the pregnancy experience fall 2010 debbie perez, rn, cns, msn
TRANSCRIPT
THE PREGNANCY EXPERIENCE
Fall 2010Debbie Perez, RN, CNS, MSN
Tiny FeetTiny Feet
SituationSituation
Mr. and Mrs. Andrews visit the Mr. and Mrs. Andrews visit the clinic and tell the nurse that clinic and tell the nurse that
Mrs. A has “missed two Mrs. A has “missed two menstrual periods, has urinary menstrual periods, has urinary frequency, and is tired all of the frequency, and is tired all of the
time”. time”.
First Prenatal VisitFirst Prenatal Visit
What is the most important What is the most important thing that the nurse can do at thing that the nurse can do at this first prenatal visit?this first prenatal visit?
Most important intervention for the nurse is to:
MAKE THE PATIENT WELCOME !MAKE THE PATIENT WELCOME !
Why?Why?
FIRST PRENATAL VISIT
Now that the couple has Now that the couple has been welcomed to the been welcomed to the clinic, one of the first clinic, one of the first things that must be done is things that must be done is to confirm that Mrs. A is to confirm that Mrs. A is pregnant.pregnant.
Mrs. A says that she used a Mrs. A says that she used a home pregnancy test and the home pregnancy test and the results were positive.results were positive.
What are some of the What are some of the advantages and advantages and disadvantages of using home disadvantages of using home pregnancy testing? pregnancy testing?
Home Pregnancy TestingHome Pregnancy Testing
AdvantagesAdvantages• Easily available
• Uncomplicated
• Convenient
• Have a greater than 97% accuracy
• Minimal time
DisadvantagesDisadvantages• 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
What other types of pregnancy What other types of pregnancy tests might be utilized to confirm tests might be utilized to confirm the pregnancy? the pregnancy?
Confirm the PregnancyConfirm the Pregnancy
Pregnancy Tests
All tests rely on detection of HCG
Urine Hema-agglutination Inhibition Tests
Radioimmune assay Tests
EnzymeImmunoassay Tests
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.
Legal ImplicationLegal Implication
Nurses must exercise caution when discussing obstetric history with the expectant mother in the presence of her family or significant other.
The confidentiality of the pregnant woman must always be protected.
Why?
Health History Assessment
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
Perform Physical Examination including a Pelvic Examination (Pap test, measurements, cervical culture)
Perform Laboratory Studies• Hgb., Hct, Type, Rh, CBC, Rubella, Hepatitis, HIV
Pelvic MeasurementPelvic Measurement
Calculation of Gravida and ParityCalculation of Gravida and Parity
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
Calculation of ParityCalculation of Parity
Further Breakdown into TPALFurther Breakdown into TPAL
• T = TermT = Term
• P = PretermP = Preterm
• A = AbortionsA = Abortions
• L = Living childrenL = Living children
Check Yourself !Check Yourself !
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.
What is her gravida and parity?What is her gravida and parity using the TPAL
system?
Mr. and Mrs. Andrews are both excited about Mr. and Mrs. Andrews are both excited about the pregnancy. It is her fourth so she is the pregnancy. It is her fourth so she is considered a Gravida 4, Para 2 accoding to considered a Gravida 4, Para 2 accoding to the prior scenario.the prior scenario.
They ask the nurse “When is the baby due”?They ask the nurse “When is the baby due”?
How will you calculate this? How will you calculate this?
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 ____________.
TEST YOURSELFTEST YOURSELF
Mrs. B. began her menses onJanuary 21. What is her E.D.C.using Nagele’s Rule?
Mrs. C. started her menses onJune 27. What is her E.D.C. using Nagele’s Rule?
Problem SolvingProblem Solving
If Mrs. Andrews did not know If Mrs. Andrews did not know the first day of her last the first day of her last menstrual period, what menstrual period, what method of calculation would method of calculation would you use? you use?
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?
AssessmentAssessment
The nurse continues with The nurse continues with assessment of Mrs. Andrews assessment of Mrs. Andrews and gathers data regarding and gathers data regarding presumptive, probable, and presumptive, probable, and positive signs of pregnancy.positive signs of pregnancy.
Presumptive Signs of PregnancyPresumptive Signs of Pregnancy
Cessation of Menstruation Breast changes -- tenderness Nausea and Vomiting Frequent Urination Quickening Fatigue
Probable Signs of PregnancyProbable Signs of Pregnancy
Enlargement of the Abdomen Hegar’s Sign Goodell’s Sign Braxton-Hicks contractions Ballottment Outline of the fetus by abdominal palpation Positive Pregnancy Test Chadwick’s Sign Increases Pigmentation Ausculation of Uterine and Fetal Souffle
Positive Signs of PregnancyPositive Signs of Pregnancy
Ausculation of fetal heart tones
Active fetal movement felt by trained Practitioner
Ultrasound showing fetal outline and fetal heart beat
Conclusion of VisitConclusion of Visit
You have completed Mr. and Mrs. Andrew’s You have completed Mr. and Mrs. Andrew’s first prenatal visit. first prenatal visit.
it is important to discuss information that will it is important to discuss information that will help ensure a good outcomehelp ensure a good outcome
Conclusion of VisitConclusion of Visit
Patient Teaching
Diet Counseling
Referrals
Danger Signals
Date of next visit
Danger SignalsDanger Signals
Vaginal Bleeding Fluid from the Vagina Abdominal Pain Increased Temperature Dizziness, Blurred vision or Double Vision Persistent Vomiting Edema Headache Dysuria Absence of Movement of the Baby
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The EndThe End
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