Nursing Management During Pregnancy Flashcards
Preconception Care and Diagnostic Testing
- Amniocentesis
- Biophysical profile (BPP)
- Chorionic villus sampling (CVS)
- Natural childbirth
- Perinatal education
- Preconception care
Risk Factors for Adverse Pregnancy Outcomes
- Isotretinoins
- Alcohol misuse
- Antiepileptic Drugs
- Diabetes (preconception)
- Folic Acid Deficiency
- HIV/AIDs
- Hypothyroidism
- Maternal Phenylketonuria (PKU)
- Rubella Seronegativity
- Obesity
- Oral Coagulation
- STI
- Smoking
Reproductive Health Care Practices
Preconception Care
- Pelvic exams
- Use of contraceptives
- STIs
Sexuality and Sexual practices
Preconception Care
- Safer-sex practices
- Body image issues
Lifestyle Practices
Preconception Care
Occupation and recreational activities
Psychosocial Issues
Preconception Care
- Levels of stress
- Exposure to abuse and violence
Medication and Drug use
Preconception Care
- Use of tobacco
- Alcohol
- OTC and prescription medications
- Illicit drugs (cocaine, heroine)
Support System
Preconception Care
friends , family and community
What happens during a prenatal visit?
- Establishment of trusting relationship
- Focus on education for overall wellness
- Detection and prevention of potential problems
- Comprehensive health history, physical exam and laboratory tests: CBC, STI, Urine analysis, Glucose
What are the glucose recommendations for pregnant women during fasting, 1hr and 2hr after meals?
First Prenatal Visit
Postprandial = After Meals
Glucose:
* Fasting: <95 mg/dL
* 1hr postprandial: <140 mg/dL
* 2hr postprandial: <120 mg/dL
*fasting and postprandial self-monitoring of blood glucose are recommended to achieve glycemic control
*Insulin is the preferred treatment for hyperglycemic in OB patients
What to do document for reasons for seeking care?
Comprehensice Health History
- Suspicion of pregnancy
- Reports of missing menstrual period or positive result on home pregnancy test
- Date of last menstrual period (LMP)
- S/S of pregnancy
- Urine or blood test for hCG; confirms pregnancy
What to do document for past medical, surgical and personal history?
Comprehensive Health History
- Conditions in the past may recur or exacerbated during pregnancy (ex. UTI)
- Ask about chronic illnesses (diabetes or heart disease)
- Any history of allergies to medications, food, or environmental substances
- Ask about mental health problems (depression or anxiety)
- Personal history is important too (occupation, exposure to teratogens, exercise, activity level and recreational activity such as alcohol, drugs etc.)
What to document about women’s reproductive history?
- Menstrual
- Obstetric
- Gynecological history
What to document for pregnant women’s mentrual history?
- Menstrual cycle
- Age at menarche
- Number of days in cycle
- Flow characteristics
- Discomforts
- Use of contraception; when did they last use it
- Date of LMP (can be seen in prenatal history)
- *Calculation of estimated or expected date of birth (EDB), delivery (EDD) or confinement (EDC)
Nagele’s Rule
Obstetric History
Gravida I
(Primigravida or Primipara)
First Pregnancy
Obstetric History
Gravida II
(Secundugravida)
Second pregnancy (+)
Obstetric History
Primipara
(Primip)
Para: woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more
one birth after a pregnancy of at least 20 weeks
Obstetric History
Multipara
(Multip)
two or more pregnancies resulting in viable offspring
Obstetric History
Nullipara
no viable offspring; para = 0
Obstetric History
GTPAL
Calculates the number of times the mother is pregnant.
- G (gravida): total number of pregnancies; includes current pregnancies
- T (term births): number of pregnancies delivering between 37-40 weeks 6/7 days, at term
- P (preterm births): number of preterm pregnancies ending <20 weeks or viability but before completion 37 weeks
- A (abortion):number of pregnancies ending before 20 weeks or viability
- L (living children): number of children currently
GTPAL Practice Example 1
38 weeks 2/7 days
2 term births
1 at 34 weeks
7 miscarriages
3 living children
Obstetric History
G: 11
T: 2
P: 1
A: 7
L:3
GTPAL Practice Example 2
Currently pregnant with 4th child
2 at term
1 at 35 weeks
3 living children
Obstetric History
G: 4
T: 2
P: 1
A: 0
L: 3
GTPAL Practice Example 3
20 year old, currently 8 weeks
Miscarriage at 12 weeks
No living childre
G: 2
T: 0
P:0
A:1
L: 0
