module 2: 1 st , 2 nd , and 3 rd trimester nursing care
DESCRIPTION
MODULE 2: 1 ST , 2 ND , AND 3 RD TRIMESTER NURSING CARE. By Professor A. Portzline 8/2010. In this module we will :. Discuss things that occur during prenatal appointments, up until labor begins Introduce you to electronic fetal monitoring - PowerPoint PPT PresentationTRANSCRIPT
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MODULE 2:
1ST, 2ND, AND 3RD TRIMESTER
NURSING CARE
By Professor A. Portzline 8/2010
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IN THIS MODULE WE WILL :
Discuss things that occur during prenatal appointments, up until labor begins
Introduce you to electronic fetal monitoring
Please note- this Module only covers the normal course of pregnancy. We will discuss abnormal aspects in Module 4.
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A woman calls her OB’s office and says she took a pregnancy test, and it was positive. She’s very excited!
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SO WHAT HAPPENS NOW?
Usually the first prenatal appointment occurs between
8-10 weeks gestation.
The earliest a woman can discover she’s pregnant is 5
days before her menses is due. This is different for
each woman, but typical menstrual cycles are
considered 28 days.
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THE 1ST TRIMESTER= WEEKS 1 TO 13
During the first OB appointment, the woman
is interviewed by the nurse, who completes a
health history called the Hollister form
(named after the man who created the form).
Prenatal labs are drawn at this time.
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A med check is done
to ensure the woman is
taking a prenatal
vitamin and that none
of her meds are
contraindicated in
pregnancy.
A transvaginal
ultrasound may be
done to measure
length and auscultate
the fetal heartbeat.
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Notice the gestational age= 13weeks 5 days
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THE 2ND TRIMESTER=
WEEKS 14-27
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Many things occur during the 2nd
trimester:
1. If her blood is Rh negative, she receives
Rhogam between 24- 28 weeks.
2. Optional amniocentesis and/or genetic
testing to determine the risk of syndromes.
3. 1 hour glucola test ~28 weeks.
4. Fetal monitoring occurs at OB appointments,
starting ~24 weeks.
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AM
NIO
CE
NT
ES
IS
Under the
guidance of
ultrasound, a
needle enters
the amniotic
sack through the
woman’s
abdomen and
draws a sample
of amniotic fluid.
This is tested
for various
genetic
syndromes, like
Downs (aka
Trisomy 21).
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THE GLUCOLA TEST
Checks for gestational diabetes mellitus.
A fasting blood glucose level is drawn, then the patient
drinks a glucose solution.
A 1 hour blood glucose level is drawn to check her
metabolism of the glucose solution. Any value
> 130mg/dL is considered abnormal.
This will be discussed at length in Module 4.
Explore this website for details if you’re curious:
Gestational Diabetes
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INTRODUCTION TO FETAL MONITORING
View this patient educational video first: http://www.youtube.com/watch?v=DvcDXvlCXAE
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Fetal monitoring can be:
external, using a tocodynamometer or toco and an electronic fetal monitor disc or EFM.
internal, using an intrauterine pressure catheter or IUPC and a fetal scalp electrode or FSE. These can only be used once the amniotic sack is ruptured.
or a combination of the above.
Please read this fetal monitoring article
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Internal fetal monitors
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Main types of fetal heart rate
decelerations
Variable Early Late
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Intro to fetal heart rate monitoring
Please read an overview about fetal heart rate monitoring here: http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations
You are responsible to know: tachycardia, bradycardia, baseline heart rate, accelerations, variability (long-term only), contraction pattern, early, late and variable decels.
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Please contact me with any questions. I’m here to help you!
Don’t be overwhelmed by all this new info. You will come to understand it.
Module 3 will continue with info about electronic fetal monitoring.
Thank you for viewing this presentation.
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REFERENCES
Edwards Hospital. (2010). Fetal monitoring. Retrieved from http://www.youtube.com/watch?v=DvcDXvlCXAE
Medline Plus. (2010). Fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations
Norman, J. (2010). Diagnosing diabetes. Retrieved from http://www.endocrineweb.com/diabetes/diagnosis.html
The Brookside Associates Medical Education Division. (2009). Electronic fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations