Week 1 power points-prenatal care Flashcards
Healthy People 2020 Maternal and infant health goals
The health of a nation is reflected in the health of expectant women and their infants”
Some of the goals set by the CDC are to:
One overall goal is to decrease health care disparity in at risk lower income people.
One way to do that is to increase the number of women who receive early and adequate prenatal care.
Reducing SIDS (Sudden infant death) through education about safe sleeping practices.
Reduction of C-sections.
Reduction of substance abuse.
Diagnosing pregnancy
Presumptive.
Probable
Positive
Presumptive signs of pregnancy
Amenorrhea
Slight spotting in about 20% of patients. During implantation.
Urinary frequency.
N/V.
Breast enlargement and tenderness.
Fatigue.
Quickening. (perception of fetal movement) around 18-20
Many women experience these signs when they are pregnant.
Amenorrhea may be the most common sign in women who have regular periods
Spotting occurs due to the fertilized egg implanting into the uterine wall. It occurs anywhere from 10-14 days after fertilization and a few days before menstruation would have begun.
Probable signs of pregnancy
Chadwick’s sign (Bluish/purple mucous membranes of the vagina, cervix, and vulva) at 6-8 weeks.
Goodell’s sign- softening of the cervix with leukorrheal discharge. (cloudy white mucous caused from increased progesterone)
Hegar’s sign (softening of the lower uterine segment).
Ballottement (passive fetal movement).
Positive Pregnancy test. (Detects hCG levels)
Positive signs of pregnancy
Fetal heartbeat: 10-12 weeks gestation by Doppler.
Ultrasound visualization and cardiac movement at 4-8 weeks
These are true positive signs of pregnancy
Gravidity
Gravidity =number of pregnancies
Parity
Parity=number of pregnancies carried to viability. (20+ weeks or more specifically 24 weeks)
G T P A L
Can also be broken down further into: Gravidity = Number of pregnancies T= # of term pregnancies P= Preterm deliveries A= number of spontaneous or induced abortions L= the number of living children.
Gravidity is the number of pregnancies despite their possible outcomes.
Parity number of pregnancies carried to generally 20+ weeks
For example, if a women has 2 kids and is currently pregnant she is considered to be G3P2. A women who is pregnant for the first time is G1P0.
GTPAL is the longer version that is documented in her history.
Naegeles rule
Naegele’s rule: Minus 3 months from the first day of the last menstrual cycle and add 7 day.
Just an estimated due date. Many factors can influence this such as regularity of the menstrual cycle and or cycles that are greater than 28 days.
Not all women can remember the first day of their last menstrual cycle.
The Gestational wheel is helpful to aid calculation.
First prenatal Visit.
Obtain the Maternal health history
History of previous pregnancies.
Gynecologic history:
History of multiple births.
Use of prescription and nonprescription drugs
Use of alcohol, tobacco including vaping, THC, Illegal drugs. First day of last menses.
Do not forget to Ask her how she is doing. Has she been having any bleeding or cramping?
Physical changes in the female body during pregnancy
The changes to a women’s body is significant. It essentially effects every system. They are primarily protective mechanisms for the mother and fetus. I am going to highlight some of the changes. You can read about the other changes in your assigned reading.
Cardiovascular system
Blood volume increase
Increased cardiac output
Lower extremity edema or varicose veins
Blood volume increases from 40-45% and is primarily due to the increase in plasma and erythrocyte volume. This increases the mothers heart rate about 15-20 beats per minute.
Cardiac output increases and peaks at about 25-30%.
This hemodilution may cause the women’s hematocrit values to appear low. This called physiological anemia (also called Pseudoanemia) this is usually the most apparent at 32-34 weeks of pregnancy.
Leukocytes also increase up to 16,000 mm3 and can climb even higher in the postpartum period and not be a sign of infection.
During the first trimester the BP decreases and then returns to normal at term.
Increased progesterone levels is a compensatory mechanism to keep BP from elevating due to the increased volume. This is because Progesterone causes the relaxation of the smooth muscles.
These changes in vascular resistance combined with increased volume put the pregnant women at an increased risk for varicose veins and hemorrhoids.
Nurses can instruct the patient to elevate her legs and lye on her left side for 20 minutes a day to help improve the venous return from the lower extremities.
