[9] PRELIMS | PRENATAL ASSESSMENT Flashcards
FOCUS OF PRENATAL VISIT
- ____ about pregnancy
- Screen for ____ that might reveal:
* M____
* H____
* H____
* E____
* I____ - ____ complications such as intrapartum cardiac arrest
- Education about pregnancy
- Screen for danger signs that might reveal:
* Morbid obesity
* HTN
* Hemorrhage
* Embolism
* Infection - Anesthesia-related complications such as intrapartum cardiac arrest
PRENATAL VISIT
- Schedule a pre-natal visit as soon as ____.
- Schedule a pre-natal visit as soon as she suspect that she is pregnant.
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
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
INITIAL INTERVIEW
Purposes:
* ____
* Gain information about a woman’s ____
* Obtain ____ for the pregnancy
Purposes:
* Establish rapport
* Gain information about a woman’s physical & psychosocial health
* Obtain basis for anticipatory guidance for the pregnancy
INITIAL INTERVIEW
- Completion of ____ by the client
- Setting: ____
- ____
- ____
- Ask ____
- Good ____
- ____
- 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
COMPONENTS OF PRENATAL ASSESSMENT
- ____
- ____
- ____
- Extensive Health Hx
- P.E. Including Pelvic Examination
- Laboratory Assessment
COMPONENTS OF HEALTH HISTORY
- D____
- C____
- F____
- H____
- H____
- D____
- G____
- O____
- R____
- Demographic Data
- Chief Concern
- Family Profile
- History of Past Illness
- History of Family Illness
- Day History/Social Profile
- Gynecologic History
- Obstetric History
- Review of Systems
DEMOGRAPHIC DATA
CHIEF CONCERN
CHIEF CONCERN
Ask the client:
* L____
* P____
* S____
* D____
* D____
Ask the client:
* LMP
* Pregnancy test
* Signs of early pregnancy
* Discomforts of pregnancy
* Danger signs of pregnancy
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
FAMILY PROFILE
FAMILY HISTORY
- Client’s ____
- Partner’s ____
- M____
- Available ____
- ____
- Situations that ____
- 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
HEALTH HISTORY
- Heart & kidney diseases, UTI, HTN, DM, asthma, common infectious diseases, etc.
- Immunizations
- Allergies
- Past surgical procedures
HISTORY OF PAST ILLNESS
HEALTH HISTORY
- Cardiovascular
- Renal
- Cognitive
- Blood disorders
- Genetically inherited diseases
- Congenital anomalies
HISTORY OF FAMILY ILLNESS
HEALTH HISTORY
- Nutrition
- Elimination
- Sleep/rest, exercise
- Recreation, hobbies
- Interpersonal interactions
- Habits
- Involvement in abusive relationship
- Medication Hx
DAY Hx / SOCIAL PROFILE
DAY Hx / SOCIAL PROFILE
- N____
- E____
- S____
- R____
- I____
- H____
- I____
- M____
- Nutrition
- Elimination
- Sleep/rest, exercise
- Recreation, hobbies
- Interpersonal interactions
- Habits
- Involvement in abusive relationship
- Medication Hx
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
GYNECOLOGIC Hx
GYNECOLOGIC Hx
- M____
- U____
- M____
- P____
- H____
- F____
- S____
- S____
- 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
HEALTH HISTORY
- Previous pregnancy
- Previous miscarriages or therapeutic abortions
- Blood transfusion
- GTPALM
OBSTETRIC Hx
OBSTETRIC Hx
- P____
- P____
- B____
- G____
- Previous pregnancy
- Previous miscarriages or therapeutic abortions
- Blood transfusion
- GTPALM
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
REVIEW OF SYSTEMS (ROS)
PRENATAL ASSESSMENT
- Baseline Height, Weight & V/S Measurement
- Assessment of Systems
- Measurement of Fundal Height & Fetal Heart Sounds
- Pelvic Examination & Estimating Pelvic size
PHYSICAL EXAMINATION
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
- 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
PHYSICAL EXAMINATION
- Baseline ____
- A____
- Measurement of ____
- P____
- Baseline Height, Weight & V/S Measurement
- Assessment of Systems
- Measurement of Fundal Height & Fetal Heart Sounds
- Pelvic Examination & Estimating Pelvic size
PHYSICAL EXAMINATION
Make sure that the pregnant client will ____ before examination
VOID
PHYSICAL EXAMINATION
General appearance & mental status
* Posture
* Manner of dressing
* Manner of speaking
* Facial expression
* Presence of bandages & dressings
ASSESSMENT OF SYSTEMS
ASSESSMENT OF SYSTEMS
General appearance & mental status
* P____
* M____
* M____
* F____
* P____
General appearance & mental status
* Posture
* Manner of dressing
* Manner of speaking
* Facial expression
* Presence of bandages & dressings
PHYSICAL EXAMINATION
Estimates AOG by the relative position of the uterus in the abdominal cavity
BARTHOLOMEW’S RULE
PHYSICAL EXAMINATION
Mesurement of Fundal Height
Mc Donals’ Rule
PHYSICAL EXAMINATION
Determines the length of the fetus in centimeters
HAASE’S RULE
HAASE’S RULE
- During the ____ of pregnancy, ____
- During the ____ of pregnancy, ____
- During the first half of pregnancy, square the number of the months
- During the second half of pregnancy, multiply the month by 5
PHYSICAL EXAMINATION
The exam is used to look at a woman’s:
* Vulva
* Uterus
* Cervix
* Fallopian tubes
* Ovaries
* Bladder
* Rectum
PELVIC EXAMINATION
PELVIC EXAMINATION
The exam is used to look at a woman’s:
* V____
* U____
* C____
* F____
* O____
* B____
* R____
The exam is used to look at a woman’s:
* Vulva
* Uterus
* Cervix
* Fallopian tubes
* Ovaries
* Bladder
* Rectum
PELVIC EXAMINATION
Performed:
* During a ____physical exam
* When a woman is____
* When a doctor is checking for ____
* When a woman is having ____
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
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 ____
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
PELVIC EXAMINATION
Looking at vulva, checking for irritation, redness, sores, swelling, discharges or other abnormalities
EXTERNAL VISUAL EXAM
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
PHYSICAL EXAM
PELVIC EXAMINATION
Using a speculum to spread open vaginal walls & see vagina & cervix
INTERNAL VISUAL EXAM
PELVIC EXAMINATION
Swiping a small wand to collect a sample of cervical cells before removing the speculum
PAP SMEAR TEST
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
Assessment of Pelvic Adequacy (Clinical Pelvimetry)
ESTIMATING PELVIC SIZE
ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)
The measurement of the female pelvis to identify ____, which is when the capacity of the pelvis is ____
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
ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)
DIAGONAL CONJUGATE
12.5 cm
ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)
TRUE CONJUGATE OR CONJUGATE VERA
10.5 - 11 cm
ASSESSMENT OF PELVIC ADEQUACY (CLINICAL PELVIMETRY)
ISCHIAL TUBEROSITY DIAMETER
11 cm
FIRST TRIMESTER (ROUTINE)
- B____
- C____
- H____
- V____
- R____
- M____
- H____
- U____
- I____
- 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
FIRST TRIMESTER (ROUTINE)
Determines risk for maternal- fetal blood incompatibility
BLOOD TYPE & RH FACTOR
FIRST TRIMESTER (ROUTINE)
Detects anemia, infection, or cell abnormalities
COMPLETE BLOOD COUNT (CBC)
FIRST TRIMESTER (ROUTINE)
Detects anemia
HEMOGLOBIN OR HEMATOCRIT
FIRST TRIMESTER (ROUTINE)
Syphilis screen
VENEREAL DISEASE RESEARCH LAB TEST (VDRL) OR RAPID PLASMA REAGIN (RPR)
FIRST TRIMESTER (ROUTINE)
Determines immunity to rubella or hepatitis B
RUBELLA OR HEPATITIS B (HBSAG) TITER
FIRST TRIMESTER (ROUTINE)
Detects neural tube or abdominal defect in the fetus
MATERNAL SERUM FOR ALPHA-FETOPROTEIN (MSAFP)
FIRST TRIMESTER (ROUTINE)
Detects HIV infection
HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREEN
FIRST TRIMESTER (ROUTINE)
Detects infection, renal disease, or diabetes
URINALYSIS & CULTURE
FIRST TRIMESTER (ROUTINE)
Determination of whether Rh antibodies are present in an Rh-negative woman.
INDIRECT COOMBS TEST
SECOND TRIMESTER (ROUTINE)
TEST
* ____ - sample is drawn ____ after ____ of liquid glucose is ingested
TEST
* Blood glucose screen - sample is drawn 1 hour after 50g of liquid glucose is ingested
SECOND TRIMESTER (ROUTINE)
BLOOD GLUCOSE SCREEN - PURPOSE
* Routine test done at ____ to identify gestational diabetes; results above ____ necessitates medical follow-up
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
PRENATAL DIAGNOSTICS TESTS
ULTRASONOGRAPHY
1st Trimester:
* ____
2nd Trimester:
* ____
ULTRASONOGRAPHY
1st Trimester:
* Transvaginal UTZ
2nd Trimester:
* Transabdominal UTZ
TRANSVAGINAL UTZ
- Determine the ____
- Detect ____
- Estimate ____
- Confirm ____
- Identify the need for ____
- Identify ultrasound characteristics that suggest ____, such as ____
- As an adjunct for ____
- 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
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 ____
- 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
Identifies whether an increase in the FHR occurs when the fetus moves, indicating adequate oxygenation
NONSTRESS TEST
Assesses a total of 5 parameters of fetal well being (FHR, fetal movement, breathing, muscle tone & amniotic fluid volume)
BIOPHYSICAL PROFILE
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 ____.
- 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
APPROPRIATE NURSING DIAGNOSES
Usually focus on the response of a ____ upon confirmation of pregnancy
Usually focus on the response of a woman & her family upon confirmation of pregnancy
