Prenatal Care and the Nursing Role Flashcards
When the nurse first encounters the patient, the nurse will take all of patient’s history. What kind of information will the nurse take?
Pregnancy History
- Ask about Gravida (# of pregnancies she has had)
- Para (# of chidren she gives birth to live children ? 20 weeks)
- When was the day of her last menstrual cycle?
- When was the first day of her last menstrual period? (Ovulation)
- Family planning –> was this pregnancy intended?
- Was a pregnancy test done at home?
- Experiencing any signs and symptoms –> nausea and vomiting, and breast tenderness
How do you calculate the gestational age of the pregnancy?
Calculate by Nagel’s Rule
-Take the last day of the last menstrual cycle period, ADD 7 to the day and then subtract 3 months. = Expected Due Date (EDD)
i.e First day of last menstrual period 01/09/17
9+7 = 16 (day)
January - 3 = October (month)
How do you write gestational age in weeks?
(total completed weeks).(number of days into the next week)
i.e 5 weeks and 6 days –> 5.6
How many weeks is a term pregnancy?
37 to 42 weeks
What does it mean when a baby is premature?
The baby was born before 37 weeks
What does it mean when the baby is postmature?
The baby was born after 42 weeks
When will most pregnancies go into labor?
41 weeks and 5 days
What objective data does the nurse collect?
Height and weight is taken
Vitals are taken - BP (increases during pregnancy)
Labs are taken - CBC (hct/hgb), Type & RH, Rubella titer, serology, HIV, sickle cell (depends on hx), Complete UA, Urine test - ketones, glucose, and protein
What is a bi-manual exam?
It is an exam the provider does when the patient does not know their first menstrual period
Two fingers go up to the vagina and another hand on the abdomen to find the uterus and sense how big it is
What is a fundus?
Top of the uterus
Nurse measures it
What is quickening?
First movement that feels like a flutter
First pregnancy –> 20-21 weeks
Second pregnancy - 16-18 weeks
What is the responsibility of the nurse during the bi-manual exam?
Prepare the patient
Stay with patient and comfort her and help relax during the exam
Provide tissue to clean herself after exam
What are some key pieces important for pregnancy?
Normal weight gain (25-35 lbs) throughout pregnancy
Uterine growth –> expect growth every week
-if there is an HUGE increasing growth –> multiple pregnancy
-Twin pregnancies –> can see in early u/s
What happens to the placenta when the baby is overdue?
Placenta will start to get old, b/c it is not meant to live after 42 days which will not provide the baby with oxygen or nutrients
What kind of patient teaching do you teach a pregnant woman at their initial prenatal visit?
Nutrition - 25-35 pounds for the pregnancy
Counteract nausea and vomiting
- advise small frequent meals
- eat things that she can tolerate and keep down
- bland meals (baked potato, butter, sour cream)
- Don’t go long periods of time not eating
- N&V is a good thing in the first trimester b/c it decreases the chances of getting a miscarriage
Ease discomfort of breast tenderness
- early pregnancy is hormonal –> cause nausea and vomiting
- Supportive bra, warm and or cool suppressor
Signs and symptoms to call provider
- increase in hormonal production –> migraine, spotting, bleeding
Exercise
- not the time to do something new
- Continue doing things that you have been doing (walking)
Sex
-important for the couple to maintain a sexual relationship
When to return to clinic (4 weeks)
Explain the 3 trimesters in pregnancy
1st Trimester - conception to 12 weeks
2nd Trimester - 13 to 26 weeks
3rd Trimester - 27 to 40+ weeks
What are some topics should a nurse be teaching in the 1st Trimester
Nutrition
Exercise
Danger signs - bleeding
Common discomforts
Avoidance of toxic substances - household chemicals, smoke, street drugs, alcohol
- can be transferred through the placenta
- wear rubber gloves when they clean
Sexuality
Reaction to pregnancy - ambivalence
Genetic testing
- if there is a history of some disease that might be a carrier for –> referral to a geneticist
What are some topics the nurse should be teaching in the 2nd Trimester?
Area of acceptance Focus on infant feeding Preparing other children for the baby Childbirth education classes What do you want for the birth? Choosing a provider Idea of circumcising (if having a boy) - if don't want, teach how to take care of it Women feel the best
What are some topics the nurse should be discussing/teaching in the 3rd Trimester?
Preparing for labor - what to pack in hospital bag Post-partum depression topic -early topic if hx of depression or if there is a family hx Baby blues Discuss what will happen when you go home with the baby Infant demands Birth control Baby care Change in the family dynamic (relationships) Going back to work Day care
What are the signs and symptoms of true labor?
Regular uterine contraction Lightening Frequent micturition (act of urination) Showing Dilation of Cervix Descent of the presenting part Membrane rupture
What are the signs and symptoms of false labor?
Uterine contraction depends on uterine segments Upper uterine segment Active contraction Stronger Muscle shorter and thicker Lower uterine segments Passive contraction Weaker Muscle weaker and thinner
What do you back in a hospital bag?
Cute gown and comfy robe Skin pick me ups Personalized swaddle Boppy and nipple cream Shampoo and conditioner
When should women return to the clinic based gestational age of pregnancy?
After the first visit: 6 wks to 28 weeks (age) –> every 4 weeks
28-36 weeks = every 2 weeks
36 weeks to 40 weeks = every week
40-birth = 2x a week
What is the composition of each visit?
Weight
Blood pressure
screening for symptoms
Listen to heart tones, estimate of fetal size
Labs by Trimester
Teaching topic by gestation of the pregnancy
Address questions that are asked.
