The Prenatal Assessment

 Nurse’s role ◦ Communicate ◦ Advocate ◦ Respect ◦ Empower women ◦ Help woman become informed recipient of care ◦ Facilitate shared decision-making

 Nurse’s role ◦ Focus on communication, personalized care, education ◦ Provide support ◦ Offer stress management techniques ◦ Gain woman’s confidence

 Access to care  Barriers to service  Health insurance  Health provider barriers  System barriers  Social disparities

 Build positive, nonthreatening relationship  Therapeutic communication ◦ Avoid medical/technical jargon  Provide user-friendly service  Goal: to explain purpose of prenatal care; to establish specific goals

 Biographical data  Social history—intimate partner violence and drug use  Psychological assessment  Obstetric history  Current pregnancy

 Presumptive ◦ Amenorrhea ◦ Nausea/vomiting ◦ Urinary frequency ◦ Breast tenderness Probable Piskacek sign: uterine asymmetry with a soft prominence on the implantation side Hegar sign: softening of the lower uterine segment Chadwick sign: violet bluish color of the vaginal mucosa and cervix

 Fetal heartbeat  Fetal movements  Visualization of fetus

 Naegele’s rule: add 7 days, then subtract 3 months from the date of the last normal menstrual period  History ◦ Intercourse/signs and symptoms  Date of last normal menstrual period

 Gravid/gravida/gravidity  Nulligravida: never experience pregnancy  Primigravida: pregnant for the first time  Multigravida: pregnant for the third time  Parity: number of pregnancies carried to viability age

 GTPAL classification system  G- gravida  T- number of Term pregnancies  P- number of preterm deliveries  A- abortions both spontaneous and induced  L- number of living children

 Medical conditions  Dental health  Eye health  Immunizations  Hepatitis B infection

 Environmental hazards ◦ Teratogens  DES exposure: diethylstilbestrol (nonsteroidal)  TORCH  Breast surgery/cancer/lumps/biopsies  History of rape, abuse

 Infertility  Surgeries  Therapeutic/elective pregnancy terminations  History of STIs  Cervical pathology

Prenatal History Current History Social History Psychological Assessment Biographical Data Obstetric History Medical History Gynecological History Homework #1: Based on this diagram, develop your concept map on how to provide prenatal care to a client who came in for her first prenatal visit. # 2. Write up of Changes of pregnancy by system & tests.

 Screening  Rh factor, antibody screen  Sexually transmitted infections  HIV  Cervical cancer  Diagnostic  To confirm presence of disease

 Prepare patient and environment  Obtain consent to be examined  Ongoing interaction  General assessment  Nutritional assessment  Abdominal palpation

 First: determine fetal body part that occupies uterine fundus  Second: determine location of fetal spine  Third: compare fundus with lower uterine segment  Fourth: determine ballottement; engagement

 Instruct woman to empty her bladder first.  Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort.  Drape properly to maintain privacy.  Explain procedure to the patient.  Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).  Use the palm for palpation not the fingers.

Purpose  First Maneuver: To determine fetal part lying in the fundus. To determine presentation. Procedure  Using both hands, feel for the fetal part lying in the fundus. ◦ Head is more firm, hard and round that moves independently of the body. ◦ Breech is less well defined that moves only in conjunction with the body.

 Purpose: To identify location of fetal back. To determine position.  Procedure ◦ One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts.

 Use gentle but deep pressure  Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

 Purpose ◦ To determine engagement of presenting part.  Procedure ◦ Using thumb and finger, grasp the lower portion of the abdomen above symphysis pubis, press in slightly and make gentle movements from side to side.  Findings ◦ The presenting part is engaged if it is not movable. ◦ It is not yet engaged if it is still movable.

 Purpose ◦ To determine the degree of flexion of fetal head. ◦ To determine attitude or habitus.  Procedure Facing foot part of the woman, palpate fetal head pressing downward. Use both hands.

 120 to 160 beats per minute  Fetoscope  Doppler ultrasound stethoscope  Electronic fetal monitoring for high-risk pregnancies  Non-stress test

 Maternal weight gain/edema  Blood pressure  Urine  Uterine growth  Fetal heart tones  Fetal movements and presentation

 Nurse’s role ◦ Heighten public awareness ◦ Empower women/families to reduce unwanted pregnancies ◦ Advocate for responsible sexual behavior  Impact on society

 Teen pregnancy accounts for more than $9 billion per year in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.4  Pregnancy and birth are significant contributors to high school drop out rates among girls.  The children of teenage mothers are more likely to have lower school achievement and drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.

 Assessment ◦ Closely monitor for iron deficiency anemia, STIs, preeclampsia ◦ High-risk behaviors  Knowledge regarding personal care and care of infant  Promote optimal nutrition  OB Exam #1 (covers week 1 lecture & Changes of Pregnancy)