1. THE PREGNANCY EXPERIENCE Fall 2010 Debbie Perez, RN, CNS, MSN

2. Tiny Feet

3. Situation Situation Mr. and Mrs. Andrews visit the clinic and tell the nurse that Mrs. A has “missed two menstrual periods, has urinary frequency, and is tired all of the time”.

4. First Prenatal Visit First Prenatal Visit n What is the most important thing that the nurse can do at this first prenatal visit?

5. n n Most important intervention for the nurse is to: MAKE THE PATIENT WELCOME ! Why? FIRST PRENATAL VISIT

6. n Now that the couple has been welcomed to the clinic, one of the first things that must be done is to confirm that Mrs. A is pregnant.

7. n Mrs. A says that she used a home pregnancy test and the results were positive. n What are some of the advantages and disadvantages of using home pregnancy testing?

8. Home Pregnancy Testing Home Pregnancy Testing n Advantages Easily available Uncomplicated Convenient Have a greater than 97% accuracy Minimal time n Disadvantages Must be able to follow the directions as described or can lead to improper collection and errors in performing or reading the test False positive results – anticonvulsants, aspirin, tranquilizers, marijuana False negative results – diuretics, promethazine Expensive

9. What other types of pregnancy tests might be utilized to confirm the pregnancy?

10. Confirm the Pregnancy Confirm the Pregnancy Pregnancy Tests All tests rely on detection of HCG Urine Hema- agglutination Inhibition Tests Radioimmune assay Tests Enzyme Immunoassay Tests

11. It is confirmed that Mrs. Andrews is pregnant. The nurse will continue with the assessment of physiological and psychological needs of the family. Assessment begins at the initial visit and continues throughout pregnancy.

12. Legal Implication Legal Implication n n Nurses must exercise caution when discussing obstetric history with the expectant mother in the presence of her family or significant other. n n The confidentiality of the pregnant woman must always be protected. Why?

13. Health History Assessment n n Collect information about: Obstetric History -- Current and past pregnancies Menstrual History – Is there regularity? Family history--genetic and environmental factors that affect health Medical history-- diabetes, heart n n Perform Physical Examination including a Pelvic Examination (Pap test, measurements, cervical culture) n n Perform Laboratory Studies Hgb., Hct, Type, Rh, CBC, Rubella, Hepatitis, HIV

14. Pelvic Measurement

15. Calculation of Gravida and Parity Calculation of Gravida and Parity n n Obstetrical Status Gravida = number of times pregnant regardless of duration or outcome Parity = number of deliveries after the age of viability (20 weeks). ** It is not the number of babies delivered, but the number of deliveries

16. Calculation of Parity Calculation of Parity n Further Breakdown into TPAL T = TermT = Term P = PretermP = Preterm A = AbortionsA = Abortions L = Living childrenL = Living children

17. Check Yourself ! Check Yourself ! 4 4 The nurse obtained the following data from Mrs. Andrews. She has five year old twins that delivered at 35 weeks, a three year old son that delivered at 39 weeks, and a miscarriage last year at 12 weeks gestation. 4 4 What is her gravida and parity? 4 4 What is her gravida and parity using the TPAL system?

18. n Mr. and Mrs. Andrews are both excited about the pregnancy. It is her fourth so she is considered a Gravida 4, Para 2 accoding to the prior scenario. n They ask the nurse “When is the baby due”? n How will you calculate this?

19. Calculation of E. D. C. Calculation of E. D. C.   Nagele’s Rule   First day of last Menstrual   Go back 3 months   Add 7 days   Mrs. Andrews tells you her last menstrual period began on July 18.   Her baby is due on ____________.

20. TEST YOURSELF TEST YOURSELF Mrs. B. began her menses on January 21. What is her E.D.C. using Nagele’s Rule? Mrs. C. started her menses on June 27. What is her E.D.C. using Nagele’s Rule?

21. Problem Solving Problem Solving n If Mrs. Andrews did not know the first day of her last menstrual period, what method of calculation would you use?

22.   McDonald’s Rule   Use Fundal height measurement, measure from the symphysis to the top of the fundus.   Months = measure cm. X 2/7   Weeks = measure cm. X 8/7   Mrs. Andrew’s fundal height is 7 cm. How far along is she?

23. Assessment Assessment n The nurse continues with assessment of Mrs. Andrews and gathers data regarding presumptive, probable, and positive signs of pregnancy.

24. Presumptive Signs of Pregnancy Presumptive Signs of Pregnancy n n Cessation of Menstruation n n Breast changes -- tenderness n n Nausea and Vomiting n n Frequent Urination n n Quickening n n Fatigue

25. Probable Signs of Pregnancy Probable Signs of Pregnancy n n Enlargement of the Abdomen n n Hegar’s Sign n n Goodell’s Sign n n Braxton-Hicks contractions n n Ballottment n n Outline of the fetus by abdominal palpation n n Positive Pregnancy Test n n Chadwick’s Sign n n Increases Pigmentation n n Ausculation of Uterine and Fetal Souffle

26. Positive Signs of Pregnancy Positive Signs of Pregnancy n n Ausculation of fetal heart tones n n Active fetal movement felt by trained Practitioner n n Ultrasound showing fetal outline and fetal heart beat

27. Conclusion of Visit Conclusion of Visit n You have completed Mr. and Mrs. Andrew’s first prenatal visit. n it is important to discuss information that will help ensure a good outcome

28. Conclusion of Visit Conclusion of Visit n n Patient Teaching n n Diet Counseling n n Referrals n n Danger Signals n n Date of next visit

29. Danger Signals Danger Signals n n Vaginal Bleeding n n Fluid from the Vagina n n Abdominal Pain n n Increased Temperature n n Dizziness, Blurred vision or Double Vision n n Persistent Vomiting n n Edema n n Headache n n Dysuria n n Absence of Movement of the Baby Return

30. The End Return