUR121 | Mother and Child Nursing (MCN) > [9] PRELIMS | PRENATAL ASSESSMENT > Flashcards

[9] PRELIMS | PRENATAL ASSESSMENT Flashcards

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1
Q

FOCUS OF PRENATAL VISIT

  • ____ about pregnancy
  • Screen for ____ that might reveal:
    * M____
    * H____
    * H____
    * E____
    * I____
  • ____ complications such as intrapartum cardiac arrest
A
  • Education about pregnancy
  • Screen for danger signs that might reveal:
    * Morbid obesity
    * HTN
    * Hemorrhage
    * Embolism
    * Infection
  • Anesthesia-related complications such as intrapartum cardiac arrest
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2
Q

PRENATAL VISIT

  • Schedule a pre-natal visit as soon as ____.
A
  • Schedule a pre-natal visit as soon as she suspect that she is pregnant.
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3
Q

PRENATAL VISIT

Schedule of Visits:
* First ____ week: every ____ weeks
* Through the ____ week: every ____ weeks
* And then ____ until birth.

  • Prompt reporting of ____ of pregnancy for evaluation
A

Schedule of Visits:
* First 28th week: every 4 weeks
* Through the 36 week: every 2 weeks
* And then every week until birth.

  • Prompt reporting of (+) danger signals of pregnancy for evaluation
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4
Q

INITIAL INTERVIEW

Purposes:
* ____
* Gain information about a woman’s ____
* Obtain ____ for the pregnancy

A

Purposes:
* Establish rapport
* Gain information about a woman’s physical & psychosocial health
* Obtain basis for anticipatory guidance for the pregnancy

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5
Q

INITIAL INTERVIEW

  • Completion of ____ by the client
  • Setting: ____
  • ____
  • ____
  • Ask ____
  • Good ____
  • ____
A
  • Completion of some of the forms by the client
  • Setting: private, quiet
  • Introduce self
  • Clarify your role
  • Ask how the client wants to be addressed
  • Good interview technique
  • Establish rapport
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6
Q

COMPONENTS OF PRENATAL ASSESSMENT

  1. ____
  2. ____
  3. ____
A
  1. Extensive Health Hx
  2. P.E. Including Pelvic Examination
  3. Laboratory Assessment
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7
Q

COMPONENTS OF HEALTH HISTORY

  1. D____
  2. C____
  3. F____
  4. H____
  5. H____
  6. D____
  7. G____
  8. O____
  9. R____
A
  1. Demographic Data
  2. Chief Concern
  3. Family Profile
  4. History of Past Illness
  5. History of Family Illness
  6. Day History/Social Profile
  7. Gynecologic History
  8. Obstetric History
  9. Review of Systems
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8
Q

DEMOGRAPHIC DATA

A

CHIEF CONCERN

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9
Q

CHIEF CONCERN

Ask the client:
* L____
* P____
* S____
* D____
* D____

A

Ask the client:
* LMP
* Pregnancy test
* Signs of early pregnancy
* Discomforts of pregnancy
* Danger signs of pregnancy

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10
Q

HEALTH HISTORY

  • Client’s age, occupation, educational level
  • Partner’s age, occupation, educational level
  • Marital status
  • Available support person/s
  • House size, room location
  • Situations that can hinder acceptance of pregnancy
A

FAMILY PROFILE

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11
Q

FAMILY HISTORY

  • Client’s ____
  • Partner’s ____
  • M____
  • Available ____
  • ____
  • Situations that ____
A
  • Client’s age, occupation, educational level
  • Partner’s age, occupation, educational level
  • Marital status
  • Available support person/s
  • House size, room location
  • Situations that can hinder acceptance of pregnancy
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12
Q

HEALTH HISTORY

  • Heart & kidney diseases, UTI, HTN, DM, asthma, common infectious diseases, etc.
  • Immunizations
  • Allergies
  • Past surgical procedures
A

HISTORY OF PAST ILLNESS

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13
Q

HEALTH HISTORY

  • Cardiovascular
  • Renal
  • Cognitive
  • Blood disorders
  • Genetically inherited diseases
  • Congenital anomalies
A

HISTORY OF FAMILY ILLNESS

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14
Q

HEALTH HISTORY

  • Nutrition
  • Elimination
  • Sleep/rest, exercise
  • Recreation, hobbies
  • Interpersonal interactions
  • Habits
  • Involvement in abusive relationship
  • Medication Hx
A

