THE PREGNANCY EXPERIENCE

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”.

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

FIRST PRENATAL VISIT Most important intervention for the nurse is to: MAKE THE PATIENT WELCOME ! Why? (so the couple will continue with prenatal care)

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.

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

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

Calculation 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 that come out, but the number of deliveries of a pregnancy

Calculation of Gravida and Parity Further Breakdown into TPAL T = Term P = Preterm A = Abortions L = Live births

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, had a miscarriage last year at 12 weeks gestation. What is her gravida and parity? What is her gravida and parity using the TPAL system?

Health History Assessment Collect information about: Obstetric History -- Current and past pregnancies Menstrual History 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 What information is included in the initial prenatal assessment? a. what are normal changes in vital signs?   What specific laboratory studies does the nurse collect at the initial OB visit? What are normal and abnormal findings, and how do the findings for a pregnant (gravid) woman differ from those of a non-pregnant (null-gravid) woman? HgB- Hct- Blood type & Rh factor- Rubella titer- Hepatitis- HIV-

Mr. and Mrs. Andrews are both excited about the pregnancy Mr. and Mrs. Andrews are both excited about the pregnancy. It is her first so she is considered a Gravida 1, Para 0. They ask the nurse “When is the baby due”? How will you calculate this?

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 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?

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

Mrs. Andrew’s fundal height is 7 cm. How far along is she? 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?

Assessment of Pelvic Adequacy Clinical Pelvimetry via ultrasound can be performed to determine if the pelvis is of adequate size to allow for a normal vaginal delivery. Manual measurement via examiner How is pelvic adequacy determined?

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

Presumptive Signs of Pregnancy Cessation of Menstruation Breast changes -- tenderness Nausea and Vomiting Frequent Urination Quickening Chadwicks sign Increased pigmentation of the Skin Fatigue What are the presumptive, probable and positive signs of pregnancy?

Probable Signs of Pregnancy Enlargement of the Abdomen Hegar’s Sign -- softening of the isthus of the uterus Goodell’s Sign --softening of the cervix Braxton-Hicks contractions Ballotment Outline of the fetus by abdominal palpation Positive Pregnancy Test

Positive Signs of Pregnancy Ausculation of fetal heart tones Active fetal movement felt by Trained person Ultrasound showing fetal outline

Conclusion of Visit You are completed with Mr. and Mrs. Andrews first prenatal visit. Before they leave, it is important to discuss the following topics:

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

Danger 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 Upon confirmation of the pregnancy, what teaching should the nurse include regarding "danger signals" and when to notify the physician?

Needs of the Pregnant Woman and Family Chapter 11

Cultural Beliefs and Practices In working with clients of other cultures, health professionals should be open to and respectful of other beliefs What are common cultural beliefs and practices that impact pregnancy? See pages 243-245.

Self Care during Pregnancy

Self Care What other teaching is necessary regarding work and breaks. Employment Criteria for work: is work environment safe for the fetus can woman carry out work commitments without undue stress\ What other teaching is necessary regarding work and breaks.

Self Care Mrs. Andrews says that she is employed as a bank teller on a full time basis. She asks whether she can continue to work throughout her pregnancy

Self Care Exercise, Leisure May attend regular prenatal exercise classes Don’t take up a new sport Travel--wear seat belt

Safety with Seat Belts Wear shoulder belt over top of abdomen Wear lap belt low over the hips

Self Care Safety Clothing Bathing Immunizations - avoid live vaccines

Substance Abuse Caution women against the use of abusive substances Tobacco  Alcohol  Caffeine  Marijuana  Cocaine May need referral for further evaluation These can all be teratogenic and lead to various fetal complications See pages 260-262

Sexual Changes First Trimester Decrease in desire Second Trimester Increase in desire   Third Trimester Alterations needed by the couple Intercourse contraindicated if woman has history of preterm labor or ruptured membranes

Maternal Nutrition

Nutrition in Pregnancy Increase in calories Increase in protein May have food cravings or Pica Nursing care: Teach to take prenatal vitamins and iron Teach about normal weight gain ~ 25 lbs.