Module 4 - Antepartal Considerations (Exam 2) 1 Flashcards
Holistic Nursing Care General Considerations
- Age
- History
- Medications
- Emotional Health
- Medical Concerns
- Nutrition and Exercise
- Lifestyle and cultural influences
Subjective (presumptive) signs of pregnancy
Symptoms experienced and reported
Objective (probable) signs of pregnancy
Signs that suggest pregnancy
Diagnositc (positive) signs of pregnancy
- Indications percieved by CNM, NP, physician
- Attributable only to pregnancy
When does quickening happen?
16-18 weeks, for sure by 20 weeks
Subjective Signs of Pregnancy
- Fatigue
- Quickening
- Amenorrhea (no period)
- Breast tenderness
- Urinary frequency
- Nausea and vomiting
Quickening
Sensation of movement of the fetus
Objective Signs of Pregnancy
- Ballottment
- Skin changes
- Uterine enlargement
- Positive pregnancy test
- Changes in reproductive organs
Diagnositc Signs of Pregnancy
- Fetal Heart Sounds
- Fetal movement felt by examiner
- Ultrasonography
Diagnostic - Fetal Heart Sounds
- At 8-12 weeks by electronic doppler
- At 17-20 weeks by fetoscope
Diagnositc - Fetal movement felt by examiner
At approximately 20 weeks
Diagnostic - Ultrasonography
Fetal heart activity at ~8 weeks
Menstrual History
- Dating the pregnancy
- Conception ~ 2 weeks AFTER menses (28 day cycle)
Previous Pregnancy (Gravida) History
- Prenatal Course
- Outcomes
Previous Delivery (Para) History
- Intrapartal course
- Neonatal status
Gravida
The number of times a woman has been pregnant, regardless of duration or outcome
Para
The number of pregnancies that have ended at 20 or more weeks. Multifetal gestations are considered one birth.
G TPAL
- T=Term
- 38-42 weeks gestation
- P=Preterm
- 20-37 weeks gestation
- A=Abortion
- Either sponaneous (SAB) or elective (TAB)
- L=Living Children
- At time of assessment
TPAL
May describe pregnancies delivered. Multiple gestationscounted as one parous experience
OR
May describe infants born. Multple gestations are counted individually.
Gestational Age
Approximately 280 days or 40 weeks following the last menstrual period
Fertilization Age
Approximately 266 days or 38 weeks following fertilization
Ways to date a pregnancy
- Nagele’s Rule
- Quickening
- Fetal Heart Tones
- Fundal Height
- Ultrasonography
Nagele’s Rule
- Determine the first day of thelast normal menstrual period
- Subtract 3 months
- Add seven days
Demographic Risk Factors
- <16 or >35 years of age
- Low socioeconomic status
Social and/or personal Risk Factors
- Tabacco
- ETOH/Social illegal drug use
- Low pre-pregnancy weight
- Obesity
Obstetrical Risk Factors
- Greater than or equal to 6 deliveries of viable infants
- Rh sensitization
- Previous Fetal/neonatal death
Medical Risk Factors
- Diabetes
- Concurrent infections
- Hypertension
Uterine Fundal Height 10-12 weeks
Above symphysis (out of pelvis, abdominal organ)
Uterine Fundal Height at 16 weeks
1/2 way between symphysis and umbilicus
Uterine Fundal Height at 20-22 weeks
At umbilicus
Uterine Fundal Height at 36 weeks
Below xiphoid process
If 16-38 weeks gestation than..
Funal height in cms ~ gestational age (within 3 cms)
Chadwick’s Sign
- Reproductive Adaptation
- Bluish coloration of vagina, cervix, labia
- R/t vascular congestion
Goodell’s Sign
- Reproductive System Adaptation
- Softening of the cervix
- Due to progesterone
Hegar’s Sign
- Reproductive System Adaptation
- Softening of the lower uerine segment
Increased blood volume
- Cardiovascular System Adaptation
- 40-50% increase
Physiologic Anemia
- Cardiovascular System Adaptation
- Plasma volume increases by ~50%
- RBC increase by ~25%
- Resolves in early PP
Respiratory System Adaptations
- Volume of air breathed increased
- Oxygen consumption increases
- Airway resistance decreases
- Progesterone relaxes respiratory structures
- Displacement of diaphragm
- Respiratory symptoms decrease close to term with lightening(lightening reduces pressure on diaphragm but replaces that pressure with pressure on the bladder)
Urinary Frequency
- Renal System Adaptation
- 1st and 3rd Trimesters
Renal System Adaptations
- Urinary Frequency
- Increased glomerular filtration r/t kidneys working harder
- Glycosuria (excessive glucose load)
- Increased risk of UTI
- r/t urine stasis, correlates with preterm labor
Gastrointestinal System Adaptations
- Nausea/vomiting of pregnancy (NVP)
- Hormonal Changes
- Altered carbohydrate metabolism
- Generally resolves by early second trimester
- Smooth muscle relaxation
- Delayed gastric emptying
- Decreased peristalsis
Straie gravidarum
- Skin Adaptation
- Stetch marks
Linea nigra
- Skin Adaptation
- Pigmentation from umbilicus to publis
Chloasma
- Skin Adaptation
- Mask of pregnancy
What does a maternal physical exam include?
- Baseline VS
- Height and Weight
- Thyroid
- Heart and lung sounds
What does a maternal gynecologic exam include?
- Pelvic measurements
- Uterine size
Complete Maternal Physical Assessment
- Complete maternal physical exam
- Gynecologic exam
- Fetal Heart Tones
Maternal Laboratory Testing
- Serologic Testing
- Blood Type and Rh
- CBC and Hgb
- Syphilis testing
- Venereal Disease Research Lab
- Rapid Plasma Reagin
- Rubella titre
- HIV screen
- Hep. B screen
- Genetic Testing
- Urinalysis
- Glucose
- Protein
- Trace is acceptable
- Ketones
- Suggests inadequate nutrition
- Bacteria, WBCs, nitrites, casts
- Suggests UTI
- Pap smear
- Cultures
- Gonorrhea
- Chlamydia
- Wet prep
- Monilia (yeast)
- Bacterial vaginosis
- Illicit drug screen (if history indicates)
Warning Signs of Pregnancy
- Dysuria
- Vaginal bleeding
- Persistent vomiting
- Presistent headache
- Preterm labor
- Decreased fetal movement
- Abdominal or epigastric pain
- Rupture of membranes (ROM)
Prenatal Visits
- Every 4 weeks until 28 weeks (first and second trimesters)
- Every two week between 28 and 36 weeks (third trimester)
- Every week until delivery
Routine Assessments for Prenatal Visits
- Vital signs
- U/A
- Weight
- Uterine Height
- Fetal Heart Rate and Fetal Activity
Trimester Specific Screening Prenatal Visits
- U/S
- Glucose tolerance Test (GTT)
- Multiple Marker Screen
- Group B Strep (GBS)