Reproductive system
Enlarged uterus
Breast enlargement and tenderness
Colostrum productions begins around 16 weeks.
Integumentary system
Darkening pigment due to the influence of estrogen and progesterone.
Striae (stretch marks) from the growth of the breasts, hips abdomen and buttocks
Respiratory system
Pressure on the diaphragm in the third trimester can cause shortness of breath.
Increased tidal volume to meet increased oxygen demand.
Musculoskeletal system
Increased strain on the muscles and joints.
Hormonal influences of progesterone and relaxin soften joints widening the pelvis.
Back pain.
Round ligament pain.
Center of gravity changes
Renal system
Increased renal blood flow due to increased cardiac output.
Increased frequency, incontinence, and risk for UTI (urinary tract infections). Due to the influence of Progesterone, estrogen and prostaglandins on the smooth muscles of the urinary tract.
Urinary system
During the first trimester progesterone rises exponentially and then plateaus.
Progesterone among other things causes the smooth muscle to relax.
The urethra and sphincter relaxation and fetal weigh adds to the urinary frequency and urgency and nocturia (the need to go at night).
In the second trimester the uterus moves up in the abdomen and less pressure is exerted on the bladder so some of these symptoms lessen. The pressure on the bladder returns in the third trimester.
GI system
Decreased gastric motility Constipation Heart burn/reflux Hemorrhoids Nausea and vomiting
GI System:
Is responsible for most of the women’s discomfort.
HCG Human Chorionic Gonadotropin. The hormone that is picked up in the pregnancy test. The rise of this hormone is likely l responsible for the nausea and vomiting (N/V). For some women the N/V is very severe and requires hospitalization for fluid volume, and nutritional replacement.
Progesterone causes the esophageal muscle to relax which can lead to heartburn
Medical Health history
Is the patient current on her immunizations?
Does she have any health problems?
She should leave the appointment knowing the follow-up plan.
And when to seek emergency medical treatment.
Personal information
Economic status, work history, physical activity. Screen for Intimate partner Violence. Education level Emotional or psychiatric disorders Her partner’s history Age: Genetic or medical disorders Alcohol or drug use.
laboratory testing at first prenatal visit
Rubella titer to assess immunity to Rubella.
Give TDAP and influenza vaccines as indicated
Complete blood count (CBC) to detect HGB, Hct, platelet count.
Blood type, RH, antibody screen. To detect risk for erythroblastosis fetalis or hyperbilirubinemia.
Hepatitis B surface antigen.
Syphilis screen.
Recommend HIV testing.
UA and possible urine drug screen as indicated
Vaginal exam done by the provider to screen for:
Gonorrhea/Chlamydia.
Bacterial Vaginosis
Yeast infection
First trimester LMP (last menstrual Period-13 weeks
7-10 days after conception HCG can be detected in serum and urine.
Rapid cell differentiation is occurring. A critical time in development.
Fatigue.
Nausea and vomiting. Small meals. Avoid greasy foods
Common normal emotions.
Ambivalence.
Grief-role adjustment.
emotional swings
Focused on self.
Second trimester15-28 weeks
Substantial uterine and fetal growth period.
By 20 weeks fetal movement is felt.
Energy returns
Nausea usually lessons
Third TrimesterWeeks 29-40
Episodic Braxton Hick’s contractions. (Helps to strengthen uterine muscles)
Risk for falls due to Increased uterine size causing center of gravity to change
Uterus Displaces intestinal and pelvic structures can cause: Nausea, SOB, Umbilicus begins to protrude.
Insomnia.
Adolescents are at risk for
Low-birth-weight and preterm neonates. Preeclampsia. Anemia. Labor dysfunction. Cephalopelvic disproportion
Maternal age over 35
Increased risk for: Trisomy 21 (1-385) Screened for in the second trimester. (Quadruple screen), Refer the patient for genetic counseling with any positive results. Placenta previa. Chronic diseases. Twins.
Report to the provider
Danger Signs at anytime
Vaginal bleeding Persistent headache or vision changes Severe nausea and vomiting Decreased fetal movement Severe persistent epigastric pain Cramping and persistent lower back pain Water breaking