DAY Hx / SOCIAL PROFILE

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15
Q

DAY Hx / SOCIAL PROFILE

  • N____
  • E____
  • S____
  • R____
  • I____
  • H____
  • I____
  • M____
A
  • Nutrition
  • Elimination
  • Sleep/rest, exercise
  • Recreation, hobbies
  • Interpersonal interactions
  • Habits
  • Involvement in abusive relationship
  • Medication Hx
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16
Q

HEALTH HISTORY

  • Menarche
  • Usual menstrual cycle & discomforts
  • Monthly perineal self-examination
  • Past reproductive tract surgery
  • Hx of frequent D & C
  • FP methods
  • Sexual Hx
  • Stress incontinence
A

GYNECOLOGIC Hx

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17
Q

GYNECOLOGIC Hx

  • M____
  • U____
  • M____
  • P____
  • H____
  • F____
  • S____
  • S____
A
  • Menarche
  • Usual menstrual cycle & discomforts
  • Monthly perineal self-examination
  • Past reproductive tract surgery
  • Hx of frequent D&C (Dilatation & Curettage)
  • FP (Family Planning) methods
  • Sexual Hx
  • Stress incontinence
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18
Q

HEALTH HISTORY

  • Previous pregnancy
  • Previous miscarriages or therapeutic abortions
  • Blood transfusion
  • GTPALM
A

OBSTETRIC Hx

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19
Q

OBSTETRIC Hx

  • P____
  • P____
  • B____
  • G____
A
  • Previous pregnancy
  • Previous miscarriages or therapeutic abortions
  • Blood transfusion
  • GTPALM
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20
Q

HEALTH HISTORY

  • Head: headache, injury, seizures, dizziness, fainting
  • Eyes: vision, glasses, diplopia, infection, glaucoma, cataract, pain, recent changes
  • Ears: infection, discharge, earache, hearing loss, tinnitus, vertigo
  • Nose: epistaxis, colds, allergies, postnasal discharge, sinus pain
  • Mouth & Pharynx: dentures, teeth condition, toothache, bleeding gums, hoarseness, dysphagia, tonsillectomy, last dental exam
  • Neck: stiffness
  • Breasts: lumps, secretion, pain tenderness
  • Respiratory system: cough, wheezing, asthma, SOB, pain, TB, pneumonia
  • Skin: rashes, acne, psoriasis
A

REVIEW OF SYSTEMS (ROS)

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21
Q

PRENATAL ASSESSMENT

  1. Baseline Height, Weight & V/S Measurement
  2. Assessment of Systems
  3. Measurement of Fundal Height & Fetal Heart Sounds
  4. Pelvic Examination & Estimating Pelvic size
A

PHYSICAL EXAMINATION

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22
Q

REVIEW OF SYSTEMS (ROS)

  • ____: headache, injury, seizures, dizziness, fainting
  • ____: vision, glasses, diplopia, infection, glaucoma, cataract, pain, recent changes
  • ____: infection, discharge, earache, hearing loss, tinnitus, vertigo
  • ____: epistaxis, colds, allergies, postnasal discharge, sinus pain
  • ____: dentures, teeth condition, toothache, bleeding gums, hoarseness, dysphagia, tonsillectomy, last dental exam
  • ____: stiffness
  • ____: lumps, secretion, pain tenderness
  • ____: cough, wheezing, asthma, SOB, pain, TB, pneumonia
  • ____: rashes, acne, psoriasis
A
  • Head: headache, injury, seizures, dizziness, fainting
  • Eyes: vision, glasses, diplopia, infection, glaucoma, cataract, pain, recent changes
  • Ears: infection, discharge, earache, hearing loss, tinnitus, vertigo
  • Nose: epistaxis, colds, allergies, postnasal discharge, sinus pain
  • Mouth & Pharynx: dentures, teeth condition, toothache, bleeding gums, hoarseness, dysphagia, tonsillectomy, last dental exam
  • Neck: stiffness
  • Breasts: lumps, secretion, pain tenderness
  • Respiratory system: cough, wheezing, asthma, SOB, pain, TB, pneumonia
  • Skin: rashes, acne, psoriasis
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23
Q

PHYSICAL EXAMINATION

  1. Baseline ____
  2. A____
  3. Measurement of ____
  4. P____
A
  1. Baseline Height, Weight & V/S Measurement
  2. Assessment of Systems
  3. Measurement of Fundal Height & Fetal Heart Sounds
  4. Pelvic Examination & Estimating Pelvic size
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24
Q

PHYSICAL EXAMINATION

Make sure that the pregnant client will ____ before examination

A

VOID

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25
Q

PHYSICAL EXAMINATION

General appearance & mental status
* Posture
* Manner of dressing
* Manner of speaking
* Facial expression
* Presence of bandages & dressings

A

ASSESSMENT OF SYSTEMS

26
Q

ASSESSMENT OF SYSTEMS

General appearance & mental status
* P____
* M____
* M____
* F____
* P____

A

General appearance & mental status
* Posture
* Manner of dressing
* Manner of speaking
* Facial expression
* Presence of bandages & dressings

27
Q

PHYSICAL EXAMINATION

Estimates AOG by the relative position of the uterus in the abdominal cavity

A

BARTHOLOMEW’S RULE

28
Q

PHYSICAL EXAMINATION

Mesurement of Fundal Height

A

Mc Donals’ Rule

29
Q

PHYSICAL EXAMINATION

Determines the length of the fetus in centimeters

A

HAASE’S RULE

30
Q

HAASE’S RULE

  • During the ____ of pregnancy, ____
  • During the ____ of pregnancy, ____
A
  • During the first half of pregnancy, square the number of the months
  • During the second half of pregnancy, multiply the month by 5
31
Q

PHYSICAL EXAMINATION

The exam is used to look at a woman’s:
* Vulva
* Uterus
* Cervix
* Fallopian tubes
* Ovaries
* Bladder
* Rectum

A

PELVIC EXAMINATION

32
Q

PELVIC EXAMINATION

The exam is used to look at a woman’s:
* V____
* U____
* C____
* F____
* O____
* B____
* R____

A

The exam is used to look at a woman’s:
* Vulva
* Uterus
* Cervix
* Fallopian tubes
* Ovaries
* Bladder
* Rectum

33
Q

PELVIC EXAMINATION

Performed:
* During a ____physical exam
* When a woman is____
* When a doctor is checking for ____
* When a woman is having ____

A

Performed:
* During a yearlyphysical exam
* When a woman ispregnant
* When a doctor is checking for aninfection(such aschlamydia,vaginosis,
trichomoniasis, and others)
* When a woman is having pain in her pelvic area or low back

34
Q

PELVIC EXAMINATION

Before the pelvic exam
* Ask to ____
* Assist to lie in a ____

During the pelvic exam
* Drape properly with a draw sheet over ____
* Suggest to ____

A

Before the pelvic exam
* Ask to void
* Assist to lie in a lithotomy position

During the pelvic exam
* Drape properly with a draw sheet over abdomen that extends over the legs
Suggest to breath in and out

35
Q

PELVIC EXAMINATION

Looking at vulva, checking for irritation, redness, sores, swelling, discharges or other abnormalities

A

EXTERNAL VISUAL EXAM

36
Q

PELVIC EXAMINATION

Palpating abdomen & pelvis by inserting two lubricated, gloved fingers into vagina with one hand, while the other hand presses gently on the outside of lower abdomen

A

PHYSICAL EXAM

37
Q

PELVIC EXAMINATION

Using a speculum to spread open vaginal walls & see vagina & cervix

A

INTERNAL VISUAL EXAM

38
Q

PELVIC EXAMINATION

Swiping a small wand to collect a sample of cervical cells before removing the speculum

A

PAP SMEAR TEST

39
Q

PHYSICAL EXAMINATION

The measurement of the female pelvis to identify CPD, which is when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal

A

Assessment of Pelvic Adequacy (Clinical Pelvimetry)

ESTIMATING PELVIC SIZE

40
Q

ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)

The measurement of the female pelvis to identify ____, which is when the capacity of the pelvis is ____

A

The measurement of the female pelvis to identify CPD, which is when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal

41
Q

ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)

DIAGONAL CONJUGATE

A

12.5 cm

42
Q

ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)

TRUE CONJUGATE OR CONJUGATE VERA

A

10.5 - 11 cm

43
Q

ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)

ISCHIAL TUBEROSITY DIAMETER

A

11 cm

44
Q

FIRST TRIMESTER (ROUTINE)

  • B____
  • C____
  • H____
  • V____
  • R____
  • M____
  • H____
  • U____
  • I____
A
  • Blood Type & Rh Factor
  • Complete Blood Count (CBC)
  • Hemoglobin or Hematocrit
  • Venereal Disease Research Lab Test (VDRL) or Rapid Plasma Reagin (RPR)
  • Rubella or Hepatatis B (HBsAg) Titer
  • Maternal Serum for Alpha Fetoprotein (MSAFP)
  • Human Immunodeficiency Virus (HIV) Screen
  • Urinalysis & Culture
  • Indirect Coombs Test
45
Q

FIRST TRIMESTER (ROUTINE)

Determines risk for maternal- fetal blood incompatibility

A

BLOOD TYPE & RH FACTOR

46
Q

FIRST TRIMESTER (ROUTINE)

Detects anemia, infection, or cell abnormalities

A

COMPLETE BLOOD COUNT (CBC)

47
Q

FIRST TRIMESTER (ROUTINE)

Detects anemia

A

HEMOGLOBIN OR HEMATOCRIT

48
Q

FIRST TRIMESTER (ROUTINE)

Syphilis screen

A

VENEREAL DISEASE RESEARCH LAB TEST (VDRL) OR RAPID PLASMA REAGIN (RPR)

49
Q

FIRST TRIMESTER (ROUTINE)

Determines immunity to rubella or hepatitis B

A

RUBELLA OR HEPATITIS B (HBSAG) TITER

50
Q

FIRST TRIMESTER (ROUTINE)

Detects neural tube or abdominal defect in the fetus

A

MATERNAL SERUM FOR ALPHA-FETOPROTEIN (MSAFP)

51
Q

FIRST TRIMESTER (ROUTINE)

Detects HIV infection

A

HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREEN

52
Q

FIRST TRIMESTER (ROUTINE)

Detects infection, renal disease, or diabetes

A

URINALYSIS & CULTURE

53
Q

FIRST TRIMESTER (ROUTINE)

Determination of whether Rh antibodies are present in an Rh-negative woman.

A

INDIRECT COOMBS TEST

54
Q

SECOND TRIMESTER (ROUTINE)

TEST
* ____ - sample is drawn ____ after ____ of liquid glucose is ingested

A

TEST
* Blood glucose screen - sample is drawn 1 hour after 50g of liquid glucose is ingested

55
Q

SECOND TRIMESTER (ROUTINE)

BLOOD GLUCOSE SCREEN - PURPOSE
* Routine test done at ____ to identify gestational diabetes; results above ____ necessitates medical follow-up

A

BLOOD GLUCOSE SCREEN - PURPOSE
* Routine test done at 24-28 weeks of gestation to identify gestational diabetes; results above 135 mg/dL necessitates medical follow-up

56
Q

PRENATAL DIAGNOSTICS TESTS

ULTRASONOGRAPHY
1st Trimester:
* ____

2nd Trimester:
* ____

A

ULTRASONOGRAPHY
1st Trimester:
* Transvaginal UTZ

2nd Trimester:
* Transabdominal UTZ

57
Q

TRANSVAGINAL UTZ

  • Determine the ____
  • Detect ____
  • Estimate ____
  • Confirm ____
  • Identify the need for ____
  • Identify ultrasound characteristics that suggest ____, such as ____
  • As an adjunct for ____
A
  • Determine the presence & location of pregnancy
  • Detect multifetal gestation
  • Estimate gestational age
  • Confirm fetal viability
  • Identify the need for follow-up testing
  • Identify ultrasound characteristics that suggest fetal abnormality, such as chromosomal defects
  • As an adjunct for trancervical or transabdominal chorionic villus sampling
58
Q

TRANSABDOMINAL UTZ

  • Confirm ____
  • Evaluate ____
  • Estimate ____
  • Assessment of ____ over a series of scans
  • Evaluate ____
  • Determine location & relation of the ____ to each other & the insertion of the cord into the ____
  • Determine ____
  • Guide ____ for procedures such as ____
A
  • Confirm fetal viability
  • Evaluate fetal anatomy
  • Estimate gestational age
  • Assessment of fetal growth over a series of scans
  • Evaluate amniotic fluid volume
  • Determine location & relation of the placenta & umbilical cord to each other & the insertion of the cord into the fetal abdomen
  • Determine fetal presentation
  • Guide needle placement for procedures such as amniocentesis or percutaneous umbilical sampling
59
Q

Identifies whether an increase in the FHR occurs when the fetus moves, indicating adequate oxygenation

A

NONSTRESS TEST

60
Q

Assesses a total of 5 parameters of fetal well being (FHR, fetal movement, breathing, muscle tone & amniotic fluid volume)

A

BIOPHYSICAL PROFILE

61
Q

MATERNAL ASSESSMENT OF FETAL MOVEMENT

  • Movements by the fetus, as assessed by the mother, are often called ____
  • Fetal movement is associated with ____, & daily evaluation of these movements provides a way of ____.
A
  • Movements by the fetus, as assessed by the mother, are often called “kick counts”
  • Fetal movement is associated with fetal condition, & daily evaluation of these movements provides a way of evaluating the fetus
62
Q

APPROPRIATE NURSING DIAGNOSES

Usually focus on the response of a ____ upon confirmation of pregnancy

A

Usually focus on the response of a woman & her family upon confirmation of pregnancy

NR-NUR121 | Mother and Child Nursing (MCN) (26 decks)

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