Copyright 2002, Delmar, A division of Thomson Learning Chapter 23 Pregnant Patient

Copyright 2002, Delmar, A division of Thomson Learning Competencies Describe the characteristics of the most common pregnancy-related complaints. Assess the psychosocial status of a pregnant woman. Differentiate the normal changes of pregnancy from pathological changes. (continues)

Copyright 2002, Delmar, A division of Thomson Learning Competencies Perform a physical assessment on a pregnant woman. Assess the learning needs of a pregnant woman.

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Skin and hair  Alterations in pigmentation  Skin  Vascular Head and neck  Enlarged thyroid gland Eyes, ears, nose, mouth, and throat  Visual changes  Nasal congestion (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Breasts  Early changes  Late changes Thorax and lungs  Increased oxygen consumption  Increased carbon dioxide excretion  Diaphragmatic breathing  Increased tidal volume (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Heart and peripheral vasculature  Increased blood volume  Increased heart rate  Diastolic blood pressure changes Abdomen  Displaced abdominal organs  Decreased bowel sounds  Increased GI emptying time (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Urinary system  Increased glomerular filtration rate  Urinary frequency  Increased risk for glycosuria, proteinuria, nocturia (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Musculoskeletal system  Widening of symphysis pubis  Unsteady gait  Lordosis Neurological system  Common changes include headache, numbness, tingling (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Female genitalia  Uterine changes  Increased cervical vascularity and friability Hematological system  Increased WBC  Increased RBC volume  Increased plasma volume  Decreased platelets (continues)

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Anus and rectum  Decreased GI tone and motility  Increased risk for hemorrhoids Endocrine system  Increased BMR  Increased resistance to insulin

Copyright 2002, Delmar, A division of Thomson Learning Psychosocial Risk Factors Abuse risk factors  Frequent visits with vague complaints  Injuries are inconsistent with complaints  Fails to plan for baby’s arrival  Frequently misses appointments Abuse crosses all socioeconomic groups

Copyright 2002, Delmar, A division of Thomson Learning Health History Age  Greater risk for complications associated with woman 35 Race  Increased risk for hypertension and preterm delivery in African Americans Common chief complaints

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical history  Presence of chronic disease Surgical history  Uterine, cervical, or abdominal surgeries Medications  Prescribed  Over the counter  Risk for teratogenic effect (continues)

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Communicable diseases  Mumps  Measles  Rubella  Varicella  Toxoplasmosis  CMV Allergies Injuries/accidents

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Special needs Childhood illnesses  Rheumatic heart disease Immunizations  Typically avoided during pregnancy  May receive hepatitis B series during pregnancy (continues)

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Family history  Maternal  Paternal (continues)

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Social history  Substance use  Sexual practices  Travel history  Work environment  Home environment  Hobbies/leisure activities  Stress  Ethnic background (continues)

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Health maintenance activities  Sleep  Diet  Exercise  Use of safety devices  Health checkups

Copyright 2002, Delmar, A division of Thomson Learning Obstetric History Present  LMP  History since LMP  S & S of pregnancy  Use of fertility drugs  Due date (continues)

Copyright 2002, Delmar, A division of Thomson Learning Obstetric History Past  Complications  Type of delivery  Length of labor  Infant gender, weight, Apgar score Breastfeeding difficulties Gravida, para Abortions Multiple births Living children

Copyright 2002, Delmar, A division of Thomson Learning Assessment Equipment  Stethoscope  Fetoscope  Urine specimen supplies  Tape measure General approach  Privacy  Quiet environment

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment General assessment, vital signs, weight  Close monitoring of blood pressure and weight changes Skin and hair  Pigment, skin, vascular changes (continues)

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Head and neck  Thyroid function Eyes, ears, nose, mouth, and throat  Visual changes  Status of oral mucosa Breasts  Shape of nipples and areola (continues)

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Thorax and lungs  Breath sounds  Diaphragmatic breathing Heart and peripheral vasculature  Heart sounds  Presence of edema Abdomen (continues)

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Urinary system  Urinalysis  Urine culture Uterine size  Fundal height Musculoskeletal system Neurological system  Abnormal findings include seizures, eclampsia, hyperreflexia (continues)

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Female genitalia  Uterine size appropriate for gestational age  Uterine and cervical changes Fetal heart rate  Doppler  Fetoscope  Normal rate is between 110 to 160 bpm Leopold’s maneuver  Determine fetal presentation (continues)

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Hematological system  Prenatal panel Endocrine system  Glucose screen  Glucose is abnormal if results are > 130 to 140 mg/dl or 120 mg/dl after meals

Copyright 2002, Delmar, A division of Thomson Learning Common Antepartum Tests Ultrasound Genetic testing Nonstress test Amniotic fluid volume Biophysical profile Fetal movement count

Copyright 2002, Delmar, A division of Thomson Learning Danger Signs of Pregnancy Vaginal bleeding Leaking or gush of watery fluid Abdominal or pelvic pain Severe headache or blurred vision (continues)

Copyright 2002, Delmar, A division of Thomson Learning Danger Signs of Pregnancy Persistent chills or fever > 102°F Persistent vomiting Decreased fetal movement or lack of fetal movement Change in vaginal discharge Frequent uterine contractions

Copyright 2002, Delmar, A division of Thomson Learning Psychosocial Assessment Feelings about pregnancy Mood changes Adaptation to pregnancy Assess age, prior history, family history Shift from focus on self to focus on the fetus’s well-being

Copyright 2002, Delmar, A division of Thomson Learning Learning Needs Consider social services consultation Provide appropriate educational materials Topics  What to expect during pregnancy  Self-care  Follow-up health needs  Infant care