Presentation is loading. Please wait.

Presentation is loading. Please wait.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Prenatal Care.

Similar presentations


Presentation on theme: "Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Prenatal Care."— Presentation transcript:

1 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Prenatal Care

2 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Goal of Early Prenatal Care Optimize the health of the woman and fetus Increase the odds that the fetus will be born healthy to a healthy mother Allow for initiation of strategies to promote health and early intervention in event of complications Healthy People 2020 goal

3 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins First Prenatal Visit Longest visit Obtain the baseline data Major objectives of this visit –Confirm or rule out a diagnosis of pregnancy –Ascertain risk factors –Determine the due date –Provide education on maintaining a healthy pregnancy

4 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins First Prenatal Visit (cont.) History taking –One of most important elements –Documentation options Written questionnaire Face-to-face interview

5 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins First Prenatal Visit (cont.) History taking (cont.) –Components Chief complaint Reproductive history Medical–surgical history Family history Social history

6 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reproductive history (terminology) –Gravida: Number of pregnancies the woman has had –Nulligravida: Woman who has never been pregnant –Multigravida: Woman who has had more than one pregnancy –Parity: Communicates outcome of previous pregnancies First Prenatal Visit (cont.)

7 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Recording the obstetric history (GTPAL) –G: Gravida – the total number of pregnancies –T: Term – the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation) –P: Preterm – the number of pregnancies that ended after 20 weeks and before the end of 37 weeks’ gestation –A: Abortions – the number of pregnancies that ended before 20 weeks’ gestation –L: Living – the number of children delivered who are alive when the history is taken First Prenatal Visit (cont.)

8 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins First Prenatal Visit (cont.) Physical examination –Head-to-toe physical –Vaginal speculum examination –Bimanual examination of the uterus Laboratory work –Complete blood count –Blood type and antibody screen –Tests for presence of infection –Pap smear

9 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins First Prenatal Visit (cont.) Teaching –Avoiding teratogenic substance ingestion Alcohol, tobacco, illegal drugs, etc. –Diet, nutrition, and exercise –Infection control –Medication use

10 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Methods of Determining EDD/EDC Nagele rule –Add seven days to the date of the first day of the LMP, then subtract three months Pelvic examination –Practitioner sizes the uterus to estimate term Obstetric sonogram –High frequency sound waves reflect off fetal and maternal pelvic structures, allowing structure measurement

11 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following question is true or false. When doing a GTPAL you know that the T stands for how many pregnancies a woman has had that ended at term (or beyond 38 weeks’ gestation).

12 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: “T” stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation).

13 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Assessment Incorporates and evaluates data –History –Physical examination –Laboratory tests Determines risk factors during pregnancy

14 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Assessment (cont.) Pregnancy risk factors –Negative attitude toward the pregnancy; unwanted pregnancy –Seeking prenatal care late in the pregnancy –Maternal substance abuse; presence of maternal disease –History of pregnancy –Social factors: Poverty, domestic violence, etc. –Age; unplanned pregnancy

15 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Subsequent Prenatal Visits Client usually seen monthly from weeks 1 to 32 Weeks 32 to 36, prenatal visits are biweekly Week 36 until delivery, client seen weekly Visits include specific assessments –Weight –Blood pressure –Urine protein and glucose –Fetal heart rate

16 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Subsequent Prenatal Visits (cont.) Ask regarding the danger signals of pregnancy –Fetal movement –Contractions –Bleeding –Membrane rupture Practitioner measures the fundal height in centimeters –Between weeks 18 and 32, the fundal height in centimeters should match the number of weeks the pregnancy has progressed

17 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Subsequent Prenatal Visits (cont.) Screening done throughout pregnancy –Between 15 and 20 weeks’ gestation maternal serum alpha-fetoprotein (MSAFP) –At 28 weeks, a woman who is Rho(D)-negative Screened for antibodies Given anti-D immune globulin (RhoGAM) –Group B streptococcus (GBS) after 35 weeks and before the end of 37 weeks

18 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Fetal Well-Being during Pregnancy Fetal kick counts (screening) Ultrasonography (diagnostic gold standard) –Transabdominal ultrasound –Transvaginal ultrasound Doppler flow study or Doppler velocimetry Maternal serum alpha-fetoprotein (MSAFP) screening Triple-marker (or multiple-marker) screening

19 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Fetal Well-Being during Pregnancy (cont.) Amniocentesis (diagnostic) Chorionic villus sampling (diagnostic) Percutaneous umbilical blood sampling (PUBS) (diagnostic) Nonstress test (NST) (diagnostic) Vibroacoustic stimulation Contraction stress test (CST) (diagnostic) Biophysical profile (BPP)

20 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question If the results of a maternal serum alpha-fetoprotein (MSAFP) is lower than expected it may indicate that the baby will be born with what? a. Neural tube defect b. Omphalocele c. Down syndrome d. Trisomy 17

21 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c. Down syndrome Rationale: Low MSAFP levels may also indicate a problem, in particular, Down syndrome.

22 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse’s Role in Prenatal Care Nursing process for prenatal care –Assessment –Selected nursing diagnoses –Outcome identification and planning –Implementation

23 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Complaints of Pregnancy Anxiety Nasal stuffiness and epistaxis Nausea Feeling faint Frequent urination Increased vaginal discharge

24 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Complaints of Pregnancy (cont.) Shortness of breath Heartburn Backaches Round ligament pain Leg cramps Constipation and hemorrhoids Trouble sleeping

25 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching Topics for Self-Care during Pregnancy Maintaining a balanced nutritional intake Dental hygiene Exercise Hygiene; clothing Breast care Sexual activities Employment; travel Medication and herbal remedy use Substance use and abuse

26 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maintaining Safety of the Woman and Fetus Monitor for warning signs at every visit Report elevated blood pressure immediately, especially if accompanied by –Headache –Epigastric pain –Blurred vision

27 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing the Woman for Labor, Birth, and Parenthood Packing for the hospital or birthing center Communicating expectations about labor and birth Choosing the support person Childbirth education classes Pregnancy and postpartum exercise classes Baby care classes Breast-feeding classes Siblings classes

28 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question During pregnancy some women experience pain that is usually on the right side and can be severe enough to awaken them at night. What is this pain called? a. Exercise pain b. Round ligament pain c. Leg pain d. Abdominal pain

29 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Round ligament pain Rationale: Because ligaments are pain-sensitive structures, some women experience round ligament pain. The pain most frequently occurs on the right side and can be severe. The pain can occur at night and awaken the woman from sleep, or exercise can bring it on.


Download ppt "Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Prenatal Care."

Similar presentations


Ads by Google