Ch 11 Assessing Fetal And Maternal Health

Question 1

Preconceptual Care assessment:

Answer 1

Health history
Pelvic exam
Pap test
Labs

Question 2

Nurse’s role

Answer 2

Educate
Listen
Counsel

Question 3

Typical Day and Social History for a Pregnant Patient

Answer 3

Nutrition
Exercise
Hobbies
Tobacco, alcohol, and drug consumption
Medication and herbal therapy
Intimate partner violence

Question 4

initial interview
health history

Answer 4

demographic data
chief concern
family profile

Question 5

Partner/Support Persons

Answer 5

. Encourage attendance at PN visits
. Interview separately
. Allow to express fears and concerns
. Note degree of acceptance and support

Question 6

Prenatal Heath Assessment

Answer 6

History of past illnesses: : kidney & heart disease, hypertension, STI, diabetes, thyroid disease, varicosities…etc.

History of family illness: Cardiovascular & renal diseases, blood disorders, genetically inherited diseases or congenital anomalies

Gynecologic history: Menstrual hx, past surgeries, reproductive planning, sexual hx, stress incontinence

Obstetric history: Previous miscarriages or therapeutic abortion, number of times she has been pregnant (Gavida status), number of delivered children over 20 wks (Para status).

Physical exam:
Baseline height/weight
vital signs
Assessment of systems (Review Of Systems)

Question 7

Assessment of systems

Answer 7

General appearance, mental status
Head, scalp
Eyes
Nose
Ears
Sinuses
Mouth, teeth, throat
Neck
Lymph nodes
Heart
Lungs
Back
Rectum
Extremities, skin

Question 8

Observe for unusual findings

Answer 8

Hair little and dry (nutrition)
Eyes swollen, diplopia (PIH)
Swollen sinuses (no OTC)
Fullness in the ear
Nose congestion
Mouth: gingival hypertrophy
Teeth with dental caries
Supernumerary nipples
Functional heart murmur
Scoliosis
Rectum/ hemorrhoids
Extremities, skin: Itching, varicosities.

Question 9

Assessment of uterine growth and fetal status

Answer 9

Fundal height
with measuring tape from symphysis pubis to the uterus

Question 10

Fetal heart rate

Answer 10

doppler 10 - 12 weeks
sthetoscope 18 - 20 weeks
normal fetal heart rate 110 - 160 beats/min

Question 11

pelvic exam:
areas
position
equipments needed

Answer 11

External genitalia
Internal genitalia
Vaginal inspection
Exam of pelvic organs
Pap smear

Lithotomy position

Equipment needed:
Speculum (movable flat blades)
Lubricants
Clean gloves
Spatula for cervical scraping
Glass slide (or liquid collection) for Pap smear
Sterile cotton applicators for cervical cx

Question 12

Pelvic Exam External organs:

Answer 12

Assess external genitalia (Vulva, vagina, Bartholin glands) for any infection, ulcerations, lesion, vaginal discharge

Hypertrophy of the Labias and clitoris normal during pregnancy

Vulva
Herpes simplex

Bartholin glands
=> streptococci, gonorrhea

Question 13

Pap smear

Answer 13

Precancerous or cancerous condition of the uterine cervix, vulva, or vagina or infection

Question 14

labs

Answer 14

CBC, Hg/Hct- Blood type, RH 1st visit
Genetic screen (sickle cell, thalassemia)
VDRL (syphilis), HIV- (1st trimester)
Maternal Serum for-Alpha-fetoprotein MSAFP (16-18 weeks)
Antibody titers for rubella and hepatitis B (1st visit)
1hr glucose loading test: GTT at 28 weeks
Screening Ultrasound at every visit
Group B Streptococcus (1st visit &35-37 weeks)
U/A by dipstick- at every visit

Question 15

Frequency of Visit

Answer 15

Nulliparous-uncomplicated pregnancies:
Every 4 weeks until 28 weeks of gestation
Every 2 weeks, from 28 - 36 weeks
36 on, weekly until delivery

Women with problems: seen more frequently

Question 16

the pelvis: parts and cavities

Answer 16

Made up of immovable bones
Pubic arch anterior
Sacrum posterior
Sacrococcygeal joint can move slightly
Divided into: The false pelvis & the true pelvis
Other terms used:
Inlet is the entrance of the true pelvis
Outlet is the inferior portion of the pelvis
Pelvic cavity is the space between the inlet and the outlet

Question 17

Pelvic Size

Answer 17

Once baby enters pelvis must exit through the outlet
Widest part of inlet is
transverse diameter
Widest part of the outlet is
AP diameter
Pelvic cavity is curved
slowing birth and
preventing head trauma
It is tight to help expel
fluid and mucus

Question 18

pelvic types

Answer 18

android: fetus facing difficulty to exit such a pelvis
anthropoid : => transverse diameter is narrow, anteroposterior
larger than usual => difficulty to exit
gynecoid : oval inlet, anteroposterior diameter is shallow
platypelloid : well rounded forward and backward, wide
pubic arch => ideal for childbirth

Question 19

Estimating Pelvic Size

Answer 19

Type
Measurements
Diagonal conjugate
Ischial tuberosity

It reveals the diameters of the inlet and the outlet
This assessment is done during last weeks of pregnancy

1- Measure diagonal conjugate
From sacrum to symphysis
AP diameter of inlet > 12.5 cm
adequate

2 - Measure Ischial tuberosities
Distance between the ischial tuberosities
Transverse diameter of outlet
>11cms is adequate

Question 20

Calculating Delivery Date using Naegele’s Rule

Answer 20

Expectant Date of Delivery (EDD) =
First day of the last Menstrual Period (LMP) – 3 months + 7 days

gestational wheel

Question 21

para:
primipara :
multipara:

Answer 21

the number of pregnancies that have reached viability regardless or whether the infants were born or not

first pregnancy

two or more

Question 22

gravida

primigravida

multigravida

nulli gravida

Answer 22

a women who is or has been pregnant

pregnant for the first time

has been pregnant previously

has never been pregnant and is not pregnant currently

Question 23

Example 1:
Hala is pregnant with her third child. Her first pregnancy ended in a miscarriage at 16 weeks. Her second pregnancy she delivered a baby at 32 weeks. What is her GPTPAL?

Answer 23

Answer: G3, P1, T0, P1, A1, L1

Question 24

Example 2:
Sawsan has just delivered term twins. She also has, at home, a 2 year old boy delivered at 42 weeks and a 6 year old girl delivered prematurely at 35 weeks. Ten years ago she had a miscarriage at 22 weeks.

What is her G,P? What is her TPAL?

Answer 24

Answer: G4, P4, T2, P2, A0, L4

Question 25

Signs of Complications

Answer 25

Most occur towards end of pregnancy
Vaginal bleeding
Continuous vomiting
Chills and fever
Fluid per vagina
Abdominal or Chest pain
Swelling of face and fingers
Pregnancy Induced Hypertension (PIH)
Decreased fetal movement