FIRST PRENATAL VISIT

1
FIRST PRENATAL VISIT

• DEBBIE AMASON, RN,MS
• SPRING 2001

2
Prenatal Care

• essential
• major focus
• should start in childhood
• good nutrition
• immunizations

3
Prenatal

• developing positive attitudes
• sexuality, womanhood, and childbearing.
• Once sexually active prepare for pregnancy
• practice safer sex
• regular pelvic exams
• prompt treatment of STDs

4
Prenatal

• who responds
• those with healthy lifestyles
• others may be first visit ever

5
Assessment

• establish baseline data
• obtain health history
• family history
• gyn history
• social history
• medical history

6
Planning

• sufficient time
• establish pattern of regular appointments

7
Implementation

• purpose
• establish baseline of present health
• determine gestational age of fetus
• monitor fetal development
• identify high risk client
• education

8
Preconception Visit

• many reasons for seeking care
• information regarding birth control options
• receive assurance about fertility

9
Healthcare Provider

• clinic
• OB-GYN
• CNM
• Family Practitioner

10
Nursing

• listening
• counseling
• teaching

11
Nursing-ways to improve

• schedule initial visit within 1 week of calling
• make waiting time educational
• provide privacy
• encourage women to feel responsible for their own
  health care
• encourage family participation
• schedule regular appointments
• educate about care options

12
Prenatal Care

• essential to decrease risk of pre-term births
• major cause of death in pregnancy
• ectopic pregnancy
• embolism
• intrapartum cardiac arrest
• HTN

13
Initial Interview

• thorough
• keep client focused
• private and quiet setting
• make sure client is aware 1st visit may be
  lenghty
• establish trust with client
• face to face interview

14
Health History

• establish rapport
• obtain data regarding physical and psychological
  health
• obtain basis for anticipatory guidance
• establish a baseline for health
• demographic data
• name, age, address, phone number, religion,
  insurance

15
Chief Concern

• pregnant or not ?
• Date of LMP
• any pregnancy test?
• Any signs or symptoms of pregnancy?
• Any discomforts
• any contagious disease exposure
• planned pregnancy?

16
Family Profile

• need to identify support system
• size of living accommodations
• ages of client and partner
• educational level
• occupation

17
Past Medical History

• need to identify possible high risk clients
• have they had all childhood diseases?
• questionable vaccines
• determine allergies

18
Family History

• important to identify any illnesses that occur
  regularly within the family
• are their any family members with genetic
  disorders
• ethnic background

19
Social Profile

• exercise
• hobbies
• any medications
• ETOH
• tobacco
• ? Abuse

20
GYN History

• any reproductive problems
• age at menarche
• cycle
• any previous GYN surgery
• what type birth control she used
• sexual history
• stress incontinence

21
OB History

• document gestational age, type delivery, sex of
  child, hours in labor, any complications
• any previous ABs
• viability
• Rh neg
• gravida
• para

22
Support

• ask client if support person is to be present
  during interview
• need to determine partners degree of acceptance
  of pregnancy

23
Physical Exam

• need to undress and put on gown
• have her empty bladder
• CCUA
• baseline height and weight
• can gain 25-30 pounds
• vital signs

24
Assessment

• general appearance and mental status
• remove any dressings/determine cause
• head and scalp
• chloasma
• eyes
• nose
• ears
• sinuses

25
Assessment

• mouth
• lymph nodes
• breasts
• areola darkens
• increase in size and tone
• veins prominent
• colostrum
• self breast exam

26
Heart

• assess rate and rhythm
• may develop innocent murmur r/t increased blood
  volume
• palpitations
• positioning

27
Respiratory

• assess respiratory rate and rhythm
• abnormal breath sounds
• while assessing respirations also assess spine

28
Extremities

• may develop rash r/t increased estrogen levels
• assess lower extremities for varicositiesgtDVT
• edema
• gait

29
Abdomen

• assess fundal height
• FHTs
• FHTs 120-160
• can hear at 10 weeks with doppler
• 18-20 weeks with stethoscope

30
Pelvic exam

• info on both external and internal organs
• assess for signs of pregnancy
• PAP smear
• cultures
• check for infections
• bimanual exam
• vaginal
• rectal

31
Pelvic

• estimate pelvis size
• done by 24th week
• type of pelvis
• android
• anthropoid
• gynecoid
• platypelloid
• measurements

32
Lab Studies

• CBC, Platelets, ?sickle cell
• VDRL or RPR
• Type and Rh
• MSAFP
• Indirect coombs
• antibody titers
• HIV screening
• GTT

33
Lab

• Urinalysis
• TB screen

34
Risk Assessment

• Evaluate all obtained data and categorize
• Some causes that would place a client as high
  risk
• infertility, prolonged labor,STD
• previous stillbirths, SZ, age
• previous c/section, weight gain lt10lbs
• cardiac disease, weight lossgt 5lbs
• no prenatal care, finances, lifestyle